Big Bang

Small hospital tackles big HIS project.

Health Data Management Magazine, 02/01/2010

Switching to an entirely new hospital information system can be an agonizing process, but sometimes the best strategy is just to get it over with. Bill McQuaid, CIO at 55-bed Parkview Adventist Medical Center, Brunswick, Maine, opted for maximum compression: He spent six months testing a complete hospital information system overhaul and scheduled 23 modules to go live the same day.

"It was quite a week," he says of the seven days leading up to Aug. 1, 2005. "But there is just as much pain if you do everything as if you did only two or three things." By the end of day one, the hospital was live with virtually all major applications, including abstracting, admissions, accounts payable, enterprise scheduling, referral management, ambulatory and inpatient medical records, general ledger, radiology, transcription, materials management, order entry, physician billing and pharmacy. At the same time, McQuaid and his staff turned on several key interfaces. These included links to the hospital's PACS and its medication administration system.

"The functions are so interrelated that it's easier to do them all at once," adds Lawrence Losey, M.D., chief medical information officer, pediatrician and physician champion for the project. "But there was a lot of anxiety on July 31."

As a result of that "big bang," along with several more modules installed after the dust settled, Parkview is now ranked Stage 6 on the EHR adoption scale of Chicago-based HIMSS Analytics, the research arm of the Healthcare Information and Management Systems Society. It is the second smallest of the 63 hospitals which share that distinction. Stage 6 hospitals are just shy of a complete electronic health record, but they have nearly all clinical functions automated and substantial physician use. Only 15 hospitals are at Stage 7, which is as high as the HIMSS Analytics scale goes.

Systems Galore

Migrating to a single vendor, to the highest possible degree, was one of McQuaid's central goals when the selection process started in 2004. A "best of breed" approach had created a slew of products from seven different vendors, and none of the systems communicated very well. "I was working my tail off as a firefighter every single day," he says.

Physicians were beginning to ask for more information than the polyglot system could produce in its current form. To complicate matters, vendors were sunsetting their products, merging or being acquired. Expensive upgrade paths often led to completely unknown products that had nothing to do with the systems that had originally won the hearts of the hospital's departments.

The hardware and operating system environment was just as complex. "I was supporting OS400, three novel systems, Windows NT, Windows 2000, and a few Unix apps," McQuaid says. "No one was looking at the big picture and the ultimate goal. We had lots of stuff, but no functionality."

Clearly, something had to change. The final straw was when the hospital's lab vendor announced it would stop supporting the version of its system that Parkview was using, McQuaid says. "When we looked at what it would cost to upgrade it, we realized it would be cheaper to start from scratch with a single-vendor solution (for all the hospital systems). It would cost more upfront, but the cost of ongoing ownership would be half what we were paying, plus we'd get more functions."

Parkview started serious shopping in 2004. The selection process narrowed the vendors to three: Healthcare Management Systems, Nashville, Tenn.; Computer Programs and Systems Inc., Mobile, Ala.; and Meditech Inc., Westwood, Mass. Meditech eventually won because of its large client base and the breadth of its offerings. "Their customer base is so big that we knew they'd be there tomorrow," McQuaid says.

He won't divulge what Parkview is paying for the Meditech system, saying only that the price is based on a percentage of the hospital's net patient revenue. Parkview bought just about everything Meditech had to sell at the time, and has since developed an oncology module that Meditech is marketing, McQuaid says.

Starting Line

February 2005 was the starting line for implementation. McQuaid eschewed the use of consultants because he wanted to make sure he and his staff of five could handle whatever the system threw at them. "If we can't do it ourselves, we shouldn't be doing it," he says. The next six months were devoted to converting data and testing, testing, testing.

As a result, go-live went very smoothly, McQuaid says. The hard part started afterwards, as the staff got used to doing things a new way. But some of the payoff was immediate. For example, the billing department started to get bills out more quickly.

And once unit managers started using a decision support function that helped them check whether they were charging for all the items and services used, they found tens of thousands of dollars in unbilled charges for the use of medical equipment.

Some bigger changes on the clinical side were still to come. McQuaid used the nursing staff to work out glitches in order entry and documentation, and to tweak workflow, before presenting the system to the physicians. He strongly recommends reworking workflow before a system goes live and striving to standardize it throughout the organization.

Quality Defined

Parkview went live with nursing documentation, medication reconciliation and bedside medication verification on all units in June 2006, and McQuaid quickly saw that each unit had its own way of doing things. For example, different units had different ways of documenting pneumonia care. "Quality is doing something the same way every time," he says. "That was tough to figure out-how to standardize everything across all units and get the physicians to agree to the way we want to do it. That's something we'll work on forever."

Physicians were given much handholding, says CMIO Losey. Parkview employs about 20 physicians, including two hospitalists. Another 100 physicians have admitting privileges; about a quarter of those account for most of the admissions.

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