HIStalk Interviews Sheryl Crowley

Sheryl Crowley is VP/CIO of Cape Cod Healthcare of Hyannis, MA.

Cape Cod was Meditech’s first client. What prompted the decision to look elsewhere?

I think it’s the same thing most clients that are still using Magic are facing, which is a pretty significant upgrade if you go to 6.0. Of course, we would all want to be on 6.0 because that’s going to be where their newest and best stuff is. That’s a technical term. [laughs]

Faced with that and saying we wanted to get to a different place in our use of systems, we were in the middle of developing a strategic plan and saying, “This is where we want to get to.” We felt we had to either go to Meditech 6.0 or do something else. 6.0 is really what prompted us to say, “Well, significant upgrade, significant dollars? It’s probably a good time to look at what else is available to us.”

Did you bring Meditech in for your demos?

Yes. Meditech was a part of the process, and certainly a strong contender given that they were the incumbent. Everyone had an opportunity to look at 6.0 in depth, as well as other vendors.

What systems did you consider and what were their strong and weak points?

We considered everything initially. Then we did a preliminary analysis of each vendor and ultimately wanted to see demos from Eclipsys, Siemens, Meditech, and McKesson Paragon. It ended up that Eclipsys was the only one that ultimately didn’t end up demonstrating. They all have pretty comparable functionality, with the exception of Paragon, which at that time didn’t have CPOE or physician documentation yet.

The thing that drove us towards Soarian was really their workflow engine that’s behind that application. The ability to take it — from our demos, our reference calls, and our site visits — to a different level.

Soarian has been viewed for years as a work in progress. Knowing that reputation, was it hard to determine that it was competitive and ready to implement?

Certainly. I think you could say the same about every vendor that we looked at, honestly. I think that we did our homework on each of the vendors and I think our team felt confident in their decision. You know, the proof is in the pudding.

I mean, we haven’t done the hard part yet. Selecting a vendor is pretty darned easy and it’s a lot of work. But I absolutely could not comment today on where I think we’ll be two to three years from now, other than we’re hopeful that we partnered with a good vendor. We certainly did our due diligence to make that happen.

What would you say are the strong and the weak points were of Soarian?

I would say that we thought the strongest points was the look and feel to it. Most people — and this isn’t me speaking, this is my team and my staff and the managers that looked at it throughout the organization — like the intuitive user interface and they like the workflow engine. Particularly, obviously, the revenue cycle piece would allow us to do everything in one application versus what we have. Today we have a lot of bolt-on applications and it just gets very confusing and labor-intensive to maintain all of them. So that was from the revenue cycle perspective. Then on the clinical side, I think they just really felt like it could make a difference in how they do their work.

What is the expected cost and timeline to implement Soarian?

I can talk a little bit about the timeline. The costs are obviously confidential. We negotiated with Siemens, as I think any organization would, and certainly my expectation and theirs is that those were confidential negotiations.

But the timeline I can talk about a little bit because I will tell you that Siemens has been really willing to be as aggressive as we want to be. Our bigger challenge is when can we get the resources together that’s required to do an implementation of this scope and size? So ultimately, this is going to be probably a two- to three- or four-year project as we bring different phases into it and that type of thing.

We’re actually heavy into the details of planning right now and are evaluating, obviously, the operating capital, budget impact, and all of that type of thing, the reality of what can an organization handle in an implementation like this. We’re right in the thick of that right now.

When you said resources, are you going to train your people or are you bringing in other resources or using consulting firms for implementation help?

What we’re primarily trying to do is use our own resources and train them and get them up to speed on the Siemens applications and back-fill legacy support with consulting resources. Ultimately, at the end of the day, we need our people to support this going forward. It’s not a lot of fun for them to sit back and watch somebody else implement it and then they have to support it and they didn’t have the opportunity to really dig into it.

That’s insightful. A lot of people do it the other way. Of course the other plus is you probably have a lot easier access to Meditech resources than Soarian resources. There are a lot more Meditech hospitals out there.

No question, no question. For us, not only did we have access to a lot of hospitals that use Meditech, but I have a lot of people who at one point in time somewhere in their career worked for Meditech because all of their employees are located in Massachusetts. I’ve got some really skilled people, but with very in-depth experience in Meditech. I want to keep their knowledge of our organization and of healthcare, but I want to bring them along and … I mean, we have a lot of non-Meditech applications in our organization, but our core, clearly, is Meditech.

I’ll ask you one more question about cost, and hopefully this isn’t too specific that you’ll be uncomfortable with it. But in the continuum of the least of the most expensive, where did Soarian fit?

I don’t really want to get specific, but what I will tell you is that we did rule out some vendors on initial costs that they brought to the table at the time of the RFP. Everyone was competitive, and that’s why they got in the door to do a demonstration. Whether one was a little more expensive than the other, ultimately those were un-negotiated costs at that point. But they were all very competitive and close to each other in order to get in the door for the demonstration.

I know you started the search a while back, but how much consideration did the HITECH funding fit into your decision?

Interestingly enough, we had developed our strategic plan prior to HITECH. Our strategic plan for IT was done in January, and then the ARRA passed in February. Much of what is going to be required by ARRA was already built in to our plan. Maybe not quite in the order that they’ve decided, but a key component of our strategic plan is adoption. We don’t want to just implement the systems and go, “OK, check, we’ve bought CPOE, we licensed it, and we went live with it. Nobody uses it. But hey, we’ve got it.”

We wanted better utilization than perhaps we’ve had in the past with systems. Our goal was really to do this differently than we’ve done in the past. As far as our process and who we brought into the mix for vendors, they all kind of converged at the same time, but we already knew what we wanted to do before the HITECH stuff passed.

Now that the initial pass of the meaningful use criteria is out, is there anything there that concerns you about your ability to be lined up for payment from there?

Oh yeah, all of it.

What parts do you think are going to be tough for hospitals, especially yours, to meet?

I’m actually in the process right now remapping, because we had actually remapped what we thought would happen to the criteria with the hopes that we would come close. Now I’m going back and saying, “OK, is there anything that concerns me in any of this?” I guess the answer to that is I’m still working on it.

To some degree, we have some of these things and they’re already challenging. Providing access to patient information; we have the ability to do that today. We use RelayHealth, so they can have a personal health record and they can also, if their physician is signed up, see their lab results or other test results. That’s great. We’re a fraction of the way there.

I think the concern I would have with any of these thing is the maturity level that I think we need to be at in order to be able to prove the meaningful use based on the measurement criteria. I think that’s going to be the biggest challenge for all of us. We may have a lot of these things in place or ultimately get there in the next couple years based on our plans.

The question will be, can we measure it in a way that truly proves it’s meaningful; and is that measurement criteria, which that’s the part I’m really diving into now saying, “OK, is that measurement criteria going to work for our organization in the way we had planned to do this implementation, or do we need to maybe change the road map a little bit to make the measurement criteria work in our situation?

Much of the documentation part was pushed off into the future and order entry to the forefront. Does that change your timeline and how do you engage your physicians?

It doesn’t change our timeline dramatically in the sense because Massachusetts has its own regulations which require hospitals to have CPOE in place by October 1, 2012. That’s a requirement to be licensed in the state of Massachusetts. Now that could change, like any of these things, as we get closer to the actual date. Suddenly it gets pushed out or that kind of thing, but I’m sort of planning for it to be a hard and fast date. If I don’t, it could be a challenge at some point. So yes, it’s a concern strictly for our organization.

We have CPOE in two ambulatory areas — our ED and our oncology area — but not in the acute area at all. So for us, it’s totally new and we really have to build that momentum with the physicians. Part of that was getting them involved in the selection process, and they were very involved. That helps generate enthusiasm and willingness to jump in on the CPOE implementation, but that certainly is going to be a challenge.

Will you have someone as the physician champion and the content builder?

We don’t have a CMIO today, but we’re looking at adding one and will have to have it. We need someone to lead that and champion it. We had a couple of great physicians who were on our selection committee who could easily do that and generate the enthusiasm and momentum. We just need to operationalize that into a position that accountable for doing that.

What advice would you have for Magic customers trying to decide what to do, facing the 6.0 upgrade or starting a search?

My advice is make sure they know what their organization is trying to accomplish. I think 6.0 is a great solution for some organizations. It didn’t happen to be the right fit for us. That has, perhaps less to do with Meditech and more to do with our organization and where we are.

I think every organization, before they even look at the vendors, have to know what it is they’re trying to achieve and accomplish. That will tell them should they even convert from Magic to 6.0. Or should they look at 6.0 and other vendors? Every organization is unique. If you don’t know what it is you’re trying to achieve, you’ll never know which solution is going to be the right solution for you.

Last question. When you look around at the projects that you have on your plate and the concerns you have as a CIO, what do you think the future looks like for the next three to five years?

It looks like a lot of work and a lot of pressure on my team and our end users. But I think, hopefully and ultimately, at the end of that period of time it looks like a much better place in terms of our ability to have our system support what it is our organization is trying to achieve in terms of patient care.