Jim Causon, CPA is CIO of Memorial Hospital in Stilwell, OK.
Tell me about yourself and the hospital.
Memorial Hospital is a 50-bed acute care hospital. It has a 10-bed geriatric psych unit and a physicians’ clinic that has anywhere from 12 to 16 physicians, depending on who comes and goes at any given time. It’s in rural Oklahoma in Adair County.
The clinic sees about 3,000 patients a month. The total population for the county is 3,000. [laughs] You know everybody. We draw a lot of people through the clinic. We see a lot of frequent flyers. It’s a nice little facility. It’s about an hour or hour and a half from the next-largest facility.
I am a partner in an accounting firm, Causon & Westhoff CPAs. We provide the CIO function for the hospital.
What technologies does the hospital use?
It terms of patient care, billing, and admission, discharge, and transfer, we use Medsphere OpenVista CareVue in conjunction with Stockell Insight CS. We just bought the clinic live on the EMR in August. We bought the hospital up first, got everybody comfortable with it, and then brought it into the clinic.
How has Medsphere worked out?
It has worked out well. That was a big concern up front when we were looking for a product. We were probably a little later to the ball game in selecting a vendor, mostly because we wanted to see how other implementations went at other sites with different vendors.
Then, of course, cost was a big factor. The government didn’t do anybody any favors by publishing what they were going to pay. Everybody was at the top of that rate for what they wanted for their product, which left little for implementation, hardware support, and that kind of stuff. We were fortunate to find Medsphere. The pricing worked out well for our small hospital and we were able to get it up and running easily. It was really an easy process, or as easy as going from paper to electronic can be. The technology part was easy compared to the people transition.
I assume your doctors are community based. Did you get good buy-in for physician order entry and other direct physician use of Medsphere?
We did. We have one doctor who probably does three times the volume of anybody else. He was a big concern for us in terms of being able to keep up. Are we going to have to hire additional staff to support him?
He was the silent champion when we came online. He picked it up real quick, didn’t have any problem with it, didn’t really get behind significantly in the beginning. He does well with it. We’ve got a couple of doctors that see a third of the patients that he does who still struggle with it a little bit.
When we went live in August with the clinic, for probably the first four weeks following go-live, we had a dip in the number of people we saw and charges going out. But by Month 2, we were back up to where we normally are. We saw very little decrease in productivity when we brought the clinic live.
You had no unexpected impact on revenue or accounts receivable?
Our days in AR went up a little bit when we first went live in the hospital. It really wasn’t significant. We did it sort of backwards. Most people bring in their ADT, billing, admit-discharge software first. We didn’t. We started with the clinical side. We kept all of our old billing software in place, and once we were up and running on the clinical side, we brought the admit, discharge, billing in on top of it. We kind of did it in a backwards order, but it worked out well for us.
When you look at hospitals paying huge maintenance costs for Epic or Cerner even as they’re trying to cut costs, are you glad you chose a less-expensive product?
It was more about, we have to get this right, because if we don’t, we can close the doors on the hospital. There is not a lot of big budget in there for getting it wrong. [laughs] We were very careful in our choice and the way we implemented it to protect the revenue streams as we brought it online to make sure we didn’t get a very big drop at the beginning.
What kind of technology staff do you have?
Until we implemented Medsphere in the hospital, I was the only IT person for the facility. We had a maintenance person that had some computer experience that I would recruit to restart this machine, fix that printer, run this cable, that kind of thing. I was it. Probably a year after we were on CareVue, we brought Insight up and added a fair number of new machines. We decided it was time to bring a person in house. We hired a person to be in house to take care of user issues. I maintain the servers and all of the larger issues. That’s the way we’ve run it since then. Really, it’s just the two of us.
Does it scare you reading about malware and having just two people to protect the systems?
Scares the pants off me. [laughs] Our biggest risk is what that end user is going to click on in their e-mail that’s going to cause us problems. We have had one laptop that was infected with ransomware, but it was a non-critical machine. It was identified almost immediately and we dropped its connection within a couple of minutes. We didn’t have any problems with the rest of the system, but that’s a worry every day. What is going to pop up that you’re not protected for that you don’t know about yet?
We do as much as we can in terms of firewalls, monitoring, protection, filtering, and education, but you never know. Our people are getting better. They send me e-mails that say, “Hey, this doesn’t look legit. Is it?” Most of the time, it isn’t.
We are getting ready to implement a process where we send fake e-mails to employees to see if they click on it or not. A lot of other people are doing that. That is our weakest area, the end user. Plan for the worst and hope for the best, is that how it goes?
Do you have other systems you would like to implement but can’t justify financially?
With current market, everybody is holding onto their dollars the best they can. Medsphere and Stockell have been very good to work with. If we need something or want something, they will help us figure out a way to do it at a relatively low cost, or a lot of times, at no cost at all. If it’s something someone else has, something they were going to do anyway, or something that would be a nice feature for some other hospital, they will help us get it done.
Stockell Insight CS has a large user group. They donate a certain number of hours every year to the user group. We meet in June every year to recommend the enhancements. They tally up the number of hours the enhancements that were submitted will require and they do as many as they can. We vote as a group on which ones we want. We have taken a large delegation this year and just about every year. Almost everything we’ve requested, they’ve been able to provide for us. I really can’t complain with the additional expenditures to get us what we want and what we need.
What opportunities and challenges do you see in using technology to align more closely with patients?
The biggest challenge for us is the consumer. We are in a small, rural community. It is primarily a Cherokee Indian population. A lot of people don’t have cell phones, don’t have computers. As we started rolling out our patient portal and trying to meet Meaningful Use by getting people to sign up, they’re like, I don’t have an e-mail. I don’t have a cell phone. OK, what do we do? [laughs]
Even down to our employees. When we tried to implement direct deposit for paychecks or self-service for payroll, where you can print your own W-2 and stuff they, didn’t have a computer. Some didn’t even have a bank account. Those are the kinds of issues that we face, more so than people saying, why can’t I do this online? It’s more like, please, will you try this online? [laughs]
Do you have any final thoughts?
I saw other hospitals is that were picking a vendor for pharmacy, picking a vendor for lab, and then trying to integrate all these vendors through interfaces. When something didn’t work, these guys were pointing at those guys who were pointing at somebody else. Getting it fixed and reconciled is almost impossible because everybody is pointing fingers at each other.
When we selected this system, all of those departments were integrated. We don’t have 10 different software products that are trying to do this work. Pharmacy, lab, and radiology are all in one software. The only interface we have is the interface from Medsphere to Stockell, and since they’re under the same umbrella, we have one throat to choke if things don’t work.
Their support for both sides is first class. They are very professional and quick to respond. If something is not working and we’re concerned about it, then they’re concerned about it. With other facilities and some other products, I don’t get that feeling. We’ve had a good working relationship with their support teams. There are times where we lean on them more than a large facility might because we don’t have the IT staff on site to do it. I can’t say enough good things about the support coming out of these guys.
We have been happy with our choice. Irv Lichtenwald is top dog at Medsphere. He has a monthly call with each client, so we talk to him directly at least once a month. If we have problems or concerns, 30 minutes after the call, someone is calling me back to say, heard you talked to Irv today. Yes, where are we on this? You don’t feel like you’re just a number. When I call and say who I am, they don’t ask me for my client number and have to look me up. They know who we are. That’s nice. That says something.