Program with projects that support it. I have used this approach for longer than I care to admit in public,…
Jessica Cox, RN is director of product solutions for Holy Name Medical Center of Teaneck, NJ.
Tell me about yourself and the hospital.
I’m the director of product solutions at Holy Name Medical Center. The hospital is located in Teaneck, New Jersey, with about 360 beds. It’s a regional health system serving the patients in the Teaneck community and surrounding communities in northern New Jersey and also folks in New York.
My role at the hospital is to manage the product offerings for software products that are deployed throughout the hospital and the health system itself. Mainly for the last two and a half years, I have been leading the development of a new in-house EHR that we just recently deployed in May in the hospital’s emergency department.
What led the hospital to decide to self-develop an EHR?
The hospital has always had an interest in technology. Close to 30 years ago, the hospital developed its own EHR, long before EHRs were prevalent and certainly long before they were mandated in the industry. The hospital, up until about two and a half years ago, was still running on that same system. It was certainly time to make a decision – do we buy, or do we build?
The hospital and the health system believe in a good mixture of both, but the leadership felt like the needs that Holy Name has were not going to be met by any EHR in the market today. The focus of Holy Name is an enterprise solution and a person-centric solution. Often systems claim to be interoperable and they are, but they certainly don’t fit the needs of an enterprise with multiple physician practices, health centers, and hospitals in the network. So the decision was made to build, and that’s what we did.
What was the makeup of the development team and how much effort was involved?
With this decision came a new leader, a new chief information officer, at the hospital. He started about three years ago and the team that he had was zero, so he had to form a team. He brought me in to manage the product side and my colleague to manage the development and architecture side. We formed a team from there. Three years ago, we had no one in place to manage this type of technology. The folks that were in place are still managing the existing legacy software.
We started with a team of basically three of us and now the team is greater than 50 folks. We have a mixture of onsite and offshore developers, QA engineers, and product managers. We are a nimble team. That’s where we’ve gotten our success and the ability to go from a concept to a minimum viable product, MVP, in just a little over two years. We are hands-on, close with our team, and we work pretty much around the clock to get the job done. We can remain agile and nimble and give the hospital what they need, but also some of the newer features and technology that they might not have even thought of without us bringing that to the table.
What does the tech stack look like?
The existing software was very legacy, as I mentioned. It was a technology that I was not even aware existed until I came on board. It was time for something new. It’s a web-based platform developed mainly on a Microsoft stack. We pride ourselves in the UI. We would love to share it with anyone that’s interested, but we brought some of the latest and greatest techniques for the UI and certainly for the behind-the-scenes architecture. We felt like it was time to modernize. A couple of other new features that we brought were facial identification for person management and person recognition when folks are coming in to be registered.
The software itself is modernized, but has some new technologies there as well. We feel like instead of looking at this as just a replica of existing EHRs, we wanted to bring technology that is not as often used in healthcare and bring it into that space. What technology is available at airports? What about banking software and technology that we can bring to healthcare and make the workflows of the hospital much more efficient?
What features were you seeking that commercial EHRs don’t have?
One of the hurdles that we had to achieve while we were developing for our own peers and our own colleagues at the hospital was that we were asking a lot of them to completely change from what they had been used to using for so many years to something from scratch. We knew that this was an MVP product, meaning the first deployed product is not going to be the most robust that can be. We are releasing new versions constantly.
Part of that advantage that you asked is to get a little buy-in from our peers. We wanted to provide them some neat, exciting kind of new-age tools that they could be excited to use. But more importantly than that, we feel like there’s a lot of advantages that we can improve the workflows that exist in the hospital today by using these technologies that aren’t traditionally in place. Our goals have been to get buy-in and interest from our colleagues, but make sure that that software is usable and that we’re not only meeting their needs, but we’re exceeding them. So far, we’ve gotten some really nice feedback.
How did your approach of using Medicomp’s Quippe differ from that of a vendor that doesn’t use it?
I will say that we are the first hospital EHR that has engaged with Medicomp to use their Quippe solution in the EHR. I really can’t imagine our charting feature without Quippe. When faced with the decision of how to manage physician, nurse, and clinician documentation, we knew that we had to have a competitive advantage there because physicians are counting seconds and counting clicks. They have high expectations that their documentation not only be complete and satisfy regulatory requirements, but that it is also readable and provides the narrative of that patient story.
The decision was to build our own database of clinical findings, or maybe integrate with another system that has just a simple database of findings, or to engage with someone like Medicomp, which provides not only that dataset, but the relationship between the findings and the ability to thread those together to tell a nice story of the patient, but also provide all of the data that’s necessary for reporting and quality measures. We feel like our chart is one of our most special features in the system and we’re really most proud of it.
Is a demo video available that would make it obvious how your product differs from commercial EHRs?
We don’t have one as of yet. Our main focus has been to ensure that Holy Name is well taken care of. Migrating to a brand new EHR is difficult. In my past, I worked on the physician practice side, and common practice was to reduce the schedule by about 30, 40, or 50% to make sure that the volume was low and everyone could ease into the new implementation. Certainly you can’t do that with the ER. So our focus has been on them and making sure that their needs are satisfied.
But we certainly would love to do that and to share. I will say our colleagues and friends at Medicomp, every time they see a demo of the software, they’re so excited and they feel like it’s something unlike anything that’s out there in the market today. We are very excited to share it with other hospitals when that time is right.
Will you commercialize the system on your own or partner with a vendor to acquire or license it?
The plan is commercialization. The route that we take, we are still navigating. But yes, I think our leadership at the hospital realizes that technology can enable hospitals to achieve much more than they currently are. I think a lot of hospitals feel like technology slows them down, and we feel like there is a need for this type of solution that is usable and easy to implement. We feel like that need is there in other regional hospitals like ourselves.
The plan certainly is commercialization. Our roadmap also involves expanding into other areas of the health system beyond the ED. I think maybe next year, when hopefully HIMSS is in a little bit of a better place, we will be excited to share what we’ve been doing.
What other technologies are you looking at or considering or developing?
We’ve been working closely with a couple of departments. One is our facilities management department. When the COVID crisis hit , our area of the country in northern New Jersey and New York was one of the hardest hit. We have worked hand in hand with our facilities management group to provide state-of-the-art exam rooms and hospital rooms that not only protect the patient, but protect the nurses as well.
Another technology that we have just implemented with our ICU — we renovated and completely built a new ICU right after COVID – is smart screens in each of the rooms that identify the clinician via facial recognition. There’s no need for tapping on the screen to access the patient’s record. There are tablet devices on the outside of every ICU room that provide indicators for the patient. They provide access into the room.
We are continuing to dive down the software development path with our roadmap to expand, but we’re also engaging with our biomed and our facilities department to enhance the experience, the patient experience, at our hospital too. That’s been something really fun and interesting.
What advice would you give a nurse who wants to become more involved with technology?
Dive right in. Nursing is one of the best fields that anyone can enter because it is so diverse. I realized after a couple of years that bedside nursing wasn’t quite for me, and I just happened onto technology about 12 to maybe 15 years ago now. Now, I would never look back. My advice would be to work hard in nursing and make sure that you learn everything you can about patient care, but then take it further.
This industry needs nurses that have the knowledge of clinical needs and background, but who also know the workflows of the day-in and day-out of taking care of patients. That’s something that a lot of tech companies are missing these days. We need to take a step back and make sure that we understand the needs of the folks serving on the front lines of the hospital. Sometimes it’s a little more simple than we think, and so having more nurses in technology to convey that will only make us better over time.