North Nation Healthcare contains three critical-access hospitals and an affiliated house well being and hospice company positioned in northern New Hampshire. Healthcare Innovation lately spoke with the well being system’s CIO, Darrell Bodnar, about unifying all three hospitals on Meditech’s Expanse EHR and being named to CHIME’s Digital Well being Most Wired 2023 checklist in each ambulatory and acute-care classes.
Healthcare Innovation: What are a number of the greatest challenges you face as a CIO of a smaller rural well being system as of late? What’s prime of thoughts for you?
Bodnar: Prime of thoughts for me is at all times staffing. I’ve 31 IT staff. We’re accountable for knowledge analytics. We’re accountable for a number of the the ancillary companies inside imaging. We’ve boots on the bottom in any respect of our places, which spreads us out thinner. So staffing might be my greatest concern, and never simply IT staffing. I imagine the answer to bettering the general scarcity of medical employees is know-how, automation, and innovation. I feel it is the one method we’ll get there, and it is overdue. There are a number of processes, whether or not they’re pushed by regulatory compliance or not, that should be improved. We’ve a lot of alternative.
HCI: Apart from automating sure duties, do you suppose whether or not the EHR is perceived as user-friendly by the clinicians is necessary to medical staffing?
Bodnar: Completely. In my private opinion, EMRs had been initially not designed for the doctor however reasonably as a monetary software that was pushed to physicians and clinicians. At this time clinicians are documenting an encounter with the affected person and that has successfully made them coders and billers, too. Doctor workload is one thing that we actually should be cognizant of. So, although there may be some resistance to AI and a number of the automation that we’re placing in, I at all times say it allows the suppliers and clinicians to be their finest. It isn’t there to interchange them. It is there to interchange that work, however allow them to be their finest. We appear to have gotten fairly a little bit of traction in doing so by presenting it to them that method.
HCI: I perceive that North Nation got here collectively in 2015. When did the deployment of the shared Meditech Expanse EHR occur?
Bodnar: In the midst of COVID so, December 1 of 2020 is once we launched it. And we’re developing on three years. Beforehand, we had a complete of 5 EHRs excluding house well being. We had three for major services, after which we additionally had an ambulatory module for a kind of organizations. After which there was one other separate ambulatory module for one of many different associates, so we had a number of EMRs.
HCI: What had been a number of the greatest challenges in regards to the transition interval?
Bodnar: We had not carried out a number of the legwork it could take to break down that many organizations right into a single EMR. I’m speaking about defining finest practices, defining order units. So within the 12 months previous to the go-live as a part of our construct, we began to work on these. This was not only a technical course of. As a corporation, we weren’t prepared for it culturally. So there was a number of negotiation that went on post-go-live that most likely ought to have been carried out prematurely.
The opposite lesson I discovered was that generally it is simpler to construct a brand new home than renovate the one that you just’re dwelling in. We collapsed all of those organizations into one of many EMRs that was at the moment in place, which was in Androscoggin Valley Hospital. They had been a Meditech buyer for a few years. It was the most effective platform to maneuver to, however that they had 25 years of bags that got here with that EMR. There are at all times issues which might be leftover or residual within the EMR, that we have now launched to the others. Possibly it could have been wiser to begin model new, after which go from scratch to our migration. However we determined to attempt to benefit from it. It made sense on the time.
HCI: You will need to have seen fairly just a few advantages from having all three hospitals and ambulatory settings on the identical platform. You had been named to the CHIME’s Digital Well being Most Wired 2023 checklist in each ambulatory and acute-care classes.
Bodnar: It’s night time and day, even with the challenges we nonetheless have. We’ve a single pane of glass over acute and ambulatory throughout our complete continuum of care. That was one thing we did not have earlier than. We’ve that visibility now. The processes of how we do care transitions are seamless. Our physicians work in a number of locations. They could not even have what they might name conventional house anymore. With a number of EMRs, it was nearly unattainable for them to operate And for our sufferers, if we had 5 EMRs, they wanted to have 5 affected person portals. Now they will use one single affected person platform to have the ability to entry data.
HCI: You talked about analytics and reporting earlier. Is that made a lot simpler with a unified well being IT system?
Bodnar: Our purpose is excessive reliability. We’re trying to be a simply tradition the place we will enhance our processes. We’ve employed a chief high quality officer who’s actually driving these efforts. Each ounce of that effort relies on knowledge that three years in the past was fully disparate and was not obtainable to us. Now, it is only a matter of mining it, it and deciphering it to get to the purpose that we need to perceive. And we’re uncovering a number of cultural and workflow points. Having knowledge and analytics gives us the perception to get to that.
HCI: What about interoperability points? I don’t suppose New Hampshire has a robust statewide well being data alternate. Are you utilizing CommonWell and different nationwide well being data networks?
Bodnar: In New Hampshire, the motto is ‘Dwell Free or Die.’ Because of legislative efforts, we would not have an HIE and we weren’t permitted to below legislation as a result of we couldn’t retailer that data. It i manifests itself in horrible methods like with an immunization registry that was not current throughout a pandemic, which made it actually difficult. However interoperability with Meditech has been nice. We have partnered with a number of our organizations for point-to-point VPN tunnels the place we’d do HL7 exchanges of knowledge as a part of our workflows and continuum of care. And we’re in a position to make use of CommonWell throughout the board. We are likely to get a number of vacationers we have now snowbirds who used to stay right here, and go to Florida or come again.
We even have individuals who come right here to ski. Having these information are available in has been instrumental in us having the ability to present care shortly. And surprisingly a few of it pertains to the ED however a number of it has been in major care.
HCI: Did your group transfer to a number of telehealth in the course of the pandemic and has that continued since?
Bodnar: We did transfer to telehealth. We had leveraged Zoom like lots of people did and received the safe licenses after which constructed workflows round that and it truly labored pretty properly. Now we’re implementing a Meditech module to assist us with that. We noticed the uptick and and we noticed a bit of little bit of a drop-off. However the space the place it has caught is behavioral well being. We’ve a reasonably vital behavioral well being inhabitants, and so they appear to want that platform, and actually the clinicians delivering care do as nicely. We’re working with Meditech now and a third-party vendor known as Phreesia to make it possible for we facilitate the documentation, the onboarding of these sufferers and consents by means of an digital format in order that they could by no means need to step foot in facility except it is for some some blood work or one thing alongside these traces.
HCI: Is there anything in your well being IT technique on the drafting board for the subsequent 12 months?
Bodnar: We’re positively shifting ahead with with Microsoft’s relationship with Nuance. I feel it is gonna be Nuance DAX Copilot. That is one of many applied sciences that I feel that can allow our clinicians to be their finest. We’ve quite a lot of automation initiatives on the medical aspect in addition to the monetary aspect. We’re scheduling an optimization evaluation this coming 12 months, focusing so much on the income cycle aspect, however we’re additionally acute and ambulatory companies. We constructed it throughout COVID. Loads has modified since then.
I feel the most important factor that I am seeing is a transfer towards automation, a transfer towards the the gradual however methodical adoption of synthetic intelligence and machine studying the place relevant, and ensuring we take a look at mature distributors, not these promising issues that would actually put us in a susceptible place. There’s a partnership between Meditech and Google that’s extraordinarily thrilling for us, significantly while you take a look at the depths of the medical document and what that search functionality would appear to be.