Four Rival Texas Hospitals Bond For Meaningful Use And To Improve Care

Here's a tale about the unlikely collaboration among hospitals in four fiercely competitive and very rural towns in Central West Texas.

It starts with a meeting between four CEOs at four very small and very rural hospitals. Those I spoke with describe the towns' cultures as similar to that of "Friday Night Lights," a book and TV series depicting football-obsessed rivalries, all very similar to their own.

"The 'Friday Night Lights' football mentality is very much real here," notes Rick DeFoore, CEO at the 25-bed Stamford Memorial Hospital. He adds in some cases, town officials "have a tendency to be suspicious of folks in other communities."

When you mention the name of a rival town in conversation, DeFoore says, it's not unusual for even respectable officials to say, with a straight face, something like, " 'I hate that town. They beat us 10 years ago in football during regional finals.' That old rivalry is a reality for us in West Texas."

The towns–Stamford, Anson, Aspermont and Throckmorton–sit between 14 and 50 miles apart in a region occupied largely by cotton farms, ranches and oil fields.

Residents travel long distances to work, play and attend sports events, perhaps the area's most popular entertainment. And they tend to be loyal to their hometown hospitals, yet may need healthcare while they are at work on a ranch or farm in one of the neighboring communities.

"Every town has a school and a hospital, and each [area] has a lot of pride, and there is fierce rivalry between the schools," says Nathan Tudor, CEO of the 20-bed Stonewall Memorial Hospital in Aspermont, about one hour north of Abilene. "In sports, we play each other in football, basketball and track. You want to be better than them. And that's the way it is with the hospitals too. We compete for the same patients because we all serve the same area."

This territorial pride, however, didn't stand in the way of these CEOs forming what technology geeks call a RHIO, or regional heath information system, to grapple with issues like meaningful use. Through their alliance they selected and bought an electronic medical record system or EMR that they all could share to benefit their patients, and their hospitals' bottom lines.

They selected one system that could link all their hospitals, their clinics and their physicians with the medical records of all of their patients. Key parts – including inpatient records –­ should be implemented by October, although some pieces, such as links with the clinics, may take longer.

"Once the database is built, and one of our patients is treated in another hospital emergency room, the provider would be able to immediately identify that the next time a patient comes into any emergency room. 'Oh, I see you went to the emergency room in Stamford last month,' " DeFoore explains. "And once the clinics get up and running on the same system, that database will be available to them too."

All four CEOs agree that none of the hospitals could have afforded such a system without the collaboration.

"To have one hospital decide to do this alone; well, it just could not have been accomplished," Tudor says. "Working collaboratively, we're able to gain a lot of synergies, and now, it's very cost-effective for all of us."

Smartly, they looked to find strength in their numbers as a region.

Tudor's 20-bed Stonewall Memorial's town of Aspermont has a population of 1,021, while DeFoore's 25-bed Stamford Memorial Hospital is in Stamford, population 3,636. CEO Ted Matthews' 45-bed Anson General Hospital serves a town of 2,556, and CEO Randy King's Throckmorton County Memorial is in Throckmorton, a town of only 905.

Tudor says he's prohibited under contract from revealing what the system, ChartAccess Comprehensive EMR from Prognosis, will cost. But he notes that because it will satisfy meaningful use criteria, "Each hospital will benefit from federal stimulus dollars. Overall, we'll be able to recoup our investment."

The system even has an iPhone app that allows physicians to access patient records remotely. That's a big change for this area, where health records now are all on paper.

The CEOs acknowledge that working together to make such a big purchase decision was not easy; they each had boards of directors to convince. "Even with rural hospital administrators, egos get in the way," says DeFoore. "We're all used to calling our own shots. To get around that, we've all taken leadership roles with different pieces of the project," he says.

How are the doctors responding to the idea? Most are enthusiastic, the CEOs say, but some are taking a "wait-and-see" approach, DeFoore says. "They know we're pushing this now because of the stimulus dollars."

The EMR system has the capability of providing computerized physician order entry (CPOE), and when the doctors heard that, "their eyes got big," DeFoore says. Dillon Miller, MD, a newcomer to Aspermont who is one year out of family medicine residency at the University of Alabama in Tuscaloosa, sees amazing potential for this EMR.

"All the towns in our RHIO system are within 25 minutes of each other, and there are lots of people working on ranches who may be closer to our hospital than the ones near their own homes," he explains. By having a system that links all the hospitals and clinics with each other, each hospital district can share patient health histories wherever they may show up."

And there's the potential to save money too, Miller adds. By being able to find out whether the patient just had an X-ray or a CT, and what their medical history says about their health, "we can treat the patient much more efficiently," he says, and avoid needless expense.

Even with the competition, Miller says, "If we're working together, it really helps everyone. If the patients are happy, and they know they can get good care at any of the facilities, then it's a win-win situation for everyone."

DeFoore says that there's another happy, although unintended, consequence of this alliance. "Since we've been talking about this the last six months, the four hospitals in this RHIO have also met to discuss common purchase of medication equipment, mutual contracting in payer negotiations, and we've discussed the purchase of another nurse call system for each hospital."

Saving money in rural healthcare settings is essential because without such efforts, many other rural hospitals will go broke, he says.

"We're positive this will work," says Tudor, 29, who says he's the youngest hospital CEO in all of Texas. "There's no doubt in my mind that it will meet meaningful use criteria. I'll put my reputation on the line."