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Faced with an expensive overhaul, an Iowa system turns to an unproven vendor to win physician adoption.

Jeff Cash faced a difficult task when he became vice president and chief information officer at Mercy Medical Center in Cedar Rapids, IA. The health system, which staffs about 350 beds and has approximately 70 affiliated physicians, had been running an information system from MediTech for more than a decade. Although the system handled financial transactions well, it was challenging to use and had limited clinical reporting capabilities. Because Mercy wanted to expand its use of clinical IT, it rebuilt the legacy system, updating how data was organized and adding a nursing documentation component. “The goal was to bring nursing documentation online and have an inter-disciplinary care plan available.” 

The strategy worked--to a point. The nursing staff accepted the revamped system, which gave them a clearer picture of current patients’ status. “We told the physicians what we were doing with nursing documentation and that we wanted them to use the system when we were done,” Cash adds. Turned off by the cumbersome access methods needed to use the MediTech system to view even limited clinical data, the physicians balked. Only about 50 physicians used MediTech to view lab results. “The docs said we needed a different hospital information system,” Cash says.

Cash was not in a position to argue. For one thing, Mercy’s efforts to implement electronic signatures in MediTech had only partly succeeded. Physicians could use the legacy system to sign dictated reports, but could not sign any other verbal or written orders that made it into the chart on the hospital floor. And even signing dictated reports was cumbersome, as physicians had to log in using a Citrix application. “They wanted a direct Web front-end to get in,” Cash explains.

To address the physicians’ concerns, Cash had three options. First, he could upgrade the MediTech system to the vendor’s contemporary, user-friendly version, which would have required upgrading MediTech-supported applications as well. That would cost $6 million and risk upending the well-worn workflows in the finance department, where the legacy system worked well. Second, he could turn to another vendor, such as Cerner, with a more developed physician portal technology. That might have cost $15 million and required revamping the entire hospital’s IT platform, he says. Third, he could turn to an unproven vendor and deploy a Web overlay to the MediTech system.

The rural hospital’s limited resources forced Cash’s hand. In early 2006, he gambled on PatientKeeper, a physician portal vendor. Signing on as a development partner, Cash deployed the PatientKeeper physician portal technology for less than $400,000, a price he says was substantially discounted.

The PatientKeeper gamble paid off. Because PatientKeeper had already written its MediTech interfaces, Cash did not need to hire consultants to build the system, turning to a single department analyst to work with the vendor during the implementation. Within a few weeks of launching the software, some 300 physicians were using the system to view lab results and sign charts. Through the PatientKeeper Web-based portal, physicians can see lab results, radiology reports, nursing documentation, and scanned images of their orders. And thanks to an interface that PatientKeeper developed for Mercy, they can also sign all their charts electronically. “All the information is clickable,” Cash says. “And the physicians can rearrange the screen how they want.”

PatientKeeper functions as more than a data aggregator, however. Because it queries the MediTech system every few minutes for any new data, the PatientKeeper server functions as a data repository back-up in case the main system goes down or is being upgraded. “If MediTech is down, the doctors don’t see it,” Cash says. “That got us past the hurdle of, ‘If you want us to review charts electronically, what do we do when they are not available?’”

Physicians use the PatientKeeper system at workstations throughout the hospital. They can also access the system from their clinics or homes using a secure Web connection. Others download data directly onto handheld devices or smartphones. “We have a primary-care physician who downloaded data onto his smartphone on a camping trip,” Cash says.

Because physician response to the technology was so positive, the medical staff lobbied the town’s other hospital, St. Luke’s, to deploy the same system. “Eighty percent of our physicians work at both hospitals,” Cash explains. “It made sense for them to do the same thing so the physicians only have to learn one application.” Down the road, Cash says the PatientKeeper technology could serve as the basis for a community data exchange. “It could be the gateway into the primary-care record,” he says, describing a scenario in which community physicians could use the technology in their office practices.

 “It could be the light-weight version of a RHIO [regional health information organization].”
—Gary Baldwin

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