Impact of the HITECH Act on a Michigan Hospital's IT Strategy

Frank D. Sottile, MD, chief medical officer at 290-bed Crittenton Hospital Medical Center in Rochester, MI, spoke with me recently about Crittenton's journey to an electronic medical record system and the impact of the HITECH Act on the hospital's IT strategy. Crittenton is a standalone community hospital that serves a population of 700,000 people in a highly competitive market

It's one of three remaining independent community hospitals in Southeast Michigan. It began implementing an EMR system in 2001 and went live with the CPOE component in August 2007. Currently, 47% of all of its orders—about 60,000 orders a month—are entered directly by providers, which include physicians, nurse practitioners, and residents, says Sottile, adding that 50% of physicians are using the CPOE system. Here are highlights from our conversation.

HealthLeaders Media: Describe the state of the hospital when you began your journey to an EMR system?
Sottile: The hospital brought in a new administration team in late 2000. I joined in March 2001. At that time, the hospital had a small IT department and a legacy system that had been built in-house. We decided that we needed to move to a clinical EMR and refurbish the IT infrastructure of institution. We looked for an enterprise-wide EMR, selected the Cerner Millennium package, and chose to remote host the clinical database in Kansas City, MO.

We struggled for nearly two years with the implementation. Realizing that our small team was not going to get the job done, we made the decision to outsource IT services. In 2003, we chose CareTech Solutions to help us. It was a major shift for us because we went to a totally outsourced IT department including the CIO. CareTech hired all of our employees so we continued to work with people we knew and trusted. After that, we moved swiftly launching one Cerner application after another—laboratory, radiology, ER systems, pharmaceutical systems, nursing documentation.

Today, almost of all of Cerner's applications are implemented and operational in the institution. During the same time, we completely refurbished the IT infrastructure going wireless throughout the institution and deploying 1,200 PCs and developed a PACS system. It took us from an HIMSS level 1 to a HIMSS level 5 on the EMR Adoption Scale.

HLM: How many people were on your IT staff when you outsourced to CareTech?
Sottile: We had 13 to14 IT employees when CareTech took over. Now we have 16 to17, but we have gone from 20 applications to 65 to 70 applications. We didn't really add any FTEs until the past couple of years. What CareTech did for me was rotate FTEs in and out for specific expertise. I was overstaffed with mainframe programmers and it provided people who could project manage, so I could leverage those 13 to14 employees very effectively.

HLM: What was your strategy to get physicians on board with CPOE?
Sottile: Part of the strategy was to get them used to interfacing daily with systems. We went live with radiology and lab in 2005, so that was a win because it makes finding data much easier for physicians. They had a full two years getting used to the platform. When CPOE went live, we mandated it for use in our ED with a group of doctors that were young and energetic. It was like a proof of concept—if they can do order entry at that pace, anyone can do it.

We then allowed physicians to do use CPOE on a voluntary basis. We had early adopters who couldn’t wait to use it, doctors who used it at other hospitals who were self starters and easy motivators, and a group that was willing to adopt/slow adopters. Our strategy is continual education and making it a little more laborious without the system. We just had medical executive committee endorse the position that by January 2010 each physician has to do at least 60% order entry as a goal. We are driving it from the physician leadership and hope to refrain from mandating it here.

HLM: Recommended "meaningful use" guidelines for EMR systems call for 10% of all orders to be entered electronically by 2011. You had two years to get physicians warmed up to the idea; can other hospitals achieve that more quickly?
Sottile: If they haven't started yet, it is a big hill to climb. But, like at Crittenton, their competing hospitals are helping to move the medical staff forward and physicians coming out of school are more prepared, so the whole physician culture is much more ready to accept this now than they were in 2005. But it's still a big hill to climb in two years.

HLM: Have you changed your strategy to meet meaningful use requirements under the HITECH Act?
Sottile: We don't think so. We are well ahead of this curve. We set our strategies to support the overall business strategy of the organization. Having said that, we are in the process of reviewing each individual objective and making sure that in my IT strategic plan I have the capabilities built in. We'll do a gap analysis—if our current strategic plan doesn't have it, then we'll figure out how to do it. My position to my partners and board members is we'll achieve 100% of meaningful use and we won't leave anything on the table.