From the March 2005 Issue

Crunch Time

PACS Is a Crowd-pleaser in Healthcare

Lab Links to Patient Safety:
Case History

Quality With Teeth

Time for a Change

Four F's Equal A+

Healthcare IT Tipping Point?

Four F’s Equal A+

 By Robin Blair, Editor

Three years ago, Brian Dieter, vice president and CFO at Mary Greeley Medical Center (MGMC) in Ames, Iowa, told Health Management Technology that his organization makes IT purchase decisions based on a system he calls the Four F’s—functionality, fit, future and finances—adding, “We don’t want to manage multiple technologies or multiple vendors.”

He says the same thing today—and his organization has acted upon it, too. MGMC has replaced its enterprise system with a single-source solution via a big-bang implementation, an event that Dieter himself says was the single event in his 16-year hospital history that has robbed him of sleep.

The healthcare organization serves an 18-county area with 220 licensed beds, more than 1,300 employees and 156 physicians representing 31 medical specialties. Prior to the enterprise implementation, Mary Greeley Medical Center had what Dieter describes as “decent transaction-processing software. We could admit a patient, bill an insurer and handle accounting. We did everything you should do in a bank. But that’s not enough for patients.” In fact, he describes the organization’s previous financial IT system as an oasis in an otherwise desert of overall IT.

As an enterprise, MGMC wanted powerful clinical applications that would lead to full electronic documentation and point-of-care utilization, and also would be fully integrated with strong financial applications. When the organization began looking in this direction, its clinical documentation was a 100 percent paper process, and delays in locating patient charts meant significant waste of time and money.

In addition, the organization embraced a strong business motivation. “We wanted data that would help us to advance the practice of medicine at this hospital. The first step is to get data into that system; the second is to make it useful at the point of care.”

The Whole Megillah
MGMC’s senior management took the comprehensive road to product selection, including an extensive RFP process, hiring an in-house consultant, participating in demos and conducting site visits. “We even got to the altar with one vendor,” says Dieter, but not the vendor they finally selected.

Making an enterprise decision for an enterprise system shouldn’t be a leap of faith, says Dieter. “It’s not an issue of ‘Who do you trust?’ It’s an issue of who is willing to put specific provisions in a contract.” With an average daily census of 110, MGMC “is a complex organization,” he says. “Burns and open heart are the only things we don’t do. We have high performance expectations of vendors.” When the incumbent vendor couldn’t show MGMC a single client that had all the functionality it was trying to sell—and that MGMC wanted to buy—up and running in a single location, “we figured we’ve danced with these guys long enough.” They changed partners and signed with Mobile, Ala.-based CPSI.

According to Dieter, there were components that CPSI wasn’t able to bring up immediately, “but we told them, you have to include this much functionality and you have to have it available within a certain time,” and the vendor agreed. “They were willing to write the future into the contact,” he says. “We have three pages of required enhancements over the next two years in that contract.”

Part of the contracting decision was a leap of faith, though, since Mary Greeley’s IT staff—about 13 people—didn’t know the programming language that the CPSI system used. Staff support was a critical success factor in getting the new system off the ground, and Dieter says everyone was involved—IT staff, physicians, nurses, admitting, patient financial services. He says the IT staff was willing to gear up and work with an unfamiliar programming language.

Vendors as Job Applicants
Dieter is careful to explain the significance of his Four F’s system. Functionality is key, he says, and the organization absolutely must know the specific functionality it requires—a finite decision, even when complete functionality is rolled out incrementally. Finances, too, constitute a finite decision: either the organization can afford the technology it wants or it can’t.

But fit and future aren’t so finite. The future includes both the information technology that the healthcare organization wants to embrace for future use, as well as an assessment of the vendor’s longevity and stability. As for fit, that’s an even more intuitive decision.

Dieter says that if MGMC had made its purchase decision strictly on functionality, it might have selected another vendor, or a different vendor yet, were the decision based strictly on finances. But fit and future were equally critical. “We got to know CPSI as a company, and they were the best fit for us. When you make a purchase decision, you’re buying the functionality that the vendor has on the ground now, that they can put on your server, but you’re also buying the future. You’re making the same kind of decision you make when you hire an employee into the organization, and we decided to utilize that mindset. In the process, we ran across some vendors that we wouldn’t hire if they were applying for jobs here.”

One factor that reinforced the organization’s purchase decision was the vendor’s implementation approach. “They swarmed us,” he says. “They had 85 people here the week we went live, and a lot stayed for the second week. They had troops on the ground with us in each key department.”

Never Enough Training
The big-bang implementation followed a planning process that extended up to 10 months and took into consideration the training needs of everyone from the most IT-savvy to those not yet comfortable with a mouse. “The process touched every person in the hospital—every patient, every staff member, every doctor.”

The organization chose to go live in November 2003. It had hoped to initiate a fourth-quarter (October) start, but doing so would have required training nursing staff on order entry under two systems. Management chose to put the extra month into planning and staff training, and to let the accounting department determine how to annualize following a November start.

Mary Greeley Medical Center employed a superuser approach, electing to have superusers extensively trained and available to physicians and other clinicians for hands-on help throughout the implementation. Two such superusers were Vice President of Nursing Neal Loes and Shaunda Calkins, supervisor of the skilled/rehab nursing unit, the latter of whom personally headed up the point-of-care documentation project.

Dieter says it was important within the organization that employees could see key leaders stepping forward to accept training as superusers and then be willing to help other employees with the system’s utilization. He adds that all superusers worked tirelessly to train and be available to help colleagues. “Following their training, they got the bright yellow polo shirt of a superuser that made them visible on any floor in the hospital. We had superusers available in-house 24/7 for the first two weeks following go-live,” he says.

In retrospect, Dieter says there is no such thing as too much training, and he wishes that MGMC had provided even more. At the same time, he acknowledges the need to pick a start date and push forward with the transformation. “If you wait for users to say, ‘Yeah, we’re ready to go now,’ you’ll wait forever.”

The Finish Line
Mary Greeley Medical Center has come a long way from its days of the AS400 mainframe and paper documentation. Today the organization has in place a VPN (virtual private network), a physician portal with online viewing of nursing notes, labs and consults that is currently used by about 30 percent of admitting physicians, electronic order entry for nurses, capability for touchscreen data input and COWS (computers on wheels) using Fujitsu notebooks on mobile carts. Since the go-live, they have added bar-coded medication administration functionality on all inpatient floors, too.

Dieter, who acts as MGMC’s CIO, says, “We were smart enough several years ago to make the infrastructure investment necessary, so our network would be robust.” He credits much of the organization’s long-term IT success to having a dedicated director of information systems “who understands that the only reason we’re here is to provide information to those who take care of patients.”

Getting it right isn’t a matter of luck or timing. There are a hundred different ways that IT-related transformations can go wrong, and maybe a dozen ways that they can succeed. Mary Greeley Medical Center secured its present and positioned itself for the future with an intense focus on its Four F’s approach, supported by planning, unceasing concern for patients’ well-being and a zeal for employee participation. May the fruits of their labor be sweet.