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Struggling Financially in a HighlyCompetitive Urban Market  By John McGee CEO, Solaris Health System Edison, N.J.   Solaris Health System places a high emphasis on quality and safety, and we see clinical IT as an avenue to radically improve both. With a background in accounting, however, I look at everything through a sharp financial lens. Shortly after becoming CEO in 1992, and realizing that Solaris was self-insured for malpractice and general liability, it was evident that the avoidance of major medical errors was the key to future financial security. Meaningful use to me meant putting in systems to avoid errors. Early on, our biggest challenge was convincing the Board of Trustees to invest in IT. Not surprisingly, their first question was, "What is the return on investment (ROI)?" Usually, determining ROI means looking back three years later and asking, "Is this system being used the way it was intended to be used? Are we exchanging information? Are clinicians logging on?" The answers to these questions point to whether or not the organization is achieving beneficial use of the systems. The question is — how does beneficial use translate to meaningful use from the government's perspective. Paperless Environment Still Elusive With board approval in hand, Solaris began making large investments in IT: $34 million between 2003 and 2005, $10 million between 2006 and 2008, and a current annual IT operating budget of $15.8 million. As a result, our acute-care hospital is almost fully automated with pharmacy robotics, closed-loop medication management, clinician order entry, physician portal, document imaging, electronic nursing and surgery documentation, electronic transcription and PACS. We've measured our use along the way, with results that include:  85% of physicians use the portal to review and complete charts,which has eliminated chart deficiencies 12.5% reduction in nursing documentation time 93% compliance with bar-code medication administration procedures 25% reduction in medication administration timing variancesTo date, most of our metrics have focused on use; ultimately they must focus on outcomes. This applies to the nation overall, but we need time to get there. Without Adoption, Interoperability Is Meaningless I'd like to say we have achieved a paperless inpatient environment, but physicians still handwrite progress notes. At the end of a patient's stay, the manual chart is scanned and combined with electronic information so the entire chart can be accessed and completed via the portal. This alone is a huge physician satisfier. Solaris has also deployed an ambulatory EHR to its 95 employed physicians. We made a conscious decision to buy a system that doesn't communicate with our inpatient EHR because the physicians overwhelmingly liked it. Without adoption, interoperability is meaningless. Acknowledging the Economic Downturn Given our location in the New York metropolitan area, we have been greatly affected by the recession. We are struggling to improve revenue management and cash flow. These setbacks have hampered our efforts to continue our EHR roll-outs, particularly CPOE, which is a huge undertaking during the best of times. Other initiatives we've had to postpone include granting consumers online access to health information and strengthening our IT infrastructure to comply with business continuity and disaster recovery planning needs. HITECH has brought a much-needed sense of urgency to the state of our nation's healthcare records. Given the current economic environment, however, can we achieve meaningful use in the near term? John McGee, CPA, has been president and CEO of Solaris Health System since 1992. Before joining the health system in 1986, he specialized in healthcare-related auditing and consulting at Ernst and Young, LLP. McGee is a member of the American Institute of Certified Public Accountants, the New York State Society of Certified Public Accountants, the New Jersey Society of Certified Public Accountants and the Health Care Financial Management Association. McGee is past chairman and a current member of the Board of Trustees of the New Jersey Hospital Association. He is a member of the Health, Research and Educational Trust of New Jersey, the Center for Health Affairs Corporation, the American Cancer Society of New Jersey and Cancer Care, Inc. 
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