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Brenda Tiefenthaler,
RN, Vice President,
Patient Care and
Informatics,
Spencer Hospital
Spencer, Iowa
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Ed Meyer
Director, Information Technology,
Spencer Hospital
Spencer, Iowa
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At Spencer Hospital, we view the use of information technology (IT) as part of our overarching clinical strategy — not a siloed technical initiative. Accordingly, our organizational structure follows suit, with the IT department reporting to the vice president of nursing. As a result, our clinical and IT co-workers share a global perspective, each with an in-depth understanding of the other’s goals and needs. To further reflect this cultural outlook, we have elected to co-write this “Performance Strategies” article, offering readers the mutual viewpoint of both a vice president of patient care and a director of IT.
In rural northwest Iowa, located two hours from any major metropolitan area, is Spencer Hospital — 99 beds with two primary care clinics in neighboring communities. Our patients are served by approximately 40 independent primary care physicians and specialists, representing eight additional clinics. Due to our size and location, we often refer patients to other area providers. In fact, many of our physicians have privileges at up to five additional hospitals.
Since 2004, McKesson’s Paragon® solution has served as our hospital information system (HIS), giving Spencer a consolidated IT foundation that expanded previous capabilities. But by 2007, hospital leadership agreed we needed to step up efforts to support both physicians and patients, as well as improve data sharing with other hospitals in an area that covers northwest Iowa, and portions of South Dakota and Minnesota.
Many of our patients were receiving care from multiple providers that included local and regional physicians at hospitals throughout the region. Patient data was not easily shared, and physician practices either had disparate electronic medical record systems or none at all. At the time, Iowa’s state government was considering creation of a health information exchange (HIE) network, but progress was slow with no foreseeable implementation dates.
So, even before ARRA offered stimulus incentives for the use of healthcare IT, we sought to:
 Improve continuity of patient care via electronic patient data sharing across providers (rather
than wait for state government to take action)
Offer our affiliated physician practices a hosted, subsidized electronic billing and medical
record solution option
Attract new physician practices by offering a subsidized IT solution
More recently, we added the goal of meeting July 2011 stimulus criteria, which includes use of a personal health record (PHR) and computerized physician order entry (CPOE).
Sandbox Meetings Help Build Consensus for IT
To meet these challenges, we involved physicians early and often in both the selection and adoption processes. We approached these challenges with the philosophy that even the best technology can’t drive adoption; only users can. Plus, our physicians are independently employed and have no obligation to follow hospital recommendations.
Through a series of “sandbox” meetings with physicians’ office staffs and providers, we evaluated and narrowed our initial list of vendors considerably, based on comparison of features, connectivity, integration and cost.
In the end, we selected McKesson’s Practice Partner® as the choice for physician practice billing and medical records, and RelayHealth® for a data-sharing engine and repository. With integration to our HIS, we can share data with employed and affiliated physicians and send results to a patient PHR. For independent practices with a different EHR, we plan to use RelayHealth to exchange clinical results.
Physician Involvement Drives CPOE Adoption
Meanwhile, we deployed Paragon’s computerized physician order entry (CPOE) module, another key qualifier for Stage 1 meaningful use funding. Again, we successfully leveraged physician involvement to motivate adoption. We contracted with three of our community physicians to become “Physician Champions,” offering design input and conducting peer-to-peer training sessions with other providers.
We also relied on the “Physician Champions” to provide design feedback on the system and promote it to their colleagues. In addition, we formed a dedicated in-house support team, including registered nurses who served as experienced clinical applications analysts and were available to assist physicians as needed.
Connecting the Community
Through our clinical strategies and technical solutions, we expect to improve continuity of patient care, increase physician access to and adoption of IT, and demonstrate meaningful use so that we can qualify for stimulus incentives in 2011. And, when the State of Iowa creates its HIE, our physicians will have an affordable, straightforward conduit, thanks to their connection with Spencer.
Today, our size and location no longer isolate us, our providers or our patients. Instead, our technology is the strategic link that connects us all.
Brenda Tiefenthaler is a registered nurse who has worked at Spencer Hospital for nearly 11 years. Initially, she provided patient care and staff management, later becoming director of Abben Cancer Center before being selected as Vice President of Patient Care Services and Informatics. She has a Bachelor of Science degree in nursing from the University of Iowa and will complete her master’s degree in Nursing and Health Care Administration in 2011. Tiefenthaler is a project lead for Spencer’s HITECH/meaningful use initiatives, as well as for all clinical software application rollouts. She is a member of American Organization of Nurse Executives and the American College of Health Care Executives.
Ed Meyer brings more than ten years of information technology experience to his role as IT director at Spencer Hospital. He is a member of Healthcare Information Management and Information Society (HIMSS) and College of Healthcare Information Management Executives (CHIME).
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IN THIS ISSUE: Rural and critical access hospitals face the same reform challenges as big city medical centers. They also face staff shortages and tight finances, and often serve an older, sicker, poorer patient population that is challenged by its distance from healthcare facilities. These factors can hinder these hospitals’ ability to adopt new and complex technologies such as electronic health records (EHRs). For these providers, the question is ‘how do we accomplish these tasks with limited IT resources and even more limited funding?’ This issue features rural healthcare organizations that have adopted advanced HIT to improve community care while working toward demonstrating meaningful use to qualify for ARRA incentive funds.