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October 27: Today on TownHall Reid Stephan, VP and CIO at St. Lukes and Chris Roark, CIO at Stillwater Medical Center discuss his system’s problem of keeping complete and accurate patient medication histories over seven different EHRs and how he was able to overcome it. How long did it take to deploy a solution where they could start seeing meaningful improvements? How much momentum and partnership was needed to implement a solution? What was the most challenging obstacle in implementation?

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Transcript

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Today on This Week Health.

Clinicians are all in it about the, care of their patients. So often within it, you know, we, put in things and a lot of those changes had not really had the desired effect, but this particular project really could show metrics where It provided a great patient care where we were able to see where patients weren't adhering to their medications and we could contact them and find out.

Welcome to This Week Health Community. This is TownHall a show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels designed to amplify great thinking to propel healthcare forward. We want to thank our show sponsors Olive, Rubrik, Trellix, Medigate and F5 in partnership with Sirius Healthcare for investing in our mission to develop the next generation of health leaders. Now onto our show.

Good afternoon everyone. This is Reed Stephan, VP and CIO at St. Luke Health System. Welcome to this episode of the This Week Health Podcast. I'm joined today by Chris Rourke, CIO at Stillwater Medical Center. Chris, thanks so much for making the time today.

It's a pleasure. Thanks for having me on today.

So Chris, maybe to start with, tell us a bit about Stillwater Medical Center, where you're at, the scope of your services.

Okay. Stillwater Medical Center is 117 bed facility. We also have two other smaller facilities that we have in small communities in the state within about 65 mile radius of Stillwater.

Oklahoma. We also have home health and, durable medical equipment. We have a hospice and we have about 36 physician practices that goes the gamut from cancer center to orthopedics family medicine, you name it. We've got a lot of it.

All right. That sounds like a broad range of services and scope you have there.

Let's talk for a minute, share about the challenge you've had historically with having access to complete and accurate medication histories for your patients.

Yeah, the, problem that we currently have a lot of or that we have had in the past, so it's been that our medication histories were not up to date in all the different systems that we have.

So, we've grown by bits and pieces over the last. 20 years specifically in the last say six to seven years, we've grown significantly during that time span. We've added two hospitals and probably I would say 30 clinics. Up until that point we had about six, seven clinics. But over the last six, seven years, we've added lot to our span of practice which in most cases has come with.

Some certain overheads, for instance we probably have about seven different EHRs that we use on a daily basis within our hospital system. It's fairly consistent. We use Meditech throughout those systems. We also use it in our hospice and our home health. But when you get into the clinic world although we're probably heavily structured in a NextGen environment for about 90% of those clinics, Some of the specialty clinics that we've taken on.

Also, we've also taken on EHRs for them as well, so we have about another six different EHRs in those. And a couple of the family care centers that we've taken on also were heavy users of Athena. And as you know, that's a, really good clinical system. And so they've stayed on those systems. The difficulty that we have is trying to marry in one way or another, the medication history of our patients throughout all those different avenues of care.

And that's been difficult. Most of the time, patients are going to see their primary care physicians or specialty physician, and it's those records that are being updated, which means that when they come into the hospital we weren't getting all that information to come across.

Over the last several years, we've done some things to plug those holes. I think that gives you kind of a good background of where we are.

Yeah. I can't imagine 70 hr, we just have one. And even that is a beast. So, multiply that by a factor of seven. That is a challenging proposition. Does Oklahoma have , an hie?

Like is that an avenue that provides any relief from that challenge or are there still difficulties?

There are difficulties, but we do have an hie, so which we participate in. Mm-hmm. . The problem is, is that not all the small clinics participate within those. We do have our primary with Meditech and NextGen, both contributing to those, but some of the smaller clinics that we have there.

Different systems are not contributing. And so that, that presents a challenge for us and also for those outside those are not always being Those medications are not always going up as well. So,

yeah. Okay. So you've done a nice job articulating the problem and the scope of the complexity.

What are some ways that you've been able to mitigate this risk and overcome this challenge?

Well that's, a great question. It, it's presented a problem for quite some time. One of the things that we've done here in the last couple of years is we've used a product from Dr. First, it's called Med History.

And it allows those histories within our Meditech ehr, we can actually go out and we can pull those in. So that, and it, searches through the pharmacy databases that are out there to find when a patient has filled a medication. And that allows us to pull those back up into those records. As you mentioned, we also have a, an hie.

If that information is out there, we can actually pull that in as well. So that's helped us significantly

give us an idea of how long it took to, deploy that solution toward started to make a meaningful difference. Are we talking years, months? What was the, nature of that project? Runway.

Yeah, it, didn't take years. , it took months. Always, there's going to be some fine tuning of that kind of a process. And really the, product that is delivered by Dr. First is pretty much, one and done. But, it's a process within our organizations to make those changes.

So, and that means Making sure that we communicate that throughout our different hospitals to make sure that they understand that there's ways that they can go out, pull in that external data into the database. The other nice thing is, is that Dr First also has kind of a population risk management piece that we've been able to develop kind of in, conjunction with them to look at some of those.

Patient populations that are most difficult, such as diabetes. Yeah. And so, that's been one of the things that has really been a great boost to our organization as we've looked at that. Like the a1c, we knew that. Just looking at the a1c, we had some kind of an issue going on there. And by using that population risk management tool that they provide are nurse care managers that are in charge of that have been able to go in, take a look and see which patients are on what medications, and also be able to determine if they're filling that because.

As you probably well know, it's adherence to medications that really is, makes the changes in a patient's condition. So, that's been a big help.

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How much of this rollout was totally within your control? Meaning was this something that you just did and it was transparent to other clinics and other locations across the state, or was it something you had to go and, create some momentum and some partnership and get people on board with this?

Yeah, it's more of the latter. We did have to kind of get with people, try to create some momentum, and it really is kind of within our own organization, I would say. So it's, that's really where it's kind of, Been derived from is just our organization as we try to get that information out to our caregivers, if they have some way to be able to go in, check those med histories on patients to determine how they're doing and look at that risk management piece that has been delivered to us.

So

what's been the most challenging part of this project for you? What was the, obstacle that was maybe the most difficult to figure out a way around.

Oh, that's a, that's a great question. I think probably the most difficult part is the change in process. I think we all have, we get comfortable with our day to day jobs and how we do them.

Anything outside of that is kind of a fly in the ordinance, so to speak. It slows us down initially And I think that's probably been the, hardest part is trying to change the processes from our caregivers to say, Hey, there's another way we can go about doing this. And this is, I think once you start showing that there is an advantage to this, they jump on board really quick.

But that's the initial thing is a little bit of resistance on the process.

change

So, yeah, so I love that last comment. So to dig into that deeper, because that why is really important, did you find any effective methods to really explain that why in a way that resonated with clinicians and let them understand what was in it for them.

Well, I think, clinicians are all in it about the, care of their patients. and they wanna see that, hey, that this actually is providing some benefits. So often within it, you know, we, put in things that have been dictated because of, government regulations. And a lot of those changes had not really had the desired effect, meaning that it didn't really.

Do what we thought it would do, and it added a documentation piece to our clinicians that prior to that they were so focused on patients and it's taken them away from that. But this particular project really could show metrics where It provided a great patient care where we were able to see where patients weren't adhering to their medications and we could contact them and find out.

Another piece that we actually put in with Drfirst was a piece that's called RXInform And what that allows you to do is for a patient when they. get prescribed a medication, it'll send them an actual text message to let them know about that medication being ordered. They can get education on that medication.

And it'll also allow them to have access to a discount that they can get on that medication. Because so often the reason that the patient may not be adhering to their medication is because of cost. And so that's a big piece of.

it

Yeah, absolutely. So we, started out talking about the problem, which was how do we improve access to complete and accurate medication histories?

You've shared a few, I think, adjacent benefits that you've enjoyed from this journey, the population health, the RX medication piece you just talked about. Have there been any other kind of unexpected silver linings or benefits that have transpired through this? effort

I think, we have closer communication with our staff, so it's built, a better give and take with the different clinical groups that we have.

I think that they feel a little bit more of a working relationship with the IT department. That's been a great lift for us.

From a communication standpoint we use a product from there called back.

Which has been very helpful in a lot of ways, especially when we had some major down times. But we use it on a daily basis for both our emergency department to kind of make things easier as patients move to the floors, and also especially use it for our home health and our, hospice areas for communicating patient information.

We have several RNs that work on the IT staff and so they've been able to establish some better relationships in that regard. We've also kind of developed greater communication out with different products that we have as well, so, there's a lot of silver linings I think the best thing is that greater patient care, And being able to, see those things that we know, are hey, that's something that we can do something about because we can talk to that patient, we can counsel them, we can see if we can get them to, maybe pay closer attention to taking those medications So,

yeah. That's perfect. What are some ways that you've measured the kind of post implementation numbers or results to really prove out that return on investment or the value that you went into this trying to achieve?

Yeah, The, we worked with Dr. First on that so that we could try to establish, what we were seeing.

We know that, for instance, on the RX inform piece that we have that we had a 44% click rate between April and August of this year. So, when you get actual numbers that we can see that patients are actually using the products that we're putting in front of them. That tells you something.

We know that there's a number of people that are not gonna go in. And not gonna do that even if you provide it to them, Yes. But when you can see that there's actually, this is actually making a difference, that really is What you're looking for in this.

Yeah. Well, Chris, congratulations on tackling a large problem that's challenging across the country and I think having a great result from it.

Just in closing, what advice or what words of guidance would you offer anyone who maybe is just starting out on this journey to really get their arms around again, trying to have access to a complete and accurate medication history for the populations they serve.

Well, I think for number one is try not to have seven or eight EHRs.

if you could have one, I think that's the way to go. So, , that would be number one. But I think if you have that many try to determine what you have and what avenues you have for. Minimizing that impact. You mentioned that HIEs, that's a, great way to start. If you're not a member of an hie, become one provide that data because not only does it do good for your patients when they're here, but it does good for your patients when they go somewhere else because that information's available.

And then, there are other ways, so don't be sty just because maybe that you can't find a way. Right now. There are companies out there just like Dr. First, who can provide those types of solutions for you and can help you with that. So,

Okay, Chris, thank you. Just really enjoyed visiting with you.

Thank you for making the time to share your experience. What's good for one is good for all, and this just helps the entire health system community. So I appreciate you making the effort today. Good to visit with you.

well, it's very nice to visit with you as well. you.

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