Baptist Health System, which owns and manages four hospitals and 38 clinics in Alabama, has begun deploying electronic health record (EHR) technology as part of a larger clinic integration strategy. The BHS IS group not only supports the company's own facilities, but also provides services to other physicians and clinics in Alabama. In delivering applications such as practice management and EHR solutions, BHS ranks performance and service levels among its top priorities. In an interview with FierceCIO, Baptist Health System CIO Rich Shirey discusses the deployment of new applications and the monitoring technology he is using to enhance the experience for clinicians and patients alike.

FierceCIO: Tell us about your deployment of electronic health record technology so far.

Rich Shirey: We have a whole strategy focused on clinical integration, a strategy that bonds us with our physicians and focuses on working together to improve the efficiency and efficacy of patient care. The EHR solution is integrated with our practice management solution. There's a lot of integration between those two products--such as billing--but they really affect different user groups.

We have a five-year plan, which started last September, to roll this out to a few hundred physicians. We have 25 to 30 physicians live in the practice management mode, and one physician in a pilot project live on the actual EHR. We believe that if you try to install EHR that doesn't tightly integrate with your practice management solution, you lose some opportunity.

Other clinics can contract with us to provide services to them. What they get is the IS department of the Baptist Health System standing behind [the service], and they get the tools that I'm putting in place to ensure the performance they need.

FCIO: In your capacity as a service provider, how do ensure performance and service levels?

Shirey: EHR systems give you availability statistics and performance statistics, but typically that's after the fact. What I want to know is if a particular location is having communication issues on the network or application issues from a local area network, or whether the application itself is having difficulties.  

Let's say, for example, that the printing function at a clinic isn't operating. The question is, how do you find that out? We had a test case like this that happened last week. If you look at an application monitoring solution, the goal is to understand that a problem exists before the customer does. You can act on it and perhaps solve it before the customer even knows. Rather than getting a dreaded phone call, you can reach out proactively, and you're already engaged.

There are a lot of CIOs who haven't really looked at the concept of application monitoring separate and distinct from server monitoring. With server monitoring you're not measuring the individual end user experience. If the server is behaving normally, but the end user is either experiencing degraded performance or perhaps an application is not working at all, where is the problem? The whole point [of application monitoring] is to move that monitoring out toward the end user. 

I'm able to use the [Compuware] Vantage application monitoring solution for the practice management technology as well as EHR. You design this solution to look at certain processes. We're still building the Vantage solution to detect these scenarios. Clearly we need vendor cooperation with the vendors we're trying to monitor.  

FCIO: What has the response been among staff to the practice management and EHR technologies?

Shirey: The ease of use of a new application and the training that you put into it really reaps a great reward. The staff has really responded well. Typically you're giving them functionality that they didn't have before, and that's what really helps with the adoption.  

It's a design process to work with the end user, whether front office or physician. The secret here is to make it efficient. I've had physicians tell me, I don't want this to slow me down. A doctor will scribble a pharmacy order on a piece of paper and say, if I can't do it that quickly I don't want to do it. It's not fair to constrain the project with that kind of expectation. The whole point is to put it in a slightly different perspective. You have to look at it in its entirety. After all, you're not practicing medicine the way you did 10 years ago. Once they become knowledgeable on the tool, it becomes second nature.

FCIO: What is your impression of the healthcare industry's adoption of EHR overall? 

Shirey: I think our clinical integration initiative is a pioneering initiative.  I think from an EHR perspective, if you look at the industry as a whole, the adoption has been slow. I think that ties back to physicians, workflow and efficiency. Quite frankly, it's taken a while for the products in the industry to deliver the value that's required. Change is not always easy.  

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