North Nation Healthcare consists of three critical-access hospitals and an affiliated residence well being and hospice company situated in northern New Hampshire. Healthcare Innovation just lately spoke with the well being system’s CIO, Darrell Bodnar, about unifying all three hospitals on Meditech’s Expanse EHR and being named to CHIME’s Digital Well being Most Wired 2023 checklist in each ambulatory and acute-care classes.

Healthcare Innovation: What are a few of the greatest challenges you face as a CIO of a smaller rural well being system today? What’s prime of thoughts for you?
 
Bodnar: Prime of thoughts for me is all the time staffing. I’ve 31 IT workers. We’re answerable for knowledge analytics. We’re answerable for a few of the the ancillary companies inside imaging. We’ve got boots on the bottom in any respect of our areas, which spreads us out thinner. So staffing might be my greatest concern, and never simply IT staffing. I imagine the answer to enhancing the general scarcity of medical employees is know-how, automation, and innovation. I believe it is the one method we will get there, and it is overdue. There are a variety of processes, whether or not they’re pushed by regulatory compliance or not, that have to be improved. We’ve got a lot of alternative.
 
HCI: Moreover automating sure duties, do you assume whether or not the EHR is perceived as user-friendly by the clinicians is essential to medical staffing?
 
Bodnar: Completely. In my private opinion, EMRs had been initially not designed for the doctor however moderately as a monetary device that was pushed to physicians and clinicians. At present clinicians are documenting an encounter with the affected person and that has successfully made them coders and billers, too. Doctor workload is one thing that we actually have to be cognizant of. So, although there’s some resistance to AI and a few of the automation that we’re placing in, I all the time say it permits the suppliers and clinicians to be their finest. It isn’t there to switch them. It is there to switch that work, however allow them to be their finest. We appear to have gotten fairly a little bit of traction in doing so by presenting it to them that method.

HCI: I perceive that North Nation got here collectively in 2015. When did the deployment of the shared Meditech Expanse EHR occur? 

Bodnar: In the course of COVID so, December 1 of 2020 is after we launched it. And we’re developing on three years. Beforehand, we had a complete of 5 EHRs excluding residence well being. We had three for main services, after which we additionally had an ambulatory module for a kind of organizations. After which there was one other separate ambulatory module for one of many different associates, so we had a number of EMRs.
 
HCI: What had been a few of the greatest challenges concerning the transition interval?
 
Bodnar: We had not executed a variety of the legwork it might take to break down that many organizations right into a single EMR. I’m speaking about defining finest practices, defining order units. So within the 12 months previous to the go-live as a part of our construct, we began to work on these. This was not only a technical course of. As a corporation, we weren’t prepared for it culturally. So there was a variety of negotiation that went on post-go-live that in all probability ought to have been executed prematurely. 

The opposite lesson I realized was that typically it is simpler to construct a brand new home than renovate the one that you just’re dwelling in. We collapsed all of those organizations into one of many EMRs that was at present in place, which was in Androscoggin Valley Hospital. They had been a Meditech buyer for a few years. It was the very best platform to maneuver to, however they’d 25 years of luggage that got here with that EMR. There  are all the time issues which can be leftover or residual within the EMR, that we have now launched to the others. Possibly it might have been wiser to begin model new, after which go from scratch to our migration. However we determined to attempt to make the most of it. It made sense on the time. 

HCI: You could have seen fairly a number of advantages from having all three hospitals and ambulatory settings on the identical platform. You had been named to the CHIME’s Digital Well being Most Wired 2023 checklist in each ambulatory and acute-care classes.
 
Bodnar: It’s night time and day, even with the challenges we nonetheless have. We’ve got a single pane of glass over acute and ambulatory throughout our complete continuum of care. That was one thing we did not have earlier than. We’ve got that visibility now. The processes of how we do care transitions are seamless. Our physicians work in a number of locations. They could not even have what they might name conventional residence anymore. With a number of EMRs, it was virtually unimaginable for them to operate And for our sufferers, if we had 5 EMRs, they wanted to have 5 affected person portals. Now they will use one single affected person platform to have the ability to entry data.
 
HCI: You talked about analytics and reporting earlier. Is that made a lot simpler with a unified well being IT system?
 
Bodnar: Our purpose is excessive reliability. We’re trying to be a simply tradition the place we will enhance our processes. We’ve got employed a chief high quality officer who’s actually driving these efforts. Each ounce of that effort relies on knowledge that three years in the past was utterly disparate and was not out there to us. Now, it is only a matter of mining it, it and deciphering it to get to the purpose that we wish to perceive. And we’re uncovering a variety of cultural and workflow points. Having knowledge and analytics gives us the perception to get to that.
 
HCI: What about interoperability points? I don’t assume New Hampshire has a robust statewide well being data trade. Are you utilizing CommonWell and different nationwide well being data networks?  

Bodnar: In New Hampshire, the motto is ‘Stay Free or Die.’ On account of legislative efforts, we shouldn’t have an HIE and we weren’t permitted to underneath legislation as a result of we couldn’t retailer that data. It i manifests itself in horrible methods like with an immunization registry that was not current throughout a pandemic, which made it actually difficult. However interoperability with Meditech has been nice. We have partnered with a variety of our organizations for point-to-point VPN tunnels the place we’d do HL7 exchanges of knowledge as a part of our workflows and continuum of care. And we’re ready to make use of CommonWell throughout the board. We are likely to get a variety of vacationers we’ve snowbirds who used to reside right here, and go to Florida or come again.

We even have individuals who come right here to ski. Having these data are available has been instrumental in us having the ability to present care shortly. And surprisingly a few of it pertains to the ED however a variety of it has been in main care.
 
HCI: Did your group transfer to a variety of telehealth throughout the pandemic and has that continued since?
 
Bodnar: We did transfer to telehealth. We had leveraged Zoom like lots of people did and received the safe licenses after which constructed workflows round that and it truly labored pretty properly. Now we’re implementing a Meditech module to assist us with that. We noticed the uptick and and we noticed just a little little bit of a drop-off. However the space the place it has caught is behavioral well being. We’ve got a reasonably vital behavioral well being inhabitants, and so they appear to desire that platform, and actually the clinicians delivering care do as effectively. We’re working with Meditech now and a third-party vendor known as Phreesia to ensure that we facilitate the documentation, the onboarding of these sufferers and consents by means of an digital format in order that they might by no means must step foot in facility until it is for some some blood work or one thing alongside these traces. 

 HCI: Is there the rest in your well being IT technique on the drafting board for the subsequent 12 months?
 
Bodnar: We’re positively shifting ahead with with Microsoft’s relationship with Nuance. I believe it is gonna be Nuance DAX Copilot. That is one of many applied sciences that I believe that may allow our clinicians to be their finest. We’ve got quite a lot of automation initiatives on the medical aspect in addition to the monetary aspect. We’re scheduling an optimization evaluate this coming 12 months, focusing quite a bit on the income cycle aspect, however we’re additionally acute and ambulatory companies. We constructed it throughout COVID. Rather a lot has modified since then. 

I believe the largest factor that I am seeing is a transfer towards automation, a transfer towards the the sluggish however methodical adoption of synthetic intelligence and machine studying the place relevant, and ensuring we take a look at mature distributors, not these promising issues that would actually put us in a susceptible place. There’s a partnership between Meditech and Google that’s extraordinarily thrilling for us, significantly whenever you take a look at the depths of the medical file and what that search functionality would appear to be.