Jupiter Medical Center – Michael Fehr

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Category: Reality
Date: April 6, 2010
Views:6,999 views

Dr. Eric Fishman: This is Dr. Eric Fishman with EHRtv and today we're speaking with Mike Fehr, VP and Chief Information Officer of Jupiter Medical Center in Jupiter, Florida. Mike, thank you for your time. I thank you for joining us today in your office and I appreciate it. I've already spoken with a couple of physicians who are on staff at Jupiter Medical Center who are using Practice Partner and I must say, they are both delighted with the software and possibly even more so delighted with the implementation assistance that they've had from Jupiter Medical Center. So I've got a lot of questions including why would Jupiter Medical Center expend such an extraordinary effort and pretty substantial resources in subsidizing the cost for physicians. I understand you have a dozen physicians or so using it with plans to roll it out to many other dozens of physicians. So what is it that Jupiter Medical Center is expecting in this relationship?

Michael Fehr: Well, thanks for that Eric and we're really glad to hear that the physicians are so supportive of the efforts that we've put into the system. Basically, Jupiter Medical Center is a community based hospital. We believe that our role in the community is to support health care across the continuum. That includes the physician offices, that includes the hospital and the best way to do that from my chief information officer point of view is to extend systems into the physician offices in order to offer a continuum of care and information on the patients whether they are in a physician office receiving care or they come to the hospital to receive care and both follow-up and pre-hospital care. So we saw that as our mission. Enhance the quality of life, enhance health care in the community and when the Stalk laws were modified, we saw this as an ideal opportunity to extend our mission even further through the use of information technology.

Dr. Eric Fishman: I must say for both of the physicians I spoke with today the rather substantial subsidy was a compelling reason for them to implement the software that they did implement at that point and time. Both of them mentioned that it's essentially a seamless process in getting information to and from the hospital; getting laboratory results, getting an inpatient. So maybe explain how that process works and what the benefits are.

Michael Fehr: Basically, we have an ASP type of model that we promote using the Practice Partner product from McKesson. The hardware, the servers sit in our offices and through secure Internet connections, we supply the application to the physician. For lab results, radiology results, in patient/outpatient results obviously we have interfaces - standard HL7 interfaces - from the McKesson products and the Practice Partner to supply that information to the physicians. That's a real advantage for the physicians. No more trying to track down the results, no more paper faxes so on and so forth in the office. Integration right into the patient record has turned out to be a big win for the physician offices and we’re really happy we were able to support that and get that up and running for them. Further, we've extended that by partnering with various different reference labs so those results also integrate right into the record when those reference labs are utilized and again, that supports our mission and that supports the patient care in the community.

Dr. Eric Fishman: It's a wonderful thing. Some of the physicians have had the software now for over a year. Do you notice that there is more allegiance to this hospital specifically, more of an affiliation? Are you able to determine things of that nature?

Michael Fehr: We've always had great relations with our physicians and they've been very supportive of the hospital. Nevertheless, that was not our major criteria in actually extending the product into their offices. Nevertheless, we do see that. There's no doubt that as we're able to offer better services to the physicians, be it in the laboratory itself or radiology itself or through information technology, that they're more likely to utilize the hospital for the services. Nevertheless, as you also know, payers have a tendency to steer patients, particularly in some of these services so we do run into that. Nevertheless, it is our mission, it is our objective to make it easier for the doctors to practice care in the community and enhance that patient care. That's why we have their interfaces with the reference labs also because that's just a reality of life.

Dr. Eric Fishman: Thank you for that. You're probably more aware of the Meaningful Use criteria than the individual physicians are, the American Recovery and Reinvestment Act, how much - and obviously, this is a mute question for today but in a year and a half it won't be - how much involvement do you anticipate Jupiter Medical Center will have in assisting the physicians in attempting to get their stimulus funding?

Michael Fehr: Well, we see ourselves key in that. We don’t believe that the average physician is going to have all the expertise to do what we see in the stage one criteria.

Dr. Eric Fishman: Only 550 pages.

Michael Fehr: Only 550 pages and I do believe that they're going to need the infrastructure that hospitals have to offer to help get them there - the support, perhaps gentle suggestions on how they can change their processes to help meet those requirements. A lot of other vendors that we compete with in putting in EMRs in physician offices have more of a "sell it" is our impression. I'll sell it and support it remotely. We don't believe it's going to be possible to meet the stage one criteria without having some folks in the offices that are available to answer questions for the physicians and help them work through those processes. We are really well positioned to help those physicians accomplish that. I believe that it’s something that a community-based hospital can bring to physicians whether it's in Jupiter, Florida or anywhere around the country. We're really glad that we're on the front edge of that.

Dr. Eric Fishman: As a surgeon, I call that the cutting edge.

Michael Fehr: The cutting edge of doing that in the country and hopefully other community hospitals will emulate this pattern.

Dr. Eric Fishman: It certainly seems to be working. One of the physicians mentioned that Kelly and her team - and I pushed them on this - were in their office somewhere between 100 and 150 hours to get the implementation accomplished. Or, if not in the office, in the office and doing some back-end work with templates and things of that nature. That does show an incredible commitment.

Michael Fehr: Correct.

Dr. Eric Fishman: Is it your expectation that each of the physician's offices as you roll this out will take quite that much effort?

Michael Fehr: No, it's not. The very first physicians that we implemented obviously they were on a learning curve, we were on a learning curve so it took some more time. We're finding that the amount of time it takes to implement the systems is going down substantially. Nevertheless, the advantage that we do bring for the physician is just what you mentioned - it's not necessarily only by phone. We send people to the offices. We find that that personal touch, having somebody there so they can see how that office operates and then adjusting the system for the needs of a particular physician is a critical success factor in making these systems work. I've heard from multiple physicians how they've gone with vendor A, vendor B or vendor C and it just doesn't seem to work and they end up de-installing the product or they actually never get it up and running. We don’t want to have that. If that means we have to get in that office to see how they operate and make adjustments, we're committed to doing that. It's been very successful for us and we plan on continuing that type of effort to make sure that Practice Partner, JMC and our physicians are successful in the community and in supporting the patient care that's required to maintain good health in our community.

Dr. Eric Fishman: Just a couple more questions maybe. I understand that you're probably planning on maybe 30 or 40 more implementations in the near future.

Michael Fehr: Correct.

Dr. Eric Fishman: What criteria do the physicians use to determine whether or not they're going to be joining this team if you will?

Michael Fehr: Well, I think that a lot of physicians have heard about the support that we offer and I think that's it’s a couple of items. First item is the Practice Partner software. It's good software.

Dr. Eric Fishman: That was my next question: how you chose it.

Michael Fehr: It's good software, it is user friendly, it has the functions and features that's required. But there are a lot of vendors that have that. So our differentiating factor to the physicians is that support. We are able to offer support that the other vendors just cannot do. They are remote, it is across phones. Our support - yes it can be across phones - it depends on the particular challenge at the time.

Dr. Eric Fishman: But I've heard that it's 24-7onsite as needed.

Michael Fehr: Nevertheless, if we need to go into that physician office, we get in our cars and we go. That is the differentiating factor that Jupiter Medical Center can offer, I believe other community hospitals can offer and that’s why physicians should be looking to hospitals to help support these efforts as they move forward in their automation challenges in future years to meet our and other regulatory requirements.

Dr. Eric Fishman: Thank you for that. What's the biggest problem you've seen and what's the biggest advantage you've seen with the roll out of the Practice Partner so far?

Michael Fehr: The biggest challenge is hardware in the physician offices and network connectivity.

Dr. Eric Fishman: This is south Florida. We have hurricanes.

Michael Fehr: Well, yes, but really what it comes down to is wherever you go I think physicians that run really small businesses and the end result is they're always pinching pennies. So the result is what type of Internet connection should they have? Should they have a home quality Internet connection or a business class type of connection? So we have to work through with them why a business class connection that may cost them a couple extra bucks is the only way to go.

Dr. Eric Fishman: And you're committed to pay 85 percent of that?

Michael Fehr: No. We do not pay any of that whatsoever. That is on the physician. We only help sponsor the actual software. That's one challenge. Your other challenge is the hardware in the physician offices. A lot of times we walk into a physician office they have antiquated hardware, the hardware is required to be replaced and that becomes additional cost. Or they go with Jupiter Medical Center and Practice Partner or some other vendor but a lot of times, you know, they're reluctant to do that and we try to get the software up and running on some antiquated hardware and it doesn't work so well. So that is really some of the big challenges. Then there's always process challenges in physician offices as it would be in a hospital when you automate a department in a hospital. What occurs is people are accustomed to doing business in a certain fashion and we need to show them to use these tools, sometimes you have to alter your processes. People like to hold on to the old sometimes, it's hard to let go. That's not unique in physician offices and they go through that learning curve that at times can be quite painful. The big return on the investment is saving time in the physician office, is getting those labs results in, getting the radiology results in, that's a big win. The e-prescribing is a big win for the physicians. No longer having to write out the scripts, being able to do that electronically for the patient is a big win all the way around. Having a formulary available that's also matched up to the Medicare Part D really helps the physicians and the patient, reduces a lot of frustration as they try to find the appropriate medication that meets their particular plan. All these things are big wins both for the physicians and then we ultimately believe, as I mentioned probably too much already, for the hospital too and the community. That's where we're heading and it's really worked very well for us.

Dr. Eric Fishman: Thank you. There's 250 EHRs possibly. You've chosen Practice Partner from McKesson. Can you give us some understanding as to why that one in particular was chosen?

Michael Fehr: Basically, before we made the decision, Jupiter Medical Center had already made a substantial investment in clinical systems from McKesson so we were looking for that future integration. We realized that all the integration points were not in place initially but with McKesson, with their R & D dollars available they would be. Two, with the 250 vendors that you mentioned or thereabouts on the market, some of them very small companies, we did realize it was going to be a consolidation in the market. This is inevitable; it's already started to go on. McKesson, being a Fortune 100 company clearly has the staying power that perhaps some of these smaller companies just do not have and we view this as a partnership with McKesson and Jupiter Medical Center and the physicians and we need that software to be supported for many years to come to be developed and altered as required to meet the regulatory environment such as American Recovery and Reinvestment Act but perhaps also functions and features that are required in the market. So a company like McKesson has the R & D dollars available to be able to make the product viable, not only today, but in the future.

Dr. Eric Fishman: And Mike, are you happy so far with your choice of McKesson's Practice Partner?

Michael Fehr: Absolutely. The physicians have accepted the product and they seem to be able to use it very effectively and efficiently in their office. It's made them more productive. That's been our objective and as such, we're happy because our customers are happy.

Dr. Eric Fishman: Mike, a lot of physicians are concerned about who owns the data, whose patient data is it. You've mentioned, and we'll get to back up recovery, disaster recovery in just a moment, but you've mentioned that the data is hosted here at the hospital. So who owns the patient data in your perspective?

Michael Fehr: Contractual. We have a contract that we skew to physicians and contractually the data, the patient records are the physician's not the hospital's. They're all also protected by HIPAA so we do not really have a right to go in and look at the records. That is reserved for the physician and their office staff. Now, clearly during the support process at the pleasure of the physician office we may sometimes have to take a look at a record, but we are a business associate at that point with the physicians but definitely the records are owned by the physician not the hospital. It is their practice.

Dr. Eric Fishman: Very good. Let's talk about disaster recovery. Obviously, South Florida is prone to hurricanes. What accommodations have been made to consider that?

Michael Fehr: First of all and I think it's really important to note that our datacenter has recently been rebuilt. We have a state of the art datacenter.

Dr. Eric Fishman: Here on the campus?

Michael Fehr: Here on the campus. We have enterprise back-up systems in place that take the data to tape but also replicated on magnetic disk drives at another section of our campus and then also ship those things off to Iron Mountain's storage facilities in South Florida and in New Jersey when a storm may approach at that point, the back-ups are all shipped off to New Jersey for safe keeping. We have, as I mentioned, an enterprise-wide back-up plan with multiple points of redundancy in order to protect the data of the physician and also the hospital. Again, that's our mission. Data is the life of the medical record I guess in my view and we've taken all precautions to make sure that we protect that data from both man-made and maybe natural disasters that may strike in South Florida.

Dr. Eric Fishman: Great. Mike, I thank you for your time.

Michael Fehr: Thank you.

Dr. Eric Fishman: This has been Dr. Eric Fishman for EHRtv. We've been speaking with Mike Fehr, Vice-President and Chief Information Officer of Jupiter Medical Center. Until next time, thank you.

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