North Nation Healthcare comprises 3 critical-access hospitals and an affiliated house well being and hospice company situated in northern New Hampshire. Healthcare Innovation just lately spoke with the well being machine’s CIO, Darrell Bodnar, about unifying all 3 hospitals on Meditech’s Expanse EHR and being named to CHIME’s Virtual Well being Maximum Stressed 2023 record in each ambulatory and acute-care classes.

Healthcare Innovation: What are one of the vital largest demanding situations you face as a CIO of a smaller rural well being machine at the moment? What is best of thoughts for you?
 
Bodnar: Most sensible of thoughts for me is all the time staffing. I’ve 31 IT staff. We’re liable for knowledge analytics. We are liable for one of the vital the ancillary services and products inside of imaging. We’ve got boots at the flooring in any respect of our places, which spreads us out thinner. So staffing is most probably my largest fear, and no longer simply IT staffing. I imagine the strategy to making improvements to the full scarcity of scientific personnel is generation, automation, and innovation. I believe it is the most effective method we are going to get there, and it is late. There are numerous processes, whether or not they are pushed through regulatory compliance or no longer, that want to be progressed. We’ve got a number of alternative.
 
HCI: But even so automating sure duties, do you assume whether or not the EHR is perceived as user-friendly through the clinicians is vital to scientific staffing?
 
Bodnar: Completely. In my private opinion, EMRs had been at the beginning no longer designed for the doctor however relatively as a monetary software that was once driven to physicians and clinicians. Lately clinicians are documenting an come upon with the affected person and that has successfully made them coders and billers, too. Doctor workload is one thing that we truly want to be cognizant of. So, even though there may be some resistance to AI and one of the vital automation that we are putting in place, I all the time say it permits the suppliers and clinicians to be their highest. It isn’t there to switch them. It is there to switch that paintings, however permit them to be their highest. We appear to have gotten reasonably a bit of of traction in doing so through presenting it to them that method.

HCI: I take into account that North Nation got here in combination 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 once we introduced it. And we are bobbing up on 3 years. In the past, we had a complete of 5 EHRs except house well being. We had 3 for number one amenities, after which we additionally had an ambulatory module for a kind of organizations. After which there was once some other separate ambulatory module for one of the most different associates, so we had more than one EMRs.
 
HCI: What had been one of the vital largest demanding situations concerning the transition duration?
 
Bodnar: We had no longer accomplished numerous the legwork it could take to cave in that many organizations right into a unmarried EMR. I’m speaking about defining highest practices, defining order units. So within the yr previous to the go-live as a part of our construct, we began to paintings on the ones. This was once no longer only a technical procedure. As a company, we were not in a position for it culturally. So there was once numerous negotiation that went on post-go-live that most probably will have to were accomplished upfront. 

The opposite lesson I discovered was once that every now and then it is more uncomplicated to construct a brand new space than renovate the only that you are residing in. We collapsed all of those organizations into one of the most EMRs that was once lately in position, which was once in Androscoggin Valley Sanatorium. They had been a Meditech buyer for a few years. It was once the most productive platform to transport to, however they’d 25 years of luggage that got here with that EMR. There  are all the time issues which are leftover or residual within the EMR, that we have now now presented to the others. Possibly it could were wiser to begin emblem new, after which pass from scratch to our migration. However we made up our minds to take a look at to benefit from it. It made sense on the time. 

HCI: You will have to have noticed reasonably a couple of advantages from having all 3 hospitals and ambulatory settings at the similar platform. You had been named to the CHIME’s Virtual Well being Maximum Stressed 2023 record in each ambulatory and acute-care classes.
 
Bodnar: It’s evening and day, even with the demanding situations we nonetheless have. We’ve got a unmarried pane of glass over acute and ambulatory throughout our complete continuum of care. That was once one thing we did not have ahead of. We’ve got that visibility now. The processes of the way we do care transitions are seamless. Our physicians paintings in more than one puts. They won’t also have what they’d name conventional house anymore. With more than one EMRs, it was once nearly unattainable for them to serve as And for our sufferers, if we had 5 EMRs, they had to have 5 affected person portals. Now they are able to use one unmarried affected person platform as a way to entry knowledge.
 
HCI: You discussed analytics and reporting previous. Is that made a lot more uncomplicated with a unified well being IT machine?
 
Bodnar: Our objective is top reliability. We are having a look to be a simply tradition the place we will be able to fortify our processes. We’ve got employed a major high quality officer who is truly riding those efforts. Each ounce of that effort is in response to knowledge that 3 years in the past was once utterly disparate and was once no longer to be had to us. Now, it is only a topic of mining it, having a look at it and deciphering it to get to the purpose that we need to perceive. And we are uncovering numerous cultural and workflow problems. Having knowledge and analytics supplies us the perception to get to that.
 
HCI: What about interoperability problems? I don’t assume New Hampshire has a robust statewide well being knowledge alternate. Are you the usage of CommonWell and different nationwide well being knowledge networks?  

Bodnar: In New Hampshire, the motto is ‘Are living Unfastened or Die.’ Because of legislative efforts, we should not have an HIE and we weren’t accredited to beneath regulation as a result of lets no longer retailer that knowledge. It i manifests itself in terrible techniques like with an immunization registry that was once no longer provide right through a plague, which made it truly difficult. However interoperability with Meditech has been nice. We’ve got partnered with numerous our organizations for point-to-point VPN tunnels the place we might do HL7 exchanges of knowledge as a part of our workflows and continuum of care. And we’re ready to make use of CommonWell around the board. We generally tend to get numerous vacationers we’ve snowbirds who used to reside right here, and pass to Florida or come again.

We even have individuals who come right here to ski. Having the ones information are available in has been instrumental in us having the ability to supply care temporarily. And strangely a few of it relates to the ED however numerous it’s been in number one care.
 
HCI: Did your company transfer to numerous telehealth right through the pandemic and has that persevered since?
 
Bodnar: We did transfer to telehealth. We had leveraged Zoom like numerous other folks did and were given the safe licenses after which constructed workflows round that and it if truth be told labored reasonably effectively. Now we’re imposing a Meditech module to lend a hand us with that. We noticed the uptick and and we noticed slightly little bit of a drop-off. However the space the place it has caught is behavioral well being. We’ve got a reasonably important behavioral well being inhabitants, they usually appear to choose that platform, and in truth the clinicians turning in care do as neatly. We are operating with Meditech now and a third-party supplier referred to as Phreesia to be sure that we facilitate the documentation, the onboarding of the ones sufferers and sees eye to eye via an digital layout in order that they’ll by no means must step foot in facility until it is for some some blood paintings or one thing alongside the ones strains. 

 HCI: Is there the rest to your well being IT technique at the strategy planning stage for the following yr?
 
Bodnar: We are indisputably shifting ahead with with Microsoft’s courting with Nuance. I believe it is gonna be Nuance DAX Copilot. That is one of the most applied sciences that I believe that can permit our clinicians to be their highest. We’ve got plenty of automation initiatives at the scientific facet in addition to the monetary facet. We are scheduling an optimization overview this coming yr, focusing so much at the income cycle facet, however we are additionally having a look at acute and ambulatory services and products. We constructed it right through COVID. So much 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 man-made intelligence and gadget studying the place acceptable, and ensuring we take a look at mature distributors, no longer the ones promising issues that might truly put us in a inclined place. There’s a partnership between Meditech and Google this is extraordinarily thrilling for us, specifically while you take a look at the depths of the scientific file and what that seek capacity would appear to be.