Lima Memorial Health System was founded in 1899 as Lima City Hospital by the citizens of the Lima, Ohio community. The hospital is a not-for-profit health care organization with more than 1,500 employees, and 25 facilities in their 10-county service area in the region. Lima’s CIO, Mathew Gaug, works hard to ensure that technology enables a convenient, efficient and high-quality experience to that same patient community that was originally responsible for the founding of the organization. Like many other healthcare delivery organizations, Lima Memorial is challenged with a non-integrated ambulatory EHR and EMR. As such, driven by its physician community, it is pursuing adoption of Meditech’s web-based ambulatory product to replace eCW. Ultimately, this will offer a streamlined solution to improve provider efficiency and consequently, patient experience, while providing a foundation for additional patient engagement and telehealth services to be offered.
From a historical context, our organization took a best of breed approach where we went MEDITECH for the acute side, but eClinicalWorks for ambulatory practices. We recently embarked on a new strategic direction, where we are looking to consolidate applications and making a patient-centric decision to have only one record across care settings.
An integrated system enhances the historical context, as the ambulatory side wouldn’t necessarily always have access to the acute side. It greatly simplifies things, as there is only one medication, allergy or problem list to maintain. From a provider perspective, harmonization of different nomenclatures isn’t as burdensome.
We rolled out the ideas of a consolidated ambulatory practice, had demos, and evaluated products. We were vigilant in ensuring it was a physician-based decision rather than being driven by IT. Our physicians drove the evaluation as to keep the status quo or to adopt a new workflow and mentality with the technology used to practice medicine.
A lot of the communities we serve are rural and telehealth will allow for our patients to have better and quicker access to care. Our goal is to have it integrate to our new patient portal, which will make visits for our patients that much more convenient.
Campbell: Tell me a little bit about Lima Memorial, your role within the organization and your background.
Gaug: Lima Memorial is a community hospital in Northwest Ohio. We have roughly 1500 employees and 25 facilities in 10 county service areas. We are an affiliate of ProMedica, but at the same time we are the furthest south, so we kind of stand on our own when it comes to medical and clinical decisions, and decision-making processes. In terms of my role here, I’ve only been at the organization for about 1 year now. I came to Lima via the Cleveland Clinic as a promotional opportunity. I was looking to spread my wings a little bit, as I’d spent 20 years at the clinic. My formal title is Executive director / CIO, and I have a team of 56+ with everything IT-related rolling up through our group, which includes technology, development, biomed, communications and informatics.
Campbell: Coming from Cleveland Clinic, obviously you come with the perspective of an organization that’s typically on the forefront of healthcare information technology adoption and it’s probably doing some innovative things that may be ahead of what the broader marketplace is doing. In terms of the application portfolio that you manage tell at Lima, can you tell me a bit more about that mix. Namely, the mission-critical applications, the history of those applications within the organization, adoption rates and any optimization you may be pursuing today?
Gaug: Our main application within the hospital today is MEDITECH. We upgraded to 6.15 a month after I started in the organization, and as such, the project was well underway when I got involved. The team did a fantastic job of getting that implemented. From a historical context, our organization took a best of breed approach where we went MEDITECH for the acute side, but eClinicalWorks for ambulatory practices. We recently embarked on a new strategic direction, where we are looking to consolidate applications and making a patient-centric decision to have only one record across care settings. As such, we are looking to adopt a new ambulatory platform with MEDITECH’s web-based ambulatory product. We’re looking to adopt that same mentality and go that way with our platforms.
Campbell: The sentiment of having an integrated, single record is one that has certainly been echoed amongst the CIOs who have participated in this series and given how the MEDITECH web-based ambulatory product has evolved from a UI perspective. It seemingly limits complexity as providers have a familiarity on the acute side and more capabilities can be offer on the ambulatory side based on some of the innovation the web-based ambulatory product has offered with syndromic surveillance, population health management, and facilitation of coordination of care. I’m sure that approach is supported even more so due to MEDITECH’s acute product being well embedded at Lima?
Gaug: The hospital has been on MEDITECH in one for form or another since the first install in 1994. An integrated system enhances the historical context, as the ambulatory side wouldn’t necessarily always have access to the acute side. It greatly simplifies things, as there is only one medication, allergy or problem list to maintain. From a provider perspective, harmonization of different nomenclatures isn’t as burdensome. In addition, the providers no longer have to familiarize with two different user interfaces, workflows, etc. Most importantly, from the patient’s perspective, via the portal, they are provided a comprehensive view of ambulatory and acute visits.
Campbell: Tying into managing multiple applications across care settings, can you touch on provider satisfaction within the organization. Recently KLAS introduced the Arch Collaborative to benchmark provider satisfaction, and the new clinical informatics track at the CHIME Fall Forum was well received as it highlighted provider engagement methodologies. How do you approach provider satisfaction within the organization today?
Gaug: We have a subset of the team from my informatics group that round, visit with and train providers as one of their sole or main responsibilities. We have a 24 hour a day, 7 day a week physician hotline where providers can call and get in touch with one of my team members directly. That goes a long way in terms of provider satisfaction because the last thing we want is a provider being stuck and have it potentially impacting patient care. We are focused on providing exceptional services and response so we avoid problems with technology or issues with the electronic medical record preventing our providers from being able to make clinical decisions. Another thing that we have most recently done is separated the role of Vice President of Medical Affairs and CMIO. It was previously a single role with dual responsibilities, and it has enabled increased energy and focus for the two areas.
When we rolled out the ideas of a consolidated ambulatory practice, had demos, and evaluated products. We were vigilant in ensuring it was a physician-based decision rather than being driven by IT. Our physicians drove the evaluation as to keep the status quo or to adopt a new workflow and mentality with the technology used to practice medicine. I think that’s key with driving the success of any type of implementation of a new application. Ultimately, we want to make sure that as a result of our decision, patient care is more convenient and it’s more efficient for the providers.
Campbell: Great. Thank you for providing some color around that. Let’s talk about population health initiatives within your organization. I imagine rollout of capabilities will be eased in having an integrated platform. That said, what initiatives are taking place today? Do you maintain any chronic disease or wellness registries? Have you evaluated or adopted technology perhaps within Meditech or externally to address the potential need?
Gaug: Thus far, the adoption has been within eClinicalWorks. As such, we are really focused on the future with the Meditech ambulatory application and what capabilities we can introduce with the integration of the two platforms. There are some exciting things that we’re anticipating coming forward, but for the time being we use care navigators and our offices to make sure that our patient scorecards are being maintained and they identify opportunities for intervention. We also have a physician group that’s within our organization which oversees all population health and care navigators that are going on in the practice today.
Campbell: It sounds like there are some innovative initiatives on the horizon regarding population health management and it should enhance what may be a manual or patchwork process today. I recently read that you achieved EMRAM Stage 6, a recognition that’s bestowed upon hospitals for achieving higher patient safety through improved documentation. Tell me a bit about that clinical documentation improvement initiative.
Gaug: That opportunity manifested itself when we upgraded to Meditech 6.1.5. We made sure that not only were we going through an EMR upgrade, but we also analyze and pursued clinical workflow optimizations. With the testing that was taking place to upgrade MEDITECH, in parallel, we went into all the clinical and ancillary departments, evaluated workflows and implemented improvements. That went a long way to eliminate non-electronic workflows and improve existing workflows as we pursue stage 7 recognition.
Campbell: Related to PHM, are there any initiatives you might be introducing to better engage patients? I recently read an article published on the Lima Memorial website that was more marketing focused, addressing how patients should plan a well visit. What other types of things are you dabbling in regarding telemedicine and telehealth?
Gaug: It’s interesting you bring this up as I recently authored an article on telemedicine’s role in advancing patient care. One of our primary strategic initiatives in 2018 is to have telehealth and telemedicine capabilities implemented and offered if not in all the practices, at least all the types of specialties we have. Telehealth may not be achieved in every family medicine practice, but we want to have at least one of those practices using telehealth. A lot of the communities we serve are rural and telehealth will allow for our patients to have better and quicker access to care. It will also enable us to offer different services we may not have today. Our goal is to have it integrate to our new patient portal, which will make visits for our patients that much more convenient.
Campbell: Absolutely. It closes the loops they have a comprehensive view of the interactions with their provider to complement the clinical record. That’s the bevy of questions that I had for you. Thank you for sharing your perspective and insights and best of luck to you with the transition.
About Mathew Gaug
Mathew is a highly accomplished IT business professional with more than twenty years of executive experience guiding the strategy and execution of mission-critical technology infrastructure and support for large-scale health service providers. Mathew is experienced and has expertise in integrating newly acquired facilities and establishing system-wide compliant technologies as well as migrating data centers. Serving as Executive Director, Information Technology at Lima Memorial Hospital, he successfully orchestrated the implementation of multiple technology initiatives, touching every aspect of health care operations, significantly reducing costs and increasing efficiencies within an aggressive time frame. Mathew holds a MS in Information Systems and a BS in Computer Science from Baker College.