One of those vendors is Pro-MED Clinical Systems, based in Plantation, Fla., which has provided Health Management with emergency department software for 19 years, according to Tom Grossjung, Pro-MED’s founder and CEO. Pro-MED also supplies ED software for most of the hospitals operated by Community Health Systems, Franklin, Tenn. Since Tenet Healthcare Corp. filed a federal securities lawsuit questioning Community’s admission practices in its EDs on April 11, the Pro-MED system has been inextricably linked to Community. A federal subpoena to Community dated March 31 requested documents related to the company’s use of Pro-MED, according to an April 15 securities filing by Community.
This is where Health Management’s serendipity comes in. Last October, the company put out a request for proposals for new ED software, and last week, health IT provider Medhost announced that it would be supplying emergency department technology to 58 of Health Management’s hospitals. The products include an ED information system, self-service check-in kiosks and software that provides updated ED wait times that can be integrated into billboards and websites, said Craig Herrod, president of Medhost.
In December, Grossjung informed Health Management that Pro-MED no longer wanted to be its vendor, he said. “With Ken Chatfield’s addition, they decided that they were going to evaluate all of their systems,” Grossjung said. “We talked philosophically about their needs, and we decided that we didn’t fit together anymore. It just seemed time for a change.”
Losing Health Management’s business will take Pro-MED down from 220 hospitals to about 160 to 170, Grossjung said. Since Community’s legal troubles began, he added, “It’s been business as usual for us, and for them as well, as far as I can tell. We provide the emergency department medical records, so it’s logical that we’d be tied to whatever comes up. It’s not been an issue.”
Community has access to all the data from the Pro-MED systems it uses, so Pro-MED has not been involved in answering any subpoenas that reference emergency department records, he added.
Tomi Galin, a spokeswoman for Community, declined to specify the number of its hospitals that use Pro-MED, but said it is the majority of them. Whether Pro-MED or another system, Galin said, Community finds that most of the systems work pretty much the same. The company is not reviewing Pro-MED or considering a change in ED information systems, Galin said.
For Health Management, the key consideration was ease of use for physicians and other clinicians, Chatfield said. “No technology decision of any kind is made without physician involvement,” he said. “We do this across all of our systems. We gather the needs of physicians, nurses and, in this case, ED directors and compare those requests to the existing vendor and look at what else is out there in the market.”
Medhost’s ED system provided an easy, intuitive way for clinicians to document their work, Chatfield said.
Grossjung said the legacy Pro-MED system is based on a version that is about 10 years old, but the company is switching to a cloud-based ED system that significantly lowers costs compared with hosting the servers on-site at each hospital. Development of the system began about two years ago, he said. Cloud-based systems, in which server services are purchased from large providers of those services, also are more easily updated, he said.
Grossjung and Medhost’s Herrod expressed the opinion that their systems are not driving clinical decisions, but merely documenting the decisions made by physicians.
Pro-MED alerts physicians if a patient’s vital signs or test results are out of the norm, Grossjung said. “From there, it’s the clinician’s decision what to do if anything,” he said. “Clinical people document their activities. What they do is based on their own clinical findings and assessments.”
Medhost, which coincidentally counts Dallas-based Tenet among its clients, provides charge capture in its ED system, but clinicians do not see the coding effects of their decisions, Herrod said.
“It doesn’t coach. It is coded behind the scenes, driven by nurse and physician documentation,” he said. The system enables large hospital systems to standardize their coding, making it “audit-proof,” Herrod claimed. “Everybody is being treated the same,” he said. “Everybody is capturing the same thing.”