A beacon for IT

Even as the Truman Medical Centers system in Kansas City, Mo., received recognition for achieving the highest levels of information technology adoption, President and CEO John Bluford was also exploring a low-tech approach to improving his community's health: opening a grocery store.

“It's an example of us treating patients outside of the hospital bed,” says Bluford, who has led Truman since 1999. “Successful organizations in the future will need to be both high-tech and high-touch, and they will need a fundamental understanding of the neighborhood and community they serve.”

Fundraising is just getting started for the $11.5 million project that will be carried out by the Hospital Hill Economic Development Corp., a not-for-profit entity led by Truman to support healthy lifestyles in the neighborhood around its TMC Hospital Hill facility—an area known as Beacon Hill. The neighborhood has been classified as a “food desert,” with just one “high-dollar specialty” retailer serving as the only grocery store within a 1.5-mile radius. Bluford, 64, serves on the board of the economic development group, and he says the store will be one way the system can target healthcare conditions “with a strong nutrition component,” such as diabetes, hypertension, obesity and sickle cell anemia.

Bluford says healthcare organizations “need to get out in front” in fighting these chronic conditions, adding that “the grocery store is about promoting health and preventing disease.”

The same is true with his organization's use of health information technology. Outside of its hospitals, Truman is doing ZIP code tracking of where diseases are most concentrated as well as analyzing areas of service utilization and hospital readmissions. Inside the hospitals, Truman has used IT to reduce the incidences of bedsores by 69%, and saved $3.6 million in the process.

IT is also vital to the 63,000 chronically ill patients Truman serves. Its use of IT in managing the care of its asthma, congestive heart failure, chronic obstructive pulmonary disease, diabetes, hypertension and sickle cell patients has helped Truman earn the National Committee for Quality Assurance's designation as a Level 3 patient-centered medical home—the NCQA's highest level of medical-home recognition.

A Healthcare Information and Management Systems Society subsidiary, HIMSS Analytics, has bestowed its highest level of recognition—its Stage 7 award—on less than 2% of the nation's more than 5,000 hospitals. Included in that 109-member elite group are Truman's two hospitals, 272-bed Hospital Hill and 98-bed TMC Lakewood. Add to that recognition Bluford's selection as one of this year's two CEO IT Achievement Award winners.

With a focus on improving quality and patient safety, Bluford set a one-year time frame for implementing the system's electronic health-record system. His involvement was said to be critical to the effort. “It's an absolute imperative that you have executive leadership on board in any IT implementation,” says Amye Gilio, Truman's director of nursing informatics.

One focus for the nursing side was eliminating redundant documentation, which Gilio says gives nurses more time to spend with patients as well as contributing to their peace of mind. “If you don't have time management, you have nothing—because you have to have time to spend with patients,” she says. “Also, we have the comfort of knowing we have all their information and we can make decisions safely and effectively because we have an integrated clinical record.

”On the physician side, Dr. Jeffrey Hackman, Truman's chief medical information officer, noted how implementing health IT can be expensive, and he credits Bluford with getting the system to where it is today.

“I think John's biggest contribution along those lines is—in his time as CEO in an organization like ours, where truly every penny matters—he's shown a commitment to IT,” Hackman says. “He helped push us over the tipping point and helped the board understand why we were going to spend so much money on something that may not have a true financial ROI, but will help us do what's best for our patients.”

Last year, in addition to providing more than $125 million in uncompensated care, Truman had revenue of $702 million and an IT budget of $25 million, which included 109 people on staff. This accounts for 11% of Truman's capital expenditures and 5% of operating expenses. To document the success of the EHR system since its July 2009 rollout, 20 monthly performance measures were set to gauge quality, safety and operational effectiveness benefits the IT system generates. So far, $12 million in savings from these benefits has been documented since December 2009.

Hackman notes how Bluford sold the IT implementation as something that would simultaneously put Truman ahead of the curve as an industry leader and also help achieve better outcomes for patients.

Hackman says that, on the hospital side, Truman has met the Medicare and Medicaid Stage 1 requirements for HHS' EHR meaningful-use program and is in the middle of the Stage 2 process. He notes how most Truman providers also met Stage 1 requirements and are in various stages of meeting Stage 2 criteria.

Perhaps predictably, Bluford deflects credit for Truman's IT success back to his staff. “If you don't have physician and nursing buy-in, then it's not going to work,” he says, adding that physician and nurse leaders issued a proclamation about how implementing IT was something Truman must do to be competitive.

“I think it is a significant competitive advantage,” Bluford says. “One of our strategic goals was to use IT for competitive advantage in recruitment, quality and safety.”

Gilio agrees that Truman's use of IT helps the organization recruit top people. “This is the generation of technology and innovation,” Gilio says. “New nurses look to see how outmoded you are, and then are very happy to see we have a full suite of technology tools specific to the nurse.”

Hackman says Truman's high level of IT adoption also helps keep physicians from looking elsewhere. “That's a significant retention issue for the medical staff,” he says. “It's a huge point that we have people practice in an environment where they have ready access to the information they need.”

Bluford says selling staff on using IT has gotten a lot easier than it was 10 to 15 years ago.

“In fact, it's not a sell—the docs are buying,” he says. “Most top-flight clinicians want to come into an environment that has all the bells and whistles that will help expedite their ability to see patients most effectively. Also, if you don't have it, they'll go somewhere else.”

Truman has estimated that its IT system has helped save more than $5.2 million through reduced use of supplies, reduced transcription expenses and “real estate optimization” as the system has moved to paperless operation.

“We don't have stacks and stacks of medical records anymore,” Bluford says.

Cerner Corp., also based in the Kansas City area, is Truman's main IT partner and EHR vendor. But Bluford says that it's more than geography that has made the 14-year relationship work. “We've had the 'A Team' from Cerner,” says Bluford, who spoke last October at the company's Cerner Health Conference and at its Meaningful Use Summit in 2010. “Our physical proximity to Cerner doesn't hurt. But, more importantly, it's the intellect they bring to the table and how that intellect is transferred to our operation.”

Gilio also gives much credit to Cerner's Millennium Lighthouse data analysis system for Truman's success in decreasing pressure ulcers. The system has also been linked to decreasing the number of patient falls and incidences of venous thromboembolisms—saving Truman about $700,000 in the process.

One of the more difficult aspects of IT implementations for healthcare organizations has been adopting computerized physician-order entry for electronic prescribing, but—after getting started on it in late 2009—Truman's CPOE system is now fully operational across its operation. “We're well down that road now,” Bluford says. While Truman has been able to tackle CPOE, Bluford acknowledges that complying with HHS' plan to implement the new ICD-10 set of diagnostic and procedural codes by Oct. 1, 2014, will be an arduous task.

“I can't tell you if it's going to be worth it or not, but I can tell it's going to be an expensive proposition,” Bluford says. “If it is delayed again, we will be pleased.”

In addition to being recognized as an IT leader, Modern Healthcare named Bluford as one of the industry's Top 25 Minority Executives in Healthcare in 2010 and 2012. Before arriving at Truman, Bluford was CEO of Hennepin County Medical Center in Minneapolis. He started his career in 1972 at Chicago's Cook County Hospital as an evening administrator. He served as the American Hospital Association's board chairman in 2011.

Having been an AHA board member since 2006, Bluford says his time with the organization helped with the IT implementation at Truman. “Obviously, it's been very advantageous to see other sites and to see what other people have done well and to learn from other people's mistakes,” he says. “People have good ideas that we're not embarrassed to borrow.”

Now, it's the other way around, Gilio says. People are looking to Truman for ideas and advice. “I frequently take calls from others that are on the same journey because everyone is on the march toward meaningful use,” she says.

Bluford has one main message when talking to other healthcare leaders about IT.

“The biggest misconception is that it's a magic bullet that will fix every problem,” Bluford says. “It's a tool. You have to have a game plan for the technology to be as helpful as you'd like it to be."

Follow Andis Robeznieks on Twitter: @MHARobeznieks