A month before Hurricane Katrina ravaged the Gulf Coast, Springhill Medical Center in Mobile, Alabama, converted its emergency department over to a new electronic medical record (EMR) system. The change was part of a complete IT overhaul with its outsourcing partner, Eclipsys Corporation.
The timing for a major change in procedure couldn't have been worse. In a big day the medical center treats 100 patients. "But through Katrina we saw 300 a day. I told my staff they could go back to the old paper system because that was what they knew. But they never came off the system. Eclipsys provided us around-the-clock assistance," reports a grateful Jeffery St. Clair, president and CEO.
Actually, three different hurricanes define this outsourcing relationship and the impact each has had on the other.
The situation before outsourcing
In 2000 "our IT system was a mess," says St. Clair. Because of the aging code, system downtime was increasing; typical daily outages were eight hours or more. This seriously impacted operations.
Then there was the staffing problem. "We couldn't find people who could keep systems of that vintage alive. We had to bring our system up to speed before we faced a disaster," recalls the CEO. Not to mention the expense.
Gary Trickett, a senior vice president at Eclipsys, says when he first visited Springhill, he saw stains on the wall of the data center. "I asked them what they were. They said they were water stains from the floods that happen after each major storm. The employees said they sometimes found the hardware floating around the room."
Trickett told St. Clair "we have to find a new place for IT." Fortunately, the top floor of another building was empty. Trickett says Eclipsys built a new data center. Then it completed classroom space for hospital employees to learn how to use the new systems.
The department had no standards, policies, or procedures to follow. In addition, the skill sets of the internal IT department "had seriously eroded," continues St. Clair. We couldn't attract or retain IT talent," he reports.
Springhill operates as a sole entity in an over-bedded market against nine other hospitals over a 50-square-mile area. "We conducted a survey of our constituents from physicians to patients to better understand how they felt about the hospital's IT department. No one had any confidence the IT department could do what it promised," says St. Clair. This affected the hospital's bottom line because the for-profit institution couldn't attract top medical talent.
Selecting an IT partner
Springhill didn't issue an RFP. It wanted a supplier that exclusively did healthcare. "Healthcare change is drastic, month in and month out," says St. Clair. So the medical center needed an IT outsourcing provider "that had the ability to adapt to industry changes." It needed an IT outsourcer with expertise in healthcare and one that was willing to invest capital.
It went virtually immediately to Eclipsys. "We liked the flexibility of its product," says St. Clair. He explains a gynecologist practices differently from a cardiologist. "You can't do a one-size-fits-all with physicians. For that reason we wanted the most flexible products. So flexibility was high on our list," he explains.
The medical center liked the fact that Trickett had been a hospital CIO. "He understood our pressures," says St. Clair.
However, the CEO says "cultural fit was huge." In his experience, "if there's a misfit, it just isn't going to work, no matter how good they are at what they do."
Rebuilding the IT department from the ground up
The first month "they came in and immediately assumed responsibility for our IT department. They brought in two-and-a-half times the FTEs we contracted for without asking for a dime. On the front end, they threw so much effort at it that I know it was a loss-leader for the first six months at least," recalls the president.
The partners' first goal: to regain the confidence of the staff that IT was able to meet deadlines and solve problems. "We recognized the value of ISO best practices. We ensured our work force understood management fully supported their introduction," says St. Clair.
The CEO says that during the transition, both Eclipsys and Springhill realized the hospital's existing network wouldn't support "the sophistication we were bringing to the system. This was a huge, unanticipated challenge since we could disrupt or go backwards on the level of patient care we were giving," he reports.
St. Clair says the two partners together "formulated a plan for staying between the ditches." Then they had to decide on software. Rather than just insisting that the medical center install Eclipsys' own financial system, a careful analysis determined that in this case, another vendor's system (from Computer Programs and Systems, Inc., CPSI) best met Springhill's current needs. The medical center felt the impact immediately. "Finally, we were able to get bills out in a timely manner. Our accounts receivable started increasing," reports St. Clair.
But Springhill decided to replace its clinical system from McKesson with Eclipsys' system. As revenues improved, the medical center also eventually purchased the Eclipsys financial system so it could have an integrated clinical, financial and access solution from a single provider.
Project management was a plus, since Eclipsys guaranteed delivery. "Whenever we did an IT project, it was always over budget and late," says St. Clair. "On some projects we came in under budget," Trickett adds proudly.
Then the hurricanes blew in
"Eclipsys did everything possible to keep our systems up during Ivan and Katrina," reports St. Clair. He says the medical center needed "Eclipsys' expertise so we could protect our data. During the hurricanes, which hit the hospital two years in a row, the Eclipsys team "babysat the system during every second of the storms and their aftermath to be sure we had the patient information at hand to properly care for our patients." To this day, he is amazed the hospital never shut its IT systems down. "Our combined staffs worked some long hours during those storms, particularly through Katrina," says Trickett.
Since the IT systems were up, the hospital's biggest challenge was gasoline. St. Clair asked Trickett, who is based in Florida, if he could find gasoline in the region for nursing staff. "I called every gasoline supplier in a four-state area. There were just no supplies to be found," recalls Trickett.
But a fellow Eclipsys employee reminded him the supplier had a corporate contract with Avis and participates in its refueling program. Trickett called Avis and found an executive who sold him gasoline from a fuel tank at the Mobile airport. "The tank lasted for three weeks and got them over the hill," he says. St. Clair gave nurses five gallons each so they could get to and from work and home.
Three weeks later a hurricane hit Florida. Eclipsys has back-up diesel power at its Boca Raton office, then the company's headquarters (now in Atlanta). "We knew we were going to run out of diesel fuel, so I asked Jeffery for help," says Trickett. The Springhill CEO returned the favor; he had a truckload of diesel fuel delivered to the Eclipsys headquarters.
Springhill's reputation in the marketplace rose like a fever after the hurricanes. The word got out that in times of crisis, go to Springhill because everything there is up and running, reports Trickett.
Customer satisfaction in the Emergency Department went from 11 percent to 92 percent. System availability went from 56 percent to 99.999 percent. For the first time, St. Clair says the medical center has its source code documented.
Medical benefits were huge: medication errors fell 80 percent and infection rates fell by two-thirds. Congressman Joe Bonner recognized the hospital on the floor of the 209th Congress.
The physicians noticed. The new IT system helped attract a leading cardiology practice and a number of orthopedic surgeons to the medical center. "What's remarkable is that by putting IT on its feet, we helped the medical center reestablish credibility with the hospital community," says Trickett.
"Automating clinical systems and financial processes has made a significant impact on our ability to serve our community," says St. Clair. It has also improved the medical center's profitability, helping it control internal and external costs. He says the new financial management system has reduced days in accounts receivable.
Eclipsys deployed a VoIP system with the help of Cisco; it is one of the first healthcare VoIP systems in the United States. Now, when a physician sets up a practice at Springhill, Eclipsys cost-effectively manages the practice's phone and IT services and the hospital earns revenue from charges to the physician. "The medical center has definitely recovered its capital investment and helped reduce communications expenses for both the hospital and their physicians," says Trickett.
St. Clair says when Eclipsys arrived nine years ago, the hospital ranked in last place IT-wise in the hospital industry in its market. "Now we're in first place. We're so far out in first place, our competition is four years behind us. They will have to spend $25 for our $1," he reports proudly.
The profitability has paid for new lab and surgery equipment. "We can acquire things we have to have at a great pace," continues St. Clair.
Why this relationship works
When Springhill ran into financial difficulties, Eclipsys extended the time on the contract to lower the medical center's costs.
In return, Springhill is a proud reference site for the company. Trickett says one year it recorded 75 percent of Eclipsys' site visits. "Springhill opened its doors to help us grow our business," says Trickett. "It continues to be a very mutually beneficial relationship."
Eclipsys also opened an arm of "Eclipsys University" on the Springhill campus. The supplier sends its new hires to Mobile for three weeks to experience "a real-life situation." Trickett says its new staff actually goes on rounds with the Springhill physicians so they can understand the clinicians' IT challenges.
Springhill also volunteers to test new Eclipsys products. "We love being their guinea pig," says St. Clair.
He says if there's a problem, he hammers the solution out in his office with the Eclipsys account executive, Mark Kilborn, who also serves as the CIO for the hospital. "Then we leave the office with a single purpose," says the CEO.
St. Clair says there are very few people in this building who can say, "Those guys over there work for Eclipsys. They're just looked at as part of the Springhill family." He says the company has "never hidden behind the terms of the contract or the stubbornness of an executive. There's no doubt they are the best business partner we have ever had," says St. Clair.
Adds Trickett, "This organization appreciates both the place and the value of technology in healthcare."
Lessons from the Outsourcing Journal:
- Investment in healthcare technology can improve hospital metrics such as infection rates as well as financial health like days in accounts receivable. Outsourcing can reduce or eliminate the capital expense of such investments.
- Sophisticated technology and a dedicated IT outsourcing services provider can help hospitals handle overloads in a crisis like a hurricane.
- Buyer/supplier relationships tighten when the buyer goes the extra mile for the supplier, such as testing new products or hosting site visits for prospects.
Best Impact Criteria: This relationship achieved the greatest impact for the buyer in one or more of the following aspects:
- Most improvement to the outsourced processes
- Most impact to the buyer's standing in its competitive marketplace
- Best use of funds from cost savings
- Allowed the supplier to enter a new market