Developing Digital Solutions for Future Generations of Doctors with Orlando Suarez

Orlando Suarez: We took it upon ourselves to ask the questions and tell them these are the challenges we're having. And like any good partnership, they listened.

Host: You're hearing from Orlando Suarez, IT director for Larkin Community Hospital in South Miami, Florida. In this episode, he shares his experience on teaching the future generation of doctors in a hospital system of 300 residents in addition to a team of experienced physicians. He also walks us through how these groups were impacted when implementing new technologies to create a complete, paperless, digital record.

Orlando: I think once we spent some time using the system, being able to just provide information became so much easier. We have quality reports on quality measures.

Host: This is Health IT on the Record, presented by MEDHOST, a show that dives into how health information technology innovations impact every aspect of a health system from multi-hospital networks down to individual patients. Orlando talks about the hospital's difficult first encounters with electronic record keeping systems. From that experience, he shares his advice for taking on nurse and physician challenges using what he calls a patient perspective. This helps teams overcome the preference for paper.

In all these lessons, we'll show how you can build a faster, more efficient documentation system for higher-quality patient experiences. He also shares how having a documentation system made it easier for his team to identify critical ways to improve their practice and transform bedside care. Enjoy the conversation.

Orlando: Hello. My name is Orlando Suarez. I'm the IT director for Larkin Community Hospital in South Miami.

Host: Orlando, thank you so much for taking some time. I know you are a really busy person, and we're really thankful to hear some of your insights, get a first-hand look from someone who is a director of IT. You've been in this for over a decade. You've seen a lot of change, so it's always a treat to be able to hear some of the high-level trends, some of the challenges that you've had to overcome. Some of your advice to other folks in your shoes and what they can be doing to overcome those challenges.

So I'm really looking forward to this. So before we really dig into some of the trends that you've seen first hand, walk me through Larkin Community Hospital. What kind of an organization? What kind of work are you doing? And we'll take it from there.

Orlando: Sure. Thank you. Larkin Community Hospital's a 146-bed facility in South Miami. We have a long list of services from behavioral to neurosurgery to orthopedics and chemotherapy. We have a pretty strong niche here in South Florida. It mainly revolves around our behavioral side. We have a strong outpatient behavioral, as well as inpatient.

And we've actually branched off into other facilities. We are developing the Larkin Health System, which consists of two other hospitals. One a 246-bed acute facility and another 50-bed inpatient behavioral facility. And our main mission is to provide healthcare in an educational environment. Larkin Community Hospital has 30 to 35 medical resident specialties, and we want to provide the future of our nation with great doctors.

Host: And how many residents is that total in those specialties?

Orlando: It's about 300 residents.

Host: Excellent. That might be an interesting place to begin hearing from your experience. So you're teaching the future generation of doctors. So on one hand, you've got 300 residents. They're younger. They're learning. Now when you blend in an experienced generational set of experienced doctors, what kind of challenges have you seen when you kind of bring those two to intersect together? Have you seen any interesting things from that, and how have you learned to overcome that?

Orlando: Yes. It's definitely an interesting dynamic watching how these two different generations handle technology. Especially from how they document on the record, how they prioritize what they do. And what I mean by that is the older generation physicians are not too concerned with the electronic medical record as much as, let's say, the millennial generation, which is mainly the people who are graduating now. But older physicians are not concerned about the whole electronic medical record, where that new physician comes in and kind of knows the importance of document correctly, not only from a data perspective where they could go back and review and mine data to provide better healthcare, but also from a reimbursement perspective.

You have all this information in a structured format, and it's going to create better results across the board. The two philosophies are – I don't think either one of them are incorrect. I think in some sense the whole providing of patient care before deprioritizing patient care to document on the record is something that I'd say is happening. People are concerned more about documentation than actually providing the care. But on the other hand, if you document correctly and you put that information out there, you will essentially provide better patient care if you're looking at that data.

Host: How have you found has been a successful way you've been able to communicate that to your team to maybe help both sides see it the way that you, as a director of IT, how you need things to be done? Is there any stories or any examples of how you've been able to successfully do that?

Orlando: Absolutely. We've had some trade-offs with the older generation and we found some ways around it. We definitely – at one point during our implementation, we removed paper altogether and that created a mini-uprising in the med-surg hallways. But we sat with those physicians. We told them the importance of why we want to do this, and we gave them other alternatives. If they said that they didn't actually want to write on the chart, well maybe they could dictate. We had several interfaces with dictation systems where this information comes over electronically anyways. So we had some challenges, but we were able to overcome them by just using different types of technology to incorporate a full digital record.

Host: So in your ten years at Larkin Community Hospital, do you have kind of a timeline – how many years ago was it when you had to make that switch to go paperless?

Orlando: About eight years ago.

Host: And now this is around the time you started working with MEDHOST?

Orlando: Yes. That's correct.

Host: Walk me through kind of how starting to use a technology platform at a time that you're describing of this uprising of people – when you're bringing change and you're introducing change, how did you maneuver around that? How'd you navigate around that? And how'd you come out the other end better and stronger and delivering better care?

Orlando: This was, I think, new to everybody. We decided to get us an electronic medical record because of the CMS mandates. And we honestly did not know what we were getting ourselves into at the time. We selected MEDHOST and we had the full suite of products that we were going to move forward with.

But after we started implementing and we looked at it from a project perspective, we met all of our timelines, we knew what the product did, we received training, but we didn't really have, I guess, the proof of concept on the medical floors. And when we rolled it out initially, it was a real eye-opener for us because we saw the challenges that some of the operations that we didn't really take into account were having. And the system out of a box didn't solve everything that a nurse did. It didn't create a solution for everything they did. There were some challenges, especially with physicians as well.

So we ended up having to take a step back once we implemented the first time. And then we looked at what we did and what we have and how we can make it better. And we did that by creating more continuity in our system.

So we analyzed each business challenge from a patient care perspective that nurses were having and physicians were having and we tried to build something in the system. I wouldn't want to say a workaround because then it became a permanent process. But I guess from the way they were looking at it in the past, which was they documented on paper, they did their medication administration on paper. It became, I guess, so to speak, a workaround for them, which eventually became an established process. And we measured it and absolutely there was much more value in using the system than there was in our previous processes.

Host: Health IT on the Record is brought to you by MEDHOST. With over 30 years of experience partnering with providers nationwide, MEDHOST is helping evolve better solutions for healthcare management through innovative workflows and technologies. For more information, visit www.medhost.com. Let's jump back in.

Host: So it was around 8 years ago. This is during your second year as a director of IT. And that's when you go paperless. And now you were describing having kind of some pushback from the old way of doing things, from some of your older doctors. That makes sense.

So my question to you, maybe this is giving yourself advice, if you can kind of look back in time, or maybe pay it forward to other folks who are in a similar role as you. But before you implement something, I'm sure you have an ideal of what it should look like, what an electronic system should do. But how do you take in account the intangibles that maybe aren't as easy to plan for, like what the nurse does or any of these other examples? How do you plan for what you don't know is ahead when you're making a new type of technology transition? Does that make sense?

Orlando: It does. And that definitely happened to us where our way of thinking when we first implemented was everything looks nice on paper, but we had a very positive point of view of it. And now, after going through that, we're always asking ourselves, what are we missing here? What is missing that we cannot define within the system? Or haven't defined in the system yet?

And I think that became our way of being successful. We looked at it from various points of views. We looked at how the user might react to this. What are we leaving out? Are we not providing better care by doing this? Are we slowing down by doing this? So there's a lot of trade-offs that take place when making a change on the system. And we have to look at it if it's truly in our best benefit to make those changes.

Host: That makes sense. When you talk about your users a little bit just now, I'm curious, whenever you made this change or going through this transition, so you being a customer of MEDHOST, I know you were an early adopter of PIMs. What would you say were some of the outcomes that you found with your team, with your organization? What were some of those items?

Orlando: Well, like I said earlier, we're a behavioral facility and most of these systems are made for acute care, for regular med-surg care. We had needs and challenges that maybe the system couldn't meet for us for the behavioral space. And we took it upon ourselves to ask the questions and tell our system provider, which is MEDHOST, these are the challenges we're having. And like any good partnership, they listened. And I think we got through to them in some ways, sometimes where we've been able to enforce change on the system or at least get some changes that we need to improve our workflow in something that wasn't thought of in the past, which was the behavioral space.

Host: I like how you have that team focus. Now, on the organization side, what would you think was an outcome that you experienced?

Orlando: Well, I think once we started using the system and we spent some time using the system, being able to just provide information became so much easier. We have quality reports on quality measures that don't require anything else, just trying to look at the data on the system. And we can identify patients that have issues and we could come up to some resolve. We could determine a lot of things.

I'll give you an example of that actually. At some point in time, we had some issues with infections and we started trying to figure out what's going on. There seemed to be a high percentage of patients that were having an infection. And as we started pulling lab data, started pulling demographic data, and trying to find some correlation we found that yes, in fact, there was a correlation. It had to do with some of our physicians and some of their practices. And we were able to identify those by the documentation in the system. And it really wasn't that hard to do. I mean, if we were back in a paper system, something like that would take years.

Host: That would be a nightmare, definitely. I like that example and it definitely makes sense. So as you're looking at patients and creating better care for them. So this is so much more than just the bedside?

Orlando: Absolutely. The bedside is the most important for the patient to get better and leave our facility in good health. But from an operational standpoint, it starts when the patient walks in the door. And it finishes when we receive reimbursement for our services. So that whole process needs to be efficient because as we all know, healthcare is not the most profitable business there is and we have to be efficient in our processes. We have to make sure that we're able to provide quality care at a low cost. And that's key. Having a system that you could leverage to provide you information and streamline processes is key to the survival of any organization.

Host: Well put. I think that is a great place to wrap up. Again Orlando, thank you so much for taking the time. We know how busy you are. You've got hundreds of people you're working with every day to move forward together.

So being able to hear some of the trends that you're seeing, some of the ways you've overcome the challenges over the years, hearing some about your experiences working with MEDHOST and looking at also how all these things combine into what the future of quality healthcare looks like. We really appreciate it, you taking the time. So I hope we get to do this again, sometime in the future, but until then, thank you.

Orlando: All right. Sounds good. Thank you.

Host: Thanks for listening to Health IT on the Record, presented by MEDHOST. For more stories and content like this, be sure to visit medhost.com/resources. Thanks.