HHSC - Update on New Electronic Medical Records System

Dr. Bruce Anderson, President and CEO of the Hawaii Health Systems Corporation (HHSC) sent out the following message yesterday. HHSC is our state's public hospital system.

July 14, 2011

MEMORANDUM

FROM: Bruce S. Anderson

President and Chief Executive Officer

TO: HHSC Employees and Medical Staff

SUBJECT: ELECTRONIC MEDICAL RECORDS UPDATE

I am extremely pleased to announce that the HHSC Corporate Board of Directors, during its monthly meeting held at the Kona Community Hospital today, Thursday, July 14, 2011, unanimously approved a motion that allows management to enter into a contract with Siemens Medical Solutions USA, Inc. for a new Electronic Medical Record system.

The board approval is the outcome of a comprehensive process that involved extensive discussion and collaboration among the HHSC regions and corporate office representatives from a range of functions, including: physicians, nursing, pharmacy, imaging, laboratory, therapies, revenue cycle, information technology, contracting, legal, administration, etc. Equally important, the selected vendor was able to respond effectively to the unique needs of our community-hospital system that provides acute, critical access, and long-term care to our island communities.

EMR is the new way that all hospitals, including all HHSC facilities, are required to keep patient records. The project involves bringing technology to HHSC in a manner that will drive excellence and automation in all of our operations. The EMR system will keep track of our patients' health and medical history in a computerized electronic format. All patient files, including history, diagnosis, medications, and other important information will be kept electronically and safely secured.

The HIS/EMR contract will include the following HHSC regions: West Hawaii - Kona Community Hospital and Kohala Hospital; Maui – Maui Memorial Medical Center; Kula Hospital, and Lanai Community Hospital; Oahu – Leahi Hospital, Maluhia, and Kahuku Medical Center; Kauai – West Kauai Medical Center and Samuel Mahelona Memorial Hospital.

The HHSC East Hawaii region – Hilo Medical Center, Ka'u Hospital, and Hale Ho'ola Hamakua – started its switch to EMR in May 2010, and will join the other regions in utilizing the accompanying Health Information System (HIS) function for some of its financials (i.e., patient accounting, order entry, admitting, etc.)

At this point, HHSC management is examining various funding options, and hopes to finalize a five-year contract with Siemens Medical Solutions, USA, Inc. by the end of July 2011.

Your regional leadership and I will be sure to keep you abreast on any new developments, including when the contract is finalized and details of the first phase of implementation.

On behalf of the HHSC Corporate Board of Directors, my sincere appreciation goes out to all of the HHSC hospital and Medical Staff, who have actively participated in this on-going effort up to this point, and who remain committed to making this implementation a success!

Kauai's public hospitals face $3.5 million shortfall

In the last of the HHSC info briefings, the House Finance and Senate Ways and Means committees heard from representatives on Kauai on the two public hospitals on the island, Kauai Veterans Memorial and Sam Mahelona, as well as the status of healthcare in the Kauai region. The story from the Kauai Garden Island can be read here.

While Kauai's projected shortfall for fiscal year 2009 is smaller in comparison to other islands, the reasons for the financial difficulties are similar: under-reimbursements from private insurers and government programs, rising costs, treating the uninsured, and bad debt.

The Kauai regional board's position is that cutting services will be the last resort. Even though programs such as long-term in-patient care and the psychiatric unit are money losers, the community would be ill-served by cutting them.

On a positive note, the Kauai regional board as a 4-pt plan to get the region back on track, financially, and it includes a long term strategy to actually expand services, improve facilities and enhance care.

HHSC briefings wrap up on Kauai today

Tropic Thunder II? No, it's the House Finance and Senate Ways and Means committees going over to hold their last in a series of informational briefings in Lihue, Kauai on the financial difficulties faced by our public hospital system network, the Hawaii Health Systems Corporation (HHSC).

Here's the notice in today's Kauai Garden Island. The meeting starts at 5 p.m. at Kauai High School.

Meanwhile, the joint committee was in Kailua-Kona on Thursday, and the West Hawaii Today filed this report. It focuses on the recent layoff of 55 workers at Kona Community Hospital. The primary question is whether this layoff constituted a substantial reduction in services to the community. If so, the hospital should have received prior legislative approval before proceeding with the layoff. According to hospital interim CEO Earl Greenia, it did not "because the emergency room would still operate, and nurses could pick up the tasks the EMTs performed."

The newspaper reports that community residents who provided testimony, "recounted experiences they or family members had with the EMTs and decried the HHSC management as "top heavy" and overpaid."

HHSC briefings continue in Hilo

Here's the story from the Hawaii Tribune Herald. Some highlights:

Robert Irvine is an orthopedic surgeon and chairman of the recently formed East Hawaii Regional Board of HHSC. He said that East Hawaii residents face a critical physician shortage and it could get worse. There is immediate need for financial support from the state.

Tom Driskill, President and CEO of HHSC, focused on the labor component. He was supported by Ron Schurra, CEO of the East Hawaii Region, who asked if the state could help with paying accounts receivable debts, state public worker benefits, and previous collective bargaining agreements. In addition, they want the flexibility to negotiate a separate collective bargaining agreement.

Rep. Robert Herkes (District 5 - Puna, Kau, North Kona, South Kona) was frustrated by the lack of financial information provided by HHSC. He indicated that the legislature can't make hard choices without knowing what the choices are, and while flipping through the testimony, said "I don't see a single number in here."

Sen. Rosalyn Baker (District 5 - South and West Maui, Kapalua, Kaanapali, Lahaina, Maalaea, Kihei, Makena, Wailea) questioned HHSC's effort to collect accounts payable.

Money (can that really be his/her name?) Atwal, HHSC Chief Financial Officer said they have now hired a medical records director and is currently doing in-house training.

HHSC - Report from Maui

The House Finance and Senate Ways & Means committees were on Maui Monday evening to gather information on a projected $62 million shortfall for the Hawaii Health Systems Corporation (HHSC), a network of the state's public hospital facilities. The Maui News was there and filed this report. Here are the highlights:

The $62 million deficit breaks down as follows (in millions): $21.8 for Maui; $26.9 for East Hawaii; $7.6 for West Hawaii; $4.2 for Kauai; and $1.5 for Oahu.

On Oahu, the deficit is for two long-term care facilities, Leahi and Maluhia.

Five major reasons why there is a shortfall: 1)mandated care for uninsured patients; 2)inadequate reimbursements from both government programs (Medicare and Medicaid) and private insurers; 3)beds taken by long-term care patients; 4)cost of physicians taking emergency calls; and 5)salaries and fringe benefits for unionized workers.

Wesley Lo, CEO of Maui Memorial Medical Center, advocated for greater flexibility for the hospitals in having authority over their own finances. He proposed a concept to create separate corporations for each acute care hospital and still maintain the regional boards. This would supposedly allow each community to deal with their own unique financial situations in their own way.

Today - the joint committee heads to Hilo this afternoon for another HHSC informational briefing to address concerns on the public hospital system in East Hawaii. The event starts at 3:30 p.m. at UH Hilo.

Final Stop - Kauai

The last info briefing on HHSC will be held on Kauai on Monday, August 18th. Here are the details on that one:

Kauai - Lihue
Monday, August 18, 2008
5:00 p.m. to 7:00 p.m.
Kauai High School Cafeteria
3577 Lala Road

How to submit testimony:

Deadline: Thursday, August 14, 2008 at 3:00 p.m.

In Person: Submit one (1) copy to the Committee Clerk, State Capitol, Room 210.

By Fax: Comments may be faxed if less than 5 pages in length. Fax to: Senate Sergeant-at-Arms at 586-6659 or 1-800-586-6659 (toll free for neighbor islands.)

By Email: Comments may be emailed if less than 5 pages in length. Email to: Joint Committee at testimony@capitol.hawaii.gov. DO NOT EMAIL TO INDIVIDUAL SENATE OF REPRESENTATIVE OFFICES AS IT WILL NOT BE ACCEPTED.

Late Testimony: Persons wishing to submit testimony after 3:00 p.m. on Thursday, August 14, 2008 must bring 35 copies of their comments to the briefing in Lihue on Kauai.

Money committees head for Maui and Big Island

The House Finance Committee and Senate Ways & Means Committee head to Wailuku, Maui this afternoon. They will conduct the first of a series of Neighbor Island informational briefings on the financial crisis of our state community hospital system - the Hawaii Health Corporation System, known as HHSC. Unlike most information briefings, the public is invited to submit comments. If you are planning to attend the meeting this evening, bring 35 copies to the meeting, 5:00 p.m. to 7:00 p.m., Maui Economic Opportunity office, 99 Mahalani Street.

From there, they head to the Big Island of Hawaii. They'll be in Hilo on Wednesday and Kailua-Kona on Thursday. Here are some details on those two events:

East Hawaii - Hilo
Wednesday, August 13, 2008
3:30 p.m. to 5:30 p.m.
University of Hawaii at Hilo
University Classroom Bldg., Room 100

West Hawaii – Kailua-Kona
Thursday, August 14, 2008
3:00 p.m. to 5:00 p.m.
King Kamehameha's Kona Beach Hotel
75-5660 Palani Road

How to submit testimony:

Deadline: Tuesday, August 12, 2008 at 3:00 p.m.

In Person: Submit one (1) copy to the Committee Clerk, State Capitol, Room 210.

By Fax: Comments may be faxed if less than 5 pages in length. Fax to: Senate Sergeant-at-Arms at 586-6659 or 1-800-586-6659 (toll free for neighbor islands.)

By Email: Comments may be emailed if less than 5 pages in length. Email to: Joint Committee at testimony@capitol.hawaii.gov. DO NOT EMAIL TO INDIVIDUAL SENATE OF REPRESENTATIVE OFFICES AS IT WILL NOT BE ACCEPTED.

Late Testimony: Persons wishing to submit testimony after 3:00 p.m. on Tuesday, August 12, 2008 must bring 35 copies of their comments to the briefing on the Big Island in Hilo or Kona.

HHSC Briefings on Neighbor Islands Start Next Week

The House Finance and Senate Ways & Means Joint Committee will continue a series of informational briefings on Hawaii Health Systems Corporation (HHSC) next week on the Neighbor Islands. HHSC is a network of Hawaii's public hospital facilities. Recently, HHSC informed the Legislature that it faces a potential $62 million shortfall for fiscal year 2009. The first briefing on Oahu was held on July 11th. You can view all the material presented here. The first Neighbor Island stop will be on Maui. View the official hearing notice here.

WHEN: Monday, August 11, 2008 at 5:00 p.m. to 7:00 p.m.

WHERE: Maui Economic Opportunity, Inc, Family Center Classroom, 99 Mahalani Street, Wailuku, Maui

WHO: The HHSC administration and the Maui Regional Board have been invited to participate. Public testimony will also be accepted.

ISSUES:
*As HHSC takes action to manage the shortfall, what will be the impacts to services?
*Can HHSC implement their plan of action without Legislative approval?
*What will be the impacts to the communities served by HHSC hospitals?
*What assistance has been provided by the Governor and state administration?
*What are HHSC's options as it strives to fulfill its mission?
*What are the fiscal and management issues critical to the ongoing operation of HHSC?

The public may submit testimony. The deadline is Friday, August 8, 2008 at 3:00 p.m.

In Person: Submit one (1) copy to the Committee Clerk, State Capitol, Room 210.

By Fax: Comments may be faxed if less than 5 pages in length. Fax to: Senate Sergeant-at-Arms at 586-6659 or 1-800-586-6659 (toll free for neighbor islands.)

By Email: Comments may be emailed if less than 5 pages in length. Email to: Joint Committee at testimony@capitol.hawaii.gov. DO NOT EMAIL TO INDIVIDUAL SENATE OF REPRESENTATIVE OFFICES AS IT WILL NOT BE ACCEPTED.

Late Testimony: Persons wishing to submit testimony after 3:00 p.m. on Friday, August 8, 2008 must bring 35 copies of their comments to the briefing on Maui.

Code Blue

The Hawaii Health Systems Corporation (HHSC) checked into the fiscal ER today. The House Finance Committee and the Senate Ways and Means Committee held their joint informational briefing on the HHSC, a network of public hospitals in Hawaii, which faces a projected shortfall of $62 million by the end of fiscal year 2009.

"The Health System used to be run by the Hippocratic Oath; now it's 'show me the money'," said Rick Vidgen, the HHSC West Hawaii board member.

How did they get to this point? HHSC cited five primary reasons why they are losing money:

1. HHSC has no Disproportionate Share Hospital status - thus losing approximately $33 million per year. Hawaii is only one of two states with no DSH.

2. Under-reimbursement resulting in a loss of $90 million per year.

3. Wait list problem, losing approximately $30-$50 million per year.

4. Physician Call Coverage and Recruitment Cost - Over $15 million per year.

5. Cost of operating as a state agency - Includes $50 million in fringe benefits, salaried vs. hourly employees; paid time off.

The administation says they are unable to intervene with the management and operations of HHSC, citing HRS 343F-11, the Executive branch; noninterference clause.

§323F-11 Executive branch; noninterference. Notwithstanding any other law to the contrary, the governor and executive branch agencies shall limit their responsibilities to that of review and oversight when the corporation or regional system board receives general funds from the State to subsidize the operating budgets of deficit facilities. The governor and executive branch agencies shall not interfere with the systemic change, capacity building, advocacy, budget, personnel, system plan development, or plan implementation activities of the corporation or any regional system board. The governor and executive branch agencies shall not interfere with the ability of the corporation or regional system board to function as a multiple facility public hospital system delivering health care services to the residents of the State. [L 1996, c 262, pt of §2; am L 2007, c 290, §29]

Finance Chair, Rep. Marcus Oshiro, asked Linda Smith, the Governor's policy advisor, if the administration has received a ruling from the Attorney General on what they can and cannot do to assist HHSC under this part of the statute. Smith said that the A.G. was the one who pointed out the section to them, but they have not received an official ruling. Rep. Oshiro said he would ask the A.G. for a ruling and would waive his attorney/client privilege in order to make the information public.

Chip Uwaine from the United Public Workers indicated that there would be an announcement on Monday on 54 layoffs, but was unsure what positions they were, or at what hospitals.

Senator Roz Baker, Ways and Means Chair, solicited agreement that monetary relief was needed for this fiscal year, and that the Legislature would not be able to make an emergency appropriation unless the Governor called the Legislature back into special session for this purpose.

Joint House Finance/Senate Ways and Means hold info briefing on HHSC

Kahuku Medical Center, the newest addition to the HHSC network of public hospitals.

Photo Credit: The Honolulu Advertiser.

About 2 weeks ago, Hawaii Health Systems Corporation (HHSC) briefed House and Senate caucuses on its dire financial situation - a $62 million projected shortfall for fiscal year 2009, on top of a deficit of $42 million at the end of fiscal year 2008.

HHSC is a network of 13 public hospitals on Oahu, Kauai, Maui, Lanai and the Big Island. The facilities are managed by regional boards. Given its financial situation, HHSC may be facing the need to reduce services and staff.

The 13 facilities are:

Maui: Maui Memorial Medical Center, Kula Hospital


Lanai: Lanai Community Hospital


East Hawaii: Hilo Medical Center, Hale Hoola Hamakua, Kau Hospital


West Hawaii: Kohala Hospital, Kona Community Hospital


Kauai: Kauai Veterans Memorial Hospital, Sam Mahelona Memorial Hospital


Oahu: Maluhia, Leahi Hospital, Kahuku Medical Center

As a followup to HHSC's announcement, the House Finance Committee and the Senate Ways and Means committee will hold joint informational briefings on Oahu, Kauai, Maui, East Hawaii and West Hawaii over the next few months. The first one for Oahu is scheduled for this Friday. In addition, House and Senate will form a health systems recovery task force to look at structural issues and improving access to healthcare.

Date: Friday, July 11, 2008


Time: 10:00 a.m. to completion


Place: State Capitol - Conference Room 325

Who's invited: Healthcare Association of Hawaii; HHSC Board of Directors; HHSC Administration; Oahu Regional Board; Office of the Governor; Hawaii Government Employees Association; United Public Workers.

Public comments: The public may provide comments on the HHSC system wide and Oahu region plans by submitting testimony by email at least 24 hours in advance to: testimony@capitol.hawaii.gov.

The purpose of the briefing will be to look at the impact to services as HHSC manages its projected $62 million shortfall, whether HHSC can implement some or all of their plans without legislative approval, assistance by the state administration, options and actions to help HHSC fulfill its mission.

Hawaii Health Systems Corporation sends out SOS

Rep. Robert Herkes discusses the impact of HHSC's financial condition for Big Island community hospitals.

Hawaii Health Systems Corporation (HHSC) met with both House and Senate caucuses last week, but today announced officially that they face "fiscal challenges" of a $62 million deficit for fiscal year 2009, on top of a projected shortfall of over $40 million in the fiscal year 2008 which ends today. State lawmakers view the situation as a potential crisis which will impact community hospitals statewide; the neighbor islands are most vulnerable.

Early this session, the legislature appropriated a $14 million emergency appropriation to HHSC which was to apply to this fiscal year's shortfall.

HHSC is technically a public benefit corporation. It operates 12 hospitals on Oahu, Maui, Kauai and the Big Island, employs 4,200 staff and over 800 affiliated physicians, and provides acute, long-term, and rural health care.

HHSC indicated that they will immediately halt recruitment and hiring and implement layoffs at certain facilities.

The legislature responded today with a plan to send members of the House Finance and Senate Ways and Means committees to the neighbor islands for information gathering. According to state law, HHSC may not reduce major services without getting approval from the legislature. There are no immediate plans to go into special session for this purpose.

The legislature will also convene a Joint Legislative Health System Recovery Task Force, made up of public and private stakeholders, to assist the HHSC with short-term and long-term plans to ensure that health services remain viable and available for those who rely on community hospital services.