Vendor service and support for Guam Memorial Hospital’s current system, Optimum, will cease in December 2020. And with only two months remaining in 2019, GMH doesn’t have the money to begin the procurement process – which itself typically takes months at a minimum – for a new system.

It also typically takes about a year to properly install an electronic health records system and train medical and clerical staff to use it, according to a hospital official.

A new system can cost up to $50 million, GMH Administrator Lillian Perez-Posadas told lawmakers during a recent oversight hearing. While it seemed to take senators by surprise, the looming expiration of Optimum support and services has been an issue that GMH officials for years have been bringing to the Legislature in hopes of obtaining additional funds.

William Kando, GMH administrator of operations, said the $20 million that was most recently discussed was “supposed to be seed money.”

Price tag: As much as $50M

As Perez-Posadas explained, the $50 million price tag for a new electronic health records, or EHR, software can be spread out over about four or five years.

The price could have been lighter. Kando said just a few years ago, the hospital had pegged the system at $30 million – but even then, GMH wasn’t getting the financial support it told lawmakers it needed.

“We were asked, ‘What would you need for one year?’” Kando said. ‘“What would you need for seed money?’”

And while the $10 million that Sen. Therese Terlaje was able to hammer out for GMH during the last budget process falls short of the total needed, “It’s something to start with,” Kando said.

Electronic records improve patient care

But why is an EHR system so crucial to the hospital?

Imagine walking into the emergency room and registering. The most basic information is entered: name and age, any known allergies, vital signs and, of course, the reason for visiting the ER, said Don Rabanal, assistant administrator of administrative services.

That’s the start of your electronic health record.

From that point on, the nurses, doctors, anesthesiologists, pharmacists, X-ray technicians, dietitians – anyone who has a hand in your treatment is going to build that record, adding information and using the information added by other medical professionals to ensure that what they’re doing is consistent with the overall care you need, Rabanal stated.

“It really centers around patient care and patient safety, using huge amounts of data,” he said. “It’s about mitigating, lessening the risk for the patient as we provide care.”  

“And providing the best level of care that we can provide,” Kando added.

GMH needs EHR to generate bills, get paid

By the end of a patient's medical care at the hospital, the information is synchronized with the accounting system to generate the bill for the patient, their insurance company, Medicaid/Medicare or MIP, Kando said. “And that’s revenue for the hospital,” he added.

Tracking patient care is crucial, which is why the breakdown of the hospital's EHR system a few weeks ago caused great concern.

It’s also why the Centers for Medicare and Medicaid Services places such a high value on EHR systems.

“As far as CMS is concerned, whenever they do visit and the surveyors come, they go directly to the documentation. If you didn’t document it, you didn’t do it – that’s the rule in clinical,” said Paula Manzon, acting clinical informatics supervisor.

No EHR? No accreditation, no Medicaid

The documented services show CMS what the patient was complaining of, the diagnosis, and the care that was provided.

“CMS has their regulations and standards and they enumerate that to us and we have to follow those,” Manzon said. “And if they don’t see a part of particular documentation that we were supposed to do, something under that regulation, then they cite us.”

For example, if you don’t have a care plan for a diabetic patient with specific actions, “then they would cite us.”

"Failing to get a new EHR system means GMH would fall out of compliance with CMS requirements," Rabanal stated. 

And failing to meet CMS requirements means GMH could lose as much as $20 million in payments for Medicaid patients each year.

‘We’ve been worried for years’

For the sake of the patient’s care – which is monitored by CMS – it is vital that medical staff be able to easily view information that is properly organized, which allows for efficiency and accuracy in treatment.

The EHR system also allows GMH to share its information on the patient quickly with hospitals in Asia, Hawaii or the continental U.S.

During the interview, Kando, Manzon and Rabanal couldn’t underscore enough how important it was to get the funding and get started on the process of procuring a system as soon as possible.

“We need to go now,” Kando said. “That’s why, even during the last administration, we were fighting for the money. We needed to go then – if we had gone then, we would be in a much better position now.”

Rabanal said the typical implementation of an EHR system is 12 months.

The Guam Daily Post asked the trio if they’re worried they’re going to get the money needed in time to get a new system in place.

“We’ve been worried for years,” Manzon replied. “We’ve been talking about this for a long time.”

“That’s why this has been one of our top three priorities for years,” Kando stated.

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