What do you do when your hospital is fighting for financial survival, but you've got a long IT to-do list full of projects that could make or break your institution's future? While many hospitals are torn between daunting balance sheets and the increasing need for investment in any number of technology solutions, I've never come across an institution fighting those dueling pressures as acutely as Cooper Green Mercy Hospital in Birmingham, Ala. The safety-net hospital — with an ER that's Birmingham's busiest with 36,000 visits a year — is currently in the middle of a massive IT overhaul as it prepares to attest for meaningful use this summer.


All told, Cooper Green has 16 ongoing IT projects, including a PACS system, the implementation of computerized physician order entry, a new revenue cycle system and a new data center.

That would be a massive undertaking for any institution, let alone one that's currently fighting for its life. Cooper Green is operated publicly via indigent care funds provided by Jefferson County, and the county itself declared bankruptcy last November in what is believed to be one of the largest municipal bankruptcies in U.S. history. In April, the hospital announced $6.7 million in across-the-board cuts, including 89 layoffs, and the future of the hospital is currently in doubt.

Back to the IT war room: Recently, I talked to Srikanth Karra, director of information services at Cooper Green, who at the time was getting ready for the May 1 launch of the hospital's EHR May 1 — with hopes of being ready to start the 90 day attesting period for meaningful use funding by June 1. "Getting capital funds is next to impossible," Karra says, so it's paying for the projects by tapping into its monthly operational funds — with help from its finance department — to pay for the improvements.

So how does a hospital in dire financial straits handle 16 IT projects at once? First off, the EHR system, Medsphere's OpenVista product, uses open source software originally developed by the VA, enabling Cooper Green to implement the project for roughly $2.3 million to $2.7 million.
"All we had to pay for was implementation services," Karra says.

Because of Jefferson County's own financial straits, Karra and other hospital officials worked closely with county officials to explain the expected return on investment from meaningful use funding, ultimately getting permission from the county's attorney to expedite every contract. At the same time, hospital officials assured vendors that the project was going ahead and had firm support from the count.

Karra acknowledges the scope of the projects alongside the hospital's financial circumstance was daunting at first. "I had my own doubts going in," Karra says. "Could I handle this many projects?"

Despite those challenges, though, Karra is using the same institutional strategies I've heard during IT rollouts at countless hospitals, relying multidisciplinary teams, physician champions and superusers to build institutional support and ultimately design workflows that will produce better patient care.

The payoff? If the hospital is able to successfully attest for meaningful use, the first payment will be for $2 million; future payments will be based on discharges. And for a hospital in the precarious position Cooper Green is in, that could make all the difference in the world.