Before she joined the staff of Edward Hospital in late 2009, Bobbie Byrne had never once thought about becoming a CIO. But when she was approached by a recruiter who told her that the organization wanted a physician, she was immediately intrigued. The move turned out to be fortuitous; just a year into her tenure, she led the way as the organization migrated to a new platform that would provide an integrated patient record. In this interview, Byrne talks about the process of selecting a major IT system, what it takes for an organization to make IT its top priority, and how her experiences as in the clinical and vendor worlds have shaped her role. She also discusses the state of HIE in Indiana, what she really thought of the ICD-10 delay, and her concerns about the IT workforce shortage.
Chapter 1
- About Edward Hospital & Health Services
- Migrating to Epic across the system
- “Epic wasn’t an automatic choice”
- Need for a single source of truth
- IT being thrust into the spotlight
- “I’m not a technical person”
- Placing a higher value on clinical experience for CIOs
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Bold Statements
People who are in IT think that everybody is picking Epic and it’s really predetermined and any of these selection processes are just farcical, and that really wasn’t the case at Edward. While certainly those of us who are in health IT thought it was likely that Epic would be a finalist, if not the finalist, we really took the organization through a complete envisioning process.
Every implementation there are times when I say, ‘Wow, I wish I’d known that a little bit sooner.’ And I say to the Epic people, ‘Take this learning to your next project because we want to make sure that nobody makes the same mistakes as we did.’
You have to have a single source of truth. And so IT went from saying, ‘Well, we probably have to have a system’ to the organization understanding that IT was going to be the big strategic project for the next few years.
That was honestly the first time in my life that I thought about being a CIO. I think the fact that they wanted a physician in the CIO position meant that they understood that they were looking for something different and they were looking for somebody who was going to be a full participant at the table.
I think people are beginning to understand now that just like with every other C-level job, you can’t be the expert in all aspects of the job that you’re being asked to do. And so you have to support yourself with individuals around you who have that different expertise.
Gamble: Hi Bobbie, thanks so much for joining me today to talk about your work at Edward Hospital.
Byrne: My pleasure, thank you for talking to me.
Gamble: Sure. Why don’t you start by telling us a little bit about the organization — things like the number of beds and what you have in the way of inpatient and outpatient facilities?
Byrne: Edward Hospital and Health Services is a two-hospital health system in Naperville, Ill., which is one of the larger suburbs outside of Chicago. We have a 310-bed acute care hospital and we have a 115-bed behavioral health hospital as well, and behavioral health ends up being about 25 percent of our total portfolio of business, so it’s pretty important to us. And then we have an employed medical group that is predominantly primary care and some other selected specialties — about 150 physicians that are employed in Edward Medical Group, and then far too many outpatient service locations to keep track of, which, like most organizations, includes urgent care centers and radiology facilities, etc.
Gamble: Do you also have independent physicians that refer into the system?
Byrne: Absolutely. Actually, our medical staff is really quite large for a hospital of our size; we have almost 1,000 physicians on the medical staff. So even when you take out the employed physicians and then the other hospital-based physicians like anesthesiologists and radiologists, the vast majority of our physicians are independent physicians who refer in. Of that group, the biggest is a multi-specialty group called DuPage Medical Group, which is about 350 physicians covering all specialties that practice at our hospital, as well as a few others in DuPage County. And so between our own employed physicians and DuPage Medical Group, that’s really the vast majority, and then we have many, many small group practices from one to ten physicians.
Gamble: Okay. So now in the hospitals, are you using Epic?
Byrne: We are in the process of implementing Epic. So we currently run Meditech Magic and have done so for 15 or 16 years — certainly long before I came here. When I came to Edward about two-and-a-half years ago, Edward was in the process of implementing the 6.0 product from Meditech for the hospital and was in the process of implementing Allscripts Enterprise for the employed physicians group. The ambulatory implementation completed and all of the physicians are live on Allscripts but the Meditech 6.0 implementation never went live. We could never quite make it work for our needs and for the size of our organization, and so about a year ago, we went out and did a vendor selection and looked at all of the usual suspects. We actually started at looking at six vendors and then narrowed the field and selected Epic. We actually have our first go-live in about 17 days; one of our ambulatory physician practices will be the first one to go live.
Gamble: What was it that made you settle on Epic? Is it the fact that they do have an integrated solution?
Byrne: It’s interesting; people who are in IT think that everybody is picking Epic and it’s really predetermined and any of these selection processes are just farcical, and that really wasn’t the case at Edward. While certainly those of us who are in health information technology thought it was likely that Epic would be a finalist, if not the finalist, we really took the organization through a complete envisioning process. We just basically said — in a wide variety of different groups that included physicians, nurses, therapists, revenue cycle managers and all the stakeholders — what do you want in a system? And then we tried to bring all of those things together to create the vision and then said, ‘okay, now we know what we want. Is it available in the marketplace?’ And the thing that came up the clearest among all these different individuals was a single patient record. And I think that had gone from some of the pain that we had been experiencing between Meditech and Allscripts — as patients move across venues of care, their information was not really following them with the two different vendors.
So the most important thing that Epic had was the single patient record. And there are other vendors that have that as well, and so the other piece that became very important was Epic’s reputation for success and the fact that they had all of the different pieces. They have a very strong clinical product, but they also have a very strong revenue cycle product, a strong surgery product, a strong medical record product, a strong radiology product, and a strong pharmacy product, and there was no other vendor that had that strength in all of the different areas. And so once that really became clear to the organization, the rest of the decision was pretty easy.
Gamble: So far has the experience been pretty good for you guys?
Byrne: It has been really good, if you can get past the average age of the Epic implementer. I mean, I’m not old, but most of the people who were implementing were a lot closer to my kids’ age than they are to me, and if you can just wrap around that, it’s been really enjoyable. We haven’t had anybody come here who isn’t just incredibly smart. So they may be young, but they’re very smart and they know their product, and they’re incredibly nice. Edward is a very nice place; there’s no yelling and fist-banging around here, and so the Epic culture of just being nice and pleasant and collegial has worked really well.
There’s tons of learning, of course. Every implementation there are times when I say, ‘Wow, I wish I’d known that a little bit sooner.’ And I say to the Epic people, ‘Take this learning to your next project because we want to make sure that nobody makes the same mistakes as we did.’ But it has been very enjoyable so far. Talk to me in 17 days when we go live and we’ll see if people are having fun.
Gamble: Yeah, exactly. And it’s funny that you say that. I have heard that they tend to be really young company, but I guess these are people who grow up on technology so that has its benefits.
Byrne: Absolutely and I’ve heard that they had just an incredible number of applications for every open position they have, so they truly are able to pick very, very smart, very socially aware individuals. So they may be 22, but they’re the cream of the crop of the 22-year-olds.
Gamble: That’s a good thing.
Byrne: Sure.
Gamble: So when you were coming on board, you knew that this is going to be something that you would be a big part of, in terms of moving toward a different system?
Byrne: No. In fact, when I came on board, the situation was laid out to me as, ‘Hey, we’ve already selected our vendors. We’re going with Meditech and Allscripts.’ So, no it was very different. I thought I was just going to come in and be doing Meditech and Allscripts. I didn’t expect that we’d be doing this big kind of switch.
Gamble: But I guess you kind of be ready to change your strategy depending on how things go.
Byrne: And a lot of things changed, not only in our own environment about feeling the pain of the disparate systems, but healthcare reform also happened in that same time period. And there really was a sense of regardless of what ends up happening with all of the different pluses and different parts of healthcare reform, we are going to have to take more risks. We’re going to have to take more responsibility for the patients that we care for. So all of a sudden, the things like, ‘we have two different medication lists’ or ‘we have two different problem lists for patients,’ moved from being an irritation or an operational inefficiency and potentially a patient safety problem to something where we said, ‘we can’t even run our business as a healthcare organization if we don’t understand our patients.’ There can’t really be a debate whether this patients has diabetes or has hypertension; you have to have a single source of truth. And so IT went from saying, ‘Well, we probably have to have a system’ to the organization understanding that IT was going to be the big strategic project for the next few years. And many organizations had come to this realization; some came to it years and years ago. But it’s very interesting to watch our organization make that change from IT as kind of a required necessity that isn’t particularly strategic to the number one strategic initiative of the organization.
Gamble: That’s a great point.
Byrne: And Epic is good at that. Epic is good at supporting the executives and making my CEO feel comfortable with this level of investment in technology, because they have such strong leadership. So it’s a good partnership.
Gamble: It seems that this change that has happened over the last couple of years has really elevated the role of the CIO.
Byrne: You know, it’s interesting for me. I never really thought I would be a CIO. I’m a pediatrician and I’m not particularly technical. I worked with Eclipsys for a long time and so I have a lot of friends who are really technical and they sort of laugh because they’ll say, ‘Bobbie, you’re really not technical.’ But I was just very lucky. Edward was looking for a CIO who was a physician because of some of the experiences that they had and some of the things that they were looking to do, and I had just gotten called up from the recruiter who I’d known who said, ‘Edward is kind of a unique place. They’re looking for a physician and I think it would be a good fit for you.’
And that was honestly the first time in my life that I thought about being a CIO. I think the fact that they wanted a physician in the CIO position meant that they understood that they were looking for something different and they were looking for somebody who was going to be a full participant at the table in that role. I’ve stood on others’ shoulders; I didn’t have to suffer through any of the pain where the CIO was marginalized in other organizations. I was lucky enough to have others do all that hard work and then be the beneficiary of the understanding that this was an important strategic role for a hospital.
Gamble: That’s interesting that they were zeroing in clinicians because this isn’t something that we saw that much a few years ago but I’m starting to notice it more now. I think maybe that’s something that’s valued a little more than the technical experience. You said that don’t consider yourself to be that technical but it seems like the skillset for the CIO is constantly changing, and maybe there are different qualities that a lot of organizations are looking for, like that clinician experience that you have.
Byrne: Right, I think that’s exactly it. And I think people are beginning to understand now that just like with every other C-level job, you can’t be the expert in all aspects of the job that you’re being asked to do. And so you have to support yourself with individuals around you who have that different expertise. For example, for me, I’m always going to need a strong chief technology officer, probably somebody who came up through the infrastructure, server-jockey path in order to complement and add to my skill set. And CIOs who came up through the technical ranks typically partner with their nurse informaticist or physician informaticist friends in order to help balance that. So I think it’s just further evidence of the maturing of the role. We don’t expect the CFO to know every single part of accounting or medical records; we couldn’t expect the CIO to do that either.
Gamble: Yeah, absolutely.
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