One of the dictums often spoken at Children’s Hospital and Medical Center is that “pediatric patients are not just small adults.” Children come with a whole different set of needs — from a lack of standard dosing to communication challenges — that must be factored in when implementing IT systems. These considerations are taking a front seat as Children’s migrates to a new EHR platform. In this interview, George Reynolds, MD, talks about the work his organization is doing to connect with affiliated physicians as well as other health systems, and the decision support system that’s being rolled out to improve patient care. He also talks about managing the dual roles of CIO and CMIO, the benefits of having clinician experience under his belt, the importance of IT rounding and appointing physician champions, and why networking is more critical now than ever before.
- Being a CIO with clinical experience
- Understanding workflow — perception vs. reality
- IT rounding — “you have to get out there”
- “Networking is critical to everything we do”
- “Have a good team and get out of their way”
- How IT is similar to the ICU environment
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I don’t know if that’s a challenge any CIO has — that physicians won’t tell him when they think things aren’t going well. If anything, it might actually buy me a little bit of extra courtesy that when they do tell me they’re not happy about something, they couch it in terms of the thing they’re not happy with rather than the person they’re not happy with.
You have to get out there. You have to spend the time; you have to talk to people and sit and watch what they do. We have a number of physician champions as well as a number of other people whose job is to communicate and to continue to optimize the system and listen and learn and see how it is being used and make adjustments.
We’re going through that material and kind of picking and choosing, saying, ‘We really like that and we’d change this.’ And so that collaborative community is critical, especially to somebody like me who doesn’t come from a strong technical background.
You’ll always going to have some turnover — people move or they have other family interests and so on. But I think, in general, we’ve been very successful and very happy with the staff we have and our ability to retain them.
If you told me when I was a fellow in pediatric critical care that one day I’d be running an IT department, I’d say, ‘you’re nuts.’ But it’s been a fun move for me, and I think we’re going to do great things in the future.
Gamble: Because you’re a CMIO but then also have so much clinical experience in that particular organization, I would imagine that does give you an advantage in communicating to the clinicians just from having the perspective.
Reynolds: Yes, absolutely. It helps to know who to go to and it helps to have a long-standing relationship with a lot of influential people in this organization.
Gamble: Do you think that physicians might be a little more honest with you because you’ve been in their shoes and they might be more forthcoming with concerns they might have about a particular system?
Reynolds: I don’t know that physicians in any place are terribly shy about letting people know what they think. So I don’t know if that’s a challenge any CIO has — that physicians won’t tell him when they think things aren’t going well. If anything, it might actually buy me a little bit of extra courtesy that when they do tell me they’re not happy about something, they couch it in terms of the thing they’re not happy with rather than the person they’re not happy with.
Gamble: Right. We speak to a lot of CIOs, and very few are MDs. If there’s any advice you could kind of give to them about maybe the importance of understanding how IT really does impact their workflow and what they do, that would be really helpful I think to our readers.
Reynolds: I haven’t met a CIO who doesn’t know how critical their work is to the clinicians at the bedside. I think that’s the passion that drives all the CIOs I’ve met. It is sometimes a challenge to really understand the workflow that you think exists versus the workflow that actually exists, and if I had any piece of advice, it would be that even if the docs and the nurses don’t always know what it is they do until you really dig in step-by-step to what is they do and how what you’re trying to provide them is going to either benefit them or impede them. And it has to be an iterative process and open dialogue. You can’t just say, ‘Here it is. Look how wonderful it is — best of luck to you if you have problems.’
Gamble: And as far as your strategy, do you do any kind of rounding with clinicians or do you have anyone who does that just to check up and make sure that things are working well for them?
Reynolds: Absolutely, yes and yes. You have to get out there. You have to spend the time; you have to talk to people and sit and watch what they do. Obviously there’s far more of them than there are of me, and so we have a number of physician champions that I mentioned as well as a number of other people whose job is to communicate and to continue to optimize the system and listen and learn and see how the system is being used and make adjustments. But like decision support, I don’t think it’s ever really going to be done.
Gamble: I’m sure. Now another thing I wanted to ask you about was your involvement with the associations like CHIME, HIMSS, and AMDIS — what you get out of that, and with CIOs having to go through so much right now, whether you use these resources to reach out to your peers and see how they’re doing. How do you utilize those resources?
Reynolds: I think networking is critical to everything we do. It can be as simple as a question that you put up on a listserv that gets some advice and some feedback. Actually, just before I picked up the phone, we were working on our physician documentation quality to make sure that we avoid problems. Many of the tools I use I’ve gotten from other CMIOs and other CIOs. And I’m kind of pulling those together with a group of interested physician here. We’re going through that material and kind of picking and choosing, saying, ‘We really like that and we’d change this.’ And so that collaborative community is critical, especially to somebody like me who doesn’t come from a strong technical background.
Gamble: Right. And I’m sure that having a strong clinical background and going through what you’ve gone through could benefit other people in the same way.
Reynolds: I hope so. I hope I’m providing support and help to the people that are providing support and help to me.
Gamble: Now with having not only the dual roles of CIO and CMIO but also everything else that CIOs have on their plate, how are you kind of dealing with having to juggle so many priorities right now? I know that there’s no like magic solution to this, but how are you able to manage having so many priorities?
Reynolds: Well, I have an excellent team. I think that’s probably the short answer. We’ve pulled down a few awards, as a lot of places do, I guess. But the one I’m proudest of late is that we were named one of the 10 Best IT Shops to work in for mid-sized hospitals. I had absolutely nothing to do with it; in fact, I didn’t even know about it until I got the results. The staff had filled out an application and done all the work and I was so proud of that because it’s an indication of the great managers. I have an operations director who essentially serves as a chief technology officer and keeps us all in line in terms of the infrastructure alignments as well as our data services and dashboard uses. So it’s a long answer; the short answer was: have a good team, hire good people, and get out of their way.
Gamble: I had seen that your organization was also ranked by U.S. News & World Report and was named Most Wired a couple of times. So when you hear things like this, what does that mean for the organization? Does it help validate the hard work that everybody is putting in?
Reynolds: Absolutely, I think especially for a small children’s hospital like us. We obviously have that network with the other children’s hospitals, but to be recognized on a national scale is very special.
Gamble: Yeah, I’m sure. And as far as the recognition for the best IT shop, that’s something where your team was recognized?
Reynolds: Yes, they applied and filled out an application. It’s really something we’ve known internally — that our people are happy to work here because it’s a good team and it’s a great mission. But to be recognized nationally that way was very cool.
Gamble: I’m sure that that goes a long way. Do you find that one of the challenges right now is trying to hold on to the good staff you have and make sure they’re not getting too burned out with projects?
Reynolds: To be honest, no. I shouldn’t say that because we just lost a couple of great people who went on to other opportunities. But in general, we’ve been very successful at recruiting high-quality people who are great cultural fits. You’ll always going to have some turnover — people move or they have other family interests and so on. But I think, in general, we’ve been very successful and very happy with the staff we have and our ability to retain them. I know other places struggle with that, and I don’t have any great insight other than it’s better to be lucky than good, but we’re very lucky.
Gamble: That’s nice to hear because as you can imagine, we do hear a lot of people who are dealing with that, and so it’s definitely a good thing. Okay, well I know we’ve talked about a lot, but is there anything else you wanted to talk about — either projects you’re working on or any of your thoughts on what’s going on in the industry?
Reynolds: I don’t think I have any brilliant insight into what’s going on in the industry. Obviously Meaningful Use stage 2 will occupy a fair amount of our time going forward, but again, I thought most of that was fairly incremental and fairly obvious. And so I don’t think in the grander scheme it’s going to significantly change our focus and our goals. Obviously the amount of regularity burden and the amount of work that everybody has is a strain for everybody, but on the other hand, it’s a great industry to be in and I’m having a lot of fun. It’s terrific. If you told me when I was a fellow in pediatric critical care that one day I’d be running an IT department, I’d say, ‘you’re nuts.’ But it’s been a fun move for me, and I think we’re going to do great things in the future.
Gamble: Would you have believed that you’d be with the same organization for that long?
Reynolds: Oh god, no. Absolutely not. I thought if I lasted two years here, it would be a miracle. So every year I last, I think it’s another miracle.
Gamble: That’s a good way of looking at it.
Reynolds: Well, working in the ICU is a bit of a fishbowl. If everything goes great, you did your job and you did what you’re supposed to do, and if things don’t go great, then everybody wants to know why, which is understandable. IT is kind of the same way; if everything works and the lights stay on, the computer’s all work, and everybody can find the order sets and so on, you did what you’re supposed to do. And if something doesn’t go right, everybody knows it and everybody wants to know why. So in some ways, it’s very similar, and obviously in other ways, it’s very different. But I became an intensivist because I went to med school to take care of sick people. Now I’m doing this because I think I can have a positive impact on a population of patients. And if there weren’t high risks, they wouldn’t be rewards.
Gamble: Absolutely. Well, you guys are doing great work and I really enjoyed speaking to you about everything you have going on at Children’s.
Reynolds: Great, thank you.
Gamble: Well thanks so much, and I hope to talk to you again soon.
Reynolds: Okay, thanks.
Gamble: Thank you.
Reynolds: Take care.