There is perhaps no better way to learn the importance of disaster planning and recovery than having to spend 11 straight days in a hospital in the wake of a hurricane. For Sonya Christian, who was then CIO at Slidell Memorial Hospital, living through the experience of Katrina taught her how to be a leader. Now CIO at West Georgia Health, Christian is applying the lessons she learned during that stressful time and ensuring that disaster planning is a top priority. In this interview, she talks about her experience with Katrina, what it was like to take on a CIO position during a major Meditech implementation, her concerns about the proposed Stage 2 rules, and the one piece of advice she has for MU attestation. She also discusses the benefits of earning a CHCIO certification and why all CIOs need to give back to the profession.
- Developing a patient portal strategy, starting with ambulatory
- Piloting BYOD with select physicians and staff
- Using Citrix to view apps on smartphones
- “We’re going to have to be able to secure these devices and allow them into our environment”
- CHCIO certification – “it shows your industry knowledge and experience”
- Leveling the playing field for female CIOs
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The question is, are they going to require the viewing or printing or transmitting of any particular part of the record? If indeed we can sit down with each patient before they leave the hospital and login and review the information that’s out there with them, that would meet a one-time requirement to login and view the information.
As we grow, we’re going to have to take a look at additional measures. I’m struggling with the same thing that other CIOs are, but I think we have no choice. I think we’re going to have to be able to secure these devices and to allow them in our environments.
We began using them using the Citrix environment the same way that we would use a remote PC to get in to the HIS. And as we have people come on board, we make it known that this is not a hospital-funded project; we’re not going to buy your devices for you. But if you choose to use one, we will help you with the connectivity that you need
The things that we’re asking to be added to that are the ability to sign charts on the remote device and the ability to place orders on the remote device. Now we can do that in the full HIS version right now, but it’s not optimized for the iPad. And so we would like that to be more user-friendly for our physicians.
That certification for me was a validation of my knowledge of the current healthcare space; the fact that I can be competitive with my peers. I think it gives me that little extra level of confidence to say, ‘I know my stuff. I know what I’m doing.’ And as a female CIO, I find that it kind of helps even the playing field a little bit.
Gamble: As far as the Meaningful Use Stage 2 proposed rules, one of the things that has come up a lot is the new requirements for making electronic information available to patients. It’s something that some of CIOs we’ve spoken to are struggling with to some degree. What are your thoughts on that requirement and how you’re going to try to get positioned for that?
Christian: Basically, I feel like we’re going to have a portal strategy for our patients. We already have that in our ambulatory practices; we went live just yesterday with our patient portal in our ambulatory environment, so our approach would be just to expand that in our hospital environment. For Stage 1, we are providing an electronic copy of the patient’s information to them via CDs, and we know that that won’t stand the test for Stage 2, so we’re actively seeking a portal strategy.
Gamble: So you can monitor how it goes on the ambulatory side and maybe take some of that and apply it on the hospital end?
Christian: Absolutely. And I think the thing that concerns us most on the hospital side is the potential 10 percent patient usage requirement that’s talked about in the proposed rules. One of the things that we’ve brainstormed about is if we bring our portal up, having the discharging nurse sit down with the patients and actually help them login to the portal before they leave the hospital. I don’t know that that’s the direction we’re going, but currently that’s the discussion toward managing network flow and meeting that 10 percent usage mark.
Gamble: That does seem to be a challenge because you’re depending on patients to be able to hit that mark. That’s where it seems to get tricky — how can you ensure that this certain group of the population does get that information electronically?
Christian: Well the question is, are they going to require the viewing or printing or transmitting of any particular part of the record? If indeed we can sit down with each patient before they leave the hospital and login and review the information that’s out there with them, that would meet a one-time requirement to login and view the information. But that’s just proposed right now, so we’re looking at how we can go about meeting that. And it may change.
Gamble: Right, absolutely. If there’s one thing we’ve learned, it’s that these things may change. So I wanted to talk a little bit about mobile devices in the hospital environment. It’s one of the big questions that comes up a lot because as a CIO or IT leader, you want to incorporate the latest devices, but there is that huge security risk, and so I wanted to see how you’re dealing with that. Do you have a bring-your-own-device policy?
Christian: Right now we’re using that with our physicians and just a few staff members, and it’s been more on a pilot project perspective. They can use Citrix receiver and authenticate into our health information system and use Citrix to view their application. That’s no different than what our physicians have done in their own offices or from their home PCs. We’ve made the application available to them, so using it on, for example, an iPad or even a Droid or iPhone is no different than viewing the record sitting in their physician office. It has the same security measures and the same authentication process that they would use, and because our application doesn’t cache to the device itself, even if the device leaves, there’s not that footprint back in. And without the authentication mechanism, someone holding the device couldn’t get into our system.
So that’s what we’re doing right now with that. I think as we grow, we’re going to have to take a look at additional measures. I think I’m struggling with the same thing that other CIOs are, but I think we have no choice. I think we’re going to have to be able to secure these devices and to allow them in our environments.
Gamble: Right. Now aside from the docs and a few staff members who are doing this as a pilot, are there other people who are requesting it or just kind of putting the bug in your ear?
Christian: We’ve had an increase. One of the things that my staff did, and I know this is probably unusual, is that several of us bought our own devices — we didn’t purchase them through hospital funds. We began using them using the Citrix environment the same way that we would use a remote PC to get in to the HIS. And as we have people come on board, we make it known that this is not a hospital-funded project; we’re not going to buy your devices for you. But if you choose to use one, we will help you with the connectivity that you need if that individual already has remote access into the HIS system.
Gamble: That could be a pretty dangerous precedent if they think that you’re going to buy devices, because something new seems to come out every month that’s either an upgrade or just a different version, and it would be hard to keep on top of that.
Christian: It is, and here’s the thing. Our application — our HIE system — is not optimized for the iPad or Droid device right now. It can be used; we’ve watched our physicians order medications and tests for their patients using it, but I would still say that there’s some work that needs to be done in that area to make it truly iPad-friendly or truly Droid-friendly. And I know that our vendor is working on some things in that direction, but it works in the state that it’s in as well.
Gamble: Right, and at least from the people who I’ve spoken to, it really doesn’t seem like in the majority of cases, that is the situation — where the HIS is optimized for devices like the iPad. It seems like it’s a very select few organizations that are doing that right now, and maybe they can serve as a model for whether it works or not, and you can see the progress that they make.
Christian: One of the things that we offer right now is a patient rounding list that is optimized for a mobile device. The problem with that is it’s a view-only type of application. The things that we’re asking to be added to that are the ability to sign charts on the remote device and the ability to place orders on the remote device. Now we can do that in the full HIS version right now, but it’s not optimized for the iPad. And so we would like that to be more user-friendly for our physicians if they choose to use the mobile devices. But frankly, our physicians have been happy just having access to our system via the iPads, and even though I feel like it’s not as elegant as it could be, they’ve seen that as a win.
Gamble: The whole issue of mobile devices is interesting because it’s the nature of that field that things do change so quickly; so it’s something that I would imagine as hard to stand on top of.
Christian: It is, and we’re not an internal development shop here at our hospital; we buy commercially-available, off-the-shelf software. So that does put a level of dependence on your vendor that you’re working with, but I think we’re going to see more and more mobile-enabled or mobile-optimized application as we move forward.
Gamble: Yeah, I think so too. It should be interesting. So I want to switch gears a little bit and talk about professional development. You’re recently earned the CHCIO certification and I just wanted to talk a little bit about how you think that that will benefit you going forward and if this is something you’d recommend for other CIOs.
Christian: I would definitely recommend it for other CIOs. One of the things that we struggle with as a CIO is staying on top of current trends. Healthcare is just changing at a phenomenal pace right now, and you’re being pushed to do more than you’ve ever done before. That certification for me was a validation of my knowledge of the current healthcare space; the fact that I can be competitive with my peers. I think it gives me that little extra level of confidence to say, ‘I know my stuff. I know what I’m doing.’ And as a female CIO, I find that it kind of helps even the playing field a little bit. You have those credentials in place and it shows your industry knowledge and your industry experience. Another certification that I obtained last year was the CPHIMSS, which is a certified professional in health information management system. And those two are really the two most recognized certifications for healthcare IT.
Gamble: I’m glad you brought that up about being a female CIO because it’s something that we may be starting to see a little more now than a few years ago, but it still is not a level playing field. Do you think that the industry is doing enough to help women to develop as leaders and create opportunities for them or is it something that you would like to see increase a little more?
Christian: I think it’s kind of a collective responsibility. Yes, I think the organizations have to make opportunities equally available to all candidates, but I also believe that the candidates have got to have that vision for themselves as well. And I will tell you that two of my best friends are CIOs at other healthcare organizations in the southern region; more and more we’re seeing females in that area.
Also as clinical informatics really moves into place, I’m seeing more and more nurses in that position, which I don’t think is a bad thing. I think in healthcare IT, it’s very important that you have your finger on the pulse of the clinical environment, and a strong clinical leader can really do some good things for your IT department.
Gamble: Yeah, absolutely.