As if CIO Chris Van Pelt didn’t have his hands full with the hospitals and physician practices already in his health system, IUH keeps building and acquiring new ones for him to automate and integrate. To bind them all together, Van Pelt and his team are using Cerner, rolling it out one facility and practice at a time, after a thorough readiness review has been conducted by a team formed specifically for that purpose. But getting to a basic level of automation isn’t enough, as Meaningful Use Stages 1 & 2 call the organization to further action, including the use of PHRs as a basis for patient engagement. To learn more about Van Pelt’s wins and challenges, healthsystemCIO.com recently caught up with the Indiana-based executive.
- Managing 160+ projects
- The advantages of a consulting background
- Doing more with less
- Full steam ahead for the foreseeable future
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… as all of us are trying to get our heads wrapped around accountable care and the impact of the Obama Care reimbursement models, we’re going to be under very, very high scrutiny with respect to trying to control costs.
The intensity and duration with which we have to perform is a lot different than it was even five years ago, and I don’t think it’s getting any better anytime in the next 15 to 20.
Gamble: Another thing I wanted to talk about was the Tele-ICU. Can you talk a little bit about what IU Health is doing from that perspective and what’s required from an IT standpoint?
Van Pelt: We’ve pioneered the use of Cerner’s product offering in there which we believe is far superior than anything else on the marketplace. We remotely monitor slightly over 300 beds across our facilities in a centralized bunker which, at this point, is not unique to us. There’s quite a few of these around the country, but we are, I believe, the largest using Cerner for that, fully integrated into our EMR with physicians and ICU nurses remotely monitoring those patients.
With respect to what’s required from an IT standpoint, you’ve obviously got a lot of BMDI work that needs to be done to make sure that you get those virtual displays of all the monitors statusing, alarming. Then on the EMR side, you’ve got a lot of customization work to do with respect to making sure alarms are configured appropriately. So we do a lot of work with our intensivists on statistical trending with our vendors to make sure that we’re constantly tweaking either the displays, the alarm values, etc., to make sure that we’re monitoring the patients to the best of our ability. The unique fun stuff is trying to solve 2-way cameras and mics and how all that interoperates point to point.
Specifically I was talking about our e-partner’s initiative, which is the bunker that monitors over 300 ICU beds. We’re foraying into virtual consults and other things, especially with some of the smaller outlying hospitals. We can do a neuro consult remotely over tele. Certainly we’ll be looking into home monitoring equipment and those types of matters. But there again, I think the published material is questioning at least the return on investment, if there is one, with respect to throwing much or a lot of equipment at a specific individual’s home and then getting that reported, and we hope that with the chronic disease patients, they will self-report and be more engaging with a PHR, versus just allowing something to transmit wirelessly, because there’s other things we’d like them to do when they’re in the PHR, such as recording an A1c, or looking for prompts from the physician, or to get the real-time alarms themselves to then prompt a visit to the doctor, or whatever needs to happen there.
Gamble: But certainly, with the cost that you have to put out, ROI with a project like this is a huge concern, I would imagine.
Van Pelt: Yes, absolutely. As you know, there’s no reimbursement models for a lot of these activities. So it’s definitely something that we’re doing as an additive cost, just to see if we can find some efficacy in certain matters.
Gamble: We’ve talked about a lot of the major projects that you’re working on right now. Is there anything else you want to touch on?
Van Pelt: Obviously, we’re still moving in parallel paths with ARRA for Stage 2, we’ve got initiatives that will run through these next 15 months to make sure we’re going to hit the proposed Stage 2. So there’s major pushes on the next phases of CPOE. We’re pushing hard on our pediatric populations right now. They’re not technically tied into ARRA but, at the end of the day, we need to have a nice closed loop around all those processes as well.
So we’ve got two major initiatives on CPOE right now. At any given point in time, we’ve got about 160 projects running concurrently. One project could be opening a hospital, just to give you a breadth of what I’m defining as 160 projects. Another initiative could be med rec or specific initiatives within ClinDoc. Our project management office tracks about 160 to 180 active projects at any given point in time. There’s not a lack of things that we’re working on at any point.
Gamble: I would imagine. I know CIOs at any size system are dealing with challenges, as far as juggling all the priorities. Being CIO at such a large system, do you find that you really have to rely particularly on your leadership team to be able to keep track of everything that’s going on?
Van Pelt: Yes absolutely. When I came here in 2004, I was previously with Ernst & Young and Computer Sciences Corporation running projects nationwide. IU Health alone had a project portfolio bigger than most consultancies at the time, so that required us to put in place project management methodology that I would say is pretty much akin to the consulting models, as far as being able to manage costs, resources and deliverables over what I just said, 160 projects running concurrently at any given point in time.
So that required us to go through a pretty significant change in skill set, as far as my leadership team that we’ve had here and developed. We’ve got an extremely strong team and we’ve had a very high success rate, with respect to delivering out what we’ve promised or what’s required of the health system over the same years. Here again, we haven’t touched on cost efficiency, but as all of us are trying to get our heads wrapped around accountable care and the impact of the Obama Care reimbursement models, we’re going to be under very, very high scrutiny with respect to trying to control costs. That’s a tough paradigm and, at the same time, you’re trying to develop all these new functions or meet new hurdles with respect to adoption and use.
We’re one of the larger health systems, I think, in the United States. We’re certainly one of the top 4 Cerner health systems in the United States. But on a cost efficiency basis, we’re extremely cost efficient. On a benchmark basis, we run the IS costs for here at about 3.5% of total operating. So IS expense as a division into the organization’s total operating expense is a good metric to use. I don’t find many large health systems running at that. I think the national average based on the HIMSS Analytics data was about 4.5 or 4.6 in the last annual report that they have; so a full percentage point below what the median – not just the average, the median – percent benchmark is.
We’re going to keep being pressed. As I said, I think the whole industry is going o spend a lot less money to support the institution, at the same time the institutions are going to be demanding exponential use and growth of those same technologies. It’s just a tough paradigm to be in.
Gamble: I would think so. I can tell from hearing you speak, I can really hear that consulting background coming out. Do you feel that you really get to utilize those skills?
Van Pelt: Yes. I think it’s imperative for any CIO, especially in these large health systems, especially with the adoption curves that we’re having to push through with all this reform. I don’t know how you can really get your head wrapped around 160+ projects or even opening new facilities at any pace if you don’t have a consulting background — it would definitely be tough. It’s just a competency and skill set, I think, that lends itself well to the complexity of these initiatives that we’re all attempting to do. Obviously, you’ve got hard deadlines you need to hit with respect to all these initiatives as well, and with these tight cost constraints coming in, it’s just exponentially taking up the risk profile of all these matters.
Gamble: As far as what your organization is doing with opening up new facilities like you said, that’s not a simple project by any means. Do you find yourself having to do a lot of the travelling? Are you on the road a lot, trying to oversee some of this or are you forced to delegate more?
Van Pelt: Going back to 2004 when we opened our first hospital, I was way more active at that time. Over time, I’ve built up our teams. I have folks that run those initiatives now, so I don’t go over them providing daily supervision or doing that activity. I’ve got a very strong team that handles all that for me. So no, I don’t have to bounce around too much, but certainly I go around and visit all of our facilities as we’re migrating. But I’ve got a strong leadership team under me that divides out that portfolio.
Gamble: The last thing I wanted to ask you about was, with how much you have on your plate, like many other CIOs, how challenging is it to carve out some time in your life where you’re not working? Right now, that’s just really challenging?
Van Pelt: Work-life balance? J That was a fun term in the late ’90s, wasn’t it? Yeah sure, everybody’s got to find some way to carve out their personal time, get your down time. I personally do a lot of running on my down time. It helps clear the head. But I’m sure it’s no worse than any of my peer C levels that are hospital administrators. The intensity and duration with which we have to perform is a lot different than it was even five years ago, and I don’t think it’s getting any better anytime in the next 15 to 20.
Gamble: Right. Unfortunately, that’s the common thread that we’re hearing.
Van Pelt: Yes, and it’s interesting too from my career perspective, you see a lot of folks that are just opting to retire early or just switch. There’s been a huge wave of people that have turned over in my peer group here, just within the last 12 to 24 months. So it’s an interesting observation to make. So we’ll continue to see what that impact is on CIOs, but it’s just going to be a hard road here for a while.
Gamble: I think that must be the really tough part, knowing that there’s a light at the end of the tunnel, but it’s not coming anytime soon.
Van Pelt: No, not at all.
Gamble: Well, we’ve covered a lot here. Thanks so much for your time. I really appreciate it.
Van Pelt: Okay Kate. Have a good day.
Gamble: You too.