Being CIO of a two-hospital system within the massive Catholic Healthcare East superstructure presents opportunities and challenges for CIO Maureen Hetu. On the upside, her facilities are able to afford advanced technologies they would never have been able to obtain on their own, while, on the challenge side of the equation, dotted-line governance and having “multiple” bosses means going out of one’s way to keep everyone informed. But those are challenges she’s taking in stride as Hetu works to deepen the usage of Siemens Soarian clinicals at her hospitals. To learn more about her HIT journey, healthsystemCIO.com recently caught up with the long-time executive.
- About Lourdes
- Governance and dotted lines
- Being part of a (much) larger health system
- Standardization versus customization
- Two primary clinical suites in play — Siemens Soarian & Meditech
- Holding off on revenue cycle
- “Chasing” the electronic medical record
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There’s a tradeoff that goes with that. It means that we may not always have the flexibility to get every bell and whistle that we’re looking for, but since we’re aggregating all of our intelligence into a single system, we have an opportunity to get hopefully the best of both worlds.
We couldn’t do that and do revenue cycle at the same time, not to mention that there’s significant risk in doing that, at least from our perspective, just trying to manage something that massive and not bring revenue cycle to its knees.
Our strategy was get everything else automated and digitized, and then bring the physicians up with CPOE and physician documentation — to let them be the last people to come on to the electronic health records.
Guerra: Good morning Maureen, I’m looking forward to chatting with you about your work at Lourdes Health System.
Hetu: Good morning Anthony.
Guerra: You’re in the greater Philadelphia area, which you can define further for me. Tell us a little bit about the health system, facilities, components, just so we have the lay of the land, please.
Hetu: Lourdes Health System is actually comprised of two hospitals – Our Lady of Lourdes Medical Center is in Camden, New Jersey. It’s a regional referral center that provides a wide variety of care, including a perinatal center, it provides care for high-risk mothers and infants, a regional rehabilitation center, a dialysis center, organ transplantation, and then we also have a very robust cardiac program.
Guerra: Approximately how many beds combined, or if you want to tell me each hospital?
Hetu: In Our Lady of Lourdes Medical Center, it’s 410 beds. It’s a reasonable size. Lourdes Medical Center Burlington County is a community hospital that has about 249 beds. The Lourdes Medical Center Burlington County is located in Willingboro, New Jersey. So it’s about 25 minutes to half an hour away from Camden.
The community hospital provides all the typical medical and surgical services, and then also has behavioral health services and a Lourdes Specialty Hospital, which is a long- term acute care hospital.
Guerra: 240 beds, that’s a good size for a community hospital, right?
Hetu: It is. Obviously these days the census tends to be much lower than the licensed bed count, so they’re basically the licensed bed counts at those hospitals.
Guerra: What about clinics, physician practices, that kind of stuff?
Hetu: We have Lourdes Medical Associates and Lourdes Cardiology Services, our employed physician practices. Lourdes Medical Associates, I believe at this point has about 100 physicians, give or take. Then Lourdes Cardiology Services, and I forget the exact number, but I want to say that there’s in the neighborhood of 50 cardiologists.
We have a pretty significant employed physician model, although we do still have a multitude of independent physicians, private physicians that practice on each of our medical staffs. So it’s an open medical staff.
Guerra: Right. So you’ve got to deal with all the different dynamics of employed physicians and the independents coming in?
Hetu: Absolutely. Lourdes Health System is actually part of Catholic Health East. Catholic Health East is one of the largest Catholic healthcare providers, with hospitals from Maine to Florida. Literally, I believe there are about 34 hospitals up and down the East Coast.
Guerra: What’s the governance model for you? I guess if you weren’t part of Catholic East, you might be reporting to the CEO or CFO. Do you instead report to someone in a larger IT structure that’s part of Catholic Healthcare East?
Hetu: Both. It’s always interesting when you have multiple bosses. But most environments do these days.
Hetu: So I actually report to Donnette Herring, who is the CIO at Catholic Health East, and then I have a dotted line to the COO here at Lourdes Health System, who is Mark Nessel.
Guerra: I’m not going to put you in trouble with your bosses, but does that present some interesting challenges that someone else may not have to deal with? Do you have to make sure everyone stays informed of conversations you’re having with the other one, that type of thing?
Hetu: Absolutely. But I can’t say that it’s really presented a lot of challenges. I tend to find that the local executives and the system executives don’t necessarily end up out of sync very often. So it’s more communication, making sure that we understand what the system office initiatives are and can put those in context at the regional healthcare corporations, which is how we refer to our local ministries. Then I also make sure that I can translate the strategic priorities and the business needs of the ministry for the system office executives.
Guerra: The larger the purview, the more you want standardization. So the people with Catholic Healthcare East running IT for all of the hospitals say we need uniformity, standardization here…
Guerra: Are you occasionally in the position of talking to Catholic Health East and saying ‘Here’s why you may want to give us some leeway or let us do…’ do those kinds of dynamics happen?
Hetu: All the time. The reality is, for the local ministries, affordability is always an issue. So the advantage that you have in a large system, when you manage to deal with the standardization effectively, is that you realize significant savings from a cost perspective. So they’re able to afford technologies that we wouldn’t be able to afford otherwise. There’s a tradeoff that goes with that. It means that we may not always have the flexibility to get every bell and whistle that we’re looking for, but since we’re aggregating all of our intelligence into a single system, we have an opportunity to get hopefully the best of both worlds. We’re able to achieve the standardization, get the cost savings, but still have a product that’s robust and supports our needs.
Then, on the smaller initiatives, there is flexibility. If there’s not a corporate standard, then there is flexibility to take a look at different types of products and technologies.
Guerra: Do you find that sometimes you’re in a position of being convinced yourself, but knowing that you have to go back home to your two hospitals and convince your people to go with the corporate program?
Hetu: Yes, absolutely. But if you’re in the right position, you have the opportunity to actually have input in the conversation before a decision is made. You would be able to take that local perspective, understand what the rationale is from a system office perspective, make sure that we voice any concerns, any implications, what this means for the local businesses and the local ministry, and then hopefully you come out of it with a decision that, although it may not be exactly what we might have done independently, isn’t going to create significant business issues.
Guerra: Right. Let’s get a little specific. When we talk about standardization, we’re usually talking about standardizing applications, that kind of thing. Is there a standard for the health system in terms of the clinical application?
Hetu: There are actually two at this point. Catholic Health East came together about 13 years ago. So most of the health systems, when we came together, were independent systems. There were two primary products that were in play from a hospital information systems standpoint. Some of the hospitals, the New Jersey hospitals in particular, we were Siemens customers. So at this point, we’ve deployed Siemens Soarian as our HIS and the complement Siemens products for radiology, pharmacy, medication administration, bar coding, etc. The other contingent of CHE hospitals is running Meditech.
Guerra: Okay. So you’re on Soarian. Were you on Invision and then you went to Soarian?
Guerra: When did that happen?
Hetu: We actually deployed Soarian Clinical Access back in 2008. So we took our first step into the Soarian environment when we were looking for something more robust in terms of clinical data repository. Then in 2011, and through April of 2012, we deployed the balance of the Soarian clinical products. So we are running Soarian for all of our order processing and clinical documentation and are in the process of deploying CPOE, and then we’ll move into physician documentation.
Guerra: Did you go up on Soarian on the financial side?
Hetu: No we did not. We’re still Invision on the financial side.
Guerra: Is that just because you don’t want to mess with the revenue cycle unless you absolutely have to?
Hetu: I think it’s a combination of that and affordability. We need to stage the investment so we can afford it. On the clinical side, we’ve been chasing our electronic health record probably for the past 12 years. This was our opportunity — recognizing Meaningful Use — to make the very significant investment in getting to the electronic record. We couldn’t do that and do revenue cycle at the same time, not to mention that there’s significant risk in doing that, at least from our perspective, just trying to manage something that massive and not bring revenue cycle to its knees.
Guerra: I think every CIO has a deep fear of messing up the revenue cycle. It can make Meaningful Use dollars seem like peanuts.
Hetu: We actually had done that back in 2001. We were two hospitals running two different systems at that point and deployed Siemens Invision both on the revenue cycle as well as the clinicals. So we had gone through that within my memory here and decided that we didn’t want to try doing big bang again and doing both the revenue cycle and the clinical.
Guerra: Usually the revenue cycle, the number of days, is significant enough as it is, right?
Hetu: It becomes even more complex, we have a combined business office that supports not just the two Lourdes facilities but also St. Francis and St. Michaels in Newark. So the four New Jersey hospitals are actually run out of the CHE system office, although it’s physically located in New Jersey. So it becomes even more complex, and from a CHE perspective, they brought all four hospitals live at the same time we were on the same implementation cycle. So the project was big enough. So we decided to put off doing revenue cycle. We didn’t have a whole lot of conversation about it but I think, intuitively, we’re all thinking this is enough for us to bite off in a single fiscal year.
Guerra: Right. When you talked about the electronic medical records, you used the term “chasing for the last 12 years.” I thought that was an interesting term. Tell me more about that dynamic.
Hetu: Sure. I can remember in the early days of my career — and I’m going to date myself and go back to the early 1980s — going to a Delaware Valley HIMSS conference with the person who was then the director of medical records, that’s how they referred to the function. In that conference, we were talking about an electronic medical record. So if you think about how healthcare has evolved, we have been thinking and attempting to get to an electronic record for decades. In my early days, as I came into Lourdes Health System back in 2000 — so I’ve been with the health system for 12 years as CIO — one of the first things that we did was put together our first IT strategic plan. It was evident within that plan, with the support of the executive team, that our long term vision involved getting to electronic health records.
There were, from a clinical and quality and patient safety standpoint, no arguments that it would significantly improve the quality of care. Also from an efficiency and care delivery standpoint, we know that if we are really going to gain the efficiency that we need in the health system and reduce the cost, that we needed to eliminate all of the manual paper processes that we have. The only way you do that is to get to an electronic health record.
So incrementally, over the past 12 years, we’ve been making the investments that were too big for us to bite off in any one year. So we started automating various systems and it was what most health systems do. We take each of the individual areas, make investments strategically over a period of time, and then ultimately get to the point where we have an EMR. Our strategy was get everything else automated and digitized, and then bring the physicians up with CPOE and physician documentation — to let them be the last people to come on to the electronic health records.
So we’ve pursued that pretty steadily over the course of the past 12 years. And we are at the point where we’re anticipating we’ll have our physicians come live in a pilot, potentially, the fourth quarter of this year, if not early in 2013.