It’s no secret that in the race to achieve Meaningful Use, critical access and small, rural hospitals are at a distinct disadvantage. For years, Chuck Christian and other industry leaders have argued that factors such as limited capital and resources can make it too difficult for the little guys to compete. Recently, their pleas were answered when ONC announced plans to provide up to $30 million for regional extension centers to target critical access hospitals and small hospitals. In this interview, Christian discusses the unique challenges many organizations face in recruiting IT talent and managing vendor relationships, programs that can help small hospitals successfully leverage consultant expertise, and why implementations are “still more of an art than a science.”
- Rural/critical access hospitals and consultants
- Working with Stoltenberg
- Leveraging best practices
- “If you can standardize a process, then you can optimize it”
- The real definition of “implementation services”
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One of my biggest burrs underneath my saddle is that you’ll have a firm send somebody in, and they don’t really come out and say that they’re an expert, but they give that impression, and you come to find out they’ve never been onsite before and they’re winging it.
The whole idea of ACHIEVE is coming in and doing an implementation partnered up with your own internal staff so that when the project is done, the expertise that you need about how everything was put together, what the process is, and why the decisions were made stays with you rather than walking out the door.
I’m a firm believer in standardization, because if you can standardize a process, then you can optimize it. If you have a process that’s not standard throughout the entire organization, you have absolutely zero hope of making it more efficient.
Installing the software is really, truly the easiest part. It’s changing the work processes to incorporate the very best parts of the software and learning how to utilize that to have a positive impact on how we take care of our patients and the efficiency at which we’re able to do it — that’s the key.
What I think has worked well for us in this region is reaching out to each other. You’re not really asking for a handout, but you’re asking, ‘Lend me your expertise.’ I’m not shy enough or dumb enough to think that I know everything.
Guerra: Let’s talk a little bit about consulting. I know you’ve done work with Stoltenberg. They’ve got a product geared toward small and rural hospitals. Tell me about what you’ve done with Stoltenberg and the ACHIEVE roadmap.
Christian: Sure. I’ll give you full disclosure. I’ve known Sheri and a lot of her folks for a lot of years through the CHIME organization. She’s a member of the CHIME Foundation, and I wound up being her board liaison when I was on the board of directors. I’ve gotten to know Sheri and we’ve used her services here at Good Samaritan. I’ve recommended her services for some of the other facilities in the area, and they chose to go in that direction as well.
One of the things that I really like about the ACHIEVE model is that it provides some resources that small facilities may or may not have. The one thing I’ve always worried about with consultants — and I’ve talked to Sheri about this — with bringing somebody in to do an implementation or do a project and stuff, is when they’re done, they take all that knowledge right back out the door with them. And I think what Sheri and her group have designed dovetails right into their Junior Consultants program. Are you familiar with that as well?
Guerra: No, I’m not.
Christian: She’s got a program where she’ll bring in folks right out of school or fresh to the industry and partner them up with a more seasoned consultant, and the price of them is much, much less. And so they’ll get to do work and learn at the same time, and at the end of that, if you want to employ them, you can. That way, that expertise can stay onsite if you want to hire them as a member of your staff.
I think that’s a pretty creative and innovative way because one of my biggest burrs underneath my saddle, if you will, is that you’ll have a firm send somebody in, and they don’t really come out and say that they’re an expert, but they give that impression, and you come to find out they’ve never been onsite before and they’re winging it. And they’re on the phone a lot with seasoned folks and they’re trying to do the best they can, but what you get is a little less than something that’s perfect. This way, with the junior consulting program, you’re told upfront that they don’t know everything that they need to know, but they’re going to learn during this process. And you’re not going to pay for them at the same rate that you would, but they’re going to be more like an intern or an extern. You kind of marry those two things together. The whole idea of ACHIEVE is coming in and doing an implementation partnered up with your own internal staff so that when the project is done, the expertise that you need about how everything was put together, what the process is, and why the decisions were made stays with you rather than walking out the door.
The other thing they do is that in a lot of these implementations, a lot of the work that needs to be done is the same work that needs to be done in any organization. There are also some standards and best practices that can be gleaned from doing things multiple times. I think that’s one of the things I like — getting those best practices and being able to leverage that, because that’s what I do. When we run into an issue with an application or something, I’ll just send out some emails to some other buddies that I know are doing the same thing, put my staff up with their staff who has already been there and done that, and I don’t have to repave that cow path. I can learn from someone else’s experiences and not get a leg blown off on that landmine out there.
I think that’s what Sheri’s program does as well; it provides some of those standard best practices that can be implemented very quickly from one place to the next. They also provide the resources to do some of the standard built. And so these people — this is what they’ve done before. They know how to do it. They just drop in and get it done, because it’s going to be the same. And as far as the timeframes that we’re dealing with now with the implementations, if you think about it, everybody on the planet, if you’re attesting this year you have another full year of Stage 1, you‘ve got to meet the new certification criteria and have Stage 2 ready to go. The latest you could possibly start your 90-day data gathering is July 1, 2014. So if you look at the calendar and look at the development life cycles of the vendors, you’re really going to have a 15 to 18-month window to get this stuff done. You need to be looking at best practices; there’s no time to customize anything. You just have to get it in and make sure it’s usable.
It’s kind of like the Epic optimization. After the implementation, you go and optimize it. It’s a really good approach if you’ve got good standard best practices — this is how you do this — that can be adequately trained and that is not such a derivation from your current practices. I’m a firm believer in standardization because if you can standardize a process, then you can optimize it. If you have a process that’s not standard throughout the entire organization, you have absolutely zero hope of making it more efficient, because you’ll never get it nailed down. That’s what I like about Sheri’s approach with that.
Guerra: That lawsuit I mentioned before, I remember reading the story about it, and I think it was the CEO of the hospital who said, ‘Next time, I’ll definitely hire consultants, and I wont be too proud to bring in some help.’ And I thought, ‘Oh my god, you’re just realizing that now?’ I thought that was an unbelievable statement that you let pride get in the way of bringing in consulting. To be a small hospital and to try and do this on your own, to me, is just crazy. You need someone to come in and give you that help. If the vendor can’t do it or isn’t going to do it or it’s not part of the package or it’s not what they do — ‘We do the software; we’ll give you the basics of putting it in.’ But you need to bring in someone to help you roll these stuff out, don’t you think?
Christian: I think everybody is learning what the definition of implementation services is. It’s getting the software in and allowing you to do all the process stuff and it’s a lot harder than what everybody really, really thinks. There’s so much difference between implementation and adoption. What we’ve got to shoot for is adoption because actually the software, we’ve rolled it in and incorporated it into our work processes, and it doesn’t get in the way, but it enhances our ability to provide high quality healthcare. I think that’s the hard part. That’s why you’re seeing a lot of expertise, particularly, in the large organizations like CMIOs, CNIOs and all those clinical informatics departments and that kind of stuff springing up, because installing the software is really, truly the easiest part. It’s changing the work processes to incorporate the very best parts of the software and learning how to utilize that to have a very positive impact on how we take care of our patients and the efficiency at which we’re able to do it — that’s the key.
I just had a conversation early this morning on that very topic about how do we use the data that we’re gathering and turn it into information that’s useful and present it in a manner that saves time and steps and enhances communications between the various arrays of caregivers that are involved in the patient stay. If you look at the length of stay in this country, it continues to shrink. That means a couple of things; we’ve got sicker people coming to the hospital these days and they’re here for shorter periods of time, and the incentives are lined up to do those types of things — not admit them to the hospital and make sure they’re getting the care they need and they’re sent home to finish their recovery.
In the future, I think we’re going to see some of the sickest patients. They’re going to be really sick before they get to the hospital, because care is going to be provided at different levels before they’re actually admitted to the hospital, because that’s the most expensive care that we have. We’re trying to do more with taking care of that patient and addressing their illness state in a compressed timeframe. So that means in order to do it well, you’ve got to have a tightly integrated care team, and those care team members are going to change depending upon what the patient’s difficulty is, and they’ve got to be really good and coordinated through those care processes.
Guerra: As a final question, Chuck, because I know you’ve got to get going, what would be your message or advice or inspirational comment to those running technology in critical access and rural hospitals and those facilities that are struggling with the Meaningful Use program?
Christian: I don’t know how inspirational I can be, Anthony, but what I think has worked well for us in this region is reaching out to each other. You’re not really asking for a handout, but you’re asking, ‘Lend me your expertise.’ I’m not shy enough or dumb enough to think that I know everything, and because when you have somebody that has to get their job done, they get really creative and innovative about how to be efficient, and we all can learn from each other. We need to try to get groups together, reach out to each other, and create that network of individuals locally and even nationally.
I’ve had the privilege of getting to know a lot of folks that are really, really good at what they do and are really, really smart, and I leverage those relationships so I can bring what I’ve learned from them back to Good Samaritan. Will I do it exactly the way they did it? No, because I may or may not have the resources. It’s like when I was telling you before we started recording about me building a coffee table that my wife saw in a magazine. Is it just exactly like it? No, but it’s what she wanted. It’s made out of the material that she wanted. I made her happy, so I’m good. You incorporate that knowledge and bring it back locally. So that’s my advice — reach out to those networks of individuals, ones that you trust their knowledge, and create those relationships that could come in real handy when things are not going well, or you’re about to step onto thin ice and you really don’t know where the stones are underneath the ice that’ll support you.
Guerra: All right, Chuck. That is all I had for you today. I want to thank you so much for your time. It’s a pleasure as always.
Christian: Thanks very much for the opportunity. I appreciate it, and I’ll see you at the Fall Forum.
Guerra: All right, my friend. See you soon. Thank you.
Christian: Okay, take care.