In today’s world, logging more than 20 years with the same health system is no easy feat. But what’s even more impressive is when a CIO has spent his entire career with the same organization and played an integral role in its growth, particularly from an IT standpoint. Twenty years after being asked to build a network at DuBois Regional, Tom Johnson is guiding the organization through a major evolution that has included acquiring community hospitals and achieving a successful big-bang implementation of Cerner. In this interview, Johnson talks about the challenges in working with owned physician practices, the paradigm shift that is needed to get patients more involved in their care, how he spends most of his time, and what he’s doing to avoid being pigeon-hold as a technology guy.
Chapter 1
- About DuBois Regional & Penn Highlands Health Care
- PHHC’s evolving governance model — “CIO by default”
- Getting owned physician practices on the same page
- “Each physician practice is its own individual kingdom that you have to overtake.”
- Big-bang, 6-month Cerner install
- “The longer a project takes, the greater chance it’s going to fail”
- From HIMSS Analytics Stage 3 to Stage 6 in 6 months
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Bold Statements
With our other two hospitals, we’re working on plans to see how we can get everyone on the same system, where they are on their Meaningful Use journey, what kind of investments they’ve already made, and how long the contracts are for. That gets a little sticky trying to time that appropriately with those competing priorities.
We’re constantly fighting that battle back and forth — if you’re a family physician, we’ve already developed all the forms and workflows, so we don’t have to do it again for you.
We try to take a very collaborative approach, because we want them to buy in. We want them to understand the value and how it’s going to streamline their operations and improve patient care, but you have to go through that whole process with each doctor, and some of these guys are very feisty.
We really did take on a lot of risk to do that many applications, but we thought it was the only way it was going to make sense because Cerner is a fully integrated system. It’s hard to do just half of a fully integrated system.
I’ve done three-year projects before, and by the time you get even halfway through, half the staff is gone, the technology has changed, and the market has shifted. By the end of the project, you don’t even know why you started it. It’s just too long of a time span — healthcare is too dynamic and technology evolves so quickly.
Gamble: Hi Tom, why don’t you start by giving us an overview of your organization?
Johnson: DuBois Regional Medical Center is a 250-bed regional medical center with a few centers of excellence in oncology, behavioral health, cardiology and orthopedics. We also have a Level 3 NICU. We are now members of a new health system that we formed last year called the Penn Highlands Healthcare, which is a four-hospital health system in Western Pennsylvania. So we have a critical access hospital, and besides DuBois Regional, we picked up two additional 80-bed community hospitals. We’re now a small integrated delivery network in Northwestern Pennsylvania. So that’s the basic composition of our organization.
Gamble: In terms of leadership at Penn Highlands Healthcare, do you have separate CIOs for the different hospitals? How does that work?
Johnson: Well, it’s kind of an evolving process. Right now Penn Highlands has a CEO and a CFO, but that’s it. We don’t have a CIO at the health system level. However, I do that role by default simply because the other hospitals are small enough that they don’t have a formal CIO. So I’ve been acting in that capacity to set the vision and strategy for the IT services for all of Penn Highlands, but I’m not actually in Penn Highlands yet.
Gamble: Are there department level managers that you meet with at those hospitals just to talk about where we are and what we’re looking to do, things like that?
Johnson: Yes, absolutely. We have regular meetings discussing ideas regarding how to better work together, to be more integrated, to do more shared projects, and just kind of keep us all on the same page.
Gamble: And you said the health system was formed in 2011?
Johnson: Yes, it was in October of 2011 when Penn Highlands was officially formed. We did acquire the critical access hospital in 2009. DuBois Regional acquired Brookville Hospital, which is critical access, and then we later formed Penn Highlands Healthcare, which all of that reports up to.
Gamble: Are the hospitals on different systems as far as EMRs, and if so, are there plans to get everyone on the same page?
Johnson: Sure. As you can imagine, they are on all different EMRs, unfortunately. That’s the way it goes. But since Brookville Hospital came on in 2009, we were able to put them on the same Cerner System that we have. So fortunately, from a timing perspective they were just about ready to make their EMR decision, so we were able to do that in collaboration. We signed with Cerner for what they call their community‑hosted model where we share the same domain for our applications but have separate databases for our EMPI and our patients.
We did find some very nice integration with Brookville. However, with our other two community hospitals, we’re currently working on plans to see how we can get everyone on the same system, where they are on their Meaningful Use journey, what kind of investments they’ve already made, and how long the contracts are for. That gets a little sticky trying to time that appropriately with those competing priorities.
Gamble: I can imagine. Now are there physician practices that refer into the hospitals?
Johnson: Yeah, we have a relatively unique model where we own almost all the physician practices in our community. I would say almost 90 percent of them are owned by the medical center. So really it’s more of just trying to standardize operations, find operational efficiencies, get everyone on the same EMR, get the interfaces all working properly, get them all tested for Meaningful Use, and really drive productivity. It’s not so much the referrals as it is just getting everyone on the same page. So when you have 100 physician practices and clinics, which is about where we are, the challenge is more getting everyone on the same page.
Gamble: Have you found that there’s a willingness among the community practices to get on the same page?
Johnson: We had a group of physicians do a vendor selection. They chose GE Centricity in the ambulatory space. So we have Cerner in the inpatient and GE in the ambulatory space. It’s the challenge of getting them all under the GE system and trying to standardize versus fighting each doctor to completely customize everything for them. We’re constantly fighting that battle back and forth — if you’re a family practice physician, we’ve already developed all the forms and workflows, so we don’t have to do it again for you. And then they all say, ‘but I’m special and I do everything differently.’
Gamble: Of course.
Johnson: So that’s the real challenge. Every time we go to a new practice or group of practices, we fight the same battles all over again.
Gamble: Are there kind of a few representative physicians, almost like physician champions? How do you try to communicate with all of them?
Johnson: There are physician champions, but what we’ve found out is they don’t necessarily represent everybody. Everyone’s their own individual. So when you say, these two guys represent everybody else, they do but they actually don’t, if that makes any sense.
Gamble: Yeah.
Johnson: So they’re the appointed representatives. But when you actually get to those individual doctors that they’re supposedly representing, they’re like, ‘no, that’s not how I do things.’ Or, ‘they don’t know how I practice.’ It’s almost like each physician practice is an own individual kingdom that you have to overtake.
Gamble: Yeah, I can imagine. Just because they’re owned by the hospital or health system that doesn’t necessarily mean everyone’s just going to use this system. It’s a little trickier than that, I guess.
Johnson: When we acquire them, it’s more in name, not in practice. We say, ‘you work for us and we’ll pay you, but you do what you want. You operate the way you have for 20 years.’ So it’s the breaking of the culture and breaking of the behavior that’s the real challenge. And obviously, we try to take a very collaborative approach, because we want them to buy in. We want them to understand the value and how it’s going to streamline their operations and improve patient care, but you have to go through that whole process with each doctor, and some of these guys are very feisty, so it’s a real challenge.
Gamble: Sure. Now as far as the hospital environment, you said you’re on Cerner. Tell me a little bit about the clinical application environment — how deep you are into the adoption and what you’re looking at in the immediate future.
Johnson: Yeah, we signed in 2009 with Cerner for 36 applications and the goal was to do a big-bang installation in six months that basically would transform our entire organization and get everyone on the same page. We really did take on a lot of risk to do that many applications, but we thought it was the only way it was going to make sense because Cerner is a fully integrated system. It’s hard to do just half of a fully integrated system. We covered all major clinical areas minus just a few, and we went live. It was a very rocky installation, but as things settled down, we really started to achieve the benefits of what we were looking for.
We were one of the first in Pennsylvania to attest for Meaningful Use. Shortly after we attested, which was in June of last year, a week later, we got HIMSS 6 recognition. And more importantly, we finally started to get everyone on the same page. We finally started to see that we already know the information when the patient shows up because it was captured in another department. We did the 5 Rights barcode scanning so we really started to significantly increase patient safety, because you have that 5 Rights checking right there. It doesn’t matter if you’re in a hurry, if you’re tired, or if you misread something — the barcode scanning verifies it. From when the pharmacist puts it in the dispense cabinet to the whole way down to administration, those safety features are built in.
It’s the same thing on the prescribing side. When the doctors actually go to put in the orders, it’s all backed by evidence-based medicine. It does all the drug-to-drug, drug-to-food, drug-to-allergy — all those checks, those contraindications are all right there to let the physician know and to alert them of the problem so they can address it upfront. All these safety features built in have made a significant impact to the quality of the care we provide here.
Gamble: I imagine. Now you said the goal was to do it in six months. Was that something you were able to achieve? That’s got to be extremely challenging, especially with everything you were trying to implement.
Johnson: What we found is that the longer a project takes, the greater chance it’s going to fail. So we focused the entire hospital’s resources on making that happen. We did achieve it in six months and the whole time everyone was telling us, ‘it can’t be done. Pull the plug. I’m quitting. This is not safe.’ All the naysayers told us it couldn’t be done, but we just believed in the vision and the strategy so much. I’ve done three-year projects before, and by the time you get even halfway through, half the staff is gone, the technology has changed, and the market has shifted. By the end of the project, you don’t even know why you started it. It’s just too long of a time span — healthcare is too dynamic and technology evolves so quickly that you have to compress the timeline to get the real value out of it. I can definitely verify doing that project in six months. It was a huge risk and a huge challenge, but the value we obtained from it is just tremendous.
Gamble: I’m sure that you have to just say, ‘okay, for six months, this is it. This is what we’re working on.’
Johnson: That’s exactly what we did. We brought in about 50 consultants and we just had people everywhere. We just mobbed the town and we had all the hotels and restaurants booked. It’s a risk to the organization, but it’s a greater risk to just sit back and say, ‘well, over the next five years, we’re going to incrementally creep closer to getting to where we want to be.’ We went from HIMSS Analytics Stage 3 to HIMSS Stage 6 in six months, and we just transformed our entire organization in the process.
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