Of the many lessons Maggie Ratliff learned from working at large organizations, none was more valuable than the need to do your due diligence. For some CIOs, that might mean using data to argue the case for a new system. For Ratliff, it means doing everything she can to avoid a major rip and replace, including bringing in the vendor to do an optimization study. In this interview, she talks about what it’s like to lose the red tape, how she approached being the new CIO, her concerns about MU stage 2, and how she is leveraging physician leaders to help drum up support for IT tools. Ratliff also talks about the staffing challenges that come with being in a rural area, the one thing you can’t do with physicians, and what she does to unwind.
Chapter 2
- Leveraging physician leaders
- The need for structure within IT
- Upgrading to Meditech 5.6.6
- Optimization study — “We want to make sure we do our due diligence.”
- Preparing for MU 2
- Recruiting challenges
- Leadership development
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Bold Statements
One thing you can’t do is waste the physician’s time. Their time is so valuable. You want to have a committee that has a good structure to it, has some clout behind it by being an official committee named in the bylaws, and has a good reporting structure.
We need to take a deep breath, get the update in, do an optimization study, and figure out if this is truly going to work for our organization. And if not, what’s going to be our strategy going forward.
You can’t do anything quickly in a large organization, so you have to make sure you do your due diligence, because you only get one chance to present it. Once you do, you want to make sure you have all your ducks in a row.
We are very concerned that our vendor is going to be able to deliver, and if they do deliver, the timeline of what we’re going to have to do to make sure that we can attest and get things ready in a timely fashion.
Being in a rural area, it’s very hard to recruit people. Even though we’re very close to Eastern Illinois University, it’s still hard to get people to come and want to stay here and commit to being here.
Gamble: As far as clinicians, are there physician leaders or people like that who you’ve involved in this?
Ratliff: Yes, there are. We have a CMIO who’s part-time — he has been extremely helpful with some of the projects that we’ve rolled out recently. For example, we just rolled out voice recognition, and it has been hugely successful. We probably have about 60 percent of our physicians using it close to 100 percent of the time. There are some practices, obviously, that cannot use it because of the complex cases they see, but they are using it on the backend instead of the frontend. It’s been hugely successful, and I think the reason for that is because we’ve had our CMIO actively involved.
We have what we call our medical informatics team; it’s a team of physicians that meet once a month. We talk about physician strategies and how IT can support them — things like standardization among the systems and what types of information they need to see for their patients. That team itself has been very successful moving forward.
Gamble: Is that something that was already in place, having that medical informatics team?
Ratliff: It wasn’t in place. I think they had a team per se, but not really an official team. They had a group that got together every now and then. We just added a little more structure to it, and so now it meets regularly. There’s a regular group of people that are in attendance. It’s an official committee, and it’s written in the bylaws now. It gives it more power and more clout, and physicians really feel like they have input into what we’re doing, from an IT system perspective going forward.
Gamble: That seems to me like something that could be an example of your experience with a larger health system, making something like that an official committee. That could be a positive of having been part of a big corporation.
Ratliff: I think it was. It’s been my experience in the past with the larger organizations that this is how you are successful. You have to have a committee and you have to have structure. One thing you can’t do is waste the physician’s time. Their time is so valuable to them. You want to have a committee that has a good structure to it, has some clout behind it by being an official committee named in the bylaws, and has a good reporting structure, up to the medical executive team and then on to the board. Things like that really make it worth their while.
Gamble: I imagine. That’s a good point — you really want to make sure that since they’re putting in this time with their busy schedules, that they’re getting enough out of it. That’s key. Let’s talk a little bit about the clinical application environment. Are you on Meditech?
Ratliff: We are on Meditech for the inpatient side, and we are using LSS for the outpatient EMR.
Gamble: On that front, are there any major plans for the immediate future in terms of upgrades and things like that?
Ratliff: We’re going through an upgrade right now with Meditech. We’re on Client Server, version 5.6.4. We are in the middle of an update to 5.6.6, which is also an update to our LSS System — our ambulatory record. We have really had some issues here with the ambulatory EMR and how it works for the physicians — or how it doesn’t work for the physicians. They really, truly haven’t been happy with it. Part of my strategy has been, let’s do the update. Let’s get the update going and let’s implement the functionality that they’re saying is new with this update. Let’s make sure that we do that correctly, and then I want to have a group of people come in from Meditech to help us do an optimization study to make sure that we are using the software to its fullest potential and that our physicians are using it correctly.
I think what’s happened in the past — and I know it’s not just here; it’s probably every system out there — is you get a software application and then you end up customizing it to the point where it’s almost unrecognizable or it’s not easily usable throughout the organization. I think that’s what we’ve done here. We need to take a deep breath, get the update in, do an optimization study, and figure out if this is truly going to work for our organization. And if not, what’s going to be our strategy going forward — do we continue to try to develop it or do we just walk away from it? That’s not a decision you take lightly, because obviously IT systems are very expensive and there’s been a huge investment made here. We want to make sure we get the most out of that investment. So that’s why we want to do the optimization study — to make sure we do our due diligence before we make any decision going forward. If what we have will work, then we need to develop it and we need to train our physicians and we need to make sure we are using it optimally so that we can have good data for our physicians to provide care to patients and things like that.
Gamble: I like what you said about due diligence. That’s the kind of thing where if it does turn out that you have to make a change, you’ll be able to say, okay, these are all the steps we went through to make sure that this is what needed to happen.
Ratliff: Absolutely. I think you learn that too in big organizations. You really can’t do anything quickly in a large organization, so you have to make sure you do your due diligence, because you really only get one chance to present it. Once you do, you want to make sure you have all your ducks in a row.
Gamble: You’re fighting for every dollar, so you have to make sure that everything is being spent in the best way possible.
Ratliff: I have to feel good about that too. I have to know that what I’m asking for is truly needed, because I know that any money I get related to IT is not being spent on equipment toward patient care or something like that. I want to make sure that it’s something that’s going to be valuable to the organization and help support quality patient care rather than take away from it.
Gamble: Where does the organization stand as far as Meaningful Use at this point?
Ratliff: We have completed Stage 1 year one and two, and we are working toward Stage 2. Part of our update is going to deliver some of the software we need to meet Stage 2 compliance with the patient portal and things like that. We’ve been very successful here with Meaningful Use. We’ve attested for all of the eligible providers that we can attest for. It’s a continuing process, because as we bring new providers on and they become eligible, then we attest for them. The hospital has attested for both Stage 1 years, and hopefully, going forward we’ll be successful with Stage 2 as well.
Gamble: We’re hearing a lot about the push to extend Stage 2. We’re hearing from a lot of organizations that are waiting for certain vendor updates. Is this extension something that you support and you think that could benefit your organization?
Ratliff: Absolutely. I think where we are right now, we are very concerned that our vendor is going to be able to deliver, and if they do deliver, the timeline of what we’re going to have to do to make sure that we can attest and get things ready in a timely fashion. I think the extension would help a great deal.
Gamble: Being in a rural area, are you doing work with telemedicine or do you have any plans for that?
Ratliff: We are looking into that now. We’ve looked at a couple of grants. We’ve looked at working with our local university for some psych telemedicine. We’ve looked at maybe partnering with an organization in Springfield. We’re sort of vetting it out now. We haven’t really determined whether or not — or when — we’re going to move forward with it. We probably will; it’s just a matter of when. Right now our focus, quite honestly, is on Meaningful Use and trying to get this update done and make sure that we are using the right system and going forward. I see it in our future, but we’re not doing it now.
Gamble: It sounds there’s a lot on your plate, like so many people we talk to. There’s just so much on everyone’s plate and it seems like it’s a balancing act right now.
Ratliff: It really is. I know there are some things now that qualify, but I think until we really get a lot of the reimbursement questions answered, I’m not sure how many organizations are going to try to move forward, especially smaller organizations like this one.
Gamble: Yeah, exactly. It has to make sense in every way.
Ratliff: Absolutely.
Gamble: When we talk about having so many things going on, a key issue there is staffing and having enough people — and having the right people — in place. How is your organization been able to recruit and hold on to top people? Is that something that’s been a challenge?
Ratliff: Recruiting is a challenge for us. Being in a rural area, it’s very hard to recruit people. Even though we’re very close to Eastern Illinois University, it’s still hard to get people to come and want to stay here and commit to being here. Our success really honestly has been with people from our area that have sort of maybe gone away for training and then come back and have family ties or have a commitment to the community. That’s really where our success has been. Obviously, that’s not a huge pool of people to pull from, so we have had our challenges.
Gamble: I can imagine. Has there been more of a focus on trying to really advance the skills of the people you do have — the ones who are committed to the area?
Ratliff: Absolutely. We do a lot of work in employee development — not just in the IT area, but across the board in the hospital. It’s a huge focus. We implemented an Excellence Way of Life program, and part of that is leadership development and really trying to enhance the skills of the people that are here and help support them in their growth.
Gamble: Are there educational programs or things like that? Anything related to the university at this point?
Ratliff: Not necessarily right now. We do a lot of internal education, and obviously there area conferences out there that people attend all the time. We don’t have a partnership with the university at this point for education.
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