After spending 16 years at Trinity Health — which had just merged with Catholic Health East, graduating from being a large organization to a mega system — Kyle Johnson knew it was time for a change. Several hundred miles away, Eastern Maine was looking for a leader with experience in data management and analytics, and a match was made. In this interview, Johnson talks about building a foundation for population health, the organization-wide effort to restructure, EMHS’ homegrown umbrella portal, and her thoughts on the growing M&A trend in healthcare IT. She also talks about what it’s like to go through the merger process as a CIO, and when she knew it was time to move on.
- About Eastern Maine
- Cerner in hospitals, GE Centricity in ambulatory
- Clinician engagement — “We’re looking to take it to the next level.”
- Maine’s “robust” HIE
- Building a successful ACO — “You have to really understand the operation.”
- Shared services across the organization
- “How can we do things in a more efficient and more effective way?”
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That’s something I think that’s going to be new — to really heighten that engagement in the organization. But I don’t think anybody is opposed to it; I think it just hadn’t ever been really the expectation.
A lot of HIEs haven’t really matched and normalized data as it’s come in. It comes in as an admission/discharge/transfer record, and it goes back out that way.
Coming in to help enable some of that technology and automation is a better place to be than if you’re trying to establish the operations at the same time that you’re putting the technology in.
We brought all the folks together to say, how can we do this in a more efficient and more effective way for the organization? And so we redesigned IS, really looking with an eye toward the future.
Gamble: Hi Kyle, thank you so much for taking the time to speak with us today.
Johnson: Good morning, Kate.
Gamble: So to get us started, can you please give me a little bit of background information about Eastern Maine Healthcare — what you have in the way of hospitals and ambulatory, things like that.
Johnson: Eastern Maine Healthcare Systems is located in Bangor, Maine, which is in the central part of Maine. There are eight hospital facilities today associated with Eastern Maine, and they span from Portland in the south, all the way to the Aroostook Medical Center in the north, and points in between. We have about 12,000 employees and about 700 employed physicians in the health system. We really are full service with home health, behavioral, and all the services in between. We’re a level 1 trauma center at the Eastern Maine Medical Center here in Bangor, so we really offer the breadth of services across the health system.
Gamble: And it was Mercy Hospital that was acquired last year by Eastern Maine?
Johnson: Yes, and we’re in the process of due diligence with Mid Coast in Ellsworth, Maine.
Gamble: Okay. In terms of the clinical application environment, what type of ER system do you have in place in the hospitals?
Johnson: We use Cerner within the hospitals across all of our facilities. In fact, on October 1, we just converted Mercy Portland to the Cerner platform.
Gamble: What about in the ambulatory setting?
Johnson: In the ambulatory setting we predominantly use GE Centricity, but we also run a bit of Cerner’s ambulatory for our specialty clinics. Portland came to us on Allscripts in the ambulatory setting. We are in the midst of an ambulatory RFP process right now and we will be picking a single ambulatory solution for the enterprise by the end of the year, probably in the December timeframe.
Gamble: The goal there I’m sure is to have that easier integration, but as far as the relationship with the clinician leaders or physician leaders, is that something where they’re involved in the process as well?
Johnson: They are. I think we’re looking to take that involvement to the next level. I would tell you from my background and upbringing in healthcare IT that I would like to see even more clinician involvement than we’ve had historically here, and that’s the path that we are headed down.
Gamble: Is that challenging from the standpoint that you have physicians who are obviously are so busy? Would do you think has been the roadblock in getting that participation?
Johnson: Truthfully, I think we probably don’t have enough physician leadership in particular. I think the leadership has been a little bit better on the nursing side, but I don’t know that we have enough physician leaders in the system that have really been involved at that level. So quite honestly, I don’t think they know really what that looks like and the reasons why it’s important to be really engaged in that activity. That’s something I think that’s going to be new — to really heighten that engagement in the organization. But I don’t think anybody is opposed to it; I think it just hadn’t ever been really the expectation.
Gamble: So it’s like a cultural shift that needs to happen as far as that the clinicians just taking ownership to that next level.
Johnson: That’s right.
Gamble: Now as far as data exchange with other organizations, what are you doing from that standpoint?
Johnson: We are actually blessed in the state of Maine to have a really robust health information exchange at the state level. It’s called HealthInfoNet. It’s been live since 2003, around that timeframe. Just about everybody in the state participates — hospitals and providers, homecare, FQHCs and all the different provider organizations in the state. That’s really where the exchange happens, and it’s very robust.
I think what makes HealthInfoNet more of a leader in HIEs across the nation is the gentleman who runs the HealthInfoNet knew a long time ago that we should be normalizing data and creating a longitudinal patient record and matching all those artifacts together. It’s very robust in that way. A lot of HIEs haven’t really matched and normalized data as it’s come in. It comes in as an admission/discharge/transfer record and it goes back out that way. They haven’t grouped the data to create a single record for Kyle Johnson, no matter how many different records come in on me. That has been done here in the state of Maine, and really that information is available for sharing across the state. That’s one big way that we do that.
Gamble: It has to be an encouraging thing that HealthInfoNet has been sustainable or at least has stood the test of time, which is a concern with a lot of HIEs.
Johnson: If you ask me my prediction on that, I think at some point we’ll probably be down to kind of one per state, unless you have states like in New York City and these big metropolitan areas. I don’t know that even New York City will sustain 10 HIEs like they do today, so I think that will be interesting to watch over time.
Gamble: Yeah, definitely. I had read that Eastern Maine recently received funding from the CDC for a population health initiative, and I just wanted to talk a little bit about that and what that means for the organization.
Johnson: That is fairly new, but I do know Eastern Maine has been a recipient of a number of grants over the years, and because of the rural setting here, there are a lot of things we see that are different than metropolitan areas. On the population health journey, it’s interesting — we’ve had an ACO here for four years now, but it’s not very highly automated, and we don’t really have a true data warehouse to be doing population health analytics. I do know that to help support the work of the grant, we are going to be going after more automation in bringing the data together for analytics in that space. It’s an important initiative that we have on our list of projects for the coming couple of years.
Gamble: Okay. That’s a fairly new announcement, so I guess it’s going to obviously take some time to figure all of that out. Let’s talk a little bit about your data management and analytics strategy. Where does that stand?
Johnson: We really do not have a data warehouse here at Eastern Maine, and that was something I knew coming in. In fact, I think that was really one of the reasons Eastern Maine was excited about me, as I have quite an extensive background in data management, data warehousing, and data analytics. So I’ll be helping to build that here.
It’s kind of interesting though, the thing I like about being here is that particularly from the ACO perspective, they’ve been running the ACO as a business for the last three or four years, and they really understand what they’re trying to do from a business and clinical standpoint. So I think coming in to help enable some of that technology and automation is a better place to be than if you’re trying to establish the operations at the same time that you’re putting the technology in.
I came from Trinity before I came here, and we didn’t have an ACO set up. We were actually trying to stand the ACO up at the same time we were trying to put technology, and it was hard because folks didn’t really understand the operation yet. It’s very different here. They really do understand the operation. I like that position, and I think it’s going to mean much better partnering as now we’re trying to enable some of this with technology.
Gamble: I guess it’s really important how you choose to go about it. Like you said, if they’re talking about trying to stand up the ACO at the same time as kind of getting that data together and getting the data in then maybe that’s not the most effective way to go about it depending on the size of the scope of the organization.
Johnson: Yeah. It can just make it more challenging, for sure.
Gamble: I had read on the website that Eastern Maine had talked about a new model for IS and kind of a restructuring to maybe make things a little bit more efficient. I don’t know if this is something that had started before you got there or not, and just kind of what the organization is hoping to do with this initiative.
Johnson: Actually, IS is not the only organization that’s going through shared services. At the home office or corporate level of EHMS, we are going through some consolidation and shared services activity, which includes legal, HR, finance, IS, our community health organization, and our communications organization — really all of our corporate level departments are consolidating with the old level operation. From an IS perspective, IS is actually already fairly consolidated, but there were still about 75 people doing IS activities at our member hospitals. So this IS Shared Services activity kind of brought out the whole IS team together.
And then we were tasked to look at synergies as we brought all the folks together to say, how can we do this in a more efficient and more effective way for the organization? And so we redesigned IS, really looking with an eye toward the future. There were some new positions created, and there were positions that we decided were no longer needed.
During this time — and this was probably about a six- to nine-month process, some of which started before I came — we figured out that there would be about 43 positions that would no longer be needed in IS. Throughout that nine-month period of time, we really held tight on not hiring vacant or open positions, so much of that we were able to do through the vacant positions that we held that would not affect people in positions. A lot of people moved roles with this change, and I think probably when it was all said and done, five or six people to this point in time had been affected. So we were working with all those folks to look for other job opportunities.
Even as I say that, I’m still sitting on five or six leadership positions in IS that are open that I’m looking to fill. So it was really a reinvention that we did of IS to set ourselves up for the next five years, making sure we get people that have data management and data warehousing skills as an example of some of the new areas we’re going to need to be able to support.
Chapter 2 Coming Soon…