When Sheri Rawlings started as CIO at San Juan Regional more than 4 years ago, the EHR picture in the physician community was dire. Users were giving up and going back to paper, and action needed to be taken. Quickly. But as a longtime veteran of healthcare, Rawlings knew that the situation wasn’t going to right itself unless the clinicians participated in and owned the selection of a new solution. And so IT stood on the sideline and offered support instead of running the show, and it paid off. In this interview, Rawlings provides her honest take on Meaningful Use — and why it’s much more challenging for community hospitals, and the strategy she employs when introducing change. She also talks about business continuity planning versus disaster prevention, why culture plays such a huge role in engagement, and when she got bit by the health IT bug.
- GE Centricity in owned practices
- Clinicians in the driver’s seat — “I allowed and encouraged them to make the selection.”
- IT as consultants, not owners
- Lack of ROI in HIEs
- Patient engagement obstacles
- “We never intended to chase the dollar.”
- Thoughts on MU – “I don’t think it achieved near what they thought it would.”
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It’s not just the EMR, but the delivery mechanism such as VMware or Citrix, along with the combination of some kind of a single sign-on. Those three pieces together can cause difficulties and challenges. That’s where we struggle.
IT took a hands-off approach. I think that helped because it wasn’t IT shoving it down their throat. It was, ‘we picked it, we’re going to make it work, and this is what we’re going to do with it.’
So many of the patients who would use this technology are younger and they’re not chronic patients. There’s no value in it for them. The group of people that you’re going to be able to target that would do it aren’t the ones that need it.
Meaningful Use works great if you’re working in a big city with a bunch of organizations in it. But for the majority of us who are community type hospitals, it really didn’t do anything except give us some extra funding and get our paper records electronic.
Gamble: With the clinics being on GE Centricity, how has that gone so far in terms clinician adoption? And is this both the owned and affiliated physicians?
Rawlings: It’s only the owned. Overall, I don’t think it’s gone badly. I think we have some technology challenges in how we deliver that particular product, and we continue to work on that. It’s a case of having not just the EMR, but the delivery mechanism such as VMware or Citrix, along with the combination of some kind of a single sign-on. Those three pieces together can cause difficulties and challenges. That’s where we struggle.
Overall, I think the groups have adopted it. It’s not uncommon; as with most places, physicians don’t like it as much. They would prefer paper. And you always get, ‘it was much faster.’ Yes, it was. It absolutely was, doctor. But that’s not why we’re doing it.’ Overall, they’ve done very well. They’re making their Meaningful Use numbers.
Gamble: Now in dealing with things like that or issues that arise, what’s your approach there? Are there specific committees set up or what is that approach as far as trying to help the physicians with these challenges?
Rawlings: Actually, the approach that I’ve taken with that whole group of people started actually when I first got here. It’s all a big picture thing. When I got here, the EMR that was being implemented was not meeting their needs. Clinics were closing, going back to paper, throwing a fit. We immediately started a new project to select a different one when I arrived. I allowed them and encouraged them to make the selection. I pruned the field down to acceptable ones. They were a part of that, and that was a formal process with people participating.
Once we picked the EMR and began the implementation, the clinics pretty much took over. IT stood to the side and supported them, guided them, and acted as consultants, but we let the clinics own that. We even brought in a project manager from INHS again and they led them through that. IT took a hands-off approach. I think that helped because it wasn’t IT shoving it down their throat. It was, ‘we picked it, we’re going to make it work, and this is what we’re going to do with it.’
Today, it continues the same way. The only analyst is working for me now, but in terms of what the design is, that kind of thing, we will participate and build it. We have core teams that work through that, but that’s not our system, and I think that’s where we’ve been able to get the adoption.
Gamble: That definitely can be key. When people think something is being forced on them, you’re just not going to get good results.
Rawlings: Right. And they can use it against you and say, ‘It’s all your fault.’ We’re not going down that path.
Gamble: That’s true in so many facets of management.
Gamble: Are you doing anything with telemedicine at this point, or is it something that you plan to look into?
Rawlings: Yes and no. We have a challenge in our neurology coverage and so we are employing teleneurologists. In terms of telemedicine with us being the monitors on the physician side, we are not doing that. We’ve talked about it, but we tend to be the recipients of it. We have a University of New Mexico Hospital Association group down in Albuquerque. They have specialists that maybe we will receive consulting services from them via telemedicine, but we have not been on that end of it yet.
Gamble: One of the biggest things there is the whole payment issue and that’s a pretty serious roadblock.
Rawlings: Yes, payment issues and also, we’re in the Four Corners. So we actually draw patients from Utah, Arizona, Colorado and New Mexico. The credentialing ocess for our providers is a bit of a challenge, so we haven’t even tried to start that process yet.
Gamble: That’s a really good point, especially in that unique geographical area that you’re in.
Gamble: Now, as far as data exchange or HIEs, are you involved in anything like that?
Rawlings: We have one in the State of New Mexico. It’s run by the Lovelace Foundation. There’ve been a lot of challenges with that, and I can honestly say we’ve not made much progress there. I think they’re still trying to develop what their process is. They made a vendor change this year, and so we’re just behind.
Gamble: I have to say that there aren’t that many success stories. It’s such a tough model to build and sustain.
Rawlings: Right. Again, because of our location, it was really difficult to determine where we wanted to put our dollars, because Colorado’s got two. They seem to be functioning well, and I don’t know about Utah or Arizona. Quite frankly, being a part of the one in Albuquerque really doesn’t do us much good because the providers are all in Albuquerque and we don’t see Albuquerque patients. Basically, what ends up happening is the data we put in to it is going to be available to the Albuquerque providers and they’ll use it when we send our folks, but it’s not going to be of any benefit to us at all. So we’ve just had to say, okay, it’s for the greater good. We’ll participate. We’ll do what we need to do because we see the value in it, but there’ll be no real good return on investment for us in the long run.
Gamble: There are enough projects that you have to worry about that do bring in returns.
Gamble: Now, as far as Meaningful Use, where do you stand?
Rawlings: We attested earlier in the year for Stage 1, Year 2. We’ve started the Year 2 with everybody else and we’re still hopeful with the 90 days that they’ll come through. Our clinics are finishing up their 90-day for this year. They’ll start their Year 2 January 1.
We have significant concerns about being able to make those, primarily in the patient engagement area. Because of our culture, we have large pockets of people who don’t have access to internet and who don’t speak English. We’re just not going to even be close. We’re working on all kinds of programs to get people involved, but I think at the end of the day, we’re just not going to make that number, and that’s okay. We never intended to chase the dollar. We’ve done everything else. We’ve put everything else in place, and I feel like that’s a huge success, and we’re a lot further ahead than we were three years ago.
Gamble: Right. When when you talk about the patient engagement piece, the way it’s set up is they have to do some kind of blanket. Everybody has to meet these numbers. But in your area that is just so different from something like Boston or another metropolitan area that’s very tech savvy area as far as patients. That’s a really tough one. I can certainly understand your strategy there.
Rawlings: We have the ability to become an exception and not have to meet that measure if we don’t have broadband coverage. The problem is we do have the broadband coverage; the culture hasn’t adopted it.
The other piece of that — and this is just my own personal soapbox — is that so many of the patients who would use this technology are younger and they’re not chronic patients. There’s no value in it for them. The group of people that you’re going to be able to target that would do it aren’t the ones that need it. The folks here in this area who are older and who are chronic patients who need that care, that engagement in their record, they just aren’t going to adopt that kind of technology. It’s not even a measure that makes sense for us to, but it is what it is and you can’t make laws for everything or programs for everything.
Gamble: It’s interesting. On the whole though, are you happy with the direction of Meaningful Use or at least the objectives of it?
Rawlings: No. And I don’t mean to be non-supportive. In spite of where we are today, I think we’re a lot further than where we were. I don’t think it achieved near what they thought it would. The whole interoperability piece, like I talked about earlier in terms of feeding my records to some place in Albuquerque, those aren’t the things that are going to help me or help us take better care of our patients. I think that Meaningful Use works great if you’re working in a big city with a bunch of organizations in it. But for the majority of us who are community type hospitals, it really didn’t do anything for us except give us some extra funding and get our paper records electronic.
Gamble: That’s a really valid point, and you’re not the only one who feels that way. You understand what it was trying to do, but it just didn’t necessarily get there and may not get there.