When you’re the new CIO, the first few months can be a big adjustment period, but the key, according to Sarah Richardson, is to listen. “You talk to everybody and ask a million questions and listen.” For Richardson, who joined NCH as CIO last fall, this strategy has paid off in the past, and continues to be pivotal in becoming part of the leadership team. In this interview, Richardson talks about how her experiences in the not-for-profit and corporate IT worlds helped prepare her for her current role; what she’s learned about how to build a strong team and keep staff motivated; and how to determine when it’s time to move on. She also discusses the benefits of being a fully outsourced IT shop, her team’s strong focus on population health and patient engagement, and why volunteering is so important to her.
- About NCH
- Cerner in hospitals & physician practices
- Fully outsourced IT shop — “It feels like we have 80-plus people when we only have 52”
- NCH’s “matrixed” reporting structure
- Reaching HIMSS Stage 7
- “There’s no such thing as paperless.”
- Smart room technology
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We’re able to really share some best practices and ideas across the board. So there’s a huge piece of being a Mayo-affiliated network from a clinical perspective, but then the operational and technology perspective have also married themselves very well.
To me, management has never been about an org chart. That is probably more true than ever in the fact that nobody in IT ‘reports to me,’ and yet we work hand in hand, side by side, all day in the trenches.
Clinical leadership and IT leadership are in lockstep, because IT cannot be the leader of a lot of these big initiatives. We just supply the pathway to get there and help people work through how to make it successfully happen.
My favorite thing about being in IT today is trying to figure out what paperless will actually be someday. There’s no such thing. We create different piles in different locations — just because we’re scanning them in, does not make it a paperless environment.
It’s a pretty exciting place to be when you hear, ‘hey, we’re going to get an X million dollar donation to finish out a technology,’ and boom, it’s on your roadmap and we’re going for it.
Gamble: Hi Sarah, thank you so much for taking some time to speak with us today.
Richardson: Absolutely, thank you.
Gamble: So to give our readers and listeners some background, can you just talk a little bit about NCH Healthcare System — what you have in terms of hospitals, bed size, ambulatory, things like that?
Richardson: Sure. NCH is a not-for-profit multi-facility healthcare system located in Naples, Florida. We have two campuses, NCH Downtown and NCH North. We provide personalized care for over 30,000 patients a year in our two-hospital, 715-bed system. We are consistently recognized for our outstanding reputation. Through Joint commission, we have accreditation in joint and hip replacement, and we’ve just recently been accredited for our stroke program. Our quality metrics consistently exceed most others. We have a Leapfrog ‘A’ rating time and again.
From a technology perspective, we are fully integrated with Cerner in both ambulatory and inpatient. We are a Cerner ITWorks client, which means we have all of our IT outsourced to Cerner, although we have 52 associates here on site for the healthcare system. We are a Most Wired organization three years running; we just applied for year four. And we were at HIMSS in April to except our HIMSS Level 7 award. In addition, we are a Mayo affiliated network member. So we became that in August of 2012. NCH is the first member of the network in Florida and the southeast region of the United States, which is also a very cool designation for us.
We’ve got over 650 physicians that practice medicine here throughout Collier County in southwest Florida. In 2014, there were some record numbers for us. We had 30,000 admissions. We have almost 94,000 ED visits, 3,400 births, 450 open-heart surgeries and 11,000 surgical procedures with just over 3,000 members on our staff.
Gamble: And what does that entail exactly, the affiliation with Mayo?
Richardson: The affiliation with Mayo allows our physicians to have access to Mayo e-consults at any given time. So if you had a situation where you needed to have a secondary opinion or you wanted to have a consult from another physician, our physicians can reach out to Mayo and receive that e-consult. We also have Mayo on site quite often to do special workshops and seminars for our physicians to get ongoing CME credits. And then from a strategic perspective, we have their medical director from the Jacksonville Mayo Clinic on our board. He helps us set strategic direction and work through a lot of our operational plans.
And even from an IT perspective, I reached out for them for dot-net programming strategies, how we wanted to work on our app development, different functions of our patient portal, new phases we want to add to that, and even our physician referral dashboard build. With a lot of the different things that they do incredibly well in a specified manner, we reach out to them and say, ‘hey, what are you guys doing?’ Currently they are also a Cerner client, so we’re able to really share some best practices and ideas across the board. So there’s a huge piece of being a Mayo-affiliated network from a clinical perspective, but then the operational and technology perspective have also married themselves very well.
Gamble: Really interesting. I can certainly see the benefits of that. Now in terms of physicians, do you have practices that are both owned and affiliated with the system?
Richardson: We absolutely do. We have an employed physician base of about 82 physicians. When you add mid-levels, we have about 123 licensed providers and 35 clinic locations. That’s a space for us like in most areas of the country that continues to expand. We always look for the right opportunity to recruit for specific specialties. Primary care is always going to be a big one, but then you think, do we need foot and ankle, do we need a certain type of surgeon, do we want more GI docs to come on board, etc. So we look really closely at the market growth patterns for southwest Florida, and then also how busy are our docs. Certain types of physicians are just slammed. They can’t get any more patients in without continuing to tax the system, and so we start to recruit for those types of physicians. We’re lucky in that we have a great base of physicians today, and so we can very particular about the types of physicians we are starting to recruit going forward.
Gamble: You mentioned that you have Cerner both in the hospitals and ambulatory as well?
Gamble: So now as far as having the Cerner ITWorks, can you talk a little bit about just how that works and what that’s like from your perspective to be fully outsourced?
Richardson: It was a fascinating proposition when I came to interview with NCH, because I have historically always worked where IT is in-house. About six years ago in 2009, NCH realized that it was not going to be able to keep up with technology by having an in-house IT team. Naples is a really difficult place to recruit talent because it’s a very specific part of the country. Most people think of Naples and they think about retirement — if you look at the demographic of Collier County the average age is about 61 years old. And so at that point, the hospital knew that it wanted to grow and really keep up with technology. As you can tell by the HIMSS Level 7 designation, they’ve done that. So they approached Cerner, because it’s already a Cerner shop on the in-house side, and said, here’s the proposition. So ITWorks was developed with NCH as the very first client.
Dr. Allen Weiss, who’s our president and CEO, had reached out to Neil Patterson and said, here’s an idea — can we outsource our IT to you? And it not only turned out to be a fantastic move for the hospital, because we are highly referenceable, completely integrated, running on all cylinders all of the time — but they’ve continued to build up that business model. There are now 21 health systems that utilize Cerner ITWorks, and it continues to be a growing business for them. For us, it’s been amazing because when we have a position that’s open, say like a senior network engineer or a clinical informaticist, we can post the position and look to hire it, and Cerner hires that position for us and then Cerner brings that person to Naples, Florida. So you think of the recruiting power of Cerner versus the recruiting power of a two-hospital system in southwest Florida. When we have an opening or we have a gap on our staff, that automatically gets filled by Cerner because they always have somebody to help us during a time of need. So while we’re looking for an open position to be filled, we have that backend resource sitting somewhere else in the country to fill in that gap until we have somebody on site that is here and our own. And the model’s amazing because we have 52 people here on site, plus we have all of the backend AMS Cerner support and CernerWorks. So it feels like we have 80-plus people when we only have 52 here in Naples, Florida.
Gamble: Did you have any hesitations about it, because like you said, you had been accustomed to IT being in-house?
Richardson: It’s funny because initially I thought, okay, so IT’s going to be all Cerner and I’m going to be a hospital employee. It comes to mind how you can effectively manage a team if they don’t report to you. Well, everybody today lives in a matrixed environment. We all have two or three bosses and dotted lines everywhere. And to me, management has never been about an org chart. That is probably more true than ever in the fact that nobody in IT ‘reports to me,’ and yet we work hand in hand, side by side, all day in the trenches, all the time. Some ITWorks sites have a CIO as part of Cerner, and some of them have as part of the hospital. And, again, I don’t think that it matters who produces your paycheck. As long as you are aligned on what your strategic initiatives and operational goals are, you can achieve anything if you’re on the same team.
Gamble: That’s a good way of looking at it. You talked about stage 7, which was pretty recent. That’s obviously a big deal. It’s a really nice accomplishment. Can you talk a little bit about what it was like to reach that and what that’s meant for your team?
Richardson: I came onboard November of 2014, and they had already earned the designation. So I remember going through the interview process and they were in the process of applying, and then in the interim of accepting the position and coming onboard, they received the notification from HIMSS Analytics that they had achieved it. It was so incredibly exciting because when you know you’re going into an organization where in absence of a CIO, the IT director onsite and our chief nursing officer, Michele Thoman, had said, ‘okay, we’re at stage 6, what’s it going to take to get to 7?’ And they systematically put a plan in place and just went after it — when you come into a team that already is high energy, high performing, high potential, you just add to that mix and continue to just really move the bar forward.
They really did all of that work, but it just gives a lot of sense of pride and energy to the organization, because you have to put in bar coding for breast milk. You have to put in bar coding for blood transfusions. You have to have all of the components in place. It’s really rigorous, but what it’s done is allow us to be able to share our story with others, both at HIMSS and with other Cerner ITWorks clients, to say, it’s not just an IT project. And I think at the end of the day, the best part about that and being here is that clinical leadership and IT leadership are in lockstep, because IT cannot be the leader of a lot of these big initiatives. We just supply the pathway to get there and help people work through how to make it successfully happen.
Gamble: Right, right.
Richardson: It can have a pretty profound effect on medical records and some of the backend on how they’re having to process all the information. That would just be one of those things I’d say to anybody is that when you’re going for Level 7 and you realize you have to put all these different things in place to make it happen, make sure you realize the end result on support and ancillary departments, because workflows became temporarily more cumbersome until we figured out what the output was going to look like. That we are still working through.
Gamble: That’s often one of the things cited is workflow. When there is any change to it it’s a big challenge because you’re dealing with people who have so many things going on, and so to interrupt that is a big deal and it’s something that everyone tries to avoid, but it’s almost impossible.
Richardson: I think my favorite thing about being in IT today is trying to figure out what paperless will actually be someday. There’s no such thing. We create different piles in different locations — just because we’re scanning them in, does not make it a paperless environment.
Gamble: Right, very true. So what would you say is one of the big focuses on your plate right now? I know you’re at stage 7, but that certainly doesn’t mean, okay, we’re done with this whole EHR thing. So what are you really looking at right now? Is it optimization? What would you say are your biggest priorities?
Richardson: There’s always a clinical side of what we do. The fact that we are an ITWorks client and we spend a lot of time being referenceable for Cerner means that we are literally like pedal to the metal on all of it. We are fully invested in Smart Room technology. Smart Room technology is really exciting because when you think about where most organizations are, they don’t necessarily have a full gamut of automation in the rooms. We absolutely do. We have Smart Room technology in everywhere in our north campus, and on one floor of our downtown campus we’re looking to expand that out to the entire hospital system. So when you think of a full Smart Room technology, that’s vitals link with integrated vitals collection. It’s staff link with staff assignment. It’s alert link with secondary alerting to the care giver’s phone. We use iPhones for all of our nurses. Room link is integrated digital signage, so instead of having someone’s name and room outside their room with the number, we’ve got all of it electronic. We have icons for fall risks, for isolation, for just different functions that are occurring with the patient.
MyStation in the rooms has enhanced patient engagement. They can see their chart. They can see their results. They can do educational videos. When their caregiver walks in the room, their face pops up on the screen and tells you who they are. We use capacity management for provider and resource presence detection. Cerner iAware has aggregated a personalized view of all the information relevant to patient care, and then with CareAware Connect, we are a development partner with Cerner and that’s all of the data going to the iPhone and the secure texting functionality within the hospital system. We have that fully rolled out at north and partially at downtown, and we’re hoping to expand that. We’re the only place that has it to the extent that we do. So we get people down here constantly looking at that, and it’s such an exciting technology because not only are the floors in the rooms quieter and the patient experience and the healing environment is better, but the nurses can be more efficient because everything’s coming through their phones. They can connect with each other and then spend more time with the patient at the bedside, because they’re not running around to just find all this information. It follows them literally in their pocket. So that’s one big piece.
What’s fascinating about NCH Healthcare System is that we have a very active foundation, and so all of our Smart Room technology to date has been funded by independent donors, and that will continue throughout our Smart Room technology. We have an amazing foundation base. Several million dollars a year are donated to the hospital; because we are not-for-profit, we’re able to do really cool projects, expansions of cath labs and hybrid ORs and things like Smart Room, because we have people who want to donate to the hospital to see these things happen. It’s a pretty exciting place to be when you hear, ‘hey, we’re going to get an X million dollar donation to finish out a technology,’ and boom, it’s on your roadmap and we’re going for it. That’s why we’re able to do some of the cool things that we do.