When Brian Tew arrived at Greater Hudson Valley Health System two years ago — as the organization’s third CIO in 3 years — he knew he had his work cut out. But despite the fact that 40 percent of the IT positions were vacant, Tew knew that the core group in place was strong; what they needed was some stability. And so he was deliberate in his approach, building a leadership team from the ground up and improving processes one at a time. Within 20 months, GHVHS had achieved HIMSS Stage 7 recognition, and Tew’s plans don’t stop there. In this interview, he talks about what it took to change the organization’s mentality, the challenge of “keeping the lights on” while developing standards and setting up committees, the biggest priorities he hopes to tackle, and why managing expectations is absolutely critical.
- About Greater Hudson Valley HS
- Epic across the board — “We approach everything as a system.”
- Bringing in non-employed docs
- IT: 20% technical and 80% communication.”
- Epic Community Connect
- Going live 2 weeks into his role — “There was no moss growing under my feet.”
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The senior level team has gelled and we approach everything as a system, especially within IT. Our approach is whatever we do, we have to make sure that everybody’s plugged in, regardless of which site they’re in.
Within IT, it’s 20 percent technical and 80 percent communication. We have the governance structure in place and we try to make ourselves visible and available to the community providers, making sure we’re meeting their needs as they come in and use our facilities to treat their patients.
A big priority of mine was to first hire good leadership, and then get them fully engaged in what we were doing. The consultants we had actually did a very good job, but they’re consultants, and they’re going to leave and all of that knowledge is going to walk out the door with them.
The impression some of the leaders had was that they were broken, and I quickly saw that they weren’t broken. I was the third CIO in three years; 40 percent of thee FTE’s within the team were vacant. My top priority was to build a leadership team to support this core group.
Gamble: Hi Brian, thank you so much for taking some time to speak with HealthSystemCIO.com.
Tew: Hey Kate, how are you?
Gamble: Doing good, thanks. I’m looking forward to what to chatting with you. To start things off, can you give an overview of Greater Hudson Valley Health System — what you have in terms of hospitals, bed size, where you’re located?
Tew: Greater Hudson Valley, as the title says, is in the Hudson Valley, west of the Hudson River in New York, about an hour north of the city. We have two regional medical centers, one in Orange County and one in Sullivan County, and we also have a critical access hospital in Sullivan County. So it’s and Catskill Regional Medical Center, and they have two sites. The total beds are north of 600; we probably staff around 500 beds.
The organization, when I arrived, just started the medical group. It’s a unique area. I left New Hampshire, where almost 100 percent of all the providers are employed — in the Hudson Valley that is definitely not the case. So we’ve just started our medical group. We currently have about 90 providers, and we plan to grow that by about 20 percent each year for the next few years.
Gamble: That’s interesting to have such a difference in two different areas.
Tew: And it’s not that far away. If you go down into the city, it’s the same thing where everybody is pretty much employed. But here, it’s just a little different. You have some entrepreneur providers in this area, and there are clinical partners, and we try to work very, very closely with them. We do have about six clinics in Orange and Sullivan County, and we plan to grow that. We actually have two sites under construction now — one up in Monticello, and an 180,000-square-foot medical office building we’re planning to open up in late September, and that’s right here on the Orange Regional campus.
Gamble: Okay, so a lot going on. As far as the hospitals, is there anything different with the reporting structure there, or do they act as if they’re owned by the health system?
Tew: They do. We have system executives and we have the medical center’s executives, and most of those are the same role at all the sites. The senior level team has gelled and we approach everything as a system, especially within IT. Our approach is whatever we do, we have to make sure that everybody’s plugged in, regardless of which site they’re in.
Gamble: In terms of the EHR, is there one being used across the board?
Tew: It is. We’re an Epic shop, and that’s fully implemented on the inpatient and outpatient areas, as well as the ancillary groups as well.
Gamble: About how long has that been in place?
Tew: Orange Regional went live in 2011, so it’s a seasoned product here. Catskill went live a few years after they did.
Gamble: As far as the physicians out in the clinics, what are they using?
Tew: They’re using Epic as well. We actually went live two weeks after I arrived, so there was no moss growing under my feet. That’s for sure.
Gamble: I feel like there are some stories there, and we’ll definitely get to that. But as far as bringing some of the docs into the fold that are not employed, can you talk about how the organization is approaching that? I imagine there’s a lot of change management or culture change issues that come into play with trying to do things a different way.
Tew: We work very well with the physician community. I would describe the community providers here as very reasonable. Within IT, it’s 20 percent technical and 80 percent communication. We have the governance structure in place and we try to make ourselves visible and available to the community providers, making sure we’re meeting their needs as they come in and use our facilities to treat their patients. It’s a priority now to take that a step further to make sure that they have access to the information that we have when they need it. So we’re working hard with local groups to create custom interfaces with them, and we joined the regional HIE. With Epic, it does make it a little bit easier to share that continuity of care document, both to Epic and to non-Epic EMRs.
Gamble: So there’s definitely a willingness, and it’s not like you have to do a big sell?
Tew: No. Actually, one of our initiatives for next year is to push out EpicCare Community Connect and to use Epic as a service for some of the local physician groups. We have two in the cue now to roll this out and to learn from, and then once those two are done, we’ll start to present it to some of the other physician groups in the area.
Gamble: Okay, so I don’t know if I want to use the word ‘pilot,’ but you have the two that where can kind of apply some of those lessons learned going forward. I’m sure you’ll appreciate being able to leverage that.
Gamble: So a lot going on there. How long have you been with Greater Valley Hudson Health System, how long have you actually been there?
Tew: I arrived on August of 2014, so almost two years.
Gamble: It’s a pretty unusual thing to have somebody start with an organization right before go live — it was two weeks before go live?
Tew: Yeah, and that’s only part of the story. The other part of the story is it was all being done though consultants; there were no GHVHS employees on the team that was implementing the go-live. So a big priority of mine was to first hire good leadership, and then get them fully engaged in what we were doing. The consultants we had actually did a very good job, but they’re consultants, and they’re going to leave and all of that knowledge is going to walk out the door with them. So we were able to quickly promote somebody from within and get them fully engaged in that process, and she’s currently now the director over all of the ambulatory applications.
Gamble: And who’s that?
Tew: Dana Hendrickson.
Gamble: So when you walked in, obviously the consultants are there, they’re doing their thing, but you know there’s a cap on when they’re going to be there. How did you approach it from your point of view, as far as getting things to a certain place before you had to deal with them leaving? What was your approach to this situation?
Tew: My approach is generally to only use consultants to supplement the full-time folks. The model that we were employing was something that I completely disagreed with, so that’s why it was important for me to get the leadership there in place. Dana’s an RN. She was already certified in other modules within Epic, and she was one of the core group within the team. She had already built the street credit with the physician community, because they all knew her and knew that she does a great job within the analyst role, but also within communicating and project management. That was the first thing I did; promote her and put her in charge of running those implementations. It was a learning curve for her, but she was ready for the challenge.
Then I would say within six to eight months, we had already hired several of the core team. We rolled out seven or eight specialties, and probably a dozen practices within the first year.
Gamble: What about building up the rest of the team, how did you approach that? Because obviously, you want to pick the right people, but you didn’t have a whole lot of time, so I can imagine that that was challenging.
Tew: Right. So the core group that was here, and they’re still here, and that group is a great example of a group of people that work well together. They’re all mission-driven, and they’re all local — this is their hospital. So you had all the qualities that you really wanted to look for in a core group.
When I got here, the impression that some of the leaders had was that they were broken, and I quickly saw that they weren’t broken. I was the third CIO in three years; 40 percent of thee FTE’s within the team were vacant. My top priority was to build a leadership team to support this core group. We hired some really good people and we were able to hire a physician from LIJ, which is a large system down in the city — Ashok Kumar. He was able to come in and really take over the clinical applications. We’ve hired a director of technical services, and I hired somebody from the software sector of a company that built EMRs and nationally distributed them, and so we also have that experience of fee-for-service as far as providing an EMR for service.
We were able to build this core leadership group and then promote from within. So within ten months to twelve months, we had hired the core leadership group, and we had probably hired or promoted an additional 35 people. We were fortunate, because we live in a very competitive area with large systems to our south and to our east that are implementing Epic, and I have to compete with them as far as resources go. So we’ve been really fortunate to find good people and to be able to bring them onto the team.