Imagine what the US health system would look like today without Meaningful Use. For most CIOs, it’s not easy to do. Even though many organizations were on the path to digitization before the federal regulations came down, there’s little doubt that the incentive program helped move things along. In fact, Mark Farrow believes it’s precisely why the US is far ahead of Canada on the HIMSS Analytics EMRAM curve.
But although there are some notable differences in the way healthcare is structured in Canada, there are many similarities in the challenges that CIOs face, such as being expected to do more with fewer funds. And, like his fellow leaders, Farrow is finding ways to stretch budget dollars and leverage technology in innovative ways. For example, when it was becoming difficult to stay afloat without cutting staff, his organization created a consulting service that enables the staff to gain valuable experience (and help smaller hospitals) while staying in the black. It’s this type of thinking that has distinguished Hamilton Health Sciences, an Ontario-based system, as one of the country’s top organizations.
In this interview, Farrow talks about how his team has benefited from providing consulting services, the delicate relationship Hamilton has with its physicians, and the groundbreaking initiative that’s helping to create a closed-loop communication system among providers. He also discusses his strategy for fostering innovation, Canada’s different approach with population health, and what he loves most about being a CIO.
- 6-hospital system in Hamilton, Ontario
- BYOD by necessity
- On Meditech Magic 5.6.7, moving to a web-based EHR
- Providing a single view of the patient with ClinicalConnect’s portal
- Offering IT services — “It’s a win-win”
- Early Warning System with ThoughtWire — “It really does create that closed-loop communication”
They are still independent, so it’s a situation we have to handle carefully. When we’re implementing a solution, we have to find something they’re willing to work with.
Every year I was being asked to cut another 2 percent of the IT budget, and it was getting to the point where the only thing left was to start cutting the staff. I didn’t have a lot of staff to begin with, and those I did have I had invested in their training and skill sets, and I couldn’t bear to lose them.
We needed to find a way to do it real time. We wanted to find a way to move all of this data that nurses capture and turn it into actionable knowledge, and we needed something that would allow them to do it at the bedside.
It was a great way to marry this research and try to get some evidence to the bedside much faster than we would have normally, while at the same time utilizing technology to create that whole closed-loop system. That’s been very powerful.
Farrow: Sure. Hamilton Health Sciences is an academic teaching facility located in Hamilton, Ontario. We are affiliated with McMaster University, and we have six hospitals totaling about 1,200 beds. We essentially run a cradle-to-grave operation—we have a pediatric facility, a number of large tertiary centers, a trauma center, and a community hospital, as well as rehab and long-term chronic care facilities.
Our catchment is about 2.3 million patients, and we cover the central southwest region of Ontario, down to the Niagara Peninsula.
Gamble: Are the physicians employed by the health system, or are they affiliated?
Farrow: The physicians are all essentially independent contractors. We have hospitalists and specialists that work out of the hospital, but they are independent. There are a couple of hospitalists and certainly, the specialists all tend to work out of the hospital, but they are still independent, so it’s a situation we have to handle carefully. When we’re implementing a solution, we have to find something they’re willing to work with.
We’ve actually been doing ‘bring your own device’ for six or seven years, and we started it because we couldn’t just dictate what physicians needed to use. They wanted to bring their iPads to the hospital, and so we had to create a solution. So yes, they’re a very interesting group to deal with.
Gamble: I can imagine. Do you have leaders who represent the needs of the physicians?
Farrow: We do. We have an executive vice president of medical, a chief of medicine, and a chief of surgery. We also have a full-time CMIO who is a pediatric intensivist. He does a lot of the championing to bridge the gap between IT and physicians to try to ensure we know what they want. He has a number of committees to help bring the physicians along, and we also look for physicians that are championing specific technologies.
Gamble: What type of EHR system do you have in the hospitals?
Farrow: We are a Meditech shop, currently using Magic 5.6.7, and we’re planning to move to their new web-based EHR. Hopefully we’ll kick that project off late this year or early next year. Right now, we’re focused on getting all the funding in place. Our strategic plan was approved by the board in March, so now we’re securing money and trying to get moving. It’s a $160 million project that we expect to span about three to five years. But we’re still working to finalize the business case.
Gamble: What about data exchange with other organizations? Tell us about how you’re working with ClinicalConnect.
Farrow: ClinicalConnect is a trademarked portal that we developed more than a decade ago. It started within Hamilton Health Sciences as a way to connect various disparate systems without interfering with the host systems. We work with Influence Health — their CONNECT product is what drives the portal.
At this point, ClinicalConnect has now been moved out across all of Southwest Ontario. We currently have 69 hospitals, four community access centers, four cancer centers, and a number of public health organizations all feeding into it, as well as family physicians. At last count, there were around 42,000 registered active users on the system.
It’s a standard of care in the hospitals, especially in the tertiary centers and EDs. When a patient comes in, we’re able to get a real-time view of that individual across the continuum, including some of the provincial assets. The Ontario Lab Information System feeds into it, as well as the new Drug Health Information System from the province. And although it is fairly hospital-centric as far as the data, we are looking to expand it by bringing in primary care data.
Farrow: As an IT department, we’ve been providing services to some of the smaller hospitals and other organizations in our region for a number of years. At the same time we launched ClinicalConnect and started to roll it out across Southwest Ontario, we were facing intense budget pressure. We’ve basically been held flat by the government for the last five or six years, and yet our costs have been increasing at 2 to 4 percent every year. Every year I was being asked to cut another 2 percent of the IT budget, and it was getting to the point where the only thing left was to start cutting the staff. I didn’t have a lot of staff to begin with, and those I did have I had invested in their training and skill sets, and I couldn’t bear to lose them.
So we took our IT department and reformulated it into a services department. We now provide services to a number of hospitals, everything from running their entire IT department, to providing strategic, hosting and even services, and we’re continuing to expand that.
We formalized HITS in 2014. Right now, we’re doing about $3 million a year through the hospitals, and the ClinicalConnect side is running around $30 million a year. It was a way for me to protect staff and to continue to be able to invest them, rather than having to make cuts every year with no hope of moving forward. It was a different take on what one has to do to survive in the healthcare IT sector.
Gamble: So HITS has grown pretty quickly. Do you ever worry about the staff becoming too overtaxed by working with not just your own hospitals, but others as well?
Farrow: There are times when we get a little tight. But when you look at some of the smaller hospitals that in the past had been able to afford one or two FTEs and they’re supposed to be a jacks of all trades, it’s very hard to find somebody who can do everything from cybersecurity to application implementation to hardware. So when we go in, it’s a bit of a win-win. I get a couple more FTEs, and they get a fraction of all of these individuals to provide what they need, while my staff get exposure to different organizations, different sizes, and different types of environments. It allows them to grow, and it allows me to continue to staff up rather than cutting.
Gamble: How does that work in terms of balancing those efforts with everything that has to be done at Hamilton Health?
Farrow: They’re very understanding. We view them as a client as well, and we treat all clients equally. But I’ve also put into place an account manager for clients outside of HHS to ensure that we’re servicing them appropriately. So to answer your question, it’s never gotten to the point where we’ve been too stretched. It’s been tight, but I think staff appreciates the opportunity.
Farrow: Absolutely. We provide help desks for organizations where they can dial a four or five-digit number and it gets routed to our help desk. For some organizations, we run the entire Meditech operation, while for others we might just host a single application. So it truly runs the gamut.
The big uptick of late has been security. We’ve built a really strong security team here. With all the cyberattacks happening, security is a big concern, especially for smaller hospitals that only have firewalls and antivirus protection; those don’t do much at all these days. We’re able to provide them with a security operation center and tracking. We can go on in and help organizations that have been hit with ransomware and help them recover from that.
Gamble: Right. And at the same time, you have to do everything else needed to keep the lights on. I wanted to talk about an initiative in which smartphones are being used to alert clinicians before a Code Blue is called. This seems like an innovative use of technology, because it takes something that’s already being used and leverages it in a different way.
Farrow: Of course. The Hamilton Early Warning System started as a research project by a student who was working with one of our faculty members, Dr. Alison Fox-Robichaud. By looking at six vital signs, they found they were able to absolutely predict and ultimately change the outcome for a lot of patients. They approached us with the concept, and we thought, ‘Can we roll this out in the organization?’ The first thing we did was build it into the Meditech system and the nursing documentation system, which would allow nurses to document them. While that was being built, we tested it on paper, then did it on the Meditech system.
We found it was very accurate. A lot of times, they weren’t getting filled out until end of shift, which doesn’t really help to say, ‘by the way, your patient was going to have a heart attack or a respiratory event three hours ago.’ We needed to find a way to do it real time. We wanted to find a way to move all of this data that nurses capture and turn it into actionable knowledge, and we needed something that would allow them to do it at the bedside. And so we needed something light and easy they could carry, but we didn’t want them to have to document in that, and then turn around and have to document back into the Meditech system and then have a charge.
We looked for other technology that could assist us, and that’s when we found ThoughtWire’s technology, which, unlike the traditional HL7 interface, allows us to link the data and interface the data, but also create a communications system. Because that was the other piece we found — a junior nurse who is filling in on a night shift might see a score that indicates a patient is trending in the wrong direction. They might have been hesitant to call the charge nurse or call a physician or call the RACE team (which is the rapid response team) to come and check on the patient.
All of the data they enter is being fed into the Meditech nursing documentation system, so all the charting can be done on an android device. It was a great way to marry this research and try to get some evidence to the bedside much faster than we would have normally, while at the same time utilizing technology to create that whole closed-loop system. That’s been very powerful. Dr. Fox-Robichaud’s goal is to get to zero code blues in the hospital. And I can tell you, the only time I heard a code blue last year has been in an ambulatory area where we haven’t implemented the system yet.
Gamble: So you were able to see tangible results pretty quickly.
Farrow: We were.