People often like to compare a situation to “drinking from a fire hose,” but when Shane Pilcher started as CIO at Siskin Hospital in the summer of 2015, it really was quite an experience. Not just because he was the first CIO the organization had ever named, but because it was his first exposure to the post-acute care and rehabilitation environment. But although it’s been an adventure, Pilcher has cherished every moment.
In this interview, he talks about the major initiatives on his team’s plate, including selecting a new EHR system — which is “a journey it itself,” replacing legacy systems, and of course, keeping data safe. Pilcher also discusses why he believes “the post-acute space is the next frontier in healthcare,” what he looks for in a vendor partner, how consulting helped prepare him for the CIO role, and what he learned during his time with the Navy.
- About Siskin
- Selecting an EHR – “It’s a journey in itself.”
- Lack of EHRs specializing in rehab
- “The post-acute space is the next frontier in healthcare.”
- Integrating with referral sources: “It’s still a highly paper, highly manual process.”
- Need for vendors who “willing to roll up their sleeves and work with us”
- Being Siskin’s first CIO – “It has been like drinking from a fire hose.”
- Avoiding “IT speak”
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It’s truly a journey in itself, trying to work through all that and trying to anticipate everything that you might need to know, and finally making a board recommendation.
Not a lot of EHRs have really addressed that space until recently. So we’re really having to do some deep dives in terms of functionality to see if it fills the gaps that we currently have.
One thing I value tremendously is a vendor that is a partner with us. And that’s not just in the EHR space, but all the vendors that we use. We need those that can meet that need, but are willing to roll up their sleeves and walk the path with us, get their hands dirty, and help us get to that finish line, and be willing to also continue develop their products so that it grows with us.
Before we launch into a different EMR and go down that path, we really had to get the organization to understand that if we’re going to invest in a new system — and the dollars and time it’s going to take to implement it, as well as the maintenance and the licensing fee to maintain it — we also have to be willing to have the resources available to keep it going and keep it optimized.
IT can easily become the department that is seen as a roadblock. They frequently can say no, but you’ve got to get beyond that. You’ve got to be able to understand every business segment of your organization so you can understand how IT can support it.
Gamble: I think the best place is to start is by getting some information about Siskin Hospital. You have the rehabilitation hospital, but what are some of the other features and where are you located?
Pilcher: We are a just under 200-bed independent and patient rehab facility with a subacute care rehab as well. We have three clinics; one onsite and two offsite. We provide just about every service that you can within the rehab space — everything from physical therapy, occupational therapy, speech therapy, and psychology, as well as all the specialties that go along with it. One of our areas of focus is brain injury and spinal cord and stroke rehabilitation. We are located in Chattanooga, Tennessee.
Gamble: And you’re independent, but do you have any types of affiliations with other health systems or hospitals?
Pilcher: We don’t. We’re completely on our own, which is a blessing and a curse, but we are excited to be able to try and keep that way for as long as we can.
Gamble: What about referrals — do you get referrals from some of the other facilities?
Pilcher: We do. We receive referrals locally and regionally. Our two largest referral sources in the Chattanooga space are Erlanger Health Systems and Memorial. We also have some HCA hospitals that refer to us, as well as sites as far away as Vanderbilt.
Gamble: In terms of your EHR system, what do you have in place in the hospital?
Pilcher: We currently have McKesson Paragon. We’ve have actually had that in place for 10 years now.
Gamble: Are there other plans to switch it out or is that something you’re not really looking at right now.
Pilcher: Actually, that’s one of our top priorities at the moment. We are currently looking at a couple of different options that we expect to take place within the next calendar year.
Gamble: So you’re in the process right now of really doing diligence and trying to figure out what would be the best fit?
Pilcher: Absolutely. It’s truly a journey in itself, trying to work through all that and trying to anticipate everything that you might need to know, and finally making a board recommendation.
Gamble: Are you doing site visits with other facilities?
Pilcher: We have. We haven’t done a lot of site visits just yet. We’ve been doing a lot of deep dives into two different applications or two finalists. As we make it through the remaining pieces of that deep dive for specific functionalities, we’ll start our site visits at that point.
One of the biggest challenges for us is while we are an acute care hospital, of course we’re focused on rehab, and not a lot of EHRs have really addressed that space until recently. So we’re really having to do some deep dives in terms of functionality to see if it fills the gaps that we currently have, or not. Once we do that, we’re definitely starting to do some site visits.
Gamble: I would imagine that with the direction things are going in healthcare, this will be something we’ll start see more of with the EHRs, at least in the near future.
Pilcher: Absolutely. While the acute care space has been the focus — as it should have been — now that that has been pretty much addressed and is well established, although it’s definitely still growing and developing, the post-acute care space is really the next frontier in healthcare.
Gamble: And then the idea to have either the same system or a system that easily integrates with the clinic?
Pilcher: Right. Up until now, even though we’ve had an EHR in place for 10 years, we really have not been very integrated with our referral sources. It is still highly paper, highly manual processes. That’s something that is a crucial piece to this next step — whatever system we go has to be able to share data across multiple vendors since we receive from multiple locations with different EHRs.
Gamble: You might end up being an organization that others talk to as we see more interest in EHRs connecting with things like rehab.
Pilcher: Certainly, and we’d be more than open to doing that. Over the last couple of years, I’ve really tried to talk with vendors as well to lay out the case that this is the next space. And that as an organization, we’re very proud of what we do and the patient outcomes we have, and we’re more than willing to play a role with whatever vendor we have in helping to develop that space so that other post-acute care hospitals can benefit form it.
Gamble: Sure. Now, you’ve been with Siskin for about two years, right?
Pilcher: I have. July 2015 is when I arrived.
Gamble: I would imagine that what’s underway now is something you knew was going to be a priority as far as getting on a different system?
Pilcher: It is. While we’ve had it for 10 years, we really haven’t optimized it as much as we should. And we were also McKesson’s only rehab client, so while there were specific functionality related to CMS regulatory requirements that McKesson would provide us additional functionality, it just really didn’t develop over time. It wasn’t really meeting our needs. And like most rehab hospitals, we were having to bolt on two or three different EMR pieces to be able to try and fill those gaps. So it’s a high priority to be able to try and get on a single platform that would be able to meet all those needs, and be able to take a lot of our manual processes and allow us to automate it. It’s just taking us some time to get there. But we’re finally nearing that decision point so we know what direction we’re going to go.
Gamble: Whoever you end up with, that vendor has to be really ready to get their hands dirty and get in there with you guys and make the system as usable as possible.
Pilcher: Certainly. One thing I value tremendously is a vendor that is a partner with us. And that’s not just in the EHR space, but all the vendors that we use. We need those that can meet that need, but are willing to roll up their sleeves and walk the path with us, get their hands dirty, and help us get to that finish line, and be willing to also continue develop their products so that it grows with us. Because just as the acute care environment is changing, the post-acute care is changing very rapidly as well.
Gamble: As far as the IS department, what size staff do you have?
Pilcher: We are very, very lean. We have an IT department of 10 people stretched between our infrastructure network and application support. That is one thing that has also taken us time. Before we launch into a different EMR and go down that path, we really had to get the organization to understand that if we’re going to invest in a new system — and the dollars and time it’s going to take to implement it, as well as the maintenance and the licensing fee to maintain it — we also have to be willing to have the resources available to keep it going and keep it optimized so that our uses can see it as a tool instead of it becoming kind of outdated and of no value to them. It’s taken that time and we’re hoping that as whatever system we go to we’ll be able to staff up in a way that will allow to keep the system growing.
Gamble: I can certainly see the need for it, with everything it’s going to take to roll out the system and then optimize as soon as you can. It’s really an investment that the organization needs to make — not just in the system, but in human capital.
Gamble: Now, in terms of governance, who do you report to?
Pilcher: I report to the CEO. I’m actually the first CIO that Siskin has ever had. Prior to that they would have directors of IT, but they never really had a seat at the table, and they always reported to a different senior leader. I’m their first step into bringing IT to the table, and it’s really been a great experience over the last couple of years.
Gamble: I can imagine. How did you approach that situation? That’s pretty unique, stepping into a position that really hadn’t existed to that point.
Pilcher: It has been an adventure to say the least. Also, my background is on the acute care side, so not only was I developing that program and developing that role and evolving it over the last couple of years, but I was also learning the post-acute care side and learning the rehab component of post-acute care. It has truly been like drinking from a firehose, but it’s been exciting because you’re really able to leave an impact and make a big difference. It’s been just one step at a time.
Gamble: I imagine a big part of the role is in really making sure IT is aligned strategically with what the organization is doing, and doing this in a position that, like you said, hadn’t existed before.
Pilcher: That’s hugely important. Also, when you’re developing those relationships with the rest of the senior leadership team, IT can easily become the department that is seen as a roadblock. They frequently can say no, but you’ve got to get beyond that. You’ve got to be able to understand every business segment of your organization so you can understand how IT can support it.
Building those relationships has been crucial here, and then once that relationship is developed, being able to explain to them why you can or you can’t do something, or being able to anticipate what they need and be able to bring something to the table before they even ask for it. All those pieces kind of fit in to be able to have a successful relationship at that table.
Gamble: And on the flip side, for the other leaders there, there hasn’t been somebody who was in the role of focusing on making sure that IT is aligned. So I’m sure they’ve kind of felt the effects of it as well.
Pilcher: I agree. Also, it’s that person being able to speak in a language that the rest of the leaders understand. A lot of times, IT leaders tend to use terminology and words that mean really nothing to them. Being able to understand where the organization is going and the strategic goals of the organization, and being able to understand and explain how IT can enable it to go that direction in a way that they understand it, has been really important too.
Chapter 2 Coming Soon…