Dennis Sato took over as interim CIO at Hawaii Health Systems Corporation with one goal in mind: to select and implement an enterprise EMR system that meets everyone’s needs. But with a health system that includes 13 hospitals on five islands—each of which has its own board of directors, a task like that is easier said than done. For some, the idea of dealing with five separate entities that each has its own IT strategy may seem like a nightmare, but Sato is determined to make it work, even if it means making unpopular decisions, and finding victories in the smallest places.
Chapter 3
- Getting down to the system selection wire
- How to get five boards to agree on one system
- Measuring up to Meaningful Use
- The ACO NPRM
- “And let me tell you about ICD-10”
- An “energetic” CIO
- Finding a sound work/life balance
- “I was a workaholic doing 80 hours per week”
- “It’s not going to be on your obituary, ‘I met Meaningful Use'”
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That’s why we have such a large team representing all of the regions today, because we don’t want to get to that point where we have problems. And yes, we still are going to have that. People are still going to say, ‘Well, I don’t think this is right.’ But that decision’s going to be made at the corporate level.
We have to not only pick the right system, but pick one that’s flexible, scalable and able to do whatever we do as an organization. That’s a challenge on the IT side. We’re going to have to have that flexibility.
When you look at three of these things—Pay for Performance, ICD-10, and EMR—we really have our challenges, and with limited resources. And everything has to do with security. That’s out there too. But, that’s the challenge that I think that this whole health system faces—to stay in front of them. And so far I’ve been trying, as a CIO, trying to move on those agenda items.
You have to sit down and say, ‘Is there more to life than just work in 80 hours a week?’ And there is a lot. That’s why you have to have that balance. I think the CEOs now that balance their life—and it’s very difficult to do—are the ones that are going to have a more fulfilling life.
Guerra: Now you’ve selected the consultant; you’ve been working with Beacon for a little while and brought them in to help you select an enterprise-wide EHR, correct?
Sato: They’re taking us through the process. And so, where we are today is, we’re having some of the finalists demo this system. So by the end of the month, we will have at least the finals that we’re going to do site visits on next month. We’ve been scheduling this out, because we know that if we don’t start the implementation of a new system by July or August at the latest, we’re not going to meet at least the first stage of Meaningful Use. We know that, and the vendors know that. And so we established a lot of the terms and conditions upfront so that they know what our rules and our terms are. We negotiated a lot of those upfront, so when we get to the contract negotiations, hopefully, we’ll get through that quicker.
Guerra: Right. Can you give me the short list?
Sato: I can’t do that. One of the things, I know this is part of the state regulations, is that we can’t even tell you who’s there until we award to the vendor. But obviously, the vendor community knows who their competitors are, and we have people looking at demos. I don’t know how we even tell them not to say anything. But as you know, health care is a very small community.
Guerra: Right.
Sato: So I can’t give you that. But I would say it’s the ones that play in the field of integrated systems for community-based hospitals.
Guerra: Now, is there any way through the RFP process that you’ve tried to get across to these potential vendors the cultural implication is that we just discussed? Because you can pick one where you like the software, but if they don’t understand what you’ve told me, you may have a problem.
Sato: Well, what we try to do in the RFP as much as we can is to lay it all out—the number of beds, the number of communities and where they’re located—and give them some brief explanation about our regions. We had a lot of discussion during our vendor conference and there were a lot of questions on that. So at the conference, we went into more detail about each of the facilities; some of the nuances of each one of them, how many beds, and what are the requirements at that facility. Because you can’t always get that from an RFP. A lot of them, even though we call them critical access, are more long-term care beds.
And so that’s the part where even though we mentioned our statistics, a lot of it had to do with the vendor conferences. We had a lot of people on that phone call; every question has been communicated out there, and the ones who did the research—you can go to our website at www.hhsc.org and get a pretty good idea of each of the facilities and some of their goals and objectives—the ones that did their homework really did better.
Guerra: So then, are the five boards going to weigh in on the final system selection? How is that going to work?
Sato: Well, this is the way that we’re planning to do it. In all of the regions, once we make a selection, of course, the people on the committee or the CEO is going to have to go to the boards and say, ‘This is the decision that was made.’ And eventually, it’s going to be the corporate board that’s going to announce the final decision based on input from everybody. That’s why we have such a large team representing all of the regions today, because we don’t want to get to that point where we have problems. And yes, we still are going to have that. People are still going to say, ‘Well, I don’t think this is right.’ But that decision’s going to be made at the corporate level.
Guerra: Right. So your goal is to be ready for stage 1 of Meaningful Use.
Sato: Yeah, we worked it all out. We know what the penalties are for our health systems and we know the incentives. We know all that. And if we don’t meet the first one, we’re going to lost 40 percent of the incentives. And we’ve done a lot of detailed work on that.
Guerra: You’ve been in health care for a while.
Sato: Yeah, I would say over 30 years at six different organizations—community hospitals, public hospitals and private hospitals. And so I kind of understand it, but you get it right maybe the next time. You learn through experience and you get better as you do this.
Guerra: What do you think about how they’ve done drafting stage 1? Do you think they did a good job or did it miss the mark?
Sato: With stage 1, there’s a lot that went into that, and there have been a lot of changes. I think that in general, what they’re trying to do to satisfy the physicians and other clinicians is okay. If we’re going to get there, we have to have the CPOE components, the medication reconciliation components and all of that. I know it’s very difficult to get everybody on the same page. But with all the input they’ve had with all the organizations, I think they did pretty good. And it’s a tough one. I knew a lot of people that were on there, it’s not an easy thing to do. I think stage 2 and 3 are going to be even more difficult. I think the challenge right now is to challenge the organizations to do this. And it’s not going to be easy task.
Guerra: And then roll in the fact that we just had a notice of proposed rulemaking on the ACO portion of the Affordable Care Act.
Sato: Yeah, now that we know what that’s going to look like, we have to not only pick the right system, but pick one that’s flexible, scalable and able to do whatever we do as an organization. That’s a challenge on the IT side. We’re going to have to have that flexibility.
Guerra: What is it like as a CIO trying to position yourself for stage 1 meaningful use, and also having ICD-10 hanging out there in 2013.
Sato: Well, that’s the challenge. Let me tell you about ICD-10. When I got here, nobody was doing anything—no one even heard of it. So I raised the question at the steering committee, ‘What are we doing, you know, for ICD-10?’ And somebody answered, ‘Well, we’re looking at the coding part of it.’ And I said, ‘This is bigger than all everything—coding, physician’s training, everything we have to do. And, we haven’t done anything yet.’ And so finally, the CEO said to me, ‘Will you take care of this? At least come up with a scope of services for all our regions that we’re going to go forward.’ So that’s what I’ve done, and it’s been very difficult because people don’t really understand everything you have to do, from the planning, to the implementation, to training to the docs, all of that. And so now at this point today, I have that scope of services. I’m moving forward.
Now the challenge is this. Who is going to take hold of this? I mean, I did this, and it’s not IT project. And so that’s going to be tough. We have a time frame with our EMR, and we’re also on Pay for Performance out here which is another thing that we’re working with our insurers on that’s also taking place. So when you look at three of these things—Pay for Performance, ICD-10, and EMR—we really have our challenges, and with limited resources. And everything has to do with security. That’s out there too. But, that’s the challenge that I think that this whole health system faces—to stay in front of them. And so far I’ve been trying, as a CIO, trying to move on those agenda items.
Guerra: Right. I looked over some at your LinkedIn profile, and I just want to run a few things by that maybe you can expand on.
Sato: Sure.
Guerra: What are the words you would to describe your style and what you bring to the table? The word you use is energetic, and I’ve seen that a lot in different resumes and different biographies. What does that mean to you to be energetic as a CIO?
Sato: Well, you have to not only have the energy and be in shape, but you have to always have that positive outlook, and you have to always demonstrate that you have the energy and the will to get things done. You can’t be complacent. I think that you have to show that, and you have to demonstrate that you’re energetic. That’s what I’ve been trying to do with all of these things; to try to help them do that by showing them. I’m not working 80 hours like I used to, but it’s going to take that kind of effort in order to do this. You can’t do this on 80 hours; you have to do this in a positive way, and you have to keep yourself in very good shape to have that energy every day.
Guerra: Did you use to work 80 hours a week?
Sato: I did. And I did that for eight years and finally came to that realization, because every organization I went to started from scratch and had a time frame in order to do this. A lot of these organizations didn’t have the governance structure of the training or transformation officer—I did all of that in one organization. I brought the system up in 18 months; it was a very big system up in Oregon, and that’s where I won one of my awards as IT Executive of the Year. That was in 2002, I believe.
So it’s those types of things. You’re energetic; you do your work during the day time but you also participate in industry events. I’m on boards and I’m on the National Asian Health Leaders Association, which is another board. I’ve always done that all my life. So I look at energetic now as being in the professional life, as well as everything you’re doing in the community.
Guerra: When you talk about working 80 hours a week, do you see that as a problem? I’ve talked with a lot of CIOs about achieving a work-life balance where work does not completely consume you. Have you found a good balance?
Sato: Yeah, I finally decided, after doing this for a while, to come back to Hawaii; it was more setting the stage that this is what I’m going to do, because our parents are getting older. You have to have that balance in life now, as a person, as a father—you really have to have that. This is only a job. That’s what I always tell people. And it took me a while to realize that because I was a workaholic. I wanted to be successful; I didn’t want failure. In most of my career, I haven’t had failure. It was kind of driven into me. But you know what? You have to balance that. I’ve had that long discussion with family members who have been very supportive of my career and moving here. But you have to sit down and say, ‘Is there more to life than just work in 80 hours a week?’ And there is a lot. That’s why you have to have that balance. I think the CEOs now that balance their life—and it’s very difficult to do—are the ones that are going to have a more fulfilling life. Once you leave this earth, they’re not going to remember the things that you’ve done; implementing systems and attaining meaningful use. They’re going to remember you as an overall person; what you’ve done, and what other contributions you’ve made to your community or family—not that you achieved Meaningful Use. That’s not going to be in the obituary.
So that’s what I try to be realistic, because I’ve seen many people work 80 hours, and one day, they get laid off. And this happens every day. They leave, and four months later, people say, ‘What was that guy’s name?’ They forget you. Once you understand that, you realize that you have think about yourself too; that this is a business.
Guerra: Right. Or one day you come home from work and your family’s gone because you were never there.
Sato: Yeah, I’ve seen that over and over again. They see that their family is gone and they look back and say, ‘What did I do to myself?’ And fortunately, in my experience, I didn’t have a lot of support, but I came to the realization that balance is one of the most important things that you got to have. And, it’s easy for you to say this, but life’s too short. You only go around one time. And so you have to do everything you can just one time around, unless you’re going to come back in nirvana or reincarnated.
Guerra: Let’s leave that for another interview.
Sato: Yeah.
Guerra: Well I’ll tell you this. This was absolutely wonderful.
Sato: I appreciate you interviewing me, because I think we have a message that not everybody gets. Hawaii is a different kind of culture. It has its challenges, but we still have to do the same things we’re doing with the other drivers of health care.
Guerra: All right. You be well, Dennis.
Sato: Thank you very much, again.
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