Last summer, the 17-hospital Essentia Health system began a transition in which the operations of several organizations – including SMDC Health System, Brainerd Lakes Health, Innovis Health – were combined under one roof. For Innovis CIO Ken Gilles, it meant relinquishing some of the decision-making to Dennis Dassenko, Essentia’s CIO, which was just fine by him. Gilles believes that the new position will enable him to expand his current role while taking on some corporate-level responsibilities, particularly as Essentia rolls out the Epic EMR system-wide. In this interview, Gilles talks about how he is managing the transition, the importance of physician buy-in, the challenges of a geographically disparate health system, and how government initiatives are impacting his organization’s IT strategy.
- Health Care DataWorks for data management
- ACO, MU and data — “We can’t just live on rev cycle data anymore”
- Physician engagement and the MU stick
- A perfect storm of demands on the hospital IT dept — “I liken to being on a treadmill without the ability to get off”
- The human toll of an excessive workload
The downside is that they are a start-up company… So there is some risk with going with the company like that, but we felt that the advantage of all the health care knowledge, plus the idea that they’ve been doing this for that many years, is well worth the risk.
I think it’s probably overshadowed by the challenges of getting there, but I think it’s the right thing to do and it’s inevitable. It’s actually helping us move forward with some of the things that, for the most part, were our strategic initiatives anyway, like getting the systems in place to support the healthcare organization.
How do you get off the treadmill enough to slow down to make sure you’re making the right decisions and priorities? You don’t. We are moving at breakneck speed and just making sure we’re doing the right things and trying to take care of our people.
We’ve lost a few people in this process. On the other hand, we’ve had some people who have stepped up and are absolutely thriving in this environment that I would have never dreamed were going to take on that type of a challenge. So it’s really been a mixed blessing.
Guerra: Let’s talk a little bit about your association now with Health Care DataWorks. I’ll read this quote from Dennis Dassenko, your corporate CIO: “With multiple competing priorities: research, quality, finance, our ACO initiative and many others, we knew we needed to create a single enterprise data warehouse that would support each of these efforts”. So I know your work with them centers around that single view of clinical financial operational and research data, robust healthcare enterprise data model, hundreds of standard reports and a number of pre-built dashboards and score cards, but explain to me your relationship with Healthcare Data Works and what you hope to gain by it.
Gilles: Okay let me just take step back really quick. When we were an Epic customer, we had all these disparate system across all of the regions. So first of all we made the decision that we’re going to go with Epic. From a data warehouse prospective, we needed something that would bring the data from all of the systems together, and we got to the point where we just didn’t feel like Epic had the data warehouse capabilities. I mean, they’ve got a product called Clarity which works well for reporting, but bringing data from external systems—potentially from payers and all that sort of thing, wasn’t really their strong point. So we start the search; we looked at probably 15 to 20 different vendors, and we ended up with Healthcare Data Works as our top choice. They’ve been doing this for 13 years at Ohio State University, and quite honestly, they know health care. And we were really looking for an organization that knew healthcare. The downside is that they are a start-up company—an off-shoot of Ohio State. So there is some risk with going with the company like that, but we felt that the advantage of all the health care knowledge, plus the idea that they’ve been doing this for that many years, is well worth the risk.
What we’re doing right now is we’ve signed on for a four-month proof of concept. We had to get a lot of the products in place to do our ETL’s and map the data from our source systems to the HCD’s data model, etc. One of the other key things with Healthcare Data Works is they’ve got a very robust data model. We had talked about actually building this ourselves, and we found that literally to build a data model could take us two or three years. So the kick-start of having that at the center of this product is really key to us moving forward very quickly.
As you know, the health care landscape is changing dramatically and very, very quickly. ACOs are an example, we’ve got to provide the data and the knowledge for the organization to make good decision as to how we engage in ACOs here, and we can’t wait two to three years to do that. So we want to move forward very quickly.
Guerra: To get this working, does Epic have to work with Healthcare Data Works, or is there no relationship there whatsoever, and you simply handle this on your end with Healthcare Data Works?
Gilles: Epic is quite honestly not even involved. We’ve got our own folks; we have kind of a partnership with the IS Team and the information management team who know the data and the infrastructure—that Epic data so to speak—and we can migrate all of the data we need from that system and other systems on our own.
Guerra: So now you got ACO, you’ve got Meaningful Use and they’ve really integrated the ACO Program with Meaningful Use, requiring 50 percent of your physicians to be Meaningful Users by the end of the first year or second year. It’s really integrated those two programs. Just your thoughts around what we know so far about what ACO is going to mean, dovetailing that with Meaningful Use and how you see all of this coming together.
Gilles: Well the ACOs are certainly in their infant stages in terms of organizations being ready, in terms of a good definition of what it really means and how it’s going to affect us. I will say this; I think Essentia Health is well positioned and has actually has this on their radar screen for a number of years of integrated delivery of health care. Even bringing all of these regions together—all of these hospitals and all of these caregivers together is positioning us well for where the ACOs are heading. The idea of going at-risk for patient care and quality and all these types of things—I think we’re in a good position for that. And the way Meaningful Use ties into this is quite honestly, it’s something that we would have had to do regardless of where these initiatives in health care were headed. We knew we needed the electronic health record; we knew we needed to bring these different organizations and regions and caregivers together, and we’re well on our way to be in a good position to do that. And like I had mentioned, with Healthcare Data Works we really need that data; we can’t just live on revenue cycle data anymore. We have to have the clinical data, the cost accounting data, and all of our financial data tied together so we can make decisions about where we are headed.
Guerra: I don’t know how closely you follow what’s going on with Stage 2 of meaningful use—have you taken a look at what they’re talking about putting together? And just give your thoughts on what they’ve done so far. Do you think they’ve done a good job or not really?
Gilles: I have to be honest; I haven’t spent a lot of time on it. We have been so entrenched in this Epic implementation and Meaningful Use Stage 1. The little bit I have looked at seems to be an extension of the requirements for Stage 1; if something is 10 percent in Stage 1 then maybe it has to be 30 percent in Stage 2. So I know they’re ratcheting up the requirements there. But again, not having spent a lot of time on the details, I just know that as we go into these implementations with Epic, that we’re not making things like CPOE optional. The physicians are required to do it. So whether it’s 10 percent in Stage 1 and 30 percent in Stage 2, we’re going there right out of the shoot. So hopefully we’ll be in a good position for Stage 2, just getting through these implementations. As you know, it’s going to be a challenge to get all of these quality indicators and the data to support those indicators in these different stages too.
Guerra: But overall would you say the program has been orchestrated so that the effect would be positive?
Gilles: Yes, I think so. I think it’s probably overshadowed by the challenges of getting there, but I think it’s the right thing to do and it’s inevitable. It’s actually helping us move forward with some of the things that, for the most part, were our strategic initiatives anyway, like getting the systems in place to support the healthcare organization. So I think it’s a positive thing.
Guerra: I would imagine it certainly would have been harder to get physicians on board without this sort of looming government initiative behind you.
Gilles: I will tell you, it is one of those things that we do casually drop out there in these meetings with the amount of money at stake. We always throw the caveat out there that we’re not just doing this to get meaningful use dollars. We’re doing it to improve quality and safety and those types of things too. But we do use that, I’ll be honest with you.
Guerra: Now you’ve been on this business or at least in the position with Innovis for 15 years, correct?
Guerra: So you’ve been in this business a while. Have you ever seen just a confluence of requirements placed on the hospital IT department? And I’m wondering if this has challenged your abilities of prioritization and management, and all those types of things.
Gilles: I’ve always said over the years that this life—this job—is so busy. Our organization is moving at such a high rate of speed with change. It’s amazing; every time I sit back and think about it, we’re going at a faster and faster pace. And now I kind of liken it to being on a treadmill without the ability to get off. And it’s not just us; everyone in healthcare and other industries is this way. But how do you get off the treadmill enough to slow down to make sure you’re making the right decisions and priorities? You don’t. We are moving at breakneck speed and just making sure we’re doing the right things and trying to take care of our people in the process here.
Guerra: And that last point is something I want to touch on. With a lot of CIOs I interview, we talk about taking care of your people, and when you’re on that treadmill and you have to go so fast, certainly we’re hearing about burnout—some at the CIO level, but CIOs are usually so intense that they’re use to this. It’s maybe the next level under the CIO and certainly under that—they’re starting to feel the strain of a relentless pressure to accomplish under these deadlines. Have you seen any strain in your staff— any difficulties recruiting the right people with the right talent mix? What are your thoughts overall on workforce management?
Gilles: We’ve absolutely seen the strain, especially if you look at everything that’s happened with meaningful use with EHRs—in our case, integrations of systems and we’ve gone through just major organizational change bringing these three regions together. We’ve literally replaced all of the computer systems in these regions over these two or three year time frame. And Dennis has instilled a virtual IT organization that quite honestly isn’t for everyone. It’s a virtual matrix, and what we’re trying to do is leverage key expertise across all of these regions so somebody in Duluth might be working on a project that’s based in Fargo, North Dakota, and vice versa.
So I think we’ve opened up a lot of opportunities for people, and on the other hand, for some people, it wasn’t the fit they were looking for. They were used to a smaller shop where they basically knew what they were going to do every day. Their world has turned upside down and it wasn’t for them. So we’ve lost a few people in this process. On the other hand, we’ve had some people who have stepped up and are absolutely thriving in this environment that I would have never dreamed were going to take on that type of a challenge. So it’s really been a mixed blessing. And I’m not here to say that we’ve got this whole thing solved, because there is so much change happening that some folks again are just going to absolutely love this type of environment, and others will not. We’ll probably lose some more people, but we’re hoping to keep the really good ones and rehire some other really good people that would fit in to this environment. So yes, it’s been a challenge.