Don’t be fooled by the appearance of Children’s Hospital of Central California. The brightly colored building may look more like a children’s castle than a hospital, but inside those walls, the IT team – led by VP and CIO Kirk Larson – is leading a transformation that will make it one of the most sophisticated pediatric hospitals in the country. Children’s Hospital, which is located in the San Joaquin Valley, is going live on advanced clinicals and CPOE this summer, and will soon deploy an application that enables clinicians and staff to view electronic records from anywhere in the building using an iPad. In this interview, Larson talks about the IT strategy that is driving Children’s Hospital, how his experience on the vendor side has helped shape his role, and what it’s like to work in a pediatric hospital.
- End-user device selection — “We had outstanding participation”
- VMware View for the iPad
- Managing the one-off request
- Good governance
- The road to CPOE
- Measuring up to Meaningful Use
- Staffing strains
We recognize that when you’re rolling something out that’s this far-reaching, there’s not going to be one or even two devices that work for everyone. Now on the back end, does that create some additional challenge in terms of desktop support and replacement cost? To some degree, it does. But I think that’s part of the balance you have to strike.
We simply can’t accommodate every one-off request. But I think when you have that level of participation… where you’re actively soliciting input from the individual physicians, chances are that those folks are going to speak up and really make clear what their needs are so that hopefully, we can accommodate them.
I think the funding that it provides to hospitals—many of which would not necessarily be in the position to afford the software, the hardware, and the applications—is helpful. I think it’s a good thing that on a national level, whether people agree with it or not, we are establishing standards by which all hospitals will need to conform.
On the infrastructure side, we’re very fortunate that we have an average tenure of about nine years, which I think is amazing, and we really benefit from that type of experience. We have some folks who are still on staff who actually built out the infrastructure when we moved to our campus in Madera in 1998.
Guerra: I see that you’re doing some work with VMware, having to do with the end user devices in empowering clinicians with the iPad. Can you tell me about that relationship?
Larson: Sure, we’ve been customers of VMware for several years, I believe, on the service side. And for the advanced clinical systems project that we’ll be going live this summer, which includes both advanced clinical documentation as well as CPOE, we had a formal device selection process. And depending on the discipline, different devices were recommended and ultimately selected. Some of the areas of the hospital did choose an iPad and we wanted to be able to offer them, like everyone else, a virtual desktop.
When we were building that image, we were very pleased that the VMware View application became available. It really became available just in time, because to be honest, prior to that, we were not comfortable with what was out there, particularly from a security perspective. So when that application became available, we really jumped at it. That is what’s going to enable some of our caregivers to be able to use an iPad. So they’ll be using the VMware View application on their iPad to access their virtual desktop image.
Guerra: And they’ll access Meditech through the iPad using VMware View?
Larson: That’s correct.
Guerra: And what about the dynamics of this? They wanted the iPad—did you sort of have to hold everyone at bay until you were able to find the solution such as VMware, and just hold them off and say not quite yet?
Larson: Well, actually, the timing was so perfect; rarely in IT do you get as lucky as we did. To be honest, we were a little bit concerned offering the iPad as a possibility because our role—and we call it as kind of the device road show—is that we made available to our end users; a whole host of different products, one of which was the iPad, because there was a degree of clamoring for that.
We were a little concerned because initially the VMware View application was not available. But we felt that either it would become available in time, or we could figure something out. And fortunately, it did come out in time, and again, fortunately we were able to work that very quickly and build the image consistent with that product and get it on the iPad. We’re going to be able to roll that out this summer; we’re very excited about that.
Guerra: Are we talking mostly about nurses and other employees or are there a lot of physicians that actually want to use the iPad?
Larson: Initially, what we were looking at—and again, this was self-selection, so this was not being dictated to them—was dietitians, therapists, pharmacy and a couple of other areas that’ll be using it. So out of the gate, it will not be nurses and physicians. However, we do have the option to provide that. And my expectation is that over time, physicians are the most likely group that might want to explore that. But the iPad doesn’t work for everyone, and people went with different devices, which is certainly not a commentary on how we deliver a desktop to them, but more, what’s convenient for them and their workflow.
Guerra: As a CIO who has worked through the device issues—the user and end user device, the handheld and the wireless—do you have an overall philosophy or strategy or lessons learned you can share with your colleagues who are having difficulty narrowing the choices down that they give to clinicians, but also balancing that with wanting to give people what they want so they can work the way they want. Is it a tough balance to strike?
Larson: You know, I think it’s mildly challenging. As for the couple of points of advice that I would offer, our device selection committee was actually chaired by one of our nursing executive leaders. I think that reflects the culture here, where it’s not an IT project that we’re driving; it’s an organizational, enterprise-wide initiative. And on that committee, we had a lot of very diverse representation. There were a lot of voices at the table, and we were very responsive to what people wanted to see in terms of devices. And to be honest, the number of devices that we put out there—to me, it was a little overwhelming; probably a few more than I would have wanted. But through the self-selection process, the number was actually widdled down naturally. You might think maybe every nurse would want an iPad, but at least initially, the answer to that was no. Although they have the opportunity because with the device road show—and this is another important point that I would offer—we put the image on all these different devices and not only had them available for folks to use, but we took them to the individual units and people were able to work with them, to test them, to sample them. So instead of watching someone else do it or hearing about what it would be like, people were actually using them.
And in doing so, we were able to build a consensus and get the right devices for the right people that work for their individual workflows. We recognize that when you’re rolling something out that’s this far-reaching, there’s not going to be one or even two devices that work for everyone. Now on the back end, does that create some additional challenge in terms of desktop support and replacement cost? To some degree, it does. But I think that’s part of the balance you have to strike between being able to accommodate what are, at times, quite different workflows. And by doing that very kind of comprehensive process that really encourages people to participate, I think people will feel comfortable with what they are ultimately issued, because they had a role and a voice in that. And we had outstanding participation. So those are a couple of thoughts that I would share as folks wrestle with the same issue.
Guerra: I wonder how you deal with the dynamic we see a lot that CIOs have to face, which is what I call the “super doc.” It could be a surgeon or high-powered physician that really brings in a lot of business and fully understands the influence they have with the C-suite—with the CEO and the board, and wants to use a certain device, and comes to you and says, “Make this work.” It’s sort of the one-off challenge. Any thoughts on that? Do you have to deal with that dynamic like many of your colleagues?
Larson: To some degree, and it’s important to go back to our culture and how we approach things. The advanced clinical systems project as a whole is co-chaired by our chief nursing officer and our chief of staff. So we have our top position—our chief of staff—actively involved with that; the device selection committee reports up through the overall steering committee, of which our chief of staff is a co-chair. So she has the visibility to the decisions that will be made that will affect individual physicians. And I think it’s important to leverage the physician peers in situations like that because, as you and I probably all of your listeners know, we simply can’t accommodate every one-off request. But I think when you have that level of participation, and also have the device selection process, where you’re actively soliciting input from the individual physicians, chances are that those folks are going to speak up and really make clear what their needs are so that hopefully, we can accommodate them initially. That would be my best advice and I know there’s certainly no one-size-fits-all response to that, because admittedly, it could very well be a challenge.
Guerra: You mentioned that you’re going live with CPOE this summer. Tell me about how that has gone—how are you’re laying the ground work. And as far as physician documentation, are you doing it at the same time, or is that going to come afterward.
Larson: We’re doing nursing documentation. So the nursing documentation will come first, and then the CPOE will be rolled out in phases so that we have the first phase in late July, and there’ll be a series of phases that will take us through early October where we’ll do that kind of piecemeal. That way, we’ll be able to focus on individual areas instead of trying to do a big bang house-wide; we’ll be able to do it in smaller chunks.
Guerra: Do you think you’ll make Stage 1 of meaningful use and be able to get those dollars?
Larson: Yes, being a pediatric facility, all we need to do in the first year is attest. So we plan to attest in our next fiscal year, and that will initiate the beginning of the payout of our stimulus dollars.
Guerra: What are your thoughts on the overall program? I’ve interviewed CIOs at a few children’s hospitals and one—Daniel Nigrin at Children’s Hospital Boston—said that some of the quality measures are a little clunky and that they’re not really applicable to children’s hospitals, but you have to do the administrative work of reporting on them somehow. What are your thoughts overall on Meaningful Use as it pertains to children’s hospitals?
Larson: I’m generally pleased with the program itself. I think the funding that it provides to hospitals—many of which would not necessarily be in the position to afford the software, the hardware, and the applications—I think is helpful. I think it’s a good thing that on a national level, whether people agree with it or not, we are establishing standards by which all hospitals will need to conform. So I think that will ultimately be helpful.
However, at the same time, I think my peer in Boston likely raises some good points. It is a quite an administrative process and I think the fact that subsequent stages have not been clearly defined creates some additional challenges for us, not knowing specifically what those will be. I think we’ll have a sense for them, but that’s just another kind of administrative thing we need to leap over. But generally, I think it’s certainly good for the industry, and we’re looking forward to collecting those dollars.
Guerra: Are there any other major projects you want to touch on that are currently on your plate?
Larson: We’ve touched on some of the big ones; obviously upgrading Meditech in the fall, and also, next year, we’re getting ready to deploy the Meditech scanning and archiving module. Right now we’re on a non-Meditech vendor for scanning and archiving. The conversion off of that will also be a major project, and that will lead us into probably next fall, where we’ll be looking at the ambulatory EMR. So, those are some of the significant projects. And of course, I would be remiss if I did not acknowledge the ICD-10 project, which I think will also be very far-reaching. And again, that will not be solely an IT project but will truly be an enterprise-wide project that we’ll be working on together. So there is no shortage of things to do on the application side.
On the infrastructure side, I would say that everything that I just mentioned, we need to accommodate from a storage perspective and from an infrastructure perspective. So I think we’ll be no less busy on that side as well.
Guerra: How about from a staffing perspective? Are you able to put together the team you need and retain them?
Larson: We have a very solid team here, and I’m very excited to have the privilege of leading them. Although we haven’t made any organizational commitments, my expectation is that over time, IT is probably a place where we will continue to invest in terms of head count. I don’t have any specific numbers; of course the CIO would always like it to be more rather than less, but I think we have a very solid team in place.
On the infrastructure side, we’re very fortunate that we have an average tenure of about nine years, which I think is amazing, and we really benefit from that type of experience. We have some folks who are still on staff who actually built out the infrastructure when we moved to our campus in Madera in 1998. Some of those folks are still here.
On the application side, were a little bit newer. But we are really making a concerted effort to invest in training and development of those folks. So when you put it all together, combined with what I think is an outstanding leadership team and a very engaged CMIO, that package makes me a very fortunate person to lead this great team. I really enjoy speaking in our division meetings and reminding people of not only everything that we’ve done—the great work that we’ve done, but also all the great work that’s yet to come. So I’m really fortunate to have a team that I do.