For Scott MacLean, CIO of Newton-Wellesley Hospital, the expectations are high. Not only is the 200-bed community hospital located just outside of Boston, an area that has been known for years as a hotbed for IT innovation, but it is also a member of Partners HealthCare, one of the most advanced systems in the country. So what did MacLean and his team do to meet those expectations? Create an enterprise repository that enables allergies collected throughout the organization’s affiliated physician practices to be viewed in its inpatient Meditech system. In this interview, MacLean discusses how the allergy repository was set up, the key role played by Meditech in the process, and how he is dealing with the combination of Meaningful Use, ACOs, and ICD-10 requirements.
Chapter 2
- Specialists and the EMR
- Healthcare IT’s perfect storm
- Staffing strains?
- Dealing with CIO stress
- Maintaining a sound work/live balance
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There are changes in workflow and expectations to document more things and document them differently, and I think we still have some years to figure it out before we’re ready to move on from the first generation of ambulatory medical record.
As we look toward Meaningful Use, 5010/ICD-10 and ACO stuff, we feel like we’ve buttoned down infrastructure, we’ve buttoned down fiscal administrative systems, and we can now focus on the workflow of our clinicians and other people working in the hospital, and maybe move toward workflows that are better for them.
I think that one of the things people like about me as a CIO is that I don’t panic. I try to reason through things and respond, because part of the job is that there are competing demands and there are problems that are going to come up, and so a calm response helps with that.
We still have a lot of work to do to get to Meaningful Use and we’ll be diligent about that, and we really want to serve our physicians and other practitioners. Their world is changing more than ours is—that’s where the pressure point is. So we want to build things that serve them and make their lives easier.
Guerra: So you have quite a few specialists under your purview?
MacLean: You may have talked to John Glaser or Cindy Barros about this in the past, but the way that the Partners community healthcare organization rolls out the LMR is that they had essentially had given the practices a couple of choices—either the Partners LMR or the GE Centricity system. So they’re generally on one or the other, and the ones that are closely affiliated with Newton-Wellesley are on the LMR, or they’re on some GE or grandfathered system. We do have expertise to help with that adoption, and it’s appropriately separated from the hospital because of the Stark Laws and whatnot.
The physician practices pay a certain amount of money to buy into that help from the regional services organization, which is part of PG, and they have help with adoption, with maintenance of the product, and with training when new features come out. And they also work closely with the pay-for-performance contracts that we have with our insurers to make sure that the physician and practices are using the system most optimally.
Guerra: One of the issues I’ve been looking at recently is specialists’ willingness to use EMRs that we’re designed mostly for primary care. I don’t know about the LMR, but is there much customization available for the specialist? Is it a challenge for the specialist sometimes to use these generic systems that are mostly from primary care? What are your thoughts around that?
MacLean: It’s definitely a challenge, and we’ve heard that with the LMR, which one might say started out as more of a primary care record. And of course the trade-off is whether you have breadths of numbers of physicians and practices and people using the same record versus having specifics about a certain type of specialty. Now having said that, we’ve done quite a bit of work on various specialties in the LMR, including obstetrics. And as you know, I was at Dana-Farber for almost 10 years, and we did a lot of customization around oncology in the Partners LMR to record tumor staging, and there are infusion flow sheets and essentially electronic medication administration records. So we’ve been able to do some pretty specific specialty customization in the LMR as well.
Guerra: It sounds like for them to be happy, it takes customization that requires time and resources and money. But just to roll out your general vanilla clinical system—the ambulatory EMR version of the acute system you bought—is not a great recipe for a success especially for some of these specialties. And I’m talking about for any organization.
MacLean: I think that’s probably true, and there is so much that is going on for the physicians as their world is changing; there’s more measurement, the payment system is changing, there’s more regulation. And so I think it’s very hard to tease out the difficulty of adoption versus changing systems. There are changes in workflow and expectations to document more things and document them differently, and I think we still have some years to figure it out before we’re ready to move on from the first generation of ambulatory medical record, but so many folks across the country are just going through that firsts move from the paper way of doing things to electronic adoption.
Guerra: When we last spoke last year, there wasn’t much ACO stuff happening, but now that’s really coming down the pike, ICD-10 is getting close, and we’re on Stage 2 or getting toward Stage 2 of Meaningful Use. Are you finding this to be one of the more challenging times in your career in terms of managing all these projects?
MacLean: I think it is, and again just to kind of reiterate the history here at Newton-Wellesly, we’ve gone very quickly from being more or less, even though affiliated with Partners, an independent community hospital running Meditech. And in the time I’ve been here, we’ve converted a lot of the infrastructure to Partners teams, and we’ve done the PeopleSoft for ERP and then Soarian for revenue cycle.
We’ve worked very hard in the last four or five years to adopt these enterprise standards, and I think for people working in the hospital, it’s been a bit of a blur of, ‘Wow, what is all this stuff coming at us?’ And they’ve rallied and they’ve handled it reasonably well, and our IS team has worked very hard with corporate folks to make that happen.
So in some ways, as we look toward Meaningful Use, 5010/ICD-10 and ACO stuff, we feel like we’ve buttoned down infrastructure, we’ve buttoned down fiscal administrative systems, and we can now focus on the workflow of our clinicians and other people working in the hospital, and maybe move toward workflows that are better for them. And of course, there will be system upgrades that I think have more features and are more palatable to use. So yes, there is a tight schedule, both at Newton-Wellesley and at Partners to get all the stuff done, but there is also optimism I think in our IS folks.
I mentioned before that we had this leadership institute a couple of weeks ago which Newton-Wellesley does every quarter, and this last one was focused on technology. We had a number of prominent speakers from around the country come in to do that, and I think what’s so helpful about that is base-lining our leaders about what it takes to adopt technology, especially clinical technology, in a successful way. And so we’re able to show them, from outside of Newton-Wellesley and outside of Partners, that this stuff takes time; you have to think through it, consider all the stakeholders, you absolutely have to have the right design and testing, but also follow up with training and support.
Guerra: We talk about leadership, and certainly part of leadership is staff management. Are your people working harder than they’ve had to or are they putting in more hours? How is that going? Have you seen some people getting stressed out, or have you seen some people dropping out or moving on?
MacLean: That’s an interesting question for me, because I think one of the things that we’re pretty proud of here in Newton-Wellesley is that even when I came here over four years ago, there was already in place of performance management culture. We have always been about trying to serve our patients well and obviously improve patient satisfaction. But we’ve also put a lot of effort into growing our staff and our leaders, and that’s what that quarterly leadership training is about. When it comes down to IT, we’re measured very carefully using external benchmarks from other hospitals that are like us. We’ve measured pretty well in the top percentile, even when you add in the direct services we get from Partners. And I think in our case, the staff works so hard to get the other enterprise applications in that they are running at a pace that feels almost more manageable; now it will get more intense again as we get closer to go-live of some of our Meaningful Use projects.
But I want to say that I think we have some pretty darn good people here at the hospital; in past years, we’ve almost lost the people who couldn’t handle that pace, and so I’m hoping we’ll be able to keep the good people we have. I realize that part of the stimulus package is to get people back to work and maybe some of the other organizations will be hiring some of our talent and we’ll have to get others. But I’m pretty proud of who we have.
Guerra: We’ve spoken a number of times, and you never sound stressed out to me. You sound calm and relaxed and like everything is under control. Did you ever get stressed out?
MacLean: I do. I think that one of the things people like about me as a CIO is that I don’t panic. I try to reason through things and respond, because part of the job is that there are competing demands and there are problems that are going to come up, and so a calm response helps with that. Everyone has to balance their work and home life, and there are other stress points. I’m at the age now where I have parents who have some medical problems, and our kids are getting to the stage where they’re teenagers. And so they have a lot going on, and that’s more where I feel the stress. Over this week I’ll be spending a lot of time at work. but also a lot of time dealing with my parents downtown if they’re getting care at some of our academic centers.
Guerra: I appreciate you sharing that, because I think when we’re talking and we do interviews with people, we forget that those things are happening and people just talk about work and what’s going on at work. But you’re absolutely right; those are the issues that can sometimes make work a refuge where at least you can just focus on what you need to do. Some of that other stuff can be more stressful.
MacLean: One thing that has been helpful to me is that at Partners, we have invested a lot of money in a lot of different things, but I think we have a very solid computing infrastructure. I recently got one of these laptops—I basically use a docking station in my office and then I have my laptop with me, and so when I went to one of our other institutions for one of my dad’s appointments I had my laptop with me. And I was able to just open it up and I’m immediately connected as if I was at my desk. Also, as you go through the process of caring for your loved one, or helping the care process of your parents, you can observe what it’s like from a patient’s prospective. And that’s really helped me to think about our clinicians and administrators trying to help patients move through the system.
Guerra: You mentioned about being able to stay connected and that’s a blessing and a curse.
MacLean: Yes.
Guerra: We all know that sometimes it’s great if you can open up that laptop when you need to when and it’s appropriate, and that sometimes you shouldn’t open up the laptop, because you can be there but you’re still not there, either in a family setting or at work. What do you think about that? Sometimes you just have to close the laptop, right?
MacLean: Agreed, and I confess that I fail at that a lot, particularly in this latest job. Generally, I can keep up pretty well, but if I’m going to do something that has to do with family in the afternoon, I feel compelled that night to catch up on e-mail or something, and that takes away from family time, and it doesn’t always even out. And of course when you’re trying to manage these electronic devices and be present for your children, it doesn’t add up. And so actually, this past Lent, one of the things I wanted to do was to not look at my iPhone at night when I’m home, so I can be focused on my kids. And I probably still failed multiple times during the Lenten season.
Guerra: You almost need to put it somewhere you can’t reach it, like with a kid’s toy.
MacLean: Well again, it’s a blessing and a curse. I get my pages through that device and so it has to be somewhere present if it goes off, so I can respond.
Guerra: The difficult thing about peeking at e-mail is not when everything is fine, but when you see a problem that needs to be addressed, because now you’re sucked in. Certainly I’ve learned that on vacation you really want to watch that, because if you read an e-mail that irritates you, you’re sitting there on the beach and you’re irritated and your mind is elsewhere, and that’s no good.
MacLean: Well that’s one thing I have been successful with—I can sign out my pager and everything when I go on vacation and be able to turn it off. The only thing I use my device for vacation is managing my fantasy baseball teams and stuff.
Guerra: Now that’s good. Oh I don’t know if you’re family likes that any better.
MacLean: Probably not.
Guerra: All right. Is there anything else you wanted to touch on—any other main projects or things you want to discuss?
MacLean: I think you’ve covered them well. We feel very fortunate to have accomplished what we have at the hospital and with our ambulatory practices. We still have a lot of work to do to get to Meaningful Use and we’ll be diligent about that, and we really want to serve our physicians and other practitioners. Their world is changing more than ours is—that’s where the pressure point is. So we want to build things that serve them and make their lives easier.
Guerra: Well thank you very much for your time today, always enjoyable. I look forward to chatting with you again soon.
MacLean: Likewise, Anthony. Good luck with everything.
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