An organization’s name can be very telling. Doctor’s Hospital at Renaissance, which includes a 506-bed hospital and five freestanding imaging centers, was founded in 1997 by a group of physicians. Fourteen years later, it is one of the largest physician-owned facilities in the country and, as the organization has undergone a major IT renaissance, the focus has remained on physicians. In this interview, CIO Les Clonch talks about how he was able to lead an aggressive rollout of EMR and CPOE while still being mindful of the many doctors who still haven’t fully embraced IT, and how choosing the right products and getting the right help have been instrumental in positioning his organization for growth.
- Special practices and primary care EMRs
- “Physicians are becoming aware they can’t just operate in a silo”
- Educating docs on ambulatory EMR choices
- Thoughts on “accelerated” implementations — “Never understaff it”
- How does a Stage 6 measure up to MU?
- CHCIO and the value of CHIME
There are many others out there that I know do the same thing. Greenway, Sage, eClinicalWorks—all of them have really stepped up and changed their systems and put in architectures to allow modification, even by the customer, to accommodate the unique things that each of these specialties brings to the table.
There are some specialties that believe that they are so unique and so different that the only information system they can have is one that is specifically built from the ground up as a specialty tool. I believe there is a broader perspective on care at this point that may get these physicians starting to think that maybe this tool does need to have a little broader flexibility.
A DHR, we felt like ripping the band aid off because of our culture here—we like it fast-paced. We want to get it done. We’ve got tons of those things in the queue that 1) are dependent upon being successful with this, and 2) are going to take these resources we’ve allocated to our EMR program and allocate them to other places.
It’s a major milestone in the context that we did in such a short timeframe as well, but in this industry—at least in my experience—you can never say you’ve arrived, because there’s always something out there change-wise that we need to do.
Guerra: I’d like to talk a little bit about specialty physicians; refresh my memory if you went over it. If you own any specialty practices where you would be rolling out the ambulatory EMR, the dynamic I’m interested and that I’m starting to focus on more is an enterprise buy such as the one you’ve made for Cerner inpatient and Cerner ambulatory, and wanting to roll that system to inpatient in the practices. The EMRs are often designed for primary care, and what I think we’re going to see more of is attempting to roll out primary care EMRs to specialty practices and push back that may come with that. Tell me your thoughts around that dynamic, and whether you’re seeing that in your organization.
Clonch: Yes we are, and you’re absolutely right. Most of the physician clinical information systems—which are really the clinical tools—really have their roots in the primary care role. And so many organizations are trying to change their tools to reflect the specialty look and feel; the unique idiosyncrasies that an OB-GYN or cardiologist or endocrinologist might find in their practice. We’ve seen that here.
I think one of the keys that we’ve been able to do in terms of that rollout is each physician has an option of picking whatever information system they want. The relationship with Cerner is not something they have to do at all; it’s just something that we were able to include as an option for doctors if they chose to pick it. But what we do is, with the clinical systems on the specialty side, Cerner has been very willing to modify their products. I think the architecture was there to modify the product and Cerner has stepped up in terms of services and changes to accommodate the differences and the different specialties. For example, we’re bringing an endocrinology clinic on board, and Cerner’s ability to change their tool within the constraints of their architecture has been very effective in getting physicians on board. I have cardiologists, I’ve got OB-GYNs, I’ve got orthopedics, and I’ve got an endocrinology clinic that all use this Cerner tool, and find it to be very effective for their practice.
There are many others out there that I know do the same thing. Greenway, Sage, eClinicalWorks—all of them have really stepped up and changed their systems and put in architectures to allow modification, even by the customer, to accommodate the unique things that each of these specialties brings to the table. And also the services—I think the folks that deliver these tools are more knowledgeable and I think the vendors have stepped up and said, ‘We’re aware that these practices are different. We have to be sensitive of that, and we have to focus from a marketing point of view and make sure that these practices understand that they can do it and be effective with these tools, even though they do operate in a specialty world.’ Primary care has been effective and still is the workhorse of many of the roots of these systems, but they’ve morphed and changed over time. It’s been very effective to see them. We’ve seen a lot of physicians be very effective with them in the specialty world.
Guerra: So you think that—at least with Center ambulatory—the flexibility is there so that it can be customized to the satisfaction of these specialists. And you’re not finding that they say, ‘You know what? As much as you think you can customize this or as much as you try to, this is still not built for me.’ And maybe they go on the Internet and they find a specialty cardiology EMR and say, ‘This is what I want.’ You’re not finding that dynamic; that type of pushback?
Clonch: No. We have seen some physicians who believe that they are very independent. However, I have seen physicians in the specialties I noted earlier who have been successful with Cerner in that arena. But I know most of the physicians that look at these tools believe that they can’t really operate or coordinate care in a silo. So they can’t just say, ‘I’m going to buy a tool that targets me specifically,’ without concern or consideration of all the other physicians that have different specialties, and without the capabilities that I need to include in the care of this patient, because again, the community of care is expanding.
Physicians, I think, are becoming aware that they just can’t operate in a silo. Many of the physicians, whether it’s an oncologist who’s providing care for a patient or a primary care physician, need to know where the care coordination is at any point in time, and so being able to share information is very important. And I think having systems that have roots in primary care need to change, and I think Center and many of the other vendors are stepping up and doing that. But there are some specialties that believe that they are so unique and so different that the only information system they can have is one that is specifically built from the ground up as a specialty tool. And I believe there is a broader perspective on care at this point that may get these physicians starting to think that maybe this tool does need to have a little broader flexibility and accommodate primary care and other specialties beyond just what I as a physician do. So it isn’t that Cerner and everybody does it perfectly, but there are physicians who are learning that coordination of care is going to be very important, particularly with the primary care doctor.
Guerra: Do you find yourself having to educate these physicians who may be balking at using the EMR you’re offering them about why health care is not a plug-and-play environment? For example, they might say, ‘But Les, this is the system I want, and I don’t understand why you can’t just get it to talk with the other systems.’ Do you find you have to educate them and explain why it’s not as easy as import/export?
Clonch: Absolutely. Our strategy is that we never forced them to use Cerner, for example. That has never been a strategy that has worked in terms of getting doctors on board. And so what we do is, instead of grazing in the pasture, we kind of put them in the corral. We find systems that, from an architectural point of view, are certified, first and foremost. And secondarily, they are tools that other physicians are already using; they’ve been very effective on the market and have good market share in that context. We then say, ‘Here are the kind of tools and the different vendors that we’ve looked at. These are options for you. You obviously have the opportunity to go out and do something else, but if you’re looking at being able to integrate with what we’re doing in the inpatient side and you want to have a more effective process of coordinating care of that patient, which we all know is going to be paramount above now and going forward, here are the tools that we know, in our experience and our due diligence, can help you get there. And help you get there much more quickly than some of the ones that you’re considering because of these reasons: they haven’t done it. The architecture is not supported. It’s not a certified system. It’s a closed environment.
In terms of our experience with the vendors, we have many doctors who come to us and say it’s a great system, but they won’t talk to anyone else. They feel like they’re this polka-dot sheep in a flock of white, and they just don’t feel like they need to talk to anyone else. And unfortunately that, to me, is probably not the right strategy going forward.
So I encourage them to think outside the box. I’ll say, ‘Here are the tools that we’ve found to be very effective, and we’d like to encourage you to at least give them a look.’ And then we kind of line it up from a planning point of view if they have questions. We show them how we could connect with them and we give them examples of physicians who have used the tool and who have already worked through the technicalities or synchronies of doing that. And when they see that value and they see that timeframe shrink in terms of their ability get this data, it tends to make them look very hard at going toward these systems. So it’s never a mandate, but we show them the benefits and value, and that leads them to consider these tools as options compared with the types of closed systems that they typically have.
Guerra: I’d like to touch on the 14-month implementation you did. You referred to as an accelerated implementation pace, and said that it might not be the right pace for everyone. And 14 months may sound like a good chunk of time, but it is a short timeframe for a full-scale EMR implementation. We also have the HITECH deadlines, which mean getting people to maybe move faster than they would like to or than they should. Give us your thoughts overall around your organization’s pace, and general thoughts on pace to your colleagues who are starting down this path or in the middle of this path. We don’t what to rush these things—I would imagine there can be serious consequences.
Clonch: I agree with you 100 percent. The thing with Doctor’s Hospital in terms of the timeframe is that the scope of what we did—what was included in the go-live—was significant. It included all the orders, documentation, and pharmacy; it all the integration with the other systems that make up our core environment, including CPOE. There was a lot to do in that timeframe, and so the pace of getting it done was driven by 1) the organization knowing that it needed to position itself competitively, and 2) the fact that we did want to take advantage of Meaningful Use and the incentives associated with that. And when I talk about whether that’s right for DHR versus other places, at many of the organizations that I’ve had the privilege of working at, as well as those of our colleagues who have shared their experiences with me, we’ve found that sometimes it makes sense to roll this out in chunks. That allows our employees and our customers to digest what their getting, to learn it well, and then to move on to the next logical capability.
As an example, we might move to typically put in orders and pharmacy and some of the other core capabilities of an EMR, and then move to CPOE after that, and then move to physician documentation after that, which is a logical progression of continuing improvement. A DHR, we felt like ripping the band aid off because of our culture here—we like it fast-paced. We want to get it done. We’ve got tons of those things in the queue that 1) are dependent upon being successful with this, and 2) are going to take these resources we’ve allocated to our EMR program and allocate them to other places. So it’s a very important when you look at this as a program of work that has very tight timeframes, and other projects and things we want to do that are dependent on the timing being in place and being successful.
That’s kind of what drove us to do it as fast as we did—that and the fact that we’ve always done things here in a very fast-paced way. So I would suggest to you that the most important thing is to do it right, and don’t be afraid to step up and say, ‘To do this with the scope we have and the timeframe we want to do it in, we need the resources to make it happen.’ Never under-staff it or just take the staffing model that’s proposed by the suppliers as cart blanch as the way to do it, because that’s not the case. You have to look at the construct of the priorities of the organization, the culture—how well it adapts to change. Is it used to a fast-paced install? Are all the pieces in terms of governance and all those kinds of things in place to allow a program like this to be done in as fast a timeframe as this one was? Because decisions can be made quickly; there are not a lot of layers you have to go through to get a decision made. That’s very key as well.
The other thing is making sure the doctors are on board with it. That was huge. The clinicians not only have to agree to it, but they have to drive it. Ultimately, this was about change for them, and we offered the pros and cons of a fast-paced install versus one that was more measured to the person. They all wanted a fast-paced install, but again, they went into it with their eyes wide open. They knew exactly what we were getting into, and what it would take to pull it off. And then finally, bringing in a third-party firm to help make sure we stayed on pace; to help guide us and help us make decisions accurately the first time. Encore did a great job at helping us get there. We wouldn’t have been able to do it as effectively without them.
Guerra: So you are a Stage 6 hospital on the HIMSS Analytics scale, and I’m wondering how a Stage 6 hospital is lining up to meet Meaningful Use Stage 1. Did you plan on going for it this year or next year? And give us your thoughts around the measures and what they’ve put together.
Clonch: Yes, we absolutely are going to go after it this year. We’re on target to do that. That was one of the goals that we had when we first moved forward with the program. We don’t see it really as the cake; it’s more of the icing on top of the cake, or the cherry, simply because we feel like it offers us the funding to allow us to continue to reinvest in additional initiatives on information management that we want to do. Achieving Stage 6 was a significant milestone in several ways. One, it was an empirical way of identifying and sharing with our investor community here—our physicians and others—that we have made significant and substantive progress in terms of taking the investments in information systems and bringing about true value from that investment.
Two, it was a great way to assess how we did and how we were doing compared to other colleagues and providers in other communities, because we always love to benchmark ourselves to see what we can be doing better, how are others doing, and that kind of thing. Seeing that we can make measurable progress, and against that scale, was another benefit that we could tangibly show.
And it’s not the only benchmark we use to assess value. We also look at this as a Stage 6 facility. We have the ability to better coordinate care. We have put in a foundation and framework that allow us to move forward more effectively with other investments and other services we want to offer. We now have the infrastructure and the capability to do that and position ourselves well for the changes such as ACOs and other things that are coming that we need to be effectively doing. So it’s a major milestone in the context that we did in such a short timeframe as well, but in this industry—at least in my experience—you can never say you’ve arrived, because there’s always something out there change-wise that we need to do. But these types of investments have certainly positioned us to be successful with the changes that are coming.
Guerra: I noticed on your LinkedIn profile that you have the CHCIO credential and I wonder if you could give us your thoughts about working with CHIME and why you sought those continuing education credentials.
Clonch: I can tell you that CHIME has been pivotal to my success as a CIO. That organization has done a great job. Rich Correll and his crew there have done an exceptional job of allowing me and our colleagues out there to really understand what’s going on. The advocacy is great; keeping tabs on what’s going on has been huge, and the education programs and the networking have been exceptional. I can’t imagine trying to do the job of Chief Information Officer in an organization without actually being an active participant and actively part of that organization.
As far as the CHCIO credential, the continuing education that they offer and the ability of package all of that together in a way that allows us to grow as CIOs is so valuable. I’ve seen it change and grow over time, and I believe that taking advantage of that is visceral to us being successful. I can’t say enough about how well Rich and the crew and the board of directors have done to guide it, grow it, and position it as the organization it is today. It’s tremendous and I thoroughly enjoy being part of it. It has paid for itself many times over.
Guerra: Is there anything else you wanted to touch on—any major projects or thoughts that you wanted to get across to your colleagues?
Clonch: I can just say that it’s an exciting time to be in health care. I know that many of struggle with the things that keeps us awake at night like ACOs and ICD-10 and all the other programs and projects, along with the day-to-day task of trying to keep the ship sailing and that kind of thing. It’s definitely a challenging job; not for the faint hearted, but it is a job that is tremendously rewarding. I can’t think of a better position to have a privilege of being in than CIO of a health care delivery system, because of the opportunity to lead; to truly be a catalyst for change; to be able to drive that change home; and to be an active participant as part of a strong team that can truly impact the real reason we’re in this industry in the first place, and that’s to care for people. So I’m thrilled to be part of it, and I hope I have a long tenure and career in this role and in health care in doing that.
Guerra: Well that was wonderful, Les. I want to thank you so much for your generous time today.
Clonch: I sincerely appreciate the opportunity to chat with you. It’s been great, Anthony. Thank you for the opportunity.
Guerra: I look forward to speaking with you again in the future.