Five years ago, Chris Belmont was called upon to help Ochsner Health System recover from one of the worst natural disasters the United States has seen in decades. Not only was the organization able to get back on track, but it acquired several facilities, forcing leadership to begin the process of replacing the homegrown record system with an EMR that could more effectively serve its growing patient population. Belmont was looking for a partner — not just a supplier, and that’s exactly what he got with Epic, a company that uses unconventional methods to achieve results. In this interview, he talks about why Ochsner called on third-parties to assist with the enterprise EMR rollout, why integration always trumps individual preferences, and how to get the right mix of talent in the C-suite.
- Working with Initiate (IBM) and Orion
- An update on disaster recovery
- Finding the right C-suite talent mix (CIO, CTO, CMIO, CMO)
- Thoughts on social media
- Reflecting on the consultant’s life
The concern from the community physician was, I send you a patient and I lose them. Through Orion, they can see what’s going on clinically, and we send them alerts when events occur. So when a patient presents at the ED that has a relationship with a physician, we’ll send them a notice. When a patient is discharged, if there’s a lab result that they want to see, they can.
We’re not ready. And I think if anybody says they are, they’re wrong. Because when Katrina hit, we went right past pages one and two of our disaster plan and went right to page 20. It was an eye-opener.
When we’re driving change in the organization, asking docs and clinicians to do more things and to adapt the way they do business, I don’t have the clout to walk in there and do it because I’ve never practiced medicine.
This job will take whatever you throw at it. You have to enjoy it. It’s hard work, and it’s unlimited—the amount of work you have and the demands from the organization just increases exponentially. We touch literally every person every day.
When I bring somebody in, I don’t want to hear a sales pitch. I want to hear good, honest recommendations. I want a partner; an extension of my team. I don’t want somebody who’s in it to grow their business.
Guerra: In terms of integrating with the practices and the independent physicians, I see that you brought in two companies that seemed like they are involved with that; one is Orion and the other is Initiate, which I believe was bought by IBM.
Guerra: Tell me about those companies—how they play into your strategy of integrating with the physicians, and if you’re using Stark at all with the independents.
Belmont: Okay. So I’ll start with Initiate because that was one of the early solutions. We probably have had Initiate up and running for about three years. When we got here and we decided to rollout and we did the acquisition of the Tenet facilities, we had multiple patient indexes that we needed to combine. We also discovered that we had quite a few potential duplicate medical record numbers within our own system. So we brought in Initiate to help us streamline that and build out a pretty robust enterprise master patient index. So we implemented that at the same we were rolling out our core systems to the other facilities. And that’s played out really well. We discovered about a quarter million duplicates that we’ve scrubbed or at least analyzed, and now when we on-board a new facility it’s fairly easy to incorporate them into our master patient index. And that’s integrated into our legacy platforms and we’re going to keep that going forward.
The other situation we had is that post-Katrina, our population dispersed. So in terms of finding and determining whether this was the same person even though their address has changed, Initiate really helped us with that as the population continued to move around and eventually came back to the city. And typically when people came back, they came back to a different place. So it really helped us a great deal.
Our next plan is to more or less morph that into a master population index. We own a health center, so we’re going to put our employees and providers into the Initiate system by the end of this year and start building relationships dynamically and by assignment between our physicians and our patients; we’re going to start building relationships between the populations. To have a single source of truth for people that interact with Ochsner is our goal, and we plan on using Initiate for that.
And then Orion came about as we were talking earlier about our challenge with working with community physicians. So we purchased Orion; we visited Lahey Clinic up in Boston and we liked what they were doing. Orion is more or less a portal, so if you send a patient or you have a patient that interacts with Ochsner, this gives you a view into that patient as they get services provided at Ochsner.
The concern from the community physician was, I send you a patient and I lose them. It’s not that we’re not taking good care of them, it’s just that they don’t know what goes on or that they don’t get those patients back. We’re using Orion to build that connection. Through Orion, they can see what’s going on clinically, and we send them alerts when events occur. So when a patient presents at the ED that has a relationship with a physician, we’ll send them a notice. When a patient is discharged, if there’s a lab result that they want to see, they can. Orion allows us to let the community physician kind of set up their own levels of alerts and reminders. And again, it’s a portal into Ochsner. So that’s working out quite well and it’s probably worked better for our referring physicians than it has for our community physicians right now. But it does well for us.
Guerra: The general area of disaster recovery—what have you done there? Are you all set for whatever may come down the road?
Belmont: You know, we thought we were set before. But who knew that the city would be under water for weeks? It’s a constant battle, and I think it’s a balance of how much can you afford. So no, we’re not ready. And I think if anybody says they are, they’re wrong. Because when Katrina hit, we went right past pages one and two of our disaster plan and went right to page 20. It was an eye-opener, and I think the big thing that we realized is that it wasn’t necessarily EHR that you needed to have up all the time; it was your ERP and payroll system. We needed to pay people and we needed to buy things. So that was probably our most mission-critical application. It was an eye-opener for me, because I assumed that since we’re healthcare organization, we’ve got to have access to the record.
But we have a lot of work to do there. Our primary data center is still in New Orleans, so we have decisions to make on what we do about that—do we leverage the cloud, do we build another data center, and if so, where? So we’ve got a lot of work to do in that space.
Guerra: Right. I’ve interviewed Lynn Witherspoon, who is now CMIO but was CIO for a while there. He mentioned when I interviewed him last time that the chief medical officer is Joe Bisordi.
Guerra: Do you have a CTO?
Belmont: I do. I just hired a CTO, his name is Doug Lauterbach. He was previously at BayCare, and he just started in January.
Guerra: So what I find interesting is that you have a CIO, CMIO, CMO and CTO. Those four positions all have to work together to some degree and be interrelated. If you put those four positions in a pie, you need to have a certain talent mix in the whole pie. How it’s split up isn’t really that important; most organizations put it up differently. Some organizations have a CIO who’s an MD like Dr. Witherspoon was, but some don’t. Give us your thoughts around that group—what kind of interaction is needed and what kind of relationships are needed for the organization to be successful.
Belmont: I think the key is to have an MD somewhere in that pie. There are things I cannot do because I don’t have those initials behind my name. So when we were driving change in the organization, asking docs and clinicians to do more things and to adapt the way they do business, I don’t have the clout to walk in there and do it because I’ve never practiced medicine. Having Dr. Witherspoon and Dr. Bisordi there just breaks those ties.
Also, as part of our Epic governance, we have an entire group called our physician champions, which is head by actually Dr. Richard Milani, who wrote the cardiology system that we referenced earlier. He is our physician champion for the Epic project, and they’re the ones that can drive change and adoption at the physician level. That’s the key to me. The technical expertise and even some of the basic CIO functions, you can find those , but having an MD that gets it from an IT perspective is extremely important. And I’m fortunate to have you know three that I work with directly and then I would argue that I have quite a few in the organization that just get it.
Guerra: What is it is a good division of duties between the CIO and the CTO, at a high level?
Belmont: Ideally, where I see this going is, I see my role as being more strategic and less operational. I almost see the CTO as the person who just keeps the trains running and drives some of the projects through. My time needs to be spent on more strategic and long-term issues and not on the day-to-day operations. That’s where we are today. I don’t know where that’s going to be in three years, but it feels like it’s going to be an ongoing thing as we grow. And as the organization becomes more dynamic with the challenges of the industry, I think I need to be in touch with that, and the CTO I think has to keep the trains running. That’s oversimplifying things, so it’s not necessarily fair to our CTO because he is doing some very strategic things, but I think that, in a nutshell, is how I see the division of duties.
Guerra: Right. We connected on Facebook so you’re on there and I know you’ve got over 400 connections on LinkedIn, so you’re active with social media and networking. Do you have an overall philosophy or an underlying philosophy on how you use those different tools and why?
Belmont: Yeah, I don’t know about a philosophy; it’s a little bit of a fear, it’s a little bit of it’s going to happen anyway, so why not embrace it. I’m concerned about it. The other thing that Ivo taught me—and those of you who know Ivo will get this. He had a saying: ‘Skate to where the puck is going.’ There’s going to be more social networking rather than less, and it’s going to be expected by our population coming through our pipeline. They’re going to expect more, so how do we leverage that?
So I don’t know that I have an active plan or strategy to embrace social media, but I’m very aware of it, and I know we have to do some things. Everybody wants things right now and it’s a convenience world that we live in, and we just have to do that. And Ochsner is out there. For example, about two years ago, we set up an iPhone app that lets you look at our ED wait times online. So if you went out to the AppStore right now and download the Ochsner app, you can see what the wait times in our EDs are right now. nd we have 150,000 hits a year on that. Patients go to their iPhones and say, ‘Okay, where can I get seen the quickest,’ and collateral benefit is we found that the ambulance services use it as much as the patient. When they pick up a patient they say, ‘Okay, who’s got the lowest wait time so I can get the patient in the door?’ So we’ve got an awareness there, and I’d love to say we have an active practice around Apple, but we just don’t. We’re just going to embrace it as it goes along.
Guerra: As the CIO, what is your main concern regarding handheld social media—is it security, data leakage, these type of things?
Belmont: It’s security, it’s data leakage, and it’s content management. Some of my followers and the people I follow on things like Twitter are employees, and there can be some damaging things said. So I’m much worried about the content as I am about the actual security and leakage. Things like misinformation. You could plant something out there on Twitter and do a lot of damage without having any credibility. That’s what concerns me.
Guerra: So we talked about Encore before; you know, they’re ramping up over there. Did they give you a call?
Belmont: They are ramping up.
Guerra: Are you interested?
Belmont: Oh no, no. I’m having a lot of fun where I am. Should things go south here, I’ll call Dana but she’s probably not going to want another old horse like me. So, I’m more damaged goods now. But yeah, they do good stuff, and as long as they keep the culture of the customer is first, I think they’re going to be a force to be reckoned with.
Guerra: I talk to a lot of CIOs that spent time in consulting, going back and forth. How would you describe the different lifestyles, and if you were talking to a CIO who was thinking about giving it a try, what advice would you give them about either doing it or not doing it?
Belmont: First of all, this job over here will take whatever you throw at it. You have to enjoy it. It’s hard work, and it’s unlimited—the amount of work you have and the demands from the organization just increases exponentially. We touch literally every person every day, whether it’s a patient or an employee or a physician. So it’s hard work, but I love it in a crazy way. If you’re on this side of the fence, you’ve got to enjoy this phase.
On the consulting side, I think you need to focus on being honest and upfront. I’ve never been one to say, ‘Let me sugarcoat this answer so I don’t upset anybody.’ They’re paying you for an opinion, so you owe it to them to go in there and tell them truth, and I think that’s what work best. Because at Healthlink, that’s what we did; we didn’t pull any punches. Some of the recommendations I made actually worked me out of the ability to bid on the next job. I remember one deal where we were asked to come in and look at an in-source versus outsource arrangement. And where the in-source arrangement would mean an opportunity for Healthlink to help them build an IT shop, we said, ‘Your best decision is to outsource.’ And it was a tough call. I remember talking to Ivo and he said, ‘Do what’s right for the customer.’ And I think if you stick to those guns, that’s when you provide value.
And that’s what I need as a CIO. When I bring somebody in, I don’t want to hear a sales pitch. I want to hear good, honest recommendations. I want a partner; an extension of my team. I don’t want somebody who’s in it to grow their business. It’s all about me; I hate to say it that way.
Guerra: Sometimes even there’s this dynamic where, tell me if I’m wrong, a CIO will bring in a consulting company to get an endorsement of something they want to do. And they kind of indicate to the consulting company, ‘Here’s where I’d like to go. Why don’t you study this?’ because they want you to come up with a specific conclusion. Have you had that experience where people indicated that and then your conclusion went to other direction and you lost a client?
Belmont: Well I had a situation where they came in and said, ‘We think we’re going to kick our vendor out,’ and once I dug in, and I said, ‘It’s not the vendor; it’s you. Your governance is kind of messed up. Your decision makers are not engaged.’ And in fact, I still talk to that client, and they’re still executing on the plan. They still have the vendor in place and they’re very engaged. So yeah, I’ve had people come in and say, ‘This is what I want to do, make this happen,’ and that doesn’t feel right. I still give them my opinion. And they still may go off and do their own thing.
But on the flip side, you know, when I was charging Ochsner for my hourly services as a consultant, I was genius. And now that I’m on the inside, they say, ‘You might want to go out and get a consultant” and I say, ‘No, I used to tell the same things.’ So I was a genius when I was on the outside and I’m less of a genius now that I am on the inside.
Guerra: Right. Well this has been really enjoyable, Chris. Is there anything else you want to add?
Belmont: Yeah, I enjoy it, and I’m very passionate about the industry. There’s a lot we can do. I still think we’re behind the curve, and I think there’s a lot we can learn form other industries. I think listening to vendors and listening to consultants, you have to do that with measured approach. You’re not always going to get the right answer from the vendor in particular. I don’t have the luxury anymore to take flyers for a bigger organization, so I’ve got to have proven solutions. I need partners; not suppliers. And the reality is at the end of the day, it’s all about Ochsner and all about Ochsner’s performance. It’s not about your fiscal year. It’s not about your sales cycle. And that’s the biggest challenge I have is getting partners to help me move Ochsner forward without a hidden agenda.
Guerra: Alright, Chris. I want to thank you so much for your time today.
Belmont: Anytime. I enjoyed it.
Guerra: Please say hi to Dr. Witherspoon, and I hope to talk to you again soon.
Belmont: I will.