Charles Colander, VP/CIO, Elmhurst Memorial Healthcare
Charles (Chuck) Colander has been around the health IT game long enough to know that choosing the most sophisticated system doesn’t necessarily guarantee high adoption rates. Colander’s experience — which includes time spent as both a CTO and consultant — has taught him the best way to get physicians engaged is to build an implementation strategy that focuses on improving the patient experience. In this four-part interview, Colander shares his thoughts on how he manages a varied application environment, the vast difference between being a CIO and a consultant, why it’s critical for the IT department to embrace its role as a service organization, and how he hopes to steer a smooth transition into a new building.
Chapter 2
- Moving facilities during Meaningful Use
- Increasing physician adoption of advanced clinicals
- “I think it’s important you compensate them when they make investments in what you’re doing”
- Working with Merge Healthcare for cardiology
- The complexity of application integration
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It’s difficult to have to go back to them and say, ‘Listen, we really need to take 60 days to get ourselves well-positioned for the move to the new building, and we need to put the brakes on some of these other activities.’ You hate to do that, because when you get some momentum going around these types of initiatives, you want to just take it and run.
If you can build your systems and build your approaches around demonstrating improvement in the patient experience and improvement the quality of care, you can get traction, whether those are contracted physicians, dedicated physicians or even split admitters, as we might call them.
Physicians need to at least see that you’re willing to acknowledge—somehow, in some way—the time investment that they’re making. If you don’t do anything like that for the independents, the disparity between what they’re feeling and what their affiliated and employed physician friends are feeling is going to be something they can’t reconcile
The average physician in our institution isn’t going to Merge directly for their reports; they’re going to Meditech. But the reports then are available in Meditech and we do provide direct links back in for images.
I think most organizations now have reverted back to something that’s either a primary vendor or core vendor model, much like we have, where they’re trying to limit the number of interfaces and the level of integration between different systems that they use.
Guerra: You talked about taking a respite from your EMR/CPOE work because of the move. I would imagine that’s a pretty stressful thing. This is probably not the time that you want to have to take respite with Meaningful Use and the deadlines and all that. It’s been tough with the move and Meaningful Use?
Colander: Only that there are physicians out there, frankly, that are anxious to move ahead, and it’s difficult to have to go back to them and say, ‘Listen, we really need to take 60 days to get ourselves well-positioned for the move to the new building, and we need to put the brakes on some of these other activities.’ You hate to do that, because when you get some momentum going around these types of initiatives, you want to just take it and run. But the reality is we have to make sure that our systems are right and in place for the move. We’ve got a lot new technology and a lot of new workflows that our nurses and physicians are going to have to adapt to as we move to this new facility, and we need to make sure that we take the time to make that all work correctly.
Guerra: As a CIO, do you see in the move a lot of patient safety issues that you need to worry about to make sure this is smooth transition?
Colander: Well certainly patient safety is a huge concern during any move or any big change like this. That’s why there’s been extensive time and effort for mock drills, mock moves, and simulation training and testing within the new facility to raise the comfort level of the doctors and nurses prior to the actual patient treatment that happens here. Hence the respite, if you will, from the electronic medical record.
We need to keep those things stable so that we can train people and get people ready to take care of patients in the new building. Obviously I rely on our clinical leadership to take the lead position when it comes to ensuring that we’re going to have a safe move, and that all of our patients are going to be well-cared for during that process. But again we were there to provide the infrastructure and technology to make sure that all of those things work well and they can depend on those systems as part of the move process and the ongoing care process in the new building.
Guerra: You talked about adaption and getting your levels up on CPOE, physician documentation, and all these types of things. Is there a big difference between the employed and non-employed physicians in terms of adaption, and what are the challenges there that you really see?
Colander: Well that’s a tough one. I think physicians, at their core, are physicians. I think that as we try to bring this new technology to bear and really change their work processes, you have to appeal to their desires for high quality care to improve the experience of their patients. I think at the core, most of them went to medical school and became doctors because they want to have success in treating their patients. And so I think if you can build your systems and build your approaches around demonstrating improvement in the patient experience and improvement the quality of care, you can get traction, whether those are contracted physicians, dedicated physicians or even split admitters, as we might call them.
I think that at the core, that’s the best way to appeal to them. And there are some differences; I don’t want to pretend there isn’t. The independent physicians are their own leadership, if you will. It’s their organization; they lead it. With the contracted physicians who are part of our clinic, we have some leadership influence over the day-to-day operations on how we do things within those practices. So there is ability to influence, to a different degree, physicians in those types of practices, and absolutely you leverage that as you go forward. But I think at the end of the day, if you want to have satisfied physicians in that environment or satisfied physicians in the independent environment, you have to put systems in place and give them the tools and the opportunity to provide better care and a better patient experience. That’s the way you’ll appeal to them and to their motivations.
Guerra: On some level, though, isn’t important to keep in mind when you’re speaking to an employed physician and you want to train them or you want to engage them in training, that they’re going to get paid? They’re on the clock and they’re getting paid. If you’re dealing with an independent physician, that’s an independent business person—don’t you have a little bit of a different angle? Because they’re not going to get paid if they’re sitting there training with you. Do you know what I mean? It’s important to keep that in mind when you’re dealing with different types of physicians, right?
Colander: Well sure, but I also think it’s important that you compensate them when they make investments in what you’re doing. We’ve seen lots of cases demonstrated. We have a large healthcare provider in our market place that has just completed or is completing the conversion to CPOE, and there’s extensive physician training that they put in place as a part of a mass conversion effort. I think there was some type of giveaway as a part of the process; recognizing the investment that the physicians were making and the time they were putting in to get prepared for their CPOE implementation.
And by no means do I think the monetary value of what they received was anywhere close to compensation for the time, because the time commitment was extensive. But I think physicians need to at least see that you’re willing to acknowledge—somehow, in some way—the time investment that they’re making. If you don’t do anything like that for the independents, the disparity between what they’re feeling and what their affiliated and employed physician friends are feeling is going to be something they can’t reconcile and they’re going to have some difficulty with. So you need to do something. And in fact, for the physicians who participate in our physician advisory committee and participate with us through special pilot programs, we have a stipend program that enables us to at least acknowledge to some degree the fact that their investment is important to us.
Guerra: I definitely think that’s appropriate. I could just picture a training room with independent physicians looking at the clock and the employed doctors enjoying the class.
Colander: Just make sure you can consult with your office of general council on what you can and can’t do.
Guerra: Right. Okay, let’s chat a little bit about what you’re doing with Merge. There are a lot of underlying issues that we’ll get into, but just give an overview of the relationship you’ve got with Merge.
Colander: We took a look at our whole cardiovascular information system just over a year ago, and we found that we had a very fragmented approach to how we were dealing with all the information needs within our cardiac program. So we studied it long and hard enough to be able to tell that there really wasn’t a solution in what we had today, and we really needed to overhaul the system.
So we did, and we got very formal about it. We did a selection process. We put together our strategy, we develop our RFPs, we went through a selection process, and we decided to move ahead with what was called Amicas at the time. The vendor was Amicas and the system was Vericis. Since then, Merge has purchased Amacus, and we’ve been moving forward with that implementation.
We’ve done a couple of things to get prepared for that. Again, the timing was a little bit difficult, because we’re moving the cath labs almost as we speak, and we had to get prepared for a whole new set of imaging modalities associated with the new facility—integration with a new 320-slice CT scanner that’s going to have significant use in the cardiac program, and a number of other new technologies within the new hospital.
So we’ve gone live with echo reporting, which is significant part of what happens in cath lab, and we’re preparing now to move to structured physician template reporting 60 to 90 days after we move in. So the move is on June 25 and the first phase of the cardio project went live earlier this month, and we will continue to move through with the implementation. Lightly, a number of different phases will be accomplished and really not wrap up till the end of the calendar year.
Guerra: Forgive me if I missed this, but does Meditech have a cardiology package and were you on that? Did you look at that?
Colander: It does not.
Guerra: Okay, so you needed to go with a third party.
Colander: Right, and we were third party before. It was just that we didn’t have a very comprehensive solution, so it was cobbled together from a number of different vendors and a number of different products. This puts us in a situation where we’re a little bit more centralized. Cardiology is very difficult as far as all the different aspects of it, and we really wanted both the invasive and non-invasive cardiology components to be as integrated as possible. We do have another vendor that handles the initial acquisition of the noninvasive images and the noninvasive information, but we do incorporate that back into the Vericis system so it becomes part of the overall cardiology record.
Guerra: Is there integration between Merge and Meditech?
Colander: Absolutely. So as the reports get done through the process in Merge and those procedures are wrapped up, we move them back to the electronic medical record so they physicians can access them. The average physician in our institution isn’t going to Merge directly for their reports; they’re going to Meditech. But the reports then are available in Meditech and we do provide direct linkages back in for images.
Guerra: And that would mean that they were available in eClinical works or NextGen?
Colander: The reports would be available in both of those, absolutely. The imaging piece will be available; it maybe through a separate link where they launch a Web viewer to see those images. I’m not sure they’re directly in the NextGen System.
Guerra: Right. So it gets complicated, right?
Colander: Yeah, it’s hard to keep track of all this stuff.
Guerra: We have Merge, we have MEDITECH, we have NextGen, and we have eClinicalWorks.
Colander: You know I’ve got it easy, because frankly, outside of Meditech, we really only have a handful of systems we’re dealing with. I’ve been in another shops where there’s a little bit more of a best-of-breed approach and the number of systems that some of my colleagues are dealing with— the sheer volume of systems—is much more significant. And again, some of my colleagues were dealing with multiple hospital situations with recent acquisitions and all those things. Their challenges are much greater than mine, frankly.
Guerra: And they’re talking about dozens or even hundreds of interfaces.
Colander: Hundreds, absolutely.
Guerra: Okay, so I was going to talk about best-of-breed versus the core product, but you don’t have that situation.
Colander: No, I lived all that when I was at what was called Evangelical Health System before it became Advocate Health years ago. We went to a best-of-breed approach back in 1989 or 1990, when that was thought to be the way to move. We literally let all of the different departments pick different systems and we, the IS department, took on the obligation to integrate them using HL7. This when HL7 was pretty new, and that turned into a very difficult task. I think most organizations now have reverted back to something that’s either a primary vendor or core vendor model, much like we have, where they’re trying to limit the number of interfaces and the level of integration between different systems that they use.
Guerra: I always think it’s fascinating, and it happens all the time. A lot of smart people sit down, come up with the plan to say we’re going to go best-of-breed; we’re going to empower the departments. And then down the road they say, ‘Well, that wasn’t the way to go.’ It’s just amazing that we can all get it wrong, no matter how much we think about it sometimes.
Colander: And it’s very cyclical, too. We could tell stories all day. Guys my age remember the mainframe days and the migration back to the personal computers, and now, between Citrix and another things that we’re doing, our PCs are more like mainframe terminals than they have been in long time. So things are very cyclical in nature. And it keeps us employed, so that’s nice.
ATMD says
Anthony, these podcasts are very well done and insightful but I think you’re missing a key piece of the picture when you discuss “employed” vs. independent physicians.
Regardless of whether physicians are salaried and/or employed by the facility (as opposed to being an independent physician with a private practice), there is still a very real cost to participating in EHR related training and meetings. Just because a physician is employed or salaried doesn’t mean that he/she only works a certain shift and then goes home. Instead, there is always a certain amount of clinical care that has to be delivered at any one time by the physicians as a group.
I am a salaried academic physician, primarily inpatient. If I am in CPOE training, my colleague would have to cover my patients as well as his/hers. Or I have to go back and see all of my patients after the training is over and just return home later that night.
Many employed physicians are on plans that have salary plus incentives based on productivity measures. So time that takes away from patient care also reduces the take home pay of these individuals just as much as it affects the independent clinicians.
Already, facilities are generally more sensitive to the needs of independent clinicians since they can always admit patients elsewhere. The employed physicians don’t have that option and are already feeling more of the brunt of a wide range of institutional demands that the independent physicians will just refuse. Although the institution may think they can keep sticking it to the employed/salaried physicians, they are wrong. You will run the risk of losing your top people and having the rest be disgruntled and burned out. Sooner or later they will revolt either overtly or covertly. Fueling perceived inequities in the ways that salaried and independent physicians’ time is valued will only accentuate problems.
Also, realize that the time spent in CPOE and other EHR training is just the tip of the iceberg. If the facility has an EHR that is poorly designed and has a negative effect on the physicians’ ability to get their work done, complete necessary documentation and provide high quality care, then this will also lead to physician dissatisfaction and resentment. Alternatively, if a CIO shows that the time and skills of the physicians (employed and independent) are valued, that the computer system functions efficiently and effectively, and that training is efficient and not perceived as a waste, then you will promote physician adoption across the board.
Why do so many physicians love iPads? They’re versatile, easily customized to fit the desires and needs of the end user and they make our lives more efficient (and fun). Why do so many physicians resist EHR adoption? Although systems are well-designed, well-implemented, and enthusiastically adopted, many are not. EHRs often don’t have any iPad-like features — they are clunky, hard to customize to meet the needs of our patients, detract from clinical decision making, focus on banal metrics rather than truly improving the quality of care to patients and above all are inefficient to use. Yet they are being rammed down our throats anyway. Simply giving training incentives or adoption incentives isn’t going to change this for employed or independent physicians. It’s the broader picture that needs to be addressed in a thoughtful manner.
Anthony Guerra says
Thank you very much for this very informative comment. I had no idea that employed docs might even feel more of the EMR-implementation/Meaningful Use brunt. My eyes have certainly been opened.