With nearly two dozen years of CIO experience under her belt, Michele Zeigler knows full well that when it comes to physicians, no two are alike. The needs and preferences of a specialist can differ drastically from those of a primary care physician, and affiliated physicians and employed doctors often present with a completely different set of concerns. So how does Zeigler handle this delicate situation? By steering clear of the cookie cutter approach when deploying new systems, and by getting physicians involved in the selection process. In this interview, she talks about the importance of being flexible, the challenges of dealing with many interfaces at once, what she looks for in a vendor, and what her organization is doing around wireless device management.
- Satisfying the specialists
- Wireless device empowerment
- “It’s a balance between access and security”
- “Now the tune is not, ‘No,’ just, ‘Not now'”
The needs of an orthopedic surgeon are very different than the needs of a family practice provider or pediatrician or an internist. So usually you can customize these tools and build them in a certain way that enables you to accommodate those different requirements.
From an application perspective, our vendors really have to get into the game, or we’ll have to buy a third-party tool. So I was pleased to see Meditech start to develop that.
Everybody has gadget lust—there’s a new gadget, I have to have it. And I have no problem with piloting and providing different tools. But when I really talk to people I want to know—at the end of the day, how is this going to make us more efficient? How are you going to use it? I think that’s been a really helpful discussion for us to have.
If you want to bring your device in and hop on our network, you’re going to have to give us a couple of months, because we just aren’t just there yet from a network infrastructure and security setup perspective. And so working with our CPOE executive sponsors, I’ve realized that we’re going to have to step up to that.
The need for flexibility is going to continue. Mobile devices have a place, so we have to balance and redesign our network to enable that.
Guerra: Let’s talk a little bit about the specialist; you say you’ve got about 110 providers in owned practices and a lot of specialists. Are you getting a different reception from some of the specialists who are using this Medent EMR? I would imagine it is a primary care-focused or generic type of EMR. Are any of the specialists balking at this—do they want their own specialty EMR?
Michele: No, I’m not hearing that. They’re actually were part of the selection committee and I know that there are other specialists that are using this tool. I believe they have some specialized modules—for instance, I know that they have an oncology module and things of that nature, although we opted not to go that direction for oncology practices. So I haven’t heard that yet. Now I will tell you that we haven’t rolled out the EMR; the rubber hasn’t hit the road. But I’m sure you can always customize to their needs, because the needs of an orthopedic surgeon are very different than the needs of a family practice provider or pediatrician or an internist. So usually you can customize these tools and build them in a certain way that enables you to accommodate those different requirements.
Guerra: Right. Before the formal interview started, we touched on the idea of wireless and handheld devices; specifically, physicians showing up at your door with their iPhone and saying, ‘I’d like to see my results from the Meditech system or from my ambulatory EMR here.’ Tell me about the whole dynamic around wireless devices, and then let’s talk a little bit about best practices in saying ‘no’ delicately to physicians—in a way that doesn’t have them marching into the CEO’s office.
Michele: Absolutely. I look it mobility from a couple of different aspects. I look at mobility from an application standpoint. So your applications that you want to provide in a mobile format have to be designed or you have to have toolsets so that you can have the appropriate screen size. Meditech has been just a little bit behind on that, but they have recently rolled out what’s called PocketPC. And the nice thing about that is that it’s mobile OS-agnostic. When we tried to look at an anti-virus tool just for smartphones, there are six different operating systems, and we couldn’t come up with the common one that would support our needs. We just had some challenges with that.
From an application perspective, our vendors really have to get into the game, or we’ll have to buy a third-party tool. So I was pleased to see Meditech start to develop that. Now, as we’ve rolled it to a pilot group of course they want more functionality, but Meditech has given us a timeline for that. From a wireless and a security and a network perspective, of course we’ve engineered our network to be tight and you can’t get in. With mobility, we really have to look very differently at how we grant access and how we do security.
We have a vendor that we work with that helps us with our security audits and does some engineering for us from a network perspectives. So we kicked off mobile strategy. They’re going to come in, do an assessment, and they’re going to help us. I gave them six scenarios that our network had to meet. And we’re actually going to provide Wi-Fi guest access; if you come in with your iPad and you want to use it, you’ll be able to.
One of the other things that we did as a stopgap is we didn’t have very good cell coverage in our two hospitals. So Verizon, our local wireless vendor, actually provided grant funding and they came in and wired both of our hospitals for cellular coverage. So that’s been good because people can come in and use their smartphones. If they can hop on a cell signal, they can use that. And because we have direct EMR access and because we have remote access, they’ve been able to use that to get access to their systems.
When we just rolled out CPOE to our two EDs, we asked as we worked with the physicians that we not roll out any new hardware, because we didn’t want a third thing for them, and they actually agreed with that. And although they were all gung-ho saying, ‘A month after we go live, we’re going have to different hardware or tablets and this that or the other thing,’ I said to them, ‘Well then, you’re going to have to think through your process.’ And a couple of them looked at me kind of funny, and I said, ‘If you’re going to do your orders like you do now—if you’re going to go in, see the patient, and then come out to your desk area and enter your orders, like you do now on paper, then the device we have there will meet your needs. If you’re going to directly put orders in right as you’re with the patient doing your assessment, a tablet would be great. But you need to think about how you’re going to use it in your workflow.’ And the funny thing is that after being live two-plus weeks, they’re not even interested in talking about a tablet.
So it’s really thinking about how am I going to use this device to improve or augment my workflow. I mean, everybody has gadget lust—there’s a new gadget, I have to have it. And I have no problem with piloting and providing different tools. But when I really talk to people I want to know—at the end of the day, how is this going to make us more efficient? How are you going to use it? I think that’s been a really helpful discussion for us to have.
Now I know that people are using other devices in their offices and they like their devices, and so maybe they want to carry it with them. Some people are like that. And then they want to come and do some things here at the hospital. I think with this mobile strategy that we’re developing, we’ll be able to enable that. We’re also in the midst of a building project that at our larger hospital. So part of this different mobile strategy is that we can offer Wi-Fi and patient guest access probably prior to us opening the expanded towers. So it’s a balance between access and security. It’s always a balance.
Guerra: And any more thoughts on articulating that ‘no’ when the physician comes into your office—the best way to couch that?
Michele: Well, what we’ve done when we partnered with Verizon, at least we provided cell coverage, and then we worked with Verizon and they have some Netbook deals and things like that that they offered our physicians and our affiliated physicians. So we provided a bit of a stopgap because that was a mechanism. Lately, the discussion has been, if you want to bring your device in and hop on our network, you’re going to have to give us a couple of months, because we just aren’t just there yet from a network infrastructure and security setup perspective. And so working with our CPOE executive sponsors, I’ve realized that we’re going to have to step up to that. And with everything going on and all the initiatives, it’s not something that I want to take a risk on. So we’re leveraging some expertise in that area to develop a secure mobile strategy pretty quickly so that we can execute it. So now the tune is not ‘no,’ it’s, ‘just not now.’
Guerra: Right. Not ‘no,’ just not now. I like that.
Michele: And we have a physician technology committee, which has been helpful, and our CPOE physician champions are absolutely fine with that. Actually, we’ve got quite a bit of work to do before our CPOE rollout. We have a lot of devices that are available to physicians, so we’re not making devices and access an issue. But I do know that the need for flexibility is going to continue. Mobile devices have a place, so we have to balance and redesign our network to enable that.
Guerra: Well, you’ve been very generous with your time today Michele. Is there anything else you want to add—anything we didn’t touch on that you wanted to address?
Michele: No, not that I can think of.
Guerra: Well thank you so much. This was wonderful. And hopefully we’ll get to talk again soon.
Michele: Okay, thank you.