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.
- The importance of attracting physicians – “That’s why we’re being flexible”
- Empowering physicians to use their wireless devices of choice
- Meditech working to make apps available on wireless operating systems
- The rise of the iPhone — “We’re starting with Apple”
- Vendor support is the key
- Thoughts on Meaningful Use
I have found that if you open up a dialogue with the independent physicians, especially as they get more and more involved with the electronic medical records in their offices, they begin to understand more deeply the challenges of the technology.
We’ve got a couple of tools that are basically web-based but will work on a mobile device. What we’ve been challenged with is trying to put together a strategy that allows us to deploy that type of technology in a secure fashion.
More than 60% of all physicians will own an iPhone by the end of this year, and so that’s a platform we want to leverage. We’re not in a position to buy devices for all of our doctors—most of the doctors are quite comfortable buying their own devices; they just want to be able to integrate your solutions onto it.
When you think about what we do, although the patients come to us—whether it’s in the doctor’s office or the hospital—that last 100 feet is the caregiver moving to the patient, And the best way to support that is with the mobile device.
We have not had a lot of conversations at the executive level about Meaningful Use dollars. We talk about patient safety. We talk about a better patient experience. We talk about clinical quality. We talk about building an evidence-based medicine practice that’s supported by electronic medical records and CPOE and clinical documentation.
Guerra: In the release that Merge put out, you were quoted as saying, ‘really getting the system was about making sure that you have a state-of-the-art cardiovascular information system to treat patients and attract physicians.’ I want to drill down on the phrase ‘attract physicians,’ because I think that’s so crucial and so honest. You’re running a business and that business is driven by physicians patronizing your facility with their patients and that’s really what you touched on. Can you expand on your thoughts around creating a facility that attracts physicians?
Colander: Sure, but speaking directly to the cardiology piece first, we have great partnerships here at Elmhurst with a cardiology group and a cardiac surgeons group—Midwest Heart, which has a significant presence in the western Suburbs of Chicago and works with a lot of different hospitals in the area. They are our partner in this; they were heavily engaged in the selection process for the system here, and we absolutely recognize that. They bring a lot of value to our patients and to our institution. So in terms of attracting them, I don’t have to attract them so much, since they are already our partner. But certainly I want to keep that partnership strong, and that’s one of the reasons that we went down this path of adapting a new strategy that eventually led us to the selection of the Merge System.
With all the challenges that we have with reimbursement and new technologies in the medical fields, you need to do what you can to make the patient experience and the physician experience at your institutions as solid as possible so that when folks need a hospital, they can come here. These are some of the things that we’ve already talked about—our flexibility when it comes to supporting different electronic medical record systems for our different independent physicians. That’s why we’re being flexible. We want to be as accommodating as we can, keeping things balanced and recognizing that physicians are out there and making independent decisions, but they still want to be integrated with our institution. So we’ll put as many technologies in place as we can. We want to still be as flexible as possible to allow our physicians to practice here without pain. Of course we have a fantastic new institution and a lot of new medical technology, so that helps with that as well.
Guerra: Right. So it’s that balance, as you said, between best-of-breed and letting everybody do their own thing and pick what they like, versus giving them some say, but within a parameter and framework that you can handle.
Colander: Absolutely. And you know I have found that if you open up a dialogue with the independent physicians, especially as they get more and more involved with the electronic medical records in their offices, they begin to understand more deeply the challenges of the technology. And you can have open discussions with these guys and talk a little bit about what you can support and what you can’t support and why, and you get much more traction with that open conversation than you might have five or six years ago.
Guerra: I guess the more they know about your challenges, the less they think you’re just not being helpful.
Guerra: Right. What about handhelds—are you doing anything around iPhones, iPods, these types of things? I know that’s one of those things where physicians will bang in your door and say, ‘I want to be able to look the results on my iPhone or put in an order.”
Colander: Absolutely. We do a number of things with handhelds. We use some specialized handhelds for nursing and some other departments within the organization. Our PCTs and nurses can use handhelds to capture vital signs and things like that at the bedside. We do have computers in all of our rooms, but we are still making handhelds available because operationally, sometimes they’re beneficial.
On the physician side, we’ve got a couple of tools that are basically web-based but will work on a mobile device. What we’ve been challenged with is trying to put together a strategy that allows us to deploy that type of technology in a secure fashion. So we’re really studying the iPhone and Apple IOS platform—both the iPod and the iPhone—as a starting point for us to build somewhat of a customized application for Elmhurst that will allow us establish the level of security that we need. Once they’re in our customized foundational app, they will then be able to launch into a mobile Meditech app, which is kind of standard offering for Meditech that works very well, and also some of the other viewing technologies—the web viewers and things that are available from some of our systems, both the cardiology and radiology PACS systems.
So the idea is, let’s get this foundational application put in place, allow the physicians to load it onto their Apple devices, and then be able to use that to securely launch into some of the accessibility capabilities that we have already.
I did talk with Meditech this week. They are working diligently toward an application for the iPhone. I think they may also be looking at some of the other platforms like Android. Today they have a really nice view-only application for the iPhone, but now they’re starting to move toward an app that physicians can actually use for rounding which includes the ability to enter orders, so we’re looking forward to that application. It’s being developed for 6.0, but the plan as I understand it is that as these things are developed for the 6.0 platform, they will be retrofitted back to 5.6. Meditech recognizes that they’re not going to move the 5.6 Client Server population to 6.0 right away, and so they need to make these things available for the 5.6 clients as well.
Guerra: Are there any areas around these handheld issues where you’ve had to say no, and have those been difficult conversations?
Colander: Not yet, but again, we haven’t fully developed the test pilot stage. I think our biggest concern is the security piece, and we’ve looked to a partner to help us develop the initial application that should solve the security piece. Once we have that solved, then we’re really hoping that we don’t’ have to say no. Once we know the information can be secure, the device itself can be secure. We absolutely want to make this information available for those devices.
We read the news clippings. The statistic I saw is that I think more than 60% of all physicians will own an iPhone by the end of this year, and so that’s a platform we want to leverage. We’re not in a position to buy devices for all of our doctors—most of the doctors are quite comfortable buying their own devices; they just want to be able to integrate your solutions onto it, and that’s exactly what we’re going for.
Guerra: My gut feeling is that they don’t want you to give them another device—they want to use their device.
Colander: Exactly. Because the iPhone and iPod are so popular, the question will be, where do we go next? And with droid and the new Windows Platform, which one will be end up supporting and which one will we not end up supporting? I think the good news is that a lot of this access is driven by mobile-friendly Web applications, and those can be pretty transparent across those platforms. Where we may have to say no is where we just don’t have vendor support to be able to extend a capability to one of those other platforms.
Guerra: You mean from the application vendor?
Colander: Yeah. An example would be if Merge was going to make their applications available through an Apple-friendly app, but they decide they can’t do it for Mobile Windows and they can’t do it for droid. So we won’t be in a position to be able to extend that support unless the vendors are behind it as well.
Guerra: What would your message be to any of your vendors about deciding not to support these types of things?
Colander: I’m not in the position to cross those bridges right now. I think most of them have recognized the dominance of the Apple devices in the industry. Most of that dominance has come from the consumer side; a lot of the buy options that the physicians are making start off as consumer choices, but there’s enough dominance there that I think where we’re settling right now is Apple. When it comes to Android or Windows, we’ll cross those bridges when we get there.
Guerra: Would you say you’re absolutely sure this is the future?
Colander: Mobile devices?
Colander: Absolutely. When you think about what we do, although the patients come to us—whether it’s in the doctor’s office or the hospital—that last 100 feet is the caregiver moving to the patient, And the best way to support that is with the mobile device.
Guerra: It’s interesting; your business—the hospital—depends on physician satisfaction. So your future almost depends on physician satisfaction, and this is going to be one of the key areas. But then you have Meaningful Use, and there’s nothing in there about supporting iPhones. So it’s interesting that you have to do what the government is telling you to do and you also have to keep an eye on what the physicians want you to do. Does that make sense?
Colander: I understand, absolutely, what you’re saying, but it’s another thing to do. You’ve got to build a strategy that allows you to leverage the vendors and leverage some of the other partners that you have out there to make it happen.
Frankly the other piece here at Elmhurst is we’ve taken on the IS strategy that supported the electronic medical record before Healthcare Reform and before ARRA and the Meaningful Use piece. So we have not had a lot of conversations at the executive level about Meaningful Use dollars. We talk about patient safety. We talk about a better patient experience. We talk about clinical quality. We talk about building an evidence-based medicine practice that’s supported by electronic medical records and CPOE and clinical documentation, and that’s where we focus.
Will we do the necessary steps to be able to gain that incentive payment from the government? Absolutely, but it’s not the reason we’re doing it. So as you’ve talked about this, you mentioned that we need to do what the government wants us to do. That’s not at the core of what we’re doing here. We’re trying to create a program that is at the highest level of clinical quality. The fact that Meaningful Use for the most part lines up with that strategy is nice, but it’s not the reason we’re doing it. That’s it in a nutshell.
Guerra: What are your overall thoughts on Meaningful Use—the way they put the program together, how stage one has come out, and how stage two is looking?
Colander: Well if you believe as I do that computer technology can bring benefit to health care, then you have to like what Meaningful Use in and ARRA has done. Because frankly, it’s forced the tipping point that I believe would have eventually come with the use of EMRs both in hospitals and physicians offices.
I think the tipping point would have come somewhere down the road—almost generational in change. It would have taken the next generation of physicians to really begin to create that kind of momentum. By putting Meaningful Use in place, establishing the incentives and the penalties associated with it, I think the government has accelerated that tipping point by at least a generation.
Guerra: Do you think that sometimes there are negative consequences to creating an artificial tipping point?
Colander: I’m a ‘glass is half-full’ kind of guy. So I’m sure there probably are, but I don’t dwell on that a lot. I’ve believed for a long time that the right information systems put in the right place are really going to improve the quality of care, and to me that’s trumps any of the negatives that might be out there. At least I really hope it does.
Guerra: Right. I’m sorry, my cynical nature is coming through.