George Evans VP/CIO, St. Joseph’s/Candler Health System
It’s a problem many CIOs know all too well. As the pressures mount to meet Meaningful Use requirements, they’re finding resources are already stretched thin, and the supply of individuals with both clinical and technical expertise dangerously low. George Evans wanted to know how his colleagues were facing the challenge of too many high-priority tasks, too little IT talent, so he put out a survey that garnered some interesting results. In this interview, Evans reveals what he learned about how organizations are building out their clinical informatics staffs, the qualities that are most valued in staffers, and why internal poaching isn’t always a bad thing. He also discusses the application environment at St. Joseph’s/Candler, and where his organization stands in its quest for Meaningful Use.
(Click Here To Download The Survey Results)
Chapter 1
- Evans’ CHIME Member-to-Member survey
- Building an informatics staff — weighing technical know-how and clinical experience
- Collaborating with competitors
- Lavely leaves Memorial Health University Medical Center
- The benefits of growing in-house
- Thoughts on the government-sponsored educational programs
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Bold Statements
Something that we’ve been talking about for a number of years is the development of a clinical informatics program; the struggle of whether that should be a degree program or a certificate program, and what the market might be like for that sort of education.
Almost three-quarters of the respondents said that they’d take someone with no technical experience, and I would agree with that. The technical component of this is the easier one to teach.
We’ve got PACS access enabled from our place to theirs or vice versa, as well as access to our clinical systems, so that if a patient presents at one place, they can gain access to the relevant medical information that the other has. It’s so sort of a poor man’s HIE.
I think the fact that so many said they were going to grow their own staff might be because of the lack of formal informatics programs. I mean, there aren’t things out there that really help assure CIOs of the capabilities of someone relative to informatics—unless you just have a pedigree and a resume with a long string of clinical systems that you implemented.
If I get a critical care nurse or an ED nurse or a surgery nurse that comes to me and he or she wants to work in informatics, I can make them useful immediately, because they understand clinical workflow and they can begin to educate me and my staff on that side of things.
Guerra: Good morning, George. Thanks for being with me today. I’m looking forward to talking with you about your CHIME member-to-member survey, and the work you’re doing at your organization.
Evans: Good morning, Anthony.
Guerra: Let’s start by talking about your survey. You’re obviously a member of CHIME, and this is a CHIME member-to-member survey. Tell me about the genesis of the survey. It’s on informatics—specifically, building a clinical informatics department, and you were looking for some guidance from your colleagues to see how they’ve done it, how they’re staffing it, and the pay and educational requirements. Can you give us a little context about this? I assume you’re trying to build out your clinical informatics department.
Evans: Yes. We work closely with a local university—Armstrong Atlantic State University here in Savannah. I serve in a somewhat advisory capacity with them, and something that we’ve been talking about for a number of years is the development of a clinical informatics program; the struggle of whether that should be a degree program or a certificate program, and what the market might be like for that sort of education. And so through that, and in combination with the fact that it’s always a challenge to find an experienced informatics staff, I wanted to throw a net out there to see what my peers were experiencing and if it was similar to what I was dealing with here, and get some of their thoughts.
Number one, is that an area that you would intuitively believe is an area of growth and great interest. And obviously, judging by the survey response, it was. But also to find out—and again, presuming the interest—what were the qualifications and what sort of people are you looking for to get in to the informatics positions. And then, how you might do the care and feeding for them, what kind of education you might offer to develop them, and whether you were going to develop them yourself internally.
Guerra: That’s interesting; I didn’t realize that. So part of it is for this educational institution, to help them figure out what kind of people they need to help create what the hospitals will want.
Evans: And that’s a very mutually beneficial relationship that we have going there. We already have extensive relationships with them in regard to some other healthcare-related programs that they have. And this was just one more area where they’re saying to us, ‘What sort of things are you interested in? We think there’s some potential here for this informatics program. We need to decide whether it should be certificate or degreed, and we want to explore that market a little bit.’ And it’s obviously to our advantage, because it would give us somewhere formal to take someone that perhaps came from a clinical area that we were going to use in an informatics capacity and send them to some more formalized training.
Guerra: And how much motivation was it for the development of your own clinical informatics department? Were you also looking for feedback, or do you feel like you’ve got a good handle on things in your shop?
Evans: I’m absolutely interested in how to develop my staff. I don’t have a large informatics staff; I only have two folks right now in that capacity, and I’m looking to expand that pretty significantly over the next several years. And I’m wondering how I’m going to take folks from clinical positions—I don’t think I’ll have a challenge finding folks who are interested. There’s a lot of interest in the clinician ranks. I don’t want to limit it to nurses. There are other disciplines that we can get qualified candidates from; there is a lot of interest in those ranks, but at the same time, somehow you’ve got to get those people familiar with the non-clinical aspect of the job—the technical components of it. And so that’s what I was looking for; where could we do that. Obviously it would be to our great advantage if we could do that here locally and not have to ship somebody off for extended training in an offsite location somewhere.
Guerra: In a far off land.
Evans: Yeah, exactly.
Guerra: That is very interesting, and we’ll get into the specific responses, but a lot of your colleagues said they’d be happy to take someone with clinical experience and no technical background. But it sounds like you’re saying that part of what they’re going to be doing is technical work, so you can’t totally forget that. Does that make sense?
Evans: Absolutely. And I don’t remember the count on that, but I think almost three-quarters of the respondents said that they’d take someone with no technical experience, and I would agree with that. The technical component of this is the easier one to teach. I do think you have to find folks who have the aptitude for it; not every nurse is going to make a good informaticist. And I think there are certainly some core competencies that you’re going to want in someone if they’re going to be successful in the informaticist role that you may or may not get in any nurse off the floor. You’ve got to somehow gain that technical component.
And there was a further question: how are you going to educate these people? And again, presuming that three-quarters of them are willing to hire people with no technical experience, the most common answer on how you’re going to educate them, more so than any other single answer, was on-the-job training. So they weren’t going to do anything formal, and I suspect that’s because there’s not really anything out there that is a formal program for informatics. There may be programs that I’m not aware of, but there certainly was not a program of that sort in this area.
Guerra: Well, you were just about dead-on with the question, ‘Would you accept a clinical person with no technical experience?’ Seventy-two responded yes, so that’s a far overwhelming majority.
Evans: And I would echo that personally. Again, the technical is of much less concern than the awareness about the workflow and how patient care is delivered.
Guerra: One of the questions was, ‘What kind of education will you provide?’ You mentioned that one of the big answers was on-the-job training. I searched through the answers and that got almost the most but not quite the most responses. On-the-job training was mentioned 16 times. But as far as I can tell, the number one response, mentioned answer 17 times, was the vendor. So they would rely on the vendor to somehow educate the informaticists about that particular application.
Evans: And I would agree. I think that I probably shaded that a little bit because when I saw the response of vendor training, I’m thinking they’re talking about module-by-module stuff, and not really informaticists in the fuller tense. Does that make sense what I’m saying there?
Guerra: Yes, absolutely.
Evans: So I sort of disregarded that answer or at least weighted it a little lighter than I did some of the other comments about education. What I was saying more so was that there was not going to be a lot of formal education beyond learning the products’ specific aspects that, again, spoke to the fuller nature of informatics at large.
Guerra: No, I think you’re definitely reading that correctly. Let me ask you again about the original intention of the survey, and the method. I have down that it was done in conjunction with one of your competitors. Was that Memorial Health University Medical Center?
Evans: Yes, that’s right here in town. And actually, the CIO [Patty Lavely] has moved on from that position, but at the time when she was there, she and I both served on the advisory group for Armstrong.
Guerra: I just noticed that as I was researching for your interview. I noticed that Patty—who I just e-mailed because she’s also on my survey panel—has moved on and founded a company called CIO Consulting.
Evans: That’s correct. She’s out on her own now.
Guerra: Wow, good for her. I think those kind of things are great. Get out there and give it a shot.
Evans: We had a very cooperative relationship. And that was a case where both of us had a need for informaticists and we both wanted to support the local educational institutions, so there was no real reason to stay fiercely competitive in that regard. We can together there.
Guerra: Do you know anything about the search over there for a new CIO?
Evans: They’re doing some reshuffling. It think IS now is a director level position and reporting to the VP of human resources. Their McKesson shop is outsourced, and I’m not sure what their future plans are there. They’ve had a lot of administrative turnover there. The former COO has now taken the full-time CEO role, and I’m not sure what she has in mind for the future.
Guerra: So it’s a director? It’s not going to be a CIO, and they’re going to have to report to the director of HR?
Evans: That’s my understanding.
Guerra: Okay, all right.
Evans: Local gossip. But I suspect that they’ve got some ideas beyond that. On the surface, that doesn’t sound like they have good direction for IS, but I suspect that I suspect they do.
Guerra: I’m sure you’re hoping that you get a counterpart that you can work with as well as it seemed you did with Patty.
Evans: Oh yeah. Even beyond the work here on stuff like education, we worked a lot with Memorial in regard to just delivering good quality patient care. We’ve got PACS access enabled from our place to theirs or vice versa, as well as access to our clinical systems, so that if a patient presents at one place, they can gain access to the relevant medical information that the other has. It’s so sort of a poor man’s HIE, I guess, that we do in the interest of making sure patients get the best care. And images are a great example. If a physician wants to look at a prior study or a radiologist wants to look at a prior study, then we make that available to them across the institutions.
Guerra: Well, maybe you’ll end up hiring Patty to do some work.
Evans: Actually, we’ve had discussions.
Guerra: Hey, why not? Who’s going to know more, especially about your shop, and have more experience? Perfect. All right, let’s move down in the survey. For the question about plans to clinical informatics staff, almost 60% said yes. So the majority are adding staff. Now if we go to one of the other questions, ‘Do you plan to grow your own staff,’ almost 80% said yes. What do you read into those two answers? Sixty percent said they were going to add, and 80% are going to grow their own staff.
Evans: When I looked at that, I really was kind of surprised. And again, I’m reading very broadly here, but it looks like the numbers sort fall in the two to six staff range with the intended levels that they’re talking about adding here. And I think the fact that so many said they were going to grow their own staff might be because of the lack of formal informatics programs. I mean, there aren’t things out there that really help assure CIOs of the capabilities of someone relative to informatics—unless you just have a pedigree and a resume with a long string of clinical systems that you implemented. Otherwise, there’s not a degree or certification out there that gives you some confidence that the person can do that.
Plus, everybody has their own unique workflows and their own ways that things happen around that place. It’s nice if you’ve got somebody that understands that, and then comes over to the technical side and begins to serve as that liaison, and helps you migrate from where you are to where you want to be with a degree of understanding. Someone who doesn’t just come in without any concept of the political or social or other undertones that may be at work somewhere, and just steamrolls over people. I think folks like the concept of being familiar with their own organization before they take off trying to implement these new systems, which represent such a marked departure from the existing norms.
Guerra: It’s nice to at least know where the cafeteria is.
Evans: Exactly.
Guerra: What about these government-sponsored educational programs? I think the national coordinator, Farzad Mostashari, just congratulated the first graduating class. What do you think of these? Some of these are out of community colleges, some of them are not. I guess you haven’t seen much of an impact from these programs on the market.
Evans: I definitely haven’t seen the result of those programs. My first glance at them and thought about them is that they’re going to produce people don’t have either clinical or the technical experience. They’re going to be a brand new graduate sort of person. And that person’s not useless, but if I get a critical care nurse or an ED nurse or a surgery nurse that comes to me and he or she wants to work in informatics, I can make them useful immediately, because they understand clinical workflow and they can begin to educate me and my staff on that side of things. But I can also usually quickly get them up to speed on technical things. But if I get someone that’s just absolutely new both to the clinical and the technical experience, I’m not going to be able to overcome that hurdle and, again, the clinical aspect of it being more difficult. I think that that certification that they’re talking about creating without being an RN or RT or MT or something is not of any great value. But we’ll see.
Guerra: So it sounds like it might have been better for them to develop programs for clinicians, for nurses. For example, you have to be a nurse to get in the program, and now we’re going to get you familiarized with the basics of the IT side and informatics, and then you go out into the workforce. It sounds like you could have done a lot more with something like that.
Evans: That would be my sense of the need—to take someone with clinical experience of some nature, and put some kind of prerequisite in there prior to informatics. I would gladly take a clinical person with no technical experience, as apparently a bunch of my peers would as well. But I would not take someone who was a fresh college graduate and put them straight into informatics. I might put them in an analyst position or something, an entry-level analyst, but I consider an informatics person to be someone who is a little higher up the scale. If you wanted to think about analysts compared to current data analysts or other systems analysts—probably be a level two or level three analyst who’s got some years of experience with your processes and with certain functional areas within the hospital and can bring that to bear upon technology.
Guerra: You were talking about if a clinical nurse—an ED nurse or surgery nurse—came into your office and said they were interested in informatics. I can’t picture you letting them out of your office without acquiring that person in your department. There’s no way they’re making it out, right?
Evans: Exactly, if I can get them in and if they have the interest and a little bit of the passion about that, then I’m going to do my best. Of course I don’t want to make the nursing department mad by stealing one of their star employees, but I absolutely would agree with that. I’d probably lock the door.
Guerra: When we talk about this kind of thing, I always ask, ‘Don’t you have to be careful about poaching?’ And the answer I usually get is, ‘Yes, you do have to be careful about poaching.’ But most people understand that if it’s between losing an experienced clinician who wants to get off the floor either to another hospital or getting them into the organization’s IT shop, you’re better off getting them into the IT shop and keeping them in-house.
Evans: And even if you don’t completely lose them, an argument I use a lot of times is that if you think about it, you’re going to lose someone who obviously you highly value. But you’re going to let them come into IS, where they can create a system that will be used by clinical staff across the organization. So it’s like you’re multiplying that person’s qualities and abilities, and you really are shortchanging yourself if you don’t engage, from a nursing perspective, and select people that you think are highly capable of representing nursing in the process of implementing technology.
Guerra: My wife was a floor nurse for 10 years and then she became a nurse practitioner. But I saw first-hand that nursing can get burned out, so they need to get off the floor at some point, and IS is a great place to go.
Evans: Absolutely, because you get to hold on to that knowledge and it’s not as hard on them, because it’s physically hard to be a nurse. You don’t think about the strains—a lot of them have back trouble as they get older. They’re constantly on their feet; it’s a high-stress job that’s literally life and death. So I have a great deal of respect for nurses, but I can certainly see how it could wear and tear on them.
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