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.
- Measuring up to Meaningful Use
- Bringing the docs along on CPOE, clinician documentation, etc.
- Shoring up the wireless infrastructure
- Thoughts on Meaningful Use – “I’m not such a huge fan of everything that’s going on”
- Loving the CCD
- The big opportunity — device integration
- The big disappointment — voice recognition
- Staying engaged and informed
- The value of a good CMIO — “I’m not an MD and, no matter what, there’s a chasm there”
We could actually qualify right now, but we’re going to wait. Based on the current wisdom I think that if you wait, you get a little bit longer to react to whatever Stage 2 ends up being.
While we’re not racing ahead to attest this year, we do have to do plenty of work to do before we can really successfully deploy this much new technology and introduce so many new processes next year. So we’re certainly planning for that.
Every time you encounter a patient, you’ve got to check their pain scale, take their height, and take their weight. You’ve got this long list of stuff that some genius who’s looking at mounds of data has decided needs to be done, when the truth is that the person’s walking in with a sore throat and all you have to do is look at it and say that is viral or not viral, and send them on their way.
I love the concept of the CCD. That, to me, makes so much more sense than some of the stuff they’ve been talking about. Are you going to have a great big government-owned data repository in the sky that scares everybody to death, or are you going to define the mechanism for providers to interchange information? And I think CCD does that.
I still think there’s a world of opportunity with device integration. I think that’s an area where they have not made as much progress as they should have.
I think that probably has served me as well as any skill that I’ve managed to develop over the years—just knowing where to poke my nose to find opportunities to change how things are done. And to not be afraid to go directly to people and step over into their turf; to do it in a polite and courteous way that ensures them that you’re not just trying to further your kingdom, but that you’re actually trying to help them operate more effectively.
Guerra: How are you looking for meaningful use? Would you say both hospitals are at the same level or is one hospital looking better than the other one?
Evans: They are absolutely at the same level. And in fact, one of the real factors in our success here has been that we run as one hospital. There isn’t another me at the other hospital. We don’t double up on directors, and we don’t double up on VPs. Everything, including policies, is the same at both places. Until you get to the frontline staff, there’s not any duplication. Now one of the hospitals does have some of the more acute service lines, like orthopedics, neurology, and cardiology, and the other one has women’s services and more of the general surgery and general medicine patients. But in terms of a difference in their allocation of funds or equipment or people, or their position relative to the meaningful use criteria, there is no difference.
Guerra: And how are you lining up for Stage 1?
Evans: We could actually qualify right now, but we’re going to wait. Based on the current wisdom I think that if you wait, you get a little bit longer to react to whatever Stage 2 ends up being.
Guerra: Okay, and the physicians are finding that with the Meditech 5.6.4, the CPOE functionality and the electronic documentation is looking like it’s going to go well?
Evans: I don’t know that I’d go that far with it.
Guerra: How far would you go?
Evans: It’s going to go eventually, I should say, but I don’t know if I’d say it’s going well. Obviously with us delaying our attestation, that allows us to delay force-feeding CPOE and physician documentation at them. We’re going to do that as slowly as we can. And hopefully in the meantime, there’ll be some improvements in the product and platform in some of our alternatives for achieving CPOE and physician documentation.
Guerra: Are there any other projects on your plate that you want to talk about? It could be ICD-10, or anything that is at the top of your list.
Evans: Not anything else is worrying me. The portal is definitely a big issue initiative, and moving the clinical systems moving forward. While we’re not racing ahead to attest this year, we do have to do plenty of work to do before we can really successfully deploy this much new technology and introduce so many new processes next year. So we’re certainly planning for that. We’re doing a lot of work with making sure the infrastructure is robust enough—particularly the wireless infrastructure—to support what we see as a really increasing number of mobile devices.
Then we’re working on some other initiatives around population health management, disease management, workforce management—things that are sort of wellness initiatives, you might say. More than just trying to be just an acute care institution, we’re trying to, as I’ve heard people, quit trying to be in the healthcare business and be in health business. We’re trying to go that way, and we’re working a lot with our local businesses to help them cut down on their healthcare costs by better managing their diabetes and other chronic conditions within their staff.
Guerra: I took a look at your LinkedIn profile. You describe yourself as a long-time healthcare CIO, and with good reason, because from my observation of your profile, you’ve been a CIO since 1986. So, 25 years?
Evans: Yup, I sure have.
Guerra: You’ve seen a lot, huh? Everybody talks how Meaningful Use has really changed the industry, but you could probably give us some real perspective. So, what has it done to the industry?
Evans: I’m not such a huge fan of everything that’s going on. I like getting things automated, and sometimes automation is good, but sometimes it’s not. I was having this discussion this morning with a doctor in the doctor’s lounge about some of the best practices that we’re implementing now. Every time you encounter a patient, you’ve got to check their pain scale, take their height, and take their weight. You’ve got this long list of stuff that some genius who’s looking at mounds of data has decided needs to be done, when the truth is that the person’s walking in with a sore throat and all you have to do is look at it and say that is viral or not viral, and send them on their way.
It doesn’t always march ahead, but I do think it’s done some great things like with bedside medication verification. I’ve certainly gotten frustrated with the difficulties and proprietariness of a lot of systems. I think that’s getting better—I think it’s far better than it’s ever has been in the past in terms of people finally realizing that they can’t create these islands that don’t communicate with anything else. I think that’s a definite trend that is working for the good.
I love the concept of the CCD. That, to me, makes so much more sense than some of the stuff they’ve been talking about. Are you going to have a great big government-owned data repository in the sky that scares everybody to death, or are you going to define the mechanism for providers to interchange information? And I think CCD does that. So I’m very glad to see some work and effort being expended in that direction.
I didn’t come up strictly through the technical side of the ranks. My dad’s a doctor, my ex-wife’s a nurse, my mom’s a nurse, and I was a respiratory therapist and EMT. So I had a lot of clinical experience when I stepped in the CIO role, and it’s been very neat to see. There was a lot of opportunity when I first came in it because it was mostly a technical pursuit at that time. It was mostly about getting somebody a PC on their desktop, and a lot of the clinical functions beyond basic order entry and lab and radiology systems were not automated. I still think there’s a world of opportunity with device integration. I think that’s an area where they have not made as much progress as they should have.
If I had one thing that I wish they would have accomplished by now—and I can’t believe they haven’t, because 25 years ago I would’ve told you we were five years from it, and at any five-year period you checked with me, I would have told you that we’re 5 years from it until now, when I will tell you that I don’t think we’ll have it in 10 years, and that’s voice recognition. It just doesn’t work, in my opinion, at least not well enough to be what it promises to be, which is the total replacement of the keyboard. When a doctor can just walk right up to a computer and speak right into the microphone and the thing understands what he or she is saying and can record the words correctly and spell them correctly and punctuate them correctly, it’s a tall order. It’s something that’s got a lot of promise that has not been implemented effectively, in my opinion. I mean, there are doctors who can make it work, but you do have to sort of make it work. Or you can use it as a backend system and then put medical editors or somebody on it. But I think those are two things—voice recognition and device integration—that are real areas of opportunity. That probably was a rambling answer that probably never answered your question.
Guerra: I love rambling answers because I get to relax. No, I’m kidding. It was a great answer. You did this survey your profile; you’re reading different books, one is “Switch: How to Change Things When Change is Hard,” and one called, “The Innovator’s Prescription.” So you obviously believe in staying engaged in continuing education. What’s your underlying philosophy behind that? Why is it so important?
Evans: All through my career I have been somebody who just won’t accept the status quo necessarily at face value. I’ll always challenge it. The old philosophy is, ‘If it ain’t broke, don’t fix it.’ But I always think, ‘If it ain’t broke, let’s look at it and see if we can make it better.” It’s a matter of not necessarily being content with the way things are. And I think that because I’m old—not because I’m smart—I’ve had enough experience to have an instinct about where opportunity lies, and seeing in some deeply ingrained process the opportunity to blow it up and reform it and create something better. Something significantly better. And I think that probably has served me as well as any skill that I’ve managed to develop over the years—just knowing where to poke my nose to find opportunities to change how things are done. And to not be afraid to go directly to people and step over into their turf; to do it in a polite and courteous way that ensures them that you’re not just trying to further your kingdom, but that you’re actually trying to help them operate more effectively and succeed in their own realm, and help show them how what you’re doing is going to help meet some of their personal objectives. I think that’s key.
I think the other thing is that with a clinical background I get a good amount of credibility when I’m talking to nursing or other clinical people. A lot of time they love to disregard a technologist, but I can go toe-to-toe with them pretty well until they get down to wanting to do a total cystectomy or something like that. I can’t do one of those, but I could certainly close up after he got through with it.
Guerra: Do you have a CMIO?
Evans: No, I don’t, and I wish I did.
Guerra: It sounds like you don’t need one as much as some other CIOs might who don’t have your clinical experience.
Evans: No, I do. I’m not arrogant enough to think that I’ve got all the clinical bases covered. I could certainly do with an advocate with the medical staff. I think I’m good at dealing with doctors because with my dad being a doctor, I grew up with one my whole life. So I got a lot of practice with that. I was around a lot of doctors. So I think I do okay, but still, I’m not an MD, and no matter what, there’s still a chasm there. I can make it small, but it’s still a chasm.
I just think a CMIO could help us a whole lot because there’s obviously an awful lot of activity in that space, and we’re asking a lot of medical staff in terms of drastically changing the way they operate. And ideally that CMIO would be somebody who came from within the ranks here, like we talked about an informaticist that was a clinician at your facility and you trained them to be an informaticist. I would love to take a doctor who had a great interest in technology and either in conjunction with a continuing clinical practice or decided to step aside from clinical practice and step over and be CMIO; someone who already knew some of my medical staff and some of the politics that go on around here. That would be the ideal person.
Guerra: Well, I hope you are able to get one because I think you deserve a CMIO. Maybe I’ll get you one for Christmas.
Evans: Thank you, I’ll tell my boss, ‘Anthony Guerra said we deserve one.’
Guerra: All right, George. That was all I had for you today, unless there’s anything else that you want to add.
Evans: No, I’m about worn out here from talking. I haven’t talked this much in a week.
Guerra: Well this was a real pleasure. I want to thank you for your time, and I look forward to catching up with you again soon.
Evans: I enjoyed it, Anthony.
Guerra: Have a great day.
Evans: You do the same.