Of all the tools and resources available to him as CIO, perhaps the most useful for Tom Stride is his clinical background. As vice president and CIO of Aria Health, a Philadelphia-based system that includes three community hospitals and a network of outpatient centers and physicians, Stride faces a challenge many CIOs can relate to in integrating independent and owned physician practices with the acute setting. But where he has an advantage is in understanding firsthand the extent to which upgrades impact workflow, and how important it is that clinicians are on board with any initiative. In this interview, Stride discusses how he has benefited from his experience, how his organization has achieved 96 percent CPOE, the importance of optimally prioritizing projects, and best practices in vendor relationship management.
- Working with Hyland Software
- Focusing on physician satisfaction
- The benefits of a clinical background
- Workload overload? Too much, too fast?
- Staff management in times of high stress
- Vendor management
- Top project — integrate the community
- Nice-to-do versus what’s financially possible
When I deal with IT staff, I make sure that they understand where we have to go and the reasons why. So I really integrated the IT staff with the clinical part of the hospital.
Traditionally in IT you’re busy, but this is extremely busy, and I believe that that could cause burnout or cause people to retire early or go in a different direction. I’ll put it this way—if you’re not willing to work, and work long hours at times, then this is probably not the place for you at this point.
You’ve got to work with the vendor. You have strategic meetings with the vendor. You’ve got to be part of their team, and you’ve got to be very in tune with the technology as it’s going forward.
If you don’t work well with other vendors, then you probably are not going to be at this institution too long, because I really need that integration and that level of cooperation to get things done.
Our strategy is to connect as many physicians and as much part of the community as we can, and we’re doing that through these relationships with the EMR vendors and with the aggregation vendors
Guerra: Let’s talk a little bit about your work with Hyland Software. I was really interested in some of your quotes I read in the release about physician satisfaction. The quote from you was, ‘The Philadelphia market is extremely competitive, and to be successful, we need our physicians to be happy. Our EMR isn’t enough to manage patient information. The physicians need the whole picture.’ So you are very keyed in to the idea of physician satisfaction, which is really what a hospital exists for, to make physicians happy so they want to practice there. I’d like you to expand on that and maybe talk a little bit about how important it is for CIOs to think like that and to think about making their organizations a place where physicians want to practice.
Stride: We have a legacy product which is called Chart 1. That was purchased or merged with Hyland Software, so one of the challenges we had was that the physicians wanted a single sign-on to view clinical documentation, whether it is scanned and/or originating in the system. One of our challenges was that that wasn’t the case at the time. So when we partnered Highland, I would say that was a physician dissatisfier. What I wanted to do is resolve that issue, and to resolve that issue, I had to do Hyland as an integration with Allscripts, and all of the information in a single sign-on would accommodate that request, and it would give the physician all of the information where he needed it. Because what Hyland is for us is a post-discharge system, so after the patient is gone, all of the information is represented in there. That’s how they do their sign off, if you will.
One of the reasons that I find physician satisfaction to be important is because for one thing, I’m clinical. I came from the clinical world, so I know a lot of the clinical workflows and how it is very difficult for physicians to get things done. So I think to move forward with the physicians, satisfaction is very important.
Guerra: It makes me think this is another one of those situations where maybe people in government putting out regulations don’t quite understand that it’s not just turning on CPOE and putting in an EMR. It’s all these additional steps that really make things valuable to the clinicians.
Stride: Correct. You’re changing a lot of workflow processes, which always take a lot of time in this situation. Plus, it doesn’t include the fact that you have many different specialties and departments that you have to deal with during this process, so one piece of this affects many areas. That’s one thing that I would bring to the table—the fact that from my clinical background, I knew that, so I wanted to make sure that we addressed all those needs for the physician.
Guerra: What is your clinical experience?
Stride: I started out as a radiology technician and got involved with MRI and CT, and then I worked in the cardiac cath lab, and then from there I was on the heart transplant team. I probably did clinical for about 10 years.
Guerra: You mentioned some of the benefits of knowing the workflows. Do you think some of your experience helps you be persuasive or to connect with some of the physicians that you talk to?
Stride: Absolutely. I think my clinical background has done nothing but made me successful due to that, because I know the situation and how the physicians are doing, how the nurses are doing, and how all the caregivers are doing. I understand their point of view. When I deal with IT staff, I make sure that they understand where we have to go and the reasons why. So I really integrated the IT staff with the clinical part of the hospital.
Guerra: Many CIOs that I speak with really favor hiring someone with some clinical experience. They have to have some idea of the technology, but they are more than happy to teach that part. It’s the clinical experience they’re really looking for. It sounds like you would agree with that.
Stride: Absolutely. We have nurses on our IT staff—a very significant part of my IT staff is clinical. We have a respiratory therapist, we have RNs, and we have some radiology people.
Guerra: Your clinical experience probably helps you recruit clinical people to your IT team, right?
Stride: Right, yes. Well they see how successful that I’ve been, so I think they see that as a path for them to go down also.
Guerra: When we look at ICD-10, ACO’s, and Meaningful Use—I’m sure you’re working on all those things, do you feel like it’s a little too much at one time, or do you feel like you’ve got everything under control?
Stride: I would say it’s a lot, and I do think it’s a lot of projects that have major impact. At this point we have it under control, but we’re also extremely busy because of that, so I think it is a lot to do. I think that IT staffs in hospitals across the United States are extremely busy. Everybody that I speak with—other CIOs at other health care systems—they all say that it’s probably the busiest we’ve ever been in the history of health care IT.
Guerra: From the way you talk, you sound like you’re an extremely high-energy person. Is that correct?
Stride: Yes, I’m very ambitious.
Guerra: Do you find that one of your challenges is not expecting that from everyone on your staff who may not have that intensity?
Stride: I would say that I try to utilize my energy and ambition and try to present that to my staff, so yes, I do have difficulty with people feeling the way I feel, but I also believe my energy is kind of setting an example for the rest of the staff.
Guerra: Do you see burnout happening with any of your staff? And I don’t want to focus just on your staff, but maybe in general with the pace that we talked about and how busy the IT teams are. Do you think we’re going to lose some good people just because the pace is somewhat unreasonable?
Stride: Yes, I do believe that. I think that you will see that. I think it is a very, very aggressive path. You have a lot of initiatives going on, and like I said, traditionally in IT you’re busy, but this is extremely busy, and I believe that that could cause burnout or cause people to retire early or go in a different direction, absolutely. I’ll put it this way—if you’re not willing to work, and work long hours at times, then this is probably not the place for you at this point.
Guerra: Right, that definitely makes sense. Let’s talk a little bit about vendors. You used the phrase ‘partner with’ before in our discussion, referring to Highland. Is that something you believe deeply in—the idea of not hiring a vendor but actually partnering? And what does that mean?
Stride: I really think that you have to partner with a vendor to be successful. You just don’t buy a solution just to buy the solution, and the vendor goes away. I think that you’ve got to work with the vendor. You have strategic meetings with the vendor. You’ve got to be part of their team, and you’ve got to be very in tune with the technology as it’s going forward. I mean, a lot of things change. There are a lot of workload changes. A lot of requirements change, and I think you have to be in tune with your vendor across the board. Just having a vendor for sake of just selling something is not really the way to go. It’s more of a partner to move forward with for the duration.
Guerra: You also mentioned the idea of getting two vendors to work together—I think you were referring to Hyland and maybe Allscripts or Eclipsys, and we talked about dbMotion. So sometimes it’s not just one vendor but it’s a matter of getting a number of vendors—the key people to the table at the same time. That’s got to be pretty difficult. Everyone’s busy right?
Stride: Yeah, and I do think that vendor relations is a challenge, but it’s almost mandated through my process. So really, if you don’t work well with other vendors, then you probably are not going to be at this institution too long, because I really need that integration and that level of cooperation to get things done.
Guerra: Those are most of my main questions. Is there anything else you want to add in terms of projects you’re working on, or maybe thoughts that you think could help your colleagues on some of the experiences you’ve had?
Stride: From my point of view, one of my challenges—and a project that we’re working on—is integration with the community. So we’ve developed and are working on a community model to make sure that everybody is on the same page across the patient care continuum. And the reason it’s a big initiative for me is because I am clinical and I feel like that’s the best-case scenario and the best advantage for the patients and the physicians. So our strategy is to connect as many physicians and as much part of the community as we can, and we’re doing that through these relationships with the EMR vendors and with the aggregation vendors and across the board.
Guerra: Are you leveraging Stark? Are you underwriting anybody?
Stride: We are leveraging Stark to a certain degree; it’s part of our EHR initiative. We are involved with some of that, just as far as if they’re looking for an EMR or an electronic health record, we will see what we could do as part of that process. That’s pretty much what it is, right? Obviously a lot of these physicians don’t have all the money to do all the things that they need to do, so we’re trying to help out wherever we can.
Guerra: You mention going out in the community; you’d be spending some money. Have you had any interesting conversations with finance or the CFO that goes something like this: you talk about what you want to do or the CMO is talking about what we should do, the right thing to do, and the CFO starts asking about return on investment and funding? When do we come up against the reality of the available dollars versus what would be nice to do?
Stride: I would say that conversation happens on a regular basis with us. We work as a team, whether it’s CMO, CFO, or COO. We work together just to make sure that we can move forward with a project as far as the entire business is moving forward. So yeah, that conversation happens and yeah, you’re right, eventually the dollars may run out for these processes but that’s something you got to determine as a business.
Guerra: Alright, I think that is all I have for you today, Tom. We got done quickly because we were really efficient. I think we covered what I usually cover in maybe another 15 minutes. Thank you, Tom.
Stride: Alright, thank you. Have a good day.
Guerra: You too.