Gary Barnes, CIO, Medical Center Health System, Chapter 2

After nearly two decades as a health system CIO, Gary Barnes has seen his fair share of change, and learned a thing or two about how to manage it. He believes that when it comes to initiatives like Meaningful Use, sometimes it’s better to just rip off the band-aid than waste time dwelling on how much it might hurt. In this interview, Barnes talks about why, even though he’s still got concerns about the program, Meaningful Use is long overdue. Barnes also discusses how his organization is preparing for Stage 2, why EMR upgrades involve more change than people expect, the shortage of quality health IT people in the industry, and how satisfying it can be to help physicians.

Chapter 1

Chapter 2

• The HIT workforce shortage
• Instituting a project management group that meets weekly — tradeoffs and prioritization
• Running a McKesson 10.3 shop
• MU stage 2
• Upgrade downtime: “I see the frustration among the physicians”
• How to be a physician-friendly CIO
• BYOD – Empowering the Apples
• Implementing Citrix
• Single sign-on

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Bold Statements

All of the hospitals are relying on the vendors to have their products ready, and I think there’s still that continuing shortage of health care IT people. That’s one thing we’re running into—every time they have a new patch, they’ve got people they bring in that are inexperienced.

We feel very fortunate that we’re out on that leading edge because I know a lot of organizations would like to be where we are, but there’s pain in being the leader. You become the beta tester.

I live in the physician’s dining room, in physician’s staff meetings every night or nearly every night, just listening to the physicians, because the key to all of this is getting them to see some value in it. And I think that’s something we’ve been successful at—listening to their concerns, and if there’s something that you can easily improve, making it happen.

Right now there are a lot of different devices out there, but we haven’t found the perfect one that meets all of their needs. I think it’s going to be a combination of a couple of different things.

I went to our management staff and I said, ‘We’ve got to make sure our protocols or escalation methods are in place.’ Because when somebody’s working on a problem, they can’t deal with all the phone calls asking, ‘When are we going to be back up?’ and ‘What’s going on?’

Guerra:  Were there any other facts or points in the survey that caught your eye?

Barnes:  Actually, none of it really surprises me, because it’s been difficult for the vendors. One of the challenges the vendors are having, and I guess that kind of shows up, is that all of the hospitals are relying on the vendors to have their products ready, and I think there’s still that continuing shortage of health care IT people. That’s one thing we’re running into—every time they have a new patch, they’ve got people they bring in that are inexperienced.

Guerra:  Right. I remember last year at CHIME, you sat on a panel with Sue Schade and you talked about the staffing shortage out there. Has that become more acute?

Barnes:  It’s become more acute out here, because we are in a big-time boom right now, so we’re really got a shortage of employees.

Guerra:  You have open positions you can’t fill?

Barnes:  Correct. It’s just difficult to keep quality people.

Guerra:  So that means the people that you have left have to do more?

Barnes:  That’s exactly right.

Guerra:  So how are you handling that as a manager—has it been difficult? One of the interesting dynamics a lot of CIOs mention to me is how to not overwork your people. There’s so much to be done. You have some key people that you could easily burn out. Do you find that it’s a delicate balance?

Barnes:  It’s definitely a delicate balance. One of the things we’re doing is, for the first time, we’ve got a project management group that meets every Monday morning that involves nursing, pharmacy and all of the different entities that have requirements for IT, and we talk about them and create our priorities. We’re trying to keep some of the projects that we’ve done in the past at that level. It’s a give and take situation. If we’re going to do this, it’s going to slow this process down. Which one do we want to do? So project management’s been the key to keeping this thing moving forward.

Guerra:  What about what’s on your plate? What are some of the top projects that you’re working on, maybe more specific than Meaningful Use?

Barnes:  Well, Meaningful Use overall affects all of the different systems. We’re a McKesson hospital, and so any time something’s affected, it affects the pharmacy system. It affects the clinical systems. It affects our document imaging system. So we still have to go through and do a lot of upgrades to systems to be ready for the next step. And I think that’s something that as we start thinking about Stage 2, we’re trying to make sure we plan out the systems that are going to need upgrades at that point.

Guerra:  Are you on 10.3?

Barnes:  Yes.

Guerra:  When did you do that upgrade?

Barnes:  Back in June.

Guerra:  Was that pretty smooth? Were there some significant improvements from what 10.1?

Barnes:  Yeah, there are definitely enhancements, and that’s one of the things—we’ve got them out there, and now our staff is having to go through and learn some of the new technologies to make sure we’re taking advantage of them.

Guerra:  How has McKesson been helping you get toward Meaningful Use? Have they been a good partner?

Barnes:  Yeah, they’ve been a good partner. I think there are about seven to 10 hospitals that are in the first stages of meeting Meaningful Use, and we’re one of those. We feel very fortunate that we’re out on that leading edge because I know a lot of organizations would like to be where we are, but there’s pain in being the leader. You become the beta tester. You run into all of those different problems when you’re one of the first ones out there.

Guerra:  What do you use in the physician group that you own?

Barnes:  In the physician group, we’re running McKesson’s Practice Partner. We’ve actually rolled the EMR out to our Texas Tech Medical School, and so we’re providing an EMR to Texas Tech Medical School for the Midland-Odessa area. So we have 120 physicians on the outpatient EMR and we’re striving to try to have something ready in the January timeframe oh having those physicians ready to start Meaningful Use for the outpatient world.

Guerra:  What about in the clinics? You said you have five or six clinics.

Barnes:  Same thing—we’re using that same product in the clinics and we’re planning in January to start testing for Meaningful Use on those.

Guerra:  How’s the integration between the McKesson acute and ambulatory products?

Barnes:  It’s not where we would like it to be. It’s still lacking a lot of areas to have total integration, that’s for sure.

Guerra:  Did it get better in 10.3 or is that not one of the areas that improved?

Barnes:  Not really one of the areas affected by that.

Guerra:  Do you know if they are working on it? I would imagine you discuss these types of things with them.

Barnes:  Yeah, we’re looking at doing a health information exchange, and that’s how we plan on doing it—just linking the two products.

Guerra:  Are there any vendors in mind there in the HIE space that you’re looking at?

Barnes:  We’ve looked at Sandlot and we’ve looked at McKesson’s relay product.

Guerra:  Sandlot is out of Texas, right?

Barnes:  That’s correct.

Guerra:  So they have the home field advantage?

Barnes:  That’s right. And we have another one of their products too. And then Relay is really McKesson. They say they have a lot of integration with their products.

Guerra:  What do you think about what you’re seeing for Stage 2?

Barnes:  As difficult as Stage 1 has been, Stage 2 is really going to be a lot of fun.

Guerra:  A lot of fun?

Barnes:  A lot of fun.

Guerra:  I guess that’s how you have to look at it, right?

Barnes:  When you’re in IT, you just have to be up to the challenges. Sometimes you have to look at it and say, ‘Wow, this is going to be interesting.’ And I see the frustration with the physicians like we were talking earlier with all of the upgrades and stuff like that. They’re seeing a lot of down time and they’re saying, ‘This system is down all the time.’ And we’re saying, ‘Yeah, we’re doing another upgrade.’ And they’re like, ‘Every time you do an upgrade, it messes something else up.’ And that’s the true facts of it all.

Guerra:  Yeah, that can definitely be frustrating.

Barnes:  And so along with that, you look at it and you think, all of this is supposed to be done to help improve patient safety, but you’re constantly doing these things that sometimes create concerns with patient safety. Because a lot of the testing—I don’t want to say it’s being done in a live environment, but there is some of that stuff when you’re an early adopter.

Guerra:  What do you see as the CIO’s role in these kinds of efforts? You put out a new upgrade and you start to hear about some issues. Are there key physicians and clinicians that you have to get out there and get in front of?

Barnes:  Absolutely. I live in the physician’s dining room, in physician’s staff meetings every night or nearly every night, just listening to the physicians, because the key to all of this is getting them to see some value in it. And I think that’s something we’ve been successful at—listening to their concerns, and if there’s something that you can easily improve, making it happen. It’s a give and take situation, and I can understand their frustration with some of it, because it’s just a constant moving target for them. And the nursing staff, they’re feeling the same thing. They’ll say, ‘last month you told us we’re doing this.’ And I’ll say, ‘Well it’s not last month. Now this is the process.’ For people that have difficulty with change, it’s very difficult at this point.

Guerra:  So do you ever have an urge to eat your meals in private?

Barnes:  Oh yeah, definitely. Some days, I’m not up to the challenge.

Guerra:  Right. You know, I actually want to enjoy my meal today and not get abused by the physicians.

Barnes:  Yup, that is true. Because everyone can come in there, and it’s a good opportunity to meet with them and to sit down and say, ‘Hey, we can fix that in a heartbeat.’ Because there are some easy fixes to problems that are frustrating to some of them.

Guerra:  When we talk about physician satisfaction, there’s this new term that I really like—BYOD, bring your own device. Do you find a lot of physicians want to see the McKesson information on their iPhones and iPads/

Barnes:  Yes.

Guerra:  So how do you deal with that?

Barnes:  We’ve been trying to work with them as much as possible, so if they say they have a new toy, we try to purchase products that’ll give them that capability. We’re going with a virtual desktop product from Citrix that we’re going to roll out in January. So we’re really hoping that’s going to help bring some opportunities for some of the different devices, but we’ll do what we can to make it easier for them. Right now there are a lot of different devices out there, but we haven’t found the perfect one that meets all of their needs. I think it’s going to be a combination of a couple of different things. The iPhone, with its small screen size, maybe is not ideal for physician rounding. It’s not going to be able to help when you want to look at a radiology image. So there’s no perfect device at this point that we see. It’s a combination.

Guerra:  And as far as them using their own devices, is that something that makes you uncomfortable from a security point of view?

Barnes:  We’ve tried to make sure that when we provide them something it is a device that we’re trying to push it out in the Citrix world so that nothing is stored on those devices.

Guerra:  What about single sign-on? That seems to be another area that can be sort of an easy-win physician satisfier. Does that make sense?

Barnes:  Yeah, we’ve started rolling out our own system. We’re using the LDAP, which has the capability of running off of the active directory within Microsoft, and so we’re trying to make all of our products LDAP-compatible so that they’re all using one sign-on to use with their product. It gives them the ability to go out there and reset their own passwords, and so far it’s been pretty nice, because our physician portal and access into our network is all based off of what we call our MCH log-in.

Guerra:  Well, I was just thinking that you have the Meaningful Use measures and you have to make physicians do things so you can comply with that, and you might think of that as the vegetables that maybe nobody wants to eat, but then you have the iPhone-iPad stuff and you have single sign-on, and that’s the dessert and it makes everything okay. Do you have to make sure you do some of those physician-satisfier projects and not just the onerous Meaningful Use stuff?

Barnes:  Absolutely. That’s what I was talking about earlier. When you’re in that physician lounge, you’re always looking for something—some carrot to give them to help ease the pain. Last week I had a physician call me, and he’s been one of those physicians has been very vocal and I was thinking, ‘Here goes my chew-in for the day.’ And he said, ‘You know what, Gary? I messed up. It’s my fault. Can you help me with this particular situation?’ Because I’d helped him with two other problems that obviously made him very happy. And when he brought that up, I said, ‘Man, I can fix that right now.’ And he said, ‘You’re kidding me.’ And I said, “No. We can fix that.’ And right there on the phone, we were able to accommodate it, and fix that problem. But by those other two carrots that I gave him earlier, it eased the pain of that call.

Guerra:  I was speaking to a CIO the other day and he had a great phrase. He was talking about single sign-on, and a physician said to him, ‘Finally, you’ve done something for us and not to us.’

Barnes:  That is true. They are looking for something for them.

Guerra:  So that’s an important dynamic. As you said, people may not realize it because it’s a C-suite position, but in the dynamics of health care, with the physicians running the show, you get chewed out, right?

Barnes:  That’s exactly right.

Guerra:  So how’s the staff holding up—are you able to make sure they get the positive feedback down there, and not just hear everything that people think is going wrong with the department?

Barnes:  Yeah, I try to isolate them from some of that. I’ve said, ‘If somebody’s chewing you out, tell them to call me.’ That’s my responsibility and I’ll deal with that piece of it. So I’ve tried to isolate them from some of that. This weekend, we had a problem where things are getting so complicated now with the technology—not only the applications but within the hardware and everything—where the person who was on call had shear heck to deal with. On Saturday afternoon one of the systems went down. We pulled that out and it just led to one thing after another, after another. He was up all night Sunday night, and then we had more problems the next night.

It was a real pain, and they were exhausted, so I went to our management staff and I said, ‘We’ve got to make sure our protocols or escalation methods are in place.’ Because when somebody’s working on a problem, they can’t deal with all the phone calls asking, ‘When are we going to be back up?’ and ‘What’s going on?’ So the management staff is trying to stay on top of that so that our staff can deal with the problems.

Guerra:  And not constantly give out updates.

Barnes:  Right.

Guerra:  Well I think that is about all I have for you today, Gary. Is there anything else you wanted to touch on?

Barnes:  I think that covered it all.

Guerra:  All right, well thank you so much for your time, and I’ll see you over at the show.

Barnes:  Okay, see you there.