Stephen Stewart is one of many CIOs who believe that Meaningful Use is happening too quickly. In fact, he believes that delaying Stage 2 isn’t just a smart idea; it’s a necessary step to avoid the perfect storm of requirements that would inevitably cause undue stress. In this interview, the CIO of Henry County Health Center — a southwest Iowa-based system that includes a 25-bed critical access hospital, a long-term care facility, and physician offices — talks about the process of attesting to Stage 1, his organization’s EMR journey, and the benefits and drawbacks of being a small facility. He also provides insights on why it’s better to lead than to manage, how to handle pushback from physicians, and what it takes to cultivate an environment that enables the staff to thrive.
- Managing clinical types
- Leveraging internships to recruit talent
- The CIO role at large and small facilities
- When hiring, knowing the app is nice, but not paramount
- Dear Dr. Mostashari … “Does the pace of change have to be quite as frenetic as it is right now?”
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You definitely need to be very sympathetic and sensitive to the clinical side of things. If you don’t have that understanding, you need to develop it.
They really don’t want to hear about the technical stuff. They want to hear about what it really means to be out there in IT, particularly in a healthcare environment. They want to hear about the business issues, and they want to know what it is really like to walk a mile in our shoes.
When organizations are looking for talent, we sometimes overemphasize experience in the system we’re on rather than focusing on experience and ability in the processes we have to execute.
I think that the Phase 2 delay for a year is almost a ‘gotta have it’ deal. I’ve described it at various times as being on a path for the perfect storm. With ICD-10 and 5010 and Meaningful Use Stage 2 and all these things coming together in a relatively short period of time, there is definitely an undue amount of stress.
The government isn’t giving us this money to be kind and generous. They’re giving us this money because they are expecting it to have a positive impact on the cost of healthcare. That being said, I would encourage those policymakers to think that if that’s our objective, even if it takes us a year or two longer, let’s make sure we get there rather than create a train wreck in the process.
Guerra: You described a few times about managing IT people and what IT people are like. When you recruit someone to work in IT from the clinical side of the house, have you found that there are different motivations and different things that resonate with them than IT people?
Stewart: I learned very quickly that a very valuable lesson is a better sense of the patient and a sense of the laying out of the hands, if you will. The nurses in the IT group have done that for years. You need to listen to them and listen to what it means to them and what these things mean in the delivery of the care itself. And it helps a guy like me who is a technologist to refocus their thinking and apply it in ways that hopefully make us overall do a better job.
Guerra: I mean more specifically in terms of managing them. When you have someone with a clinical background, do you have to lead or manage them differently than you do someone with a technology background?
Stewart: Oh yes, you definitely need to be very sympathetic and sensitive to the clinical side of things. If you don’t have that understanding, you need to develop it. I don’t think there is anybody in my role who doesn’t understand that, but if you don’t understand that, you’ve got a big problem. The clinical people will always talk about the patient first, and then the technical issues. They will always think of the technical issues—which is the right thing to do—and how to make it work clinically. They have a deep affinity for their fellow caregivers who are carrying on behind them and they want to do a very good job. You just need to be sympathetic to that and then present the technical issues in just a little bit different fashion than you might otherwise.
Guerra: You mentioned internships—working with local universities and colleges to develop a pipeline of talent. That sounds like a great way to go about it. Is there any advice you can give your colleagues on how they can start something like that; how they can go about making the approaches to the local schools? Are there any best practices you’ve found?
Stewart: Interestingly, when I got here the schools came to me. But what I would say is look at the programs that are in your geography. They’re all looking for places to get their students experience. Intern programs can be a great source of relatively inexpensive help. It’s also a good idea to reach out to the schools and to participate in things. I’ve been a guest lecturer in some of them, and they really don’t want to hear about the technical stuff. They want to hear about what it really means to be out there in IT, particularly in a healthcare environment. They want to hear about the business issues, and they want to know what it is really like to walk a mile in our shoes.
I had one intern come to me and say, ‘I can’t believe what you spend your time on all day.’ I said, ‘What do you mean by that?’ And they said, ‘The planning and strategy and negotiation and budgeting.’ And I said, ‘This stuff isn’t free. Somebody has to figure out what we need, and you guys provide a lot of input to me on that. But then how do we do it in a way that we can fit into the budget constraints and how do we pick our supplier partners and how do we negotiate with them and how do we do some of these things.’ So if you reach out to the schools, the students are looking for the opportunity. And frankly, the students in this day and age are also looking for potential employability. I’ve found them to be just unbelievably contributory and good to work with. I’ve had some that are better than others, but I haven’t had any that are bad.
Guerra: Right. I was just wondering—you are a 25-bed critical access hospital but a lot of the things that you have to do are the same things that CIOs at 500-bed hospitals or multi-hospital health systems have to do. If somebody came to you and said, ‘Stephen, we’ve got this position at a 600-bed hospital,’ how daunting would that be? Is it something where you feel like, ‘I’ve done these issues so it’s just a question of adding a few zeroes on the budget’—that type of thing?
Stewart: I think there would be an enculturation period of time. Previously in my lifetime, I’ve worked for larger facilities, so I’ve had some experience with that. I don’t think the adjustment for me personally would be that difficult. I’m very active in the College of Healthcare Information Management Executives, and a lot of my associates there are from larger facilities and academic medical centers. We had a conference here a couple of weeks ago in Texas and we were talking, and we really came to the conclusion that the breadth of the challenge, whether you’re in a 10,000-employee or FTE center or you’re in my organization, the breadth of the issues we face are the same. Yes, the bigger facility might have more specialization and sub-specialties and service offerings than we have, but when you think about it, the breadth of the things that we do to take care of the patients are pretty similar. The depth is similar. We’re 7 days a week, 24 hours a day, 365 days a year. They all agree that while they’ve got their sets of challenges, the small guy has a much smaller team to cover that breadth and depth and width than they do, and that makes for a significant challenge.
So in a larger facility, I would be expecting to find an environment where I had more resources. Now that presents more of a leadership challenge. It’s harder to do. I think the biggest adjustment would be going from a medical staff where I know everybody personally to a medical staff or 1,000 to 1,500 people. You’re never going to know them all personally, and I would miss that.
There is a place in this world for everything. I think the transition from small to large or large to small can be made. It’s really up to the individual, what their motivation is, and what it is they want to do at that particular point in time. Good leadership is good leadership. Good knowledge is good knowledge. Where you apply it is the smaller of the variables—important, but smaller. I do think that when organizations are looking for talent, we sometimes overemphasize experience in the system we’re on, rather than focusing on experience and ability in the processes we have to execute. In a perfect world, if I can get a good process-oriented person who knows my applications, that’s great, but I can train a person in my applications much more easily than I can train them to think process and to think strategy. So I’d rather bring the talent that has experience in something else in healthcare but with those innate abilities to think process and think strategically than somebody with 20 years of experience in my application who doesn’t think that way. There are pros and cons both ways but there is very definitely an advantage and I think sometimes we get too hung up on that.
Guerra: Let’s say you were talking to Dr. Farzad Mostashari, the head of ONC. If you were speaking directly to him, is there anything you’d want him to know about the effect that these programs are having on critical access hospitals, either positive or negative? We talked about the pace of change—it might be a little too much too fast, but what are your overall thoughts there?
Stewart: I think that the Phase 2 delay for a year is almost a ‘gotta have it’ deal. I’ve described it at various times as being on a path for the perfect storm. With ICD-10 and 5010 and Meaningful Use Stage 2 and all these things coming together in a relatively short period of time, there is definitely an undue amount of stress. What I would encourage is that we step back and think about whether this pace of change has to be quite as frenetic as it is right now. I consider us to be very fortunate because we began the journey to an EHR seven years ago. When I think about those who basically have a financial HIS system and haven’t done the clinical implementation yet—the amount of work that they have to do in a very short period of time, it’s just staggering to me.
So I think that what I would tell him is that we need to think about the timing and think about the impact. Look at the rate of adoption you’ve achieved so far—do you really think that keeping the pedal to the metal is going to produce the results you want, or should there be a little bit of relief? I think that there is going to be relief. Everybody has pretty much said that the delay of Stage 2 for a year is pretty much a given and that you will be able to attest three times under Stage 1 and not be denied payment because of that. I think by just applying some reason, we can still get to the end objective.
Let’s face it. At the end of the day, the government isn’t giving us this money to be kind and generous. They’re giving us this money because they are expecting it to have a positive impact on the cost of healthcare. That being said, there’s nothing wrong with that objective, but I would encourage those policymakers to think that if that’s our objective, even if it takes us a year or two longer, let’s make sure we get there rather than create a train wreck in the process. Let’s not force something in the name of regulation that has an adverse impact on patient care. Let’s not make people do unnatural things that don’t produce better outcomes and help reduce costs, because if we get too aggressive on time, we could end up missing all of the benefit that we’re trying to accomplish.
Guerra: Well Stephen, that was excellent. Is there anything else you wanted to add? I’ve covered about everything I wanted to touch on.
Stewart: No, I’ve enjoyed the opportunity to have the conversation with you and hopefully I’ve contributed something that is meaningful.
Guerra: I have no doubt of that.
Stewart: If there’s anything else I can do, just give me a holler.
Guerra: Thanks so much, Stephen. You have a wonderful day. I’ll be in touch.
Stewart: Thank you.
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