As a CIO, having all hospitals within a health system on the same EMR is the ideal scenario. But as Todd Richardson knows, it isn’t always a reality, particularly when physicians are minority owners. In this interview, Richardson, who serves as CIO of the six-hospital Deaconess Health System, gives his honest take of how having physician owners can impact IT decision making, and why organizations need to accommodate the growing need among patients to access their data. He also talks about the flaws with statewide HIEs, the challenges of managing the different needs of device users, the IT rounding program his team implemented, and the importance of viewing technology as an enabler.
- Vetting the EMR situation before acquisition
- The (sorry) state of health information exchange
- Educating the C-suite about (the lack of) plug and play
- The days of CIOs saying no first and asking questions later are over
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If an independent physician came on, they would make the migration to Epic. That is part of the expectation. It puts pressure on us on the IT side if they’ve got an existing electronic record to get those records exported out and brought into Epic, and there are certainly challenges with that.
You have all of the effort going into development of these and people linking up with them to send their data, and then when one fails because they can’t develop a sustainability model, now we as a health system have to go and connect with another one and hope it succeeds. Where does that help in lowering health care costs?
Many of the people that sit in the C-suites today started their careers before a lot of IT was there. It’s a bell curve. There are some of the up-and-comers that have got every gadget in the world, and so it’s becoming easier. They’re starting to understand IT a little more, but because of the lack of understanding, they certainly need to rely on us and have us at the table.
I think our role as CIOs is to make that link, to get those things. We’re certainly seeing the need to keep our fingers on the pulse of what is happening so that in the event that they don’t come to us, we can seek them out and say, ‘Hey, do you what I heard?’
Our gut reaction can’t be, ‘You can’t do this and you can’t do that.’ We can’t approach things that way. We’ve got to embrace technology. We got to embrace mobile technology and say, ‘Okay, it’s here. It’s not going away. How are we going to get our arms around it? How are we going to control it?’
Guerra: I have to think that with an organization like yours that has made a major investment in an enterprise-wide EMR system, with any joint ventures or projects that you get involved in going forward, is it reasonable to expect that part of the agreement would be that the entity you’re getting involved with will have to get on Epic?
Richardson: I think at a 100,000 foot-level, that would make sense. Clearly if you’re a physician that’s going to join our health system, it’s written right within our bylaws — you can go on to deaconess.com, you can look under the physician section and anybody on the internet can see the bylaws — that the use of Epic is a term of employment. You will use it within the practice.
And if an independent physician came on, they would make the migration to Epic. That is part of the expectation. It puts pressure on us on the IT side if they’ve got an existing electronic record to get those records exported out and brought into Epic, and there are certainly challenges with that because of the disparity we have in these systems. If we were to go out and acquire a critical access hospital that was fully deployed with XYZ system — EPSI or Meditech or something and they were fully deployed, I think it would probably end up making sense to move them across at some point. But first and foremost you have to get the operations up and running.
We would look at it as a business decision and go in. I think certainly that would be the preference with Epic. As we reach out even to Owensboro, they’re coming up I believe next March with Epic, and will have the ability of the interoperability that’s built within Epic. So I can exchange data directly with another Epic hospital and I can send those documents back and forth and link those patients. I think it’s huge having that direct interoperability amongst systems. We sit here today and we talk about the health information exchanges, which is really a rudimentary system where you write something on a piece of onion skin paper and let a carrier pigeon deliver it to somebody else. It’s a very inelegant way of moving data around between these disparate systems. I think 10 years from now, you and I may be having this conversation and that will have been a thing of the past, kind of like the eight-track tape.
These systems have got to be interoperable; there have to standards that are emerging like LOINC and SNOMED that are going to allow us to take data at a data level and send it among these systems so that we can do direct interoperability and not have — I don’t want to say a lame CCD document, but for lack of a better term — a very vague summary of data that, yes, is information, but is not discreet data flowing through and feeding everybody’s records. It just makes sense. Look back ten years and see where we were to where we are today, then project that forward. Doesn’t it just make sense that these systems talk directly with each other without having to pretend like you’re on Green Acres and climb up to the top of the telephone pole to call Mabel and have her connect you?
Richardson: It just seems like the government didn’t do us any favors when they put millions or billions of dollars into seeding all of these health information exchanges to create systems and create organizations where 75 to 80 percent of them have to fail, and you have all of the effort going into development of these and people linking up with them to send their data, and then when one fails because they can’t develop a sustainability model, now we as a health system have to go and connect with another one and hope it succeeds. Where does that help in lowering health care costs?
I’ve told a number of my colleagues that the ONC should have taken all that money and got Neil Patterson from Cerner and Judy from Epic and all of the major healthcare vendors and said, ‘We’re having a meeting,’ and thrown the money in the middle of the table and said, ‘You have one year. Make your system interoperable.’ Let’s use that money to make these systems interoperable and not build this house of cards on a health information exchange that has this random state-by-state rollout. We have five in Indiana. Why do we need five? And what’s magical about the state lines?
Guerra: Right, right.
Richardson: I sit here on the boarder of Kentucky and Illinois and I have patients coming from Illinois and Kentucky. Why am I going to pay to join an information exchange in Indiana in order to exchange Indiana information? What am I going to do — pay a second and a third time to the states of Kentucky and Illinois to get data from their exchanges on those patients? What’s so magical about a state line?
Guerra: You’re making too much sense here.
Richardson: You know, I’m sorry, but nobody wants to hear it because the ship has been launched. And then we’ve got the direct project. From the payer perspective, yes, we have these clearing houses, but you have a clearing house. You don’t have five in every state you have to go through. It doesn’t make sense to me and again, I apologize because I wasn’t in the room when the decision was made to ask the questions, but I’ve not had anybody explain it to me, unless it’s part of a ‘let’s create jobs’ plan. They’ve done that, but I’m not sure we’ve helped to lower the cost of healthcare. If that’s really what it’s all about, trying to lower costs, then how many HIEs do we have in the country now?
Guerra: Your tax dollars at work.
Richardson: My money at work. And now I’m going try to get it back through Meaningful Use? And I’m not trying to attack the HIEs. I think there’s a place to exchange information and it’s one of those interim things, but let’s do it in a way that’s sustainable. Don’t send me an invoice and call that sustainability. That’s just me paying for information when I’m sitting here with Epic. With a product that can directly interoperate with other systems. If their systems could interoperate, that would be one thing, but they can’t. So I’ve spent a lot of money on a very expensive system that can speak to others, but because the others can’t, now I have to spend more money to connect to send information someplace else. Where does that make sense?
Guerra: Right. How much of a perception is there among the business folks in your C-suite—the CEO, CFO, etc. Maybe not in your particular organization, but I picture this scenario. This is why the CIO has to be at the table for these discussions of acquisitions and things like that where they might say, ‘Hey Todd, we just picked up another hospital. Don’t worry, they’re electronic. They’re on Meditech. Go ahead and just port them over.’ And you say, ‘Well, it’s not quite that easy.’ Do you think there’s a lack of understanding at that level of how difficult it is or how little interoperability exists between EHRs?
Richardson: I think in general there is. I look across other industries — not even healthcare, and people in other industries first and foremost understand their operations, whatever it is; whether it’s manufacturing, making tires, making pizzas, or taking care of patients. They understand the operations of their business from a ‘how do I do this?’ perspective. They understand finance because they all have to keep a general ledger, they all have to pay taxes, and they all get capital versus operating expense. They understand bottom-line financials because if you don’t, you don’t function as a business.
So we get our operations, we get our financials, and we understand HR because it’s all about the people. We know hiring and firing, we know the wage and hour laws, we know benefits, we get that, at any executive team levels. So we get our operations, we get our finances, and we get our HR, and then comes IT. And IT in the big picture is relatively new. Many of the people that sit in the C-suites today started their careers before a lot of IT was there. It’s a bell curve. There are some of the up-and-comers that have got every gadget in the world, and so it’s becoming easier. They’re starting to understand IT a little more, but because of the lack of understanding, they certainly need to rely on us and have us at the table. I think they’re getting better at pulling us in on things. I’d be lying if I said we are always pulled in before somebody wrote a check that I have to cash, but they don’t do it on purpose. They just don’t understand it. Somebody told them that was fine and that would be okay and we can make these things operate.
We’re really good at fighting fires in IT. We do whatever it takes to get it done, just because it’s got to get done, and we don’t complain a lot. We’re a lot of introverts that aren’t very vocal and we just do it without pushing back, and so there’s no incentive to plan necessarily, because they just figure we’ll do it. It’s not technologies — zeroes and ones; how hard can it be?
But I think they’re beginning to understand more and more as we evolve as an industry. I think our role as CIOs is to make that link, to get those things. We’re certainly seeing the need to keep our fingers on the pulse of what is happening so that in the event that they don’t come to us, we can seek them out and say, ‘Hey, do you what I heard?’ So rounding is very important; finding out who those leaders are in the organization that have things going on in the service lines, and to figure it out before it bites you.
Guerra: I’ve definitely heard exactly the scenario described before about how CIOs wind up putting out the fires, and then the other members of the management think, ‘hey look, it wasn’t a problem after all.’
Richardson: Right. And the technology is so cool. I guess I wouldn’t be in IT if I didn’t say that. But you look at the technology — three years ago, did we have smart phones? We’re ready to take off this afternoon to go on Christmas break and I’m looking at my radar seeing everything that I know everywhere in the organization. I am so connected. I can listen to any radio station in the country on my iPhone, and it’s so fantastic on the personal side of it. We can go into Best Buy and buy anything. And then we expect to bring this technology in within the four walls of my health system and just use that. It’s a different game when you try to bring some of this technology in and use it in a business way. It’s a lot of fun. I mean, I sit here with my guys and try to say, ‘We don’t say no. We have to figure out what’s it going to take to make it happen.’ And I don’t mean that we don’t say no meaning that we just let chaos reign—that’s not what I mean at all.
Our gut reaction can’t be, ‘You can’t do that and you can’t do that.’ We can’t approach things that way. We’ve got to embrace technology. We got to embrace mobile technology and say, ‘Okay, it’s here. It’s not going away. How are we going to get our arms around it? How are we going to control it? How are we going to get it on our network and provide secure usage of the devices?’ The days of just writing policies and being a CI-no are over. We’ve got to figure the stuff out.