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.
- The benefits of rounding
- Fixing problems before they’re reported (and those that never would have been)
- Leveraging Six Sigma for process improvement
- Reaching HIMSS Analytics Stage 7
- Does more technology always = better care?
- The benefits of networking with CIO peers
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It’s all about efficiency. They’re not throwing more money at us. They’re not saying, ‘Todd, go hire a bunch more people.’ They’re saying, ‘Do more with less.’ And so how do you do that? You start making less to do by leaning the process out.
Without these automated tools, how do you stay current? Our perspective is, and will be, that technology’s not going away. It certainly is an enabler, and it’s going to help us stay current and help us provide better quality patient care.
It’s about taking the data that is captured through these systems and using it for improving patient care and showing results. And when you can start doing that, now you’re starting to say, ‘We’re impacting patient care.’
I can’t afford to go too deep into any one area because then I’ll miss what’s at the surface in another area. So there’s always that balance. It’s having really good people in your organization across all your technologies and expecting them to go deep and filter up to you the things that you need to know about.
And at the end of the day, it’s about solving problems. I’m networking with folks who have done something differently than I have. We’ve got a need here that they may have already found. I reach out as a CIO to my colleagues and stay involved, and I do the same thing with Epic. If we’ve done something with Epic, we can share that.
Guerra: You mentioned that you have your guys rounding and checking on the systems. Tell me a little bit more about the program you put in place to be out there on the floors making sure that everything’s working properly.
Richardson: I don’t even know how many PCs we have in the health system. We have them in every room — we have them all over the place. We have so much stuff out there. And we have the obligatory help desk. You can call the help desk line; you get back to the help desk and that line rings off the hook. We answer lots of calls.
I’ve always rounded. As a CIO, I go out and I talk. I go to the floors and I go to the units. I want to make sure that they know me, and I look for things. And as sure as the world, something’s broken. Something’s not working and they haven’t called it in because they’re busy taking care of patients.
And when you show up and they say, ‘You know what, that monitor doesn’t work,’ we say, ‘Okay, we’ll take care of it.’ You can get ahead of the curve if you get out there and start rounding. When I first got here, my technology manager, my help desk supervisor and I made sure that he designated one person — either a help desk or a desktop person — that went with us. Every Friday morning at 8 o’clock, we went rounding and for an hour, we walked around. They had picked the units ahead of time and we didn’t tell them we were coming. We just went rounding. And every time we’d come back and the person that was at the help desk or the desktop had been taking a list of notes, and they would go back and create a HEAT ticket, and they would follow up on those issues and start getting them resolved.
And then after about three months, I said, ‘Okay guys, I’m not going with you anymore.’ My expectation is that this continues to happen. I’ll do my own rounding wherever I can. It’s not going to be on a schedule like that, but I still round. I’ll go looking for stuff. And now with the smartphone, they know when I’m rounding because they get pictures of big dust bunnies on the backs of the monitors sitting in one of the ED rooms. Or one of the keyboards that is broken. I’ll take pictures of cables that are just a mess and I’ll start shooting them back the help desk to start opening tickets. So they’ve learned that either they go out there and figure it out ahead of time, or I’m going to figure it out.
I’d like to look at statistics and see if we started to have numbers of tickets going down. But I’d contend as you start getting out there and looking for problems and fixing them before they occur on the backend, you’re going to have fewer calls coming in. Or at least they’re different kinds of calls. If you can start getting proactive and stop just trying to figure out how you do what you’re doing very efficiently, you get very efficient at a bad process. Well, why don’t you look at changing the process?
Richardson: The other thing I did when I got here was, we have a Six Sigma black belt team and they provide yellow belt courses. So I mandated — and I hate to use the word ‘mandate’ because I just don’t like that word, but I’ve made it a mandatory expectation that by the end of the fiscal year, every one of the people in IS and clinical informatics had gone through the yellow belt course and received the yellow belt. So they went through the Six Sigma yellow belt course. I worked with the black belts to say, ‘Let’s create a program. Let’s streamline the class because I got 130 people who are going to run through this.’ And they just looked to me and said, ‘You’re nuts, but what a great idea.’
So from a lean perspective and from an efficiency perspective, when you get everybody in the IT department looking through the eyes of a yellow-belt Six Sigma viewpoint, that’s a huge benefit. You get somebody that’s looking for inefficiency and trained to make things more efficient; somebody that’s looking to improve. I think it’s made a difference. Yes, there are ones that get down with it and came back and said, ‘I don’t know why we went to that class.’ I said, ‘Well, you probably need to find a different place to work.’
Richardson: If you can go through a Six Sigma yellow belt course, which is pretty intensive and covers a lot of information, and come out and then not be able to track why that applies to your job, you need to find something else to do perhaps. So it’s telling. Others came back just saying, ‘Oh my God, this is fantastic.’ And now when we initiate projects like re-implementing our HEAT system for the helpdesk for our ticket system, guess what? Everybody on the team has been through yellow belt training. So they’re looking at process. They’re looking at leaning it out. What a great thing when you get people with that tool and then they say, ‘You know, maybe we should get one of the black belts to help us out with this project.’ Great idea.
So now they’re not only figuring it out themselves, but they’ve tapped into their resources. We have a few green belts in the department, but it’s all about efficiency. They’re not throwing more money at us. They’re not saying, ‘Todd, go hire a bunch more people.’ They’re saying, ‘Do more with less.’ And so how do you do that? You start making less to do by leaning the process out. That’s one of the things that we’ve done here, and I think it helps. It makes people’s day-to-day jobs a little more exciting than just saying, ‘Okay, go to the start button, go to all programs.’ Trying to walk people through fixing mundane problems.
Guerra: One of the most important things about the rounding, and you touched on this, is that it may not have your tickets going down because you’re finding a lot of things that people just don’t have the time to call for. But what you’re doing is fixing problems and improving the reputation and the performance of the department.
Guerra: Because like I said, people are busy and they figure it’s your job to make this computer work. ‘It doesn’t work. I don’t have time to tell you about it, you should know about it.’
Richardson: Right. And it helps the reputation of the department; it makes you known. Somebody says, ‘I don’t have time to call it in, but I know they’ll be here in a couple of days, so I’ll just let them know next time they come through.’ So it is that customer relationship and I’ve told the guys that are hiring people, ‘I can teach you stuff.’ If somebody’s basically smart, I can teach them things. But I can’t teach customer service.’ Well I guess I can, but you can really stink at your job and they still like you. But if you have bad customer service and you’re the best technician there, they’re going to hate you.
And it’s just that customer service focus to say, ‘You know what, I can’t fix this, but I’m going to get back to you.’ And then you go find the person, you show up, you close the loop, and then you let them know you got it fixed. If you’ve got that, you’ve won.
It is so customer service focused in our world. And we deal with professionals. It’s unlike a lot of organizations in that the people that you’re dealing with when you walk through the health system are nurses, doctors, and pharmacists. They’re professional people and then you got the whole customer side of it where all of our customers are walking around. You acknowledge them just like you do the doctors and nurses. We have a huge role to play in that. Providing wireless access to our patients, providing any assistance we can with access to MyChart, and answering calls from our patients who need to reset their password.
Guerra: It’s a lot going on.
Richardson: A lot’s going on. Every time you pick up a rock you find something under it, and sometimes you have to figure out which rocks to put back down.
Guerra: And pretend you never picked it up.
Richardson: Right, you never saw it.
Guerra: I like that. I want to touch on Stage 7, but only in one sense. I read your quote that was in the press release and two things stood out in it. One is that in the quote, you almost don’t want to focus on the award. You don’t want to make a big deal about the award. You said, ‘While it is a great achievement, it is not the finish line.’ And then you say, ‘While these types of recognition give us a sense that we’re making strides, they’re not our focus.’ So two times within a quote in a press release, you’re basically saying, ‘This is nice, but this is not what it’s all about.’
Richardson: If you look back in time, we launched our Epic initiative before Meaningful Use was contrived, before there was going to be money being reimbursed to people for making Meaningful Use of these systems. That tells you we didn’t go into it for the reasons that some organizations do. How many health systems today are going into it either because there’s money out there now and there’s a way to help fund it, or because they’re afraid of the penalty phase that’s going to come afterwards? We launched and said we’re going to spend millions and millions of dollars because it’s the right thing for patient care. I’ve been in a couple of presentations and I may screw this up, but I believe they say that if a physician graduates from a medical school residency and knows everything there is to know and every day they read a hundred articles to stay current, in one year they’ll be a thousand years behind.
I mean, it’s something that impressive that makes you just say, whoa. There’s so much data flying at us right now; there’s so much information. I don’t know if I’d want to be a doctor. How do you stay current with that much of information flying at you? How do you take care of patients with all the patients having access to so much information out there online with websites like PatientsLikeMe and Facebook and Twitter? How do you even fight that with a piece of paper and articles that you’re trying to read at night? If you don’t have systems in place with the intelligence being built into them and clinical decisions support and rules and best practice alerts popping up—without these automated tools, how do you stay current? Our perspective is, and will be, that technology’s not going away. It certainly is an enabler, and it’s going to help us stay current and help us provide better quality patient care.
And again, you see these mile markers go by you. I got here in April, and we applied for and got our Stage 6 award at the end of July that year. Then it was, ‘Okay, what’s next on the horizon?’ It wasn’t getting to Stage 7; it was, ‘We’ve got to completely get paperless.’ And so while you don’t focus on it, you see the mile markers go by and you say, ‘We’re making progress, we’re making progress,’ because so many times you can get into the minutia that you just don’t feel like you’re getting anything done. Have you ever woken up and said, ‘Man, I just haven’t done anything’? And you step back and you go, ‘Look at everything I’ve accomplished this year. I did this, I did this, and I did this.’ It helps give your team a sense that you’re making progress and that you’re not just fighting dinosaurs.
Richardson: But again, it’s not about that. It’s about getting some place better. Great, we’re Stage 7. Who cares? What does that mean? We’ll get a plaque in Las Vegas in February, and by then we’ll be in the middle of our upgrade. We’re looking for early warning systems now. And the focus at Stage 7 really when you boil it down is not that you have to just have these systems in place, but it’s a real data focus. Now that you’re capturing all this information, what are you doing with it? Are you showing that through the capturing of the data and then looking at what’s going on and saying, ‘here’s some place that were not as good as we need to be’? And then you can implement changes and then you can start watching the bar go up. It’s about taking the data that is captured through these systems and using it for improving patient care and showing results. And when you can start doing that, now you’re starting to say, ‘We’re impacting patient care.’
When they came to do the visit, and we blew them away with the data — with the quality initiatives, with the quality measures and how we’re tracking on these things and where we’re moving, what the data was before, where we implemented Epic, and where it is afterwards. Their comments at the end were, ‘You have such a data-driven culture.’ It’s about taking that data and improving. It’s not just about getting and making the go-live, but I can tell you that if you don’t go live, you’re not going to be able to capture the data to make the improvements.
Guerra: Right, so the technology helps improve care. Could you possibly implement all this technology, be at Stage 7, have Meaningful Use in stage 1 under your belt and be working on stage 2, and not be impacting care? Is it possible to throw all this stuff in place and somehow miss something and not be improving actual care, or, is it almost impossible to do that?
Richardson: You know, it’s interesting because sometimes when you start measuring it, it looks like it’s worse, because now you’re capturing it. Every time you have a close miss in pharmacy, if you never reported it because you didn’t have systems, or you reported it very rarely and you’re operating at a 95th percentile based on where you were and how many drugs you dispensed and then you had a system in place that could measure every one of them, somebody would step back and say, ‘Jeez, by implementing that system, you guys got worse at your medication misses.’ Well no, now we’re just actually able to capture the ones that were really happening. But now we can capture it. So in some senses we had measurements of where we were. When you actually have systems in place to automate that, you’ll show yourself go down, but then you’ve got the tools and the data to see why, and then start improving.
Richardson: It’s such an interesting thing. You can get bogged down with the data, and that’s where we really step back and focus with our quality folks and with our Six Sigma black belts. They’ll get involved in all kinds of projects now that they’ve got data. And now we’re looking at clinical data warehouses. We use MIDAS and we’re pulling a lot of stuff in there for quality. We’re looking at data warehousing to say, ‘Jeez, we have so many silos of data. We can do a lot with this stuff scattered. But what if it was really all in one great big bucket with some standardized reporting and more dashboards?
Even though if you’re a Stage 7, you’re a long way down the track, we can still get a lot better. I know we can, and what we’re focused on is what’s the next thing. Let’s get these early warning systems in place. Wouldn’t it be cool if you had a scale throughout your hospital where you knew, at any point in time, where all your patients were on a scale of one to 10 from a risk perspective? And that by the results that came back and that one more med that got prescribed, that just changed their risk—a risk of fall or whatever type of a risk. Name a risk that we’re on the hook for. When you have all the data about all the patients, you should be able to manage your risks and provide better care along the way.
Guerra: I don’t like to keep anybody more than an hour; we’ve had a great conversation, but there’s one more thing I wanted to touch on. I looked at your Linkedln profile and I saw that you’re a CHCIO. You have that credential from CHIME. I also saw that you connected with Chuck Christian at Good Samaritan and Steve Hoffman at Memorial Health, who are friends of the publication. Tell me about your philosophy about networking and continuing education and how it’s helped you be a good CIO.
Richardson: I’ve always said within my realm and within my staff, in our world of technology, it is changing so fast that it’s like food. If you don’t stay up with it, you’re going to die. And that’s a reality. You can graduate from school knowing everything about technology, and two years later Bill Gates has another operating system. Something’s moved on. You have newfangled technology, and if you’re not staying current, you’re going to die. You will not move. Your career will stifle and you’ll be one of those, ‘I come in at 8 and go home at 5. I just go through the motions and I keep so much information in my head. They can’t get rid of me because they couldn’t afford to.’
You’ve got to network. There’s so much going out there and so many more ideas that other people are fighting. There’s so much technology in so many areas. I feel like I’m just skimming the surface and I need to get deeper, but I can’t afford to go too deep into any one area because then I’ll miss what’s at the surface in another area. So there’s always that balance. It’s having really good people in your organization across all your technologies and expecting them to go deep and filter up to you the things that you need to know about. So my networking guys are fighting the network fires. My storage guys are fighting storage fires. My virtualization guys on VM Ware are down the virtualization path. My desktop team is doing the best they can with the technology at the desktop. My applications folks have got their finger on the pulse of all their applications and are digging into what’s next and what we need to be doing. That ends up sifting up and sorting up through my management team and then we lay out our plans of what the work is for the next year.
And so within my health system, it’s a microcosm of what’s happening out in the industry. You have Steve Hoffman, who I met through CHIME, and Chuck Christian — I see him once a month. We play golf together, we network together, and we’ve gone up there to look at what they’re doing with some of their single sign-on stuff. He’s clearly got his finger on the pulse of stuff that’s going on at the state level different in a different way than I do. He runs in a different circle with some different folks, whether it’s Russ Branzell out of Poudre Valley or any other folks I know through my fellow colleagues and CIOs. I feel like I’m young in my career, and relatively speaking, maybe I am to some. I’m in the middle of my career, but I got so much to learn from the guys that have gone before me.
I think I’ve got a different perspective than the guys who’ve gone before me — not right or wrong, just different. And so I think you owe it to yourself to stay current. I think going to the CHCIO program was invaluable to me. If nothing else, I met some really nice people and some really great networking resources that I still stay in touch with. I’ll get emails from a gentleman out of Kaiser or one of the guys of the Providence Health System in Washington saying, ‘Hey, we’re getting ready to go live with anesthesia. What do you guys do with this?’ So that leads to networking. And at the end of the day, it’s about solving problems. I’m networking with folks who have done something differently than I have. We’ve got a need here that they may have already found. I reach out as a CIO to my colleagues and stay involved, and I do the same thing with Epic. If we’ve done something with Epic, we can share that.
I was just talking with the administrator at Parkview Health, a behavioral health hospital in Fort Wayne. They’ve gone with Epic and they’d like to take some of our screenshots and would like to see some of the templates that we’ve developed. We’ve already developed them, so why should they do it again? No problem, we’ll just make sure there’s no patient information on them and then get more screen shots. Let’s share this information. I’d rather steal and build from scratch because it just makes sense. I mean, we’re talking about efficiency. We don’t compete with the folks at Fort Wayne. I know Ron Double, the CIO. He’s a great guy. I’d give anything to him. Rex Vaughn at Owensboro called me just the other day saying, ‘Hey, we need to get together.’ They’re coming up, they’re 40 miles away. They’re an Epic shop. So we say, ‘How can we help you? What can we do?’ They’ve been up here for sites visits.
Richardson: So it’s a small world. Health care is only about 5,000 hospitals or so. And how many CIOs are there? It’s a real small world and so you’ve got to network. You’ve got to take advantage of those resources and just try to stay afloat. It’s a really fun job, I think, because things are changing constantly. It’s a lot of very passionate people. With Meaningful Use we’re getting what we’ve wanted forever. We woke up and said, ‘Oh my God, now we’ve we got to do all this stuff,’ and we’re actually putting this stuff in. So now the pressure’s on. It couldn’t be a better time to be a CIO in healthcare.
Guerra: Well, that was a wonderful interview, Todd. I think it was great, and I want you very much for your time today.
Richardson: My pleasure.
Guerra: I’ll be in touch, hopefully we can work together on something else. Thank you very much.
Richardson: Sounds good.
Guerra: Have a great day, Todd.