Chuck Christian, CIO, Good Samaritan Hospital, Chapter 3

Chuck Christian, the longtime CIO at Good Samaritan Hospital, believes that health information exchanges have been getting a bad rap. Christian has been involved in HIE work for more than a decade — long before Meaningful Use was even on the radar, and he wants CIOs to realize that getting connected with data exchange can yield benefits that go beyond just qualifying for funds. In this interview, Christian talks about the state of HIE in Indiana, how his organization is leveraging HIEs to improve patient care, and the optimal role for CIOs when it comes to HIE initiatives. He also discusses negotiation points, the importance of knowing the costs involved, and why he thinks the industry is just beginning to scratch the surface on how information can be most effectively used.

Chapter 1

Chapter 2

Chapter 3

• Be prepared – why CIOs must know the costs of HIE
• The power of negotiation (start with “free”)
• Mentors
• The importance of HIE to organizations that refer out patients for certain specialty care
• An HIE checklist for CIOs

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Bold Statements

We’re very cognizant of how much healthcare costs the people that we serve. And we’re always looking at how do we do it most cost effectively. I don’t want to use the word frugal or cheap because we’re not cheap. I think we invest appropriately.

The vendors also know that if they don’t follow through with what we want and what we agree to, then if somebody calls me on the phone, I’m going to be blunt and truthful. I’m not going to throw them on the bus inappropriately, but I’ll be truthful.

There are probably two dozen CIOs that the industry is very, very fortunate to have, because they’re unselfish in their willingness to share every bit of knowledge and experience and expertise they have. This industry needs a lot more of those folks.

I don’t think we need to have our blinders on about what that exchange means. For me, being a regional hospital, we don’t provide every service that an individual may need, so we’ll have to refer that patient out. And that patient, once their service is finished, is going to come back to us.

If we have a failure with our EMR here at the hospital, I’ve got a backup. Everything we’ve done is up there in Indianapolis and we can access our own data anytime we want to. Is it in the same format that physicians are used to looking at? Absolutely not. Is it in a way that they can get to the information in a timely fashion? Absolutely.

Guerra:  As a CIO, you definitely want to talk patient safety and how IT can exchange information and can relate to better care and that kind of thing. But you probably do yourself a big disservice not to really have your numbers down, so to speak, because the CFO will just eat you alive.

Christian:  Well, I think that’s one of the nice things about our senior leadership team is we all kind of sit around the same table and we’re always looking at how do we make sure that we maintain the profitability of Good Samaritan. And it’s not that we put a lot of money in the bank every year. We’re very cognizant of how much healthcare costs the people that we serve. And we’re always looking at how do we do it most cost effectively. I don’t want to use the word frugal or cheap because we’re not cheap. I think we invest appropriately.

The other thing that is part of my job is to negotiate well. All the people I deal with know that my four letter word that starts with F is ‘free.’ They have a number, I have free, and then we negotiate to something that’s reasonable. And a lot of people, when I tell them my favorite four-letter word that starts with F, there are other things hit their mind, but it truly is ‘free.’

Guerra:  Come on, Chuck This is a family show.

Christian:  I know, I know. It’s free. And most of the vendors know that. And sometimes I think it’s like union negotiations. They know me, and so they automatically come in high.

Guerra:  Right.

Christian:  Because they know that if they can show a great discount, I’m going to be happy. But I’m on to their game. I know that. And so I kind of look at them and say, ‘don’t bring me this ridiculous thing. Let’s be realistic, because you know I’ve done my research, and I know what other people are paying for this stuff.’ And I’ll say, ‘If you want me to, I can quote you three or four folks and I can tell you what they paid. So let’s not challenge my intelligence with this.’ And so most of our business partners are really good about that. But I always scare them to death with the free piece.

Guerra:  Do you get some of them that come in and say, ‘Listen, Chuck, we’re not going to mess with you. This is the best we can do. Go ahead, check your numbers.’ Do you get people who come in and actually give you a legit price right off the bat?

Christian:  Yeah, and I always ask for less.

Guerra:  So, what benefit is to them?

Christian:  Well, this is going to sound really, really bad, but I’m going to say it anyway. They get to say that I’m using their product.

Guerra:  That’s true, it’s referenceable.

Christian:  And so it’s referenceable, and I don’t mind, because if it’s a really good product, I’ll write an article about it. I’ll give an interview about it. And I won’t pull any punches. Just because they gave us a good price, it doesn’t mean that I’m going to automatically go out and say, ‘Man, this is the best thing since sliced bread.’ But if we’re doing innovative and creative things, and if they’ve been a good partner, I’ll be happy to do that.

Guerra:  Right.

Christian:  And if they want me to help them in the future, then I’ll give you a perfect example. We were the alpha site for Fuji to do the integration between the cardiology product they bought, which is ProSolv, and Synapse. We did that integration with them. We were their development partner. And so when Bill Sponsor from Sharp wanted to look at Fuji for an integrated solution for cardiology and radiology, Fuji brought Sharp to Vincennes, Ind. San Diego to Vincennes, Ind. Figure it out. And Sharp bought it. Sharp bought Fuji’s solution. And I hope that they’ve been as successful in rolling that out as we have. And so I think that’s the value that we bring each other in that. But the vendors also know that if they don’t follow through with what we want and what we agree to, contractually and as a ladies and gentlemen, then if somebody calls me on the phone, I’m going to be blunt and truthful. I’m not going to throw them on the bus inappropriately, but I’ll be truthful.

Guerra:  The big question is, did you put the Spooner up in your house?

Christian:  Oh no, Bill didn’t come. Actually, I wasn’t even here. I was in Indianapolis at a meeting, and I had met that whole group for dinner the night before. When they came to Vincennes, I wasn’t even here. Bill is like me; if you’re going to go out and look at radiology, bring a couple of docs. You all go look. I’ll support your decision, and we’re going to do our technology homework in the background. And Bill and I talked a little bit. Bill is a little more removed from the nuts and bolts of every day than I am because he’s just got a much, much larger enterprise to run than I do.

Guerra:  And he writes his SmartBrief piece.

Christian:  Yeah. And I always tell Bill that when I grow up, I want to be him. We’re both good old southern boys. He’s from Tennessee; I’m from Alabama. So we kid each other, but I have high regard for Mr. Spooner. I really do. He’s a wonderful guy. And to be honest, he’s one of the guys that I watched to learn how to be a healthcare CIO years ago. He’s one of the ones I really watched. John Glasser is another one. There’s a short list of other folks.

Guerra:  How about Russ Branzell?

Christian:  I really couldn’t watch him, but Russ is a great guy. If I could play golf like Branzell, I’d have it all.

Guerra:  Then you could really negotiate if you could get vendors out on the links.

Christian:  I had the pleasure of playing with him at the last CHIME conference. And I was his handicap. Russ was actually giving me putting lessons. But Russ is a great guy. He’s a smart guy. There are probably two dozen CIOs that the industry is very, very fortunate to have, because they’re unselfish in their willingness to share every bit of knowledge and experience and expertise they have. This industry needs a lot more of those folks.

Guerra:  That is for sure. Is there anything else you want to touch on? We could go into the vendor negotiation stuff a little more. But is there anything else you want to touch on HIE, or do you think we covered what you wanted to mention?

Christian:  I think that the thing about health information exchange is that I don’t think we need to have our blinders on about what that exchange means. For me, being a regional hospital, we don’t provide every service that an individual may need from trauma to neurosurgery and certain levels of cardiovascular surgery, so we’ll have to refer that patient out. And that patient, once their service is finished, is going to come back to us for follow-up care. And so I want to make sure that everyone kind of understands that health information exchange is not just one way; it’s also two-way. And hopefully, it’s going to be that highway that we’re going to move that information on in the different settings of care, whether it’s trauma or it’s discharge to a skill nursing facility, a long-term facility, or to homecare — or if it’s just discharge back to their primary care physician. We need to be communicating to that.

The other thing is that we need to see how we can leverage that technology to find the efficiencies. One of the things that I talk to nursing homes about is how many phone calls are they making back to our medical records department? We’re actually going to do a lean study on that to see, as we start implementing the technology and providing a little bit different level of access to our medical records, how we can decrease that call volume.

It’s no different than anything else. It’s like banking — and I really hate to use that, because I just don’t like the banking compared to healthcare metaphor. A lot of folks do, but I don’t care for it. But my relationship with my bank is all done on a transactional basis. Since it’s all self-service for me, I can go to an ATM, or I can go online. It’s much more transitional than it used to be, when I had to either write a check or have to go to the bank to make a deposit or make a withdrawal. And so I think that anything we can do to make it more self-service, but at the same time make it appropriate and secure, will create opportunities for efficiencies. Because if you think about it for a minute, every time that homecare agency or that nursing home has to pick up the phone and call the hospital, the only thing we’re doing is that we now have folks that answer the phone. They’re looking it up online and asking what fax number would you like to fax it to.

Guerra:  Right.

Christian:  And so we’re faxing it out to them. So now we could have an impact upon staffing. If we have an opportunity to shift that staffing somewhere else, it would be more appropriate; rather than spending the time answering the phone, electronically faxing documents. So I think that we just need to look for those efficiencies on how health information exchange can be used.

And like I said earlier on, Anthony, I don’t think that we’ve really started scratching the surface on how we can do this at a regional basis because if you look at Indiana, where most of the exchanges grew out of, we’re mostly out of referral markets — Indianapolis, Fort Wayne, South Bend, Bloomington, and over in Cincinnati. These were all referral markets. And as the referral areas grow, we’re going to see much more need for health information exchange to be flexible and grow.

Guerra:  And just as a final question, like everyone else, I picture CIOs with a white board, and they have different headings on the white board of things they need to be working on. Under inpatient, you may have a whole sublist of the different departments, and ambulatory, physician practice setting — things like that. Under HIE, what might you see there under HIE, like a minimum checklist? For example, I have to be exchanging with an HIE or I have to be exchanging with at least one other organization, maybe it’s not a ‘HIE’ but it’s a competitor organization across town. What’s the minimum? How do you know if you’re on the right track or doing the right things? Just from a minimum point of view.

Christian:  Well, if you go back to just the Meaningful Use guidelines, that’s the minimum stuff — clinical data, lab results, transcriptions, those type of things. And the other thing that if you’re in Indiana, we have this thing called Indiana Network for Patient Care. We’re exchanging all of our ADT information, all of our labs, radiology, transcriptions — anything that the physician dictates, we send up there. The value is that if we have a failure with our EMR here at the hospital, I’ve got a backup. Everything we’ve done is up there in Indianapolis and we can access our own data anytime we want to. Is it in the same format that physicians are used to looking at? Absolutely not. Is it in a way that they can get to the information in a timely fashion? Absolutely.

So from a minimum standpoint, you could look at the Meaningful Use requirements. Most of the states today are requiring some type of syndromic surveillance transactions. And that typically comes out of the ER and is an HL7 transaction that contains the chief complaint. A lot of them are doing bed availability in the case of an epidemic or an attack or some disaster, like what happened in Alabama last spring. The other thing is reportable labs. The other one is immunizations. Many of those are in the menu section of the Meaningful Use regulations.

And what we’re going to do, I think, and see in Stage 2, is all those in the menu set, those ten where you get to pick five, they’re all going to be required, and then some. And I think that in a lot of the states, there’s a lot of conversation about how else can we do that. The group that we work with — I sit on a couple of different boards in Indiana related to health information exchange — is looking at how do we leverage that, at either no cost or a low cost to the providers to enhance the value that we’re providing back to them.

So the short list, of course, is going to be the Meaningful Use stuff. But there’s a whole lot of other stuff that you can do. And once again, I think that it’s going to take those creative and innovative minds to think about how do we leverage this information. Going back, when I first saw that the INPC is that looking at it as if it were an EMR light, particularly in the very rural settings, we added a couple of pieces to it. And we could use it as an EMR. Is it as functional as Allscripts or Epic or anything like that in the physician practice? Absolutely not. Would it meet the base requirements for a physician having clinical information online and accessible? Absolutely. So there are a lot of bells and whistles that an ambulatory EMR or practice management system would have for messaging and workflow improvements, that kind of stuff, that it would provide. But if it’s just a matter of getting that clinical data online so it can be shared through the other people that are providing care, and the primary care physician sitting out in the cornfields of Southwest Indiana could get to it, absolutely. So that’s my shortlist.

Guerra:  All right. Is there anything else you want to add?

Christian:  No, that’s pretty much it.

Guerra:  Well thank you very much. As always, it’s a tremendous pleasure. And I’ll see you in a few weeks.

Christian:  Absolutely, Anthony. Thanks very much. I appreciate your willingness to let me pontificate, and I look forward seeing you in a couple of weeks as well.

Guerra:  Sounds great, Chuck.

Christian:  All right, take care.