Every hospital CIO is undoubtedly feeling the burden of Meaningful Use, but for some, the weight is greater. As Tom Ciccarelli, CIO of East Orange General Hospital, leads the 211-bed, community hospital through EMR implementations and other major projects, he is finding that organizations that are on a tight budget — and can’t afford consulting help — really are at a disadvantage. In this interview, Ciccarelli speaks candidly about how the combination of ICD-10 and Stage 2 of Meaningful Use will overwhelm hospitals, how vendor flexibility can be a double-edged sword, and the effect that changing workflows and an increased data entry burden has on clinicians. He also talks about the similarities between EMR implementations and having young children, and the critical attributes needed for today’s CIOs.
Chapter 3
- The Meaningful Use toll on CIOs — “You really have to get your head straight”
- The similarities between EMR implementations and having young children
- The career benefits of going through an EMR implementation
- Having the right CIO can make all the difference
- The bottom line: “Don’t underestimate how tough this is”
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It is very difficult. You put in a lot of hours and you put in a lot of after-hours. I’m working from 4 a.m. until 9 or 10 a.m. I might not be here physically, but at home I’m constantly monitoring and communicating.
You’re going to have the same thing with an EHR. There’s a point when somebody walks up to you and says, ‘you know, this really makes a difference.’ And it’s just like when a kid graduates from college, or on their first day of school. You see them at various milestones in their life, and you look at them and you say, ‘Wow, I did it.’
I would say to various levels of management, you’re going to walk out of here and make a lot more money out of this thing in the end. So don’t see it as, ‘I’m getting my brains beat in.’ See it as a learning experience.
You need to be extremely careful and intuitive and knowledgeable about the person you have running that program, because that makes all the difference in the world. And if you don’t get the right person in that role, you’re not going to make it. You’re going to have a mess on your hands.
People will suck you into those weeds and get into a why a particular screen isn’t working the way it should. And my answer is, ‘Listen, don’t have that conversation with me. You’re wasting your time because that’s not my forte. I’ll get you to somebody who does understand that.
Guerra: So let’s talk a little bit, if you don’t mind, about how this process affects the CIO — you, personally. Have you been putting in 12-hour days?
Ciccarelli: Oh yeah.
Guerra: Has this been an incredible stress and been draining on you?
Ciccarelli: Yes and yes. I think the advice I would give the hospitals is that the key here is making sure that you have somebody who knows what he’s doing in that regard. If you don’t, you’re going to have a disaster on your hands. I mean that’s number one from a hospital standpoint. It is very difficult. You put in a lot of hours and you put in a lot of after-hours. I’m working from 4 a.m. until 9 or 10 a.m. I might not be here physically, but at home I’m constantly monitoring and communicating.
Guerra: And it’s a constant drain. I almost think of it like the battery on your cell phone. High stress means that battery goes down a lot quicker.
Ciccarelli: Yes. You really have to get your head straight. You have to get your head straight because if you don’t, you’ll be dead. The stress will kill you. There’s always somebody unhappy and ready to yell at you for something. It’s all the CIO problems, but worse. If you thought they were bad before, you have no idea what you’re going to experience.
Guerra: Oh boy. Nothing you’re saying is shocking to me. You know I interview a lot CIOs and this is what I believe is out there. Even if some people won’t admit it, I think the strain is bordering on unbearable — unbearable if you’re going to sustain it for two or three years.
Ciccarelli: But you are. The interesting part is this is just starting. This is a five-year project and the worst is yet to come. It’s like people who have just had babies. Whenever I do a speech or have a conversation, the first thing I do is I say, ‘Everybody who’s had a baby within last five years, male or female, raise your hand.’ This is like having a baby. It starts out with anticipation and beautiful nights and planning and all the wonderful things associated with having a baby. Then the baby is born. And he poops in his pants, and he keeps you up all night, and then that’s the best part. And then it gets worse from there — you go downhill.
Guerra: Can I tell you something hysterical? Earlier in the interview, you said, ‘This is harder than I ever imagined.’ You said that about the whole process. I’ve got a two-and-a-half-year-old and a nine-month-old, and I will tell you having children is harder than I ever imagined.
Ciccarelli: This is an EHR. It’s that same concept. Just think about what you’d go through. It started with elation and anticipation, and then you get to the point of ‘Oh my God, I have to give this kid formula at 3 o’clock in the morning. I got to change his diaper.’
Guerra: You have no idea how much you’re hitting home right now.
Ciccarelli: And then you say, how did I get from a senior executive to changing a diaper? And I have to change diapers all the time here. All the time.
Guerra: Oh my goodness. And I’m coming off absolutely no sleep last night because of the children.
Ciccarelli: Well, install an EHR and you’ll do the same thing. So it really does hit home because most of the people in the audience have had babies. And the best advice I give to them is, ‘Tough it out; you’ll survive. You’ll be fine.’
Guerra: Everything you said was right.
Ciccarelli: I raised two kids and I’m fine.
Guerra: Yeah and I love it when people with grown children tell me, ‘it goes so fast.’ But I say, ‘Well it didn’t seem like it was going so fast last night.’
Ciccarelli: And you’re going to have the same thing with an EHR. There’s a point when somebody walks up to you and says, ‘you know, this really makes a difference.’ And it’s just like when that kid graduates from college, or on their first day of school. You see them at various milestones in their life, and you look at them and you say, ‘Wow, I did it.’ You can tough it out.
Guerra: You are going to make me cry, Tom.
Ciccarelli: That’s what an EHR is all about. There’ll be a point when doctors are going to come over to me and hug me and say, ‘Boy, you really made my life better for me.’
Guerra: Yeah, they’re going to pull you off the couch in your office.
Ciccarelli: If they don’t kill me first.
Guerra: Right. Well, let’s talk a little bit about the staff. You know we talked about the stress that’s on you and it must be, of course, on every IT staff. How are you making sure that the positive feedback gets to them and they just don’t get bombarded with complaints?
Ciccarelli: Well, you have to be very actively involved in that process. You have to talk with them. You have to share the vision. People do things in their own self-interest all the time. You have to convince them. You got to make it clear to them that it’s in their advantage to do this, whether it be a help desk operator or whatever. It’s just like anything else in life. You know you go to school, you pay your dues, and as a result of that, you get success or not success. So I would say to various levels of management, you’re going to walk out of here and make a lot more money out of this thing in the end. So don’t see it as, ‘I’m getting my brains beat in.’ See it as a learning experience.
Guerra: Yeah. To put on that resume that I’ve gone through an EHR implementation is gold.
Ciccarelli: Absolutely. You got 4,000 hospitals out there that haven’t even started this thing. What do you think the value is going to be of these people entering the field?
Guerra: It’s true, definitely.
Ciccarelli: If you live, right?
Guerra: Right. That’s a little caveat — quite an important caveat, but a little one.
Ciccarelli: You’ll make it. It’s like anything else. Go home and have a couple of beers and suck it up. You’ll be okay.
Guerra: That’s it. I love it. You have the New Jersey toughness in you.
Ciccarelli: There’s no other choice. If you don’t have it, quit. I could quit tomorrow — do you know how many people call me for opportunities? But I’m committed here. I’m going to retire soon. I’m on the backend of my career. It’ll be fine.
Guerra: Anything else you want to touch on, just with an eye toward picturing a community hospital CIO, one of your peers in a fairly similar situation—is there anything in addition to what we’ve already discussed, any lessons learned, advice, or thoughts you want to give them?
Ciccarelli: Well, I would say that my advice would be more for the CEO. You need to be extremely careful and intuitive and knowledgeable about the person you have running that program, because that makes all the difference in the world. And if you don’t get the right person in that role, you’re not going to make it. You’re going to have a mess on your hands. That can make the difference between a pleasant experience and a horrible one. So, I would say that the people who are recruiting to just pay attention to that.
Guerra: Okay, let me ask you some follow-up questions to just get a little deeper on what you’re saying. Are the particular traits you think are critical to a CIO now that may not have been as critical in the past before this program?
Ciccarelli: Organization skills, no question about it. Project management skills are essential. This is a massively complicated thing to do, and it has thousands of moving pieces. If you can’t manage that; if you don’t know how to build an organization and manage those projects, it’s not going to work. Half of the problem these people created on their own. Listen, if somebody is putting in 12 hours a day, you have to ask the question, ‘why are you putting in 12 hours a day? What are you doing with that 12 hours? Are you using your time effectively?’ A lot of these guys don’t. They spin their wheels. They go to meetings they shouldn’t. They do things they shouldn’t.
That comes with experience. So I’d say that if I were hiring a CIO, project management skills and organization skills are essential. That’s number one. And then number two, he has to exude confidence. And he has to exude confidence not only to his senior executive but also to his staff, because if they see you sweat, they’re going to panic. You always have to be cool, man. You always have to be cool.
Guerra: If the staff senses that you don’t have the ship under control, they will panic.
Ciccarelli: That’s right. Even if you are panicking. But you don’t panic. There’s nothing to panic about here. I haven’t panic once with this thing, and I’ve done this many times before.
Guerra: Another point you just made is as a CIO, you can’t get bogged down on the details.
Ciccarelli: No.
Guerra: And you have to know what to delegate.
Ciccarelli: And you have to be very careful of that, absolutely. You get in the weeds and you lose sight of things. Before you know it, it’s 8 o’ clock at night and you haven’t gotten anything done.
Guerra: Right.
Ciccarelli: And that’s very important because people will suck you into those weeds and get into a why a particular screen isn’t working the way it should. And my answer is, ‘Listen, don’t have that conversation with me. You’re wasting your time because that’s not my forte. I’ll get you to somebody who does understand that, and that’s the person you should speak to, because they know more about it than I do.’ My role is to put the right person in the right place to get that job done.
Guerra: Well, Tom, that’s about all I have for you. Is there anything else you want to touch on?
Ciccarelli: No, actually I have to go. My phones are ringing off the wall.
Guerra: This was, as usual, refreshing, honest, and I would say very courageous of you in the sense that you’re really helping your peers. Your honesty is really going to help your peers and I want to thank you for that.
Ciccarelli: Don’t underestimate how tough this is. And when I sit at a table and everyone else tells me it’s not, they’re doing something wrong.
Guerra: Well, I’d love for us to chat again whenever you’re comfortable — six months, a year, whatever.
Ciccarelli: Sure. I would say let’s just do it in six months and then we’ll have a better piece. And we’re moving up to 6.9. Like I said, we did attest, and 6-9 is going to be GE’s standard product going out. And they’re probably going to start re-marketing. That’s my thought. They’re going to move us to 6.9 and then we’ll be in the pilot going out. So I think you’re going to see a lot of activity in the near future with that version, and I’d be happy to discuss that with you.
Guerra: Well, I will make a note and I will ping you in six months.
Ciccarelli: If something comes out with the version that you want to talk about beforehand, give me a call.
Guerra: Absolutely. Thank you so much, Tom.
Ciccarelli: I’m going to summarize by saying they really are putting a lot of time and effort. They’re putting quality time and quality money into it. We want to make it work right. And I’m very impressed with the skillset of the people and the commitment from senior management to do it. We’ve never had a situation where they’ve turned around and said no. The answer is, what do we need to do to make it right?
Guerra: Right.
Ciccarelli: Okay?
Guerra: All right, thank you so much, Tom.
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