As CIO of CentraState Health System, Neal Ganguly is in a unique position. Although the organization offers ambulatory services, it is still considered a stand-alone community hospital, and is located in the most densely populated state in the country, among a sea of large multihospital systems. For Ganguly, the challenge is to forge ahead and continue build the organization by finding new ways to connect with physicians, aligning with the state’s largest HIE, and leveraging initiatives like CHIME StateNet — a forum in which CIOs can share best practices. In this interview, Ganguly talks about why strategic planning should focus on meeting immediate needs — and not on achieving Stage 7; dealing with the growing demands of sophisticated users; and the challenges of maintaining a healthy work-life balance.
- Biggest HIE barriers: vision and alignment
- Creating a forum for CIOs to share best practices
- “We can’t afford to live in a vacuum”
- CentraState’s long-term IT strategy
- Achieving Stage 6 recognition
- The push toward BI & creating a more centralized repository
LISTEN NOW USING THE PLAYER BELOW OR CLICK HERE TO DOWNLOAD THIS PODCAST AND SUBSCRIBE TO OUR FEED AT iTUNES
There are a number of barriers, and a lot of it comes down to vision and alignment. If you’re in a highly competitive marketplace, there aren’t great incentives to share information that way, even though everybody understands the theoretic or academic reasons for it.
There was a significant amount of work going on at the state level, and we realized that there wasn’t any sharing of best practices going on. There wasn’t a lot of real good forum for that discussion even to take place.
Being part of the conversation is critical. I don’t know that any of us can afford to live in a vacuum. You don’t necessarily have to devote the time that some of the volunteer leaders are devoting to the organization, but you should make sure your voice is there.
HIT is actually on the radar in the halls of government in a pretty significant way for the first time perhaps ever. And there are few who are better positioned to help guide legislative policy and rulemaking then those CIOs who are living these challenges every day.
I think there is tremendous value in heading toward Stage 7. But I don’t know that it’s something we can accomplish in two years or five years — we still haven’t sat down to make that part of our planning process. The planning has been a lot more tactical in terms of what are the immediate needs.
Gamble: HIEs is a topic that people really seem to have pretty strong opinions about, and there is a lot of talk about why some of them have trouble with long-term sustainability. What do you think is the biggest barrier?
Ganguly: Well, I think there are a number of barriers, and a lot of it comes down to vision and alignment. If you’re in a highly competitive marketplace, there aren’t great incentives to share information that way, even though everybody understands the theoretic or academic reasons for it — certainly it’s better for patient care if it can be done properly. I’m one of the people who has always held the quiet view that HIE is a public good and is something that actually should be supported and funded by government and established in some kind of a stronger standard infrastructure than the government has done so far to help roll that out faster.
I think leaving it to the kind of free-market model that we’ve done has gotten to a point where there are HIEs that have invested millions of dollars who are financially questionable in terms of their viability. There are others who are exchanging information actively, yet competing with a number of other HIEs. So they’re offering duplicative services to a marketplace and that’s not necessarily adding value in the aggregate. As a national health system, we’re not really, for the most part, a huge for-profit environment, and even where there are for profits then money isn’t necessarily there in large amounts, not like banking or insurance and those kinds of industries. So I struggle with that, frankly. We’re funding the HIE locally here — our Mobile MD platform as a hospital and as a tool for our physicians — and we’re participating in the Jersey Health Connect environment as a community good.
Gamble: I think that what we’ve also seen is the HIEs that do get grant money up front can set up an HIE and get it working to a certain degree.
Ganguly: But they can’t sustain them
Gamble: Yeah, exactly.
Ganguly: It’s a real concern. And then there are hosts of technical concerns around privacy and security — around the issues with patient identification and the absence of a universal patient identifier, or at least a standard patient identification methodology. There are some significant challenges there.
Gamble: So that leads into one of the other things I want to get into, which is CHIME StateNet. I know that HIE is one of the many topics for which people are going to their peers for advice and things like that. So if you would just give us an overview of what StateNet is all about, and tell us about your involvement.
Ganguly: Sure, StateNet was formed out of an idea that a number of CIOs led by Russ Branzell from Poudre Valley in Colorado had gotten together and discussed probably three or four HIMSS meetings ago. We were able to sit down with CHIME and realized that we didn’t have a strong infrastructure for communicating on some of the state-based issues that were out there. CHIME had a pretty good voice in terms of national advocacy, but there was a lot of activity, particularly as the RECs and NHIEs were becoming significant topics. There was a significant amount of work going on at the state level, and we realized that there wasn’t any sharing of best practices going on. There wasn’t a lot of real good forum for that discussion even to take place, and CHIME leadership realized that that would be a good place for us to plug in, and StateNet kind of evolved from that.
I had the privilege of chairing the HIE work group which did come out with a set of guiding principles around HIE which were published, and I think have been a good tool for lot of people who are out there trying to understand what HIE is. We hope that it helps some of the HIE coordinators in various states build some of their models out. But we actually have to take that to the next step now. I’ve been talking back at StateNet about how to best do that now that some of the HIEs are becoming more mature; how we begin to disseminate that best practice, and we’re hoping we can do that with the StateNet platform that’s been created most recently. There’s been an upgrade to it and there’s a whole almost social media type of networking environment created that will be able to leverage that kind of platform to share those best practices and drive some level of adoption to the membership.
Gamble: The social media aspect is one of the things that I found pretty interesting about it. I was looking at it and saw that a CIO from Pennsylvania had put up a quick question and was able to get it answered by peers, and I think that that’s something that’s really valuable.
Ganguly: I agree. We have to be honest, and I can’t speak for all my peers, but I’m a little slow in some of the social media tools. And I’m trying to get myself up to speed more, but one of the challenges I find overall is that there are just so many different social media hotspots and you can only track so many, whether it’s Facebook, LinkedIn, Twitter, or in our case, StateNet. We’ve got to get people to identify the ones that have value to them personally. So we’re hoping that more and more CIOs, and frankly, non-CIOs, because Statenet is not restricted to CHIME members, will join in. We’re hoping to build a real community there and it will take a little time as the message gets out, and as more and more people begin to participate, I think we’ll see more robust discussion on StateNet. It is just starting.
Gamble: I know that LinkedIn does have specified groups but this is something that’s a little more focused, so it has that advantage.
Ganguly: And I think with CHIME, we have the benefit of some level of control over it. As far as LinkedIn, we’ve got groups on there, but you see a lot of people using these marketing tools and trying to advertise their services, and CHIME StateNet will not allow that kind of thing to take place.
Gamble: That’s important too. So besides HIE, are there any kinds of hot-button topics that people are going to the site for?
Ganguly: Yeah, we had a big focus early on at StateNet around the regional extension centers. I think that probably is dying down as a hot topic now, but we anticipate a lot of ramp-up around discussing Stage 2 rules now and a bunch of the other regulatory issues that are coming up. I’m hopeful as we begin to — or, I should say — continue to highlight the issue of the patient identifier, that Statenet will be a good platform for that topic to be discussed as well.
Gamble: So CHIME is something that you’re pretty heavily involved with — CHIME and HIMSS. As far as your involvement with both, which it seems like you’ve kind of increased in the last year or so, how do you benefit most from being involved with those organizations?
Ganguly: I really think it’s from the interaction with my peers. The people who are giving their time are people who have really spent time in the industry and have identified themselves as thought leaders. Certainly I’m not putting myself in that category, I’m saying that I’m really learning from those people and able to interact with them much more closely and build closer relationships then I would have had I remained just sort of a CIO closeted within my institution.
And I think frankly, whether you decide to take a leadership role in a volunteer capacity for HIMSS or CHIME or other professional organizations, or not, being a part of those organizations is critical. Being part of the conversation is critical. I don’t know that any of us can afford to live in a vacuum. You don’t necessarily have to devote the time that some of the volunteer leaders are devoting to the organization, but you should make sure your voice is there.
Gamble: I know that you have been, especially in the past, involved a lot with New Jersey HIMSS, but I’m sure it’s also pretty valuable to be able to reach out to CIOs in other parts of the country and kind of get their perspective on things.
Ganguly: Definitely, it is. And I think we have a unique opportunity as CIOs now to have our voice be heard. HIT is actually on the radar in the halls of government in a pretty significant way for the first time perhaps ever. And there are few who are better positioned to help guide legislative policy and rulemaking then those CIOs who are living these challenges every day.
Gamble: So I wanted to talk a little bit about CentraState. I know that it’s been awhile since you and I talked and that since then, CentraStatel has been named to the Most Wired list twice and just qualified for Stage 6 recognition, right?
Ganguly: We did, we’re very fortunate, and I’m very fortunate, certainly. I’ve got a great team under me and I guess a byproduct, as I said, of also the strategic plan we established a number of years ago was that we have driven our use of technology to some recently sophisticated levels and are proud to have been able to qualify as a Most Wired hospital for the last two years. And certainly attaining Stage 6 was something we’re very proud of as well.
Gamble: When you have something like that, especially Stage 6 recognition, is that something that’s a ‘nice to have’ or is that really validation of the work that everyone’s put in and kind of motivation to keep going to the next level?
Ganguly: That’ a good question. I don’t know that our clinicians necessarily understand or value that Stage 6 designation as much as perhaps our IT leadership and department do. And that’s something that we have to do a better job of here within CentraState, and perhaps as an industry, of communicating to our clinicians what it means to attain certain accomplishments. Being a Most Wired hospital is a good thing, and there are reasons why, but I don’t know that our customers, meaning, the physicians and staff here at the hospital or the patients in the community, necessarily totally understand why that’s benefit.
So I think there’s some work for us to do there, but in terms of attaining those things and how it leads us down the path further, I don’t know where we’re going to be in terms of getting to Stage 7. I mean, that’s the ultimate level and I think there is tremendous value in heading toward Stage 7. But I don’t know that it’s something we can accomplish in two years or five years — we still haven’t sat down to make that part of our planning process. The planning has been a lot more tactical in terms of, what are the immediate needs? How are we going to function in a potentially rapidly changing world from a reimbursement standpoint? What happens as the concept of accountable care takes hold? Will patient-centered medical homes be the model? How do we support that model? Those kinds of things are really more front and center for us right now than being 100 percent CPOE or meeting some of the other criteria that would drive Stage 7.
Gamble: So what are the really big projects on your radar, maybe for the next year or so? What’s on the front burner?
Ganguly: We’ve got a couple of system implementations under way. We’re replacing our lab system and we’re actively looking at some other system replacements. Those are some of the more tactical things. But from sort of a hybrid tactical strategic standpoint, business intelligence is hot on the burner right now for us. We have sort of a disparate environment where reporting comes out of various backend systems. It’s not necessarily as controlled as we’d like, and it’s fairly resource-intensive from an IS perspective as well. So we’re hoping to move toward a more centralized repository, clearer control over the reporting infrastructure, and better dashboard tools on the frontend to allow our line managers to manage their businesses effectively using those kinds of tools.
That, I think, is going to take us a little time. We’re actually laying out our roadmap for that right now, but it will be a major project for us. Plus I think if we don’t have good data and the ability to analyze it in near real-time or real-time, then we are at a disadvantage as we try to understand and navigate the waters through accountable care and those kinds of things.
Gamble: Absolutely, you can collect all the data in the world, but if you’re not able to use it and analyze it, it just doesn’t do much good.
Ganguly: Right, and of course we want to get our CPOE level up higher and higher. From an inpatient perspective, we’d like to begin to consolidate some of our external feeder systems because we use the Siemens Soarian product, and there’s a workflow engine embedded in that. So we’re always looking for opportunities to develop more workflows that will streamline the care process. Those things are all continually hot on our agenda.
Gamble: You’ve a pretty big stove with a lot of burners on it.
Ganguly: Right, I think all of us do.