When he was named CIO at Southern Illinois Healthcare three years ago, two of Dave Holland’s key goals were to reverse the trend of project delays at the five-hospital organization, and to help narrow the gap between IT and clinicians staff. His team is addressing both issues by surging ahead with a big Meditech upgrade and establishing a rounding system that will enable the IT staff to better understand how implementations impact clinicians. In the meantime, Holland is focused on building an HIE within the organization, establishing a PHO to improve outcomes for chronic disease patients, and driving EHR adoption among physicians. In this interview, Holland talks about the HIE picture in Illinois, transitioning to a true EHR environment that will enable clinical decision support, and what it takes to change the culture of an organization.
Chapter 3
- Improving project prioritization
- Meditech 5.6 upgrade
- Getting the organization to realize “these are not IT projects”
- From chief information officer to chief innovation officer
- IT as an enabler
- Implementing single sign-on
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Bold Statements
We’ve done a lot over the last three years to improve our methodology and our processes — to have a better understanding of the resources it takes to do these projects, and to have a better understanding of how to plan them, how to execute them, and how to meet milestones.
The difference in methodology is that the team is no longer nine IT people and three people from the outside. Ten percent of the team is IT people and 90 percent is people outside of IT. And when we do testing on the registration process, we don’t have IT people test it. We call in registration people and we work with them.
If you think of yourself as an IT person, you’re in the wrong place, because this is a healthcare system. We’re healthcare providers and the tool we use to provide healthcare to our community is IT. And when people start thinking of their job in that way, they start looking at things totally different.
There’s still a gap between IT and everyone else, and we’re trying to eliminate that gap and make sure that people see IT as part of the team and people who want to help, and part of that is getting out there and meeting them and talking with them and showing them.
IT people don’t think anything of signing into a computer system. But put them in with a nurse who walks into seven patient rooms plus their nursing station, so they have to log on eight times in less than an hour, and it takes 45 seconds to log on, and all of a sudden they start to say, ‘Oh now I know why they get frustrated with this.’
Gamble: That’s really a lot to have going on right now. It’s got to be challenging to prioritize when you have so many things that you’re doing.
Holland: It absolutely is, and that’s one of the things that we struggled with last year. I think we’re really kind of retrenching to try to get a better handle on how we do this effectively and prioritize it. One of the things I’m really proud of is that I’ve been here three years now, and we had a history of perpetual delays in projects where we’d say, ‘okay, we’re going to do this year-long project. We’re going to start on it in January and finish in December. And then you’d get to March and it would get delayed three months, and then delayed three and delayed three months. Projects eventually got delivered, but they didn’t come close to meeting the anticipated original implementation date.
Well, we tackled an almost year-long project which was the Meditech 5.6 Client Server upgrade and last year at this time, we said we’re going to do it on February 22, and we remain on track to do that. We’ve done a lot over the last three years to improve our methodology and our processes — to have a better understanding of the resources it takes to do these projects, and to have a better understanding of how to plan them, how to execute them, and how to meet milestones. Of course we’re not perfect, but this will be the biggest project of this size, which is literally a project of 50-60 people working, and for us, that’s pretty huge. And this will be the first year-long project where we set the go-live date a year earlier and then hit the date that we said we’re going to do it, and I’m really proud of the team for what they’ve accomplished. And they’re going to deliver this.
We did well with the implementation. I would say this is the second time we’d actually done that. We were successful at implementing our radiology project on time, but I would say that was only since radiology is a more limited area. And while I’m really proud of what they did, it was a smaller group. This is 5.6 upgrade encompasses everyone from registration people to revenue cycle people, coders, nurses, physicians — this encompasses virtually everybody in the environment, and so this has been a huge project and I’m really pleased that we’re where we are today. And I’ll knock on my desk here because February 22 is next week and hopefully everything will go without fail, but we feel really good about how we’ve done on this project so far.
Gamble: So it’s got to be really important for morale too that you were able to establish a deadline and stick to it. What was required to help improve those methodologies and change the way of thinking with projects being delayed?
Holland: One of the important improvements in methodology is getting the organization to realize that these are not IT projects. For us, a couple of things happened. We got great support from the CEO. One of the things the CEO did last year is he changed my title from CIO to CIO; he changed it from chief Information officer to chief innovation officer. And we’ve really worked hard to get people to realize that these projects affect their people. When we do a revenue cycle system, it’s the billing people and the coders — it’s their system. It’s not an IT system; it’s their system.
In the last three years we’ve really talked with people about how important it is for them to be involved. And I think the difference in methodology — and we did it well in the radiology implementation and now again in this 5.6 upgrade — is that the team is no longer nine IT people and three people from the outside. Ten percent of the team is IT people and 90 percent of the team is people outside of IT. And when we do testing on the registration process, we don’t have IT people test it. We call in registration people and we work with them.
And I think that’s been the big difference; getting the organization involved and getting the departments that are going to be impacted involved in the process. And when we do testing, bringing registration people and bringing in nurses, billers, and coders and having them look at the data. Because they are the ones that use it, and they say, ‘Wait a second, I’m expecting this and I get that—why?’ Whereas the IT people can kind of through it and say, ‘Yeah, it worked.’ It’s the workflows of the people where they say, ‘Wait a second. At this point I’m supposed to hand this off to Mary and I don’t see how that’s going to happen.’ And that, I think, has been a major change and the real reason why we’ve done that.
Another thing that I’ve emphasized since I got here that I think is paying off a lot of dividends is that I require everyone on my IT people to round for an hour once every month with a clinician. I want to remind my IT people that we’re here for healthcare. And so everyone, even my network engineers, spends an hour with a doctor or a nurse or a radiologist, and they observe how they use our systems. They talk with them about the challenges they have and I really think it helps IT people realize why we’re here. We’re all healthcare providers; we’re not IT people. And I tell my staff over and over again that if you think of yourself as an IT person, you’re in the wrong place, because this is a hospital system. This is a healthcare system. We’re healthcare providers and the tool we use to provide healthcare to our community is IT. And when people start thinking of their job in that way, they start looking at things totally different, and when they start looking at things totally different, it starts to come together. They start to realize their job isn’t to get this computer system up and running; their job is to enable physicians to be able to take better care of their patients and to enable registration people to be able to collect the data they need and get that patient off the registration desk and over to the surgery department or the ED department or wherever they go to go so they can get healthcare.
When they start thinking in terms of healthcare workflows and that I’m a healthcare provider and my goal is to help take care of the people in my community and my goal is to have the systems that provide the data to the clinicians so the clinician don’t have a mistake or near or make sure that the systems are up, it’s amazing what happens when a programmer or an analyst spends an hour and sees what a nurse does. It’s amazing the first time that that happens for people when they say, ‘Wow, nurses are really, really busy people and they do a lot of running around, and there are all these people that are reliant on them.’ It really changes the way they look at things, and I think if there’s any one thing that I’ve done here that I think has added value to the organization, it’s exactly that. It’s getting the IT people out in the clinical settings and getting them to see and observe and understand what goes on out there and why we’re here.
Gamble: I would think that really does have benefits for both the IT professionals and the clinicians, and it goes back to what you were saying before about getting physicians more engaged. I’m sure it goes a long way toward that as well.
Holland: Yeah, just getting them to talk and communicate — there was a real gap here and there’s still is. I won’t deny it. There’s still a gap between IT and everyone else, and we’re trying to eliminate that gap and make sure that people see IT as part of the team and people who want to help, and part of that is getting out there and meeting them and talking with them and showing them. It’s also amazing when you have IT people out in those types of settings. They see things and they can provide feedback like, ‘have you thought about doing it this way?’ And they can provide ideas that help people improve their process. Or sometimes they say, ‘You’re using the system this way but it’s really meant to be used that way,’ and they can help them teach that.
The other thing is they see the frustration. It’s interesting; IT people don’t think anything of signing into a computer system. But put them in with a nurse who walks into seven patient rooms plus their nursing station, so they have to log on eight times in less than an hour, and it takes 45 seconds to log on, all of a sudden they start to say, ‘Oh now I know why they get frustrated with this.’ So that was one of the things that helped spur improvements in single sign-on. We now have the Imprivata system where you have the ball by the computer and you touch your badge and it logs you in. That was all about people seeing things and saying, ‘Wow, they’re running from computer to computer and every time they do it they have to log in, log out. That’s all they’re doing all day is logging in and logging out.’ And until computer people get out with the nurses and see that, they don’t understand it.
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