Before she joined the staff of Edward Hospital in late 2009, Bobbie Byrne had never once thought about becoming a CIO. But when she was approached by a recruiter who told her that the organization wanted a physician, she was immediately intrigued. The move turned out to be fortuitous; just a year into her tenure, she led the way as the organization migrated to a new platform that would provide an integrated patient record. In this interview, Byrne talks about the process of selecting a major IT system, what it takes for an organization to make IT its top priority, and how her experiences as in the clinical and vendor worlds have shaped her role. She also discusses the state of HIE in Indiana, what she really thought of the ICD-10 delay, and her concerns about the IT workforce shortage.
- Reacting to the ICD-10 postponement — “They ripped the rug out.”
- Frustration with regulations
- Participating in the MetroChicago HIE
- Concerns with the HIE funding model — “Hospitals already have a strain on their budget”
- Investing in education and training for staff
- Using in-house talent to staff Epic rollout
- “When we lose good people, we’re able to replace them with good people”
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It’s almost like they said, ‘What is the absolutely worst thing that we could do to hospitals? We’re going to put all of this stuff out there; we’re going to fake it for a long time that none of these dates can change; we’re going to make sure that people get going and get working and get people scared at their hospitals that this stuff is coming right down the pike; and then right to the point where things are humming and cooking along and people are starting to feel like they have a plan and they can actually do this, we’re going to rip the rug out.’
The timing of saying, ‘Okay, we’re going to push it for a year into 2014’ — I think that’s fine. I mean, if they had stopped everything and then said, ‘we’re pushing it three months or six months,’ I think then people would have been in real trouble.
They had committed to being a beta site for the MCHC HIE before we decided to get together on the Epic implementation, and so they had done some of the legwork for that. So Edward probably ended up going into the HIE a little sooner than we would have otherwise planned to.
I’m just not really certain that charging hospitals subscription fees is the real way to put up a sustaining HIE. Our budgets are tight just like everybody else. It seems like a common theme — ‘we’ll just get the hospital to pay for it,’ as if hospitals are an endless source of cash.
We spent a lot of time working with HR about how to make this transition; how to really get the best and brightest out of the departments in order to staff this project — that’s so important for the organization.
Gamble: So just recently we got the official date for ICD-10. What do you think of the decision to delay and do you think that the extra year is enough time? And is it something where maybe it was a little bit frustrating because you had been working toward one goal, or at least had the original deadline in your head?
Byrne: I was so mad. I just thought it was ridiculous, and it wasn’t as if CMS didn’t have warning. It wasn’t as if people weren’t saying, for months and month and months ahead, there’s a lot happening. We have healthcare reform, we have Meaningful Use, and we have ICD-10 — this is just too much for people to do. It’s almost like they said, ‘What is the absolutely worst thing that we could do to hospitals? We’re going to put all of this stuff out there; we’re going to fake it for a long time that none of these dates can change; we’re going to make sure that people get going and get working and get people scared at their hospitals that this stuff is coming right down the pike; and then right to the point where things are humming and cooking along and people are starting to feel like they have a plan and they can actually do this, we’re going to rip the rug out.’ It’s just ridiculous. So I was very frustrated.
Gamble: You’re not the only one. I’ve heard more than one person say that it undermines the CIO’s authority too because you’re saying, ‘Okay, this is the date. We have to stick to it,’ and then all of a sudden, you say, ‘Oh, now we do have more time.’ It’s something that I’m sure that you don’t really need to deal with.
Byrne: I thought it was crazy. Now the timing of saying, ‘Okay, we’re going to push it for a year into 2014’ — I think that’s fine. I mean, if they had stopped everything and then said, ‘we’re pushing it three months or six months,’ I think then people would have been in real trouble, because they really had stopped or had certainly slowed down what they were doing while we were waiting to hear the date. So I certainly think that a year is enough time to get yourself ramped back up and get your steering committees kind of refocused, etc. I just don’t know what it’s accomplished; I don’t think it’s helped, but that’s just my opinion.
Gamble: I was surprised that between the announcement that it’s going to be delayed and the announcing of a date there was kind of a lot of time, and I think it left a lot of people with kind of a strange taste — why not just tell people upfront, ‘we’re going to detail it until X date’?
Byrne: You’re right. Sometimes I get frustrated with this and then I just think, ‘this is just regulations. That’s the way it is.’ I mean, tell me some regulation that’s worked out perfectly where we’ve all said, ‘Oh that’s wonderful. This is so good!’ It just doesn’t happen.
Gamble: That’s true. Now another thing I wanted to talk about was HIEs. Are you part of the MetroChicago (MCHC) HIE?
Byrne: Yes. Edward was part of the HIE from the beginning as part of the vendor selection and steering committee, and we’re a founding member of the HIE. We are in a little bit of an interesting situation that our Epic implementation is actually in conjunction with DuPage Medical Group — that’s the large multi-specialty physician group that I mentioned earlier — and so we are going on a single instance of Epic with them. They had committed to being a beta site for the MCHC HIE before we decided to get together on the Epic implementation, and so they had done some of the legwork for that. So Edward probably ended up going into the HIE a little sooner than we would have otherwise planned to do just because our physician partners had made that commitment to be early adopters. So I don’t have a date yet; we’re still trying to figure out when this works in conjunction with everything else that goes on. But yes, we’ll definitely be a participant.
Gamble: And this is a really sizeable HIE, right?
Byrne: Right, and I think it’s because of the size of the Chicago Metropolitan area. And there’s been some good commitment from not all of the hospitals, but from many of the hospitals. Where we are out in DuPage County, we’re getting a little bit of a critical mass here in that Edward and the other surrounding hospitals have all agreed to participate, which would be great because it means that you’ll be very likely to have patient information in the HIE if you have it in your local surrounding hospital. For most of the patients, healthcare is local, so they’re coming here or they’re coming to one of the other close-by hospitals.
So I think it should be good. My only concern is the funding model. I know that other HIEs have done it this way, but I’m just not really certain that charging hospitals subscription fees is the real way to put up a sustaining HIE. Our budgets are tight just like everybody else. It seems like a common theme — ‘we’ll just get the hospital to pay for it,’ as if hospitals are an endless source of cash. I don’t have another great idea to make it different, but I just hate the fact that it’s being done on the hospital’s backs.
Gamble: I don’t blame for you that. Just looking at the number of projects you’re involved with and the things you have going on, it’s already a big decision as to where money is being allotted, and you’d hope that there would be a different model in place for HIEs. But this is something that the states have struggled with for a few years now in terms of maintaining that sustainability.
Byrne: Absolutely and I know that payers have been involved in some other HIEs and I’m sure payers feel like everybody is just thinking, ‘Oh, the payers can pay for it.’ But I think that there’s got to be some distribution of financial responsibility among all the stakeholders.
Gamble: Sure. You’re going to run into incentive problems too where hospitals are going to be a little less incentivized to do something if they know that they’re going to have to put up the money for it, but I guess that’s a whole other issue right there.
Gamble: So one of the big issues that we’re really seeing come to the surface is burnout or fear of staff burnout, just because organizations have so much going on and it’s really a crazy time. What are you doing to try to hold on to some of your good people — are you doing anything in terms of offering additional education or any types of incentives? How are you dealing with this?
Byrne: Probably the most important thing that we do for our employees is we continue to try make Edward just a really nice place to work. For example, it’s the White Sox opening day and not everybody could go to the game, so we had a big party with Chicago-style hot dogs and food for people to celebrate the Sox home opener. So we try to do things like that to make it just really a fun place to work. People really like working with their teams. We try to celebrate the successes, and we’re more of a little bit touchy-feely; just a really nice bunch of people to work with, so that helps I think.
We clearly are making a huge investment in individuals’ education. Our Epic staffing plan, for example, was that we have almost no consultants and we hired very few people from the outside. We pulled the vast majority of the extra individuals coming to the project off the floors out of the departments, and we’d sent them to training at Epic and have paid full-time salaries for them to be studying for their certifications so that they can stay on the project. And we said that we would guarantee their jobs when they come back.
So if they’re a nurse on the floor and they want to come to the project and then go back to the floor, their job on the floor is guaranteed. We spent a lot of time working with HR about how to make this transition; how to really get the best and brightest out of the departments in order to staff this project — that’s so important for the organization. I know that some people will take their Epic certification and they’ll go out into the market and we’ll lose some people. That’s just going to happen; I’m not going to fret too much about that. I’m just going to try and make this the most attractive place to work. For many of our technical staff, we didn’t have cache expertise in-house, so they’re going to have cache trained and make sure they stay up on their Windows certification and their MWare certification and all of those things. We’re really trying to invest in education.
And we try all of the other stuff; we try to pay a competitive salary and make sure that people have a good work-life balance. We’re going to lose people, and I think that’s okay. If there’s a situation that I can’t match and I have a really great individual who gets get better opportunity someplace else, you know what? Go with god. I hope we get to work together again one day. I just lost my chief technology officer to the University of Chicago. It’s a bigger job, it’s closer to our house, and it’s more money. I hated losing her because she was so fantastic, but I think our paths will cross again professionally and it will all be okay. And it will bring us an opportunity to bring in somebody new into the organization. We haven’t had trouble recruiting. Edward is a very desirable employer and so we’re lucky that way. So when we lose good people, we’re able replace them with good people.