Bill Byers, VP/CIO, Western Maryland Health System, Chapter 2

With patient engagement such a hot Stage 2 topic, it’s no wonder CIOs are looking to ramp up the pace of their portal rollouts. And Bill Byers, VP/CIO, Western Maryland Health System, is no exception. But, more than that, Byers is also looking to get his staff and community docs up on an EHR as step 1, then facilitate a robust data flow as step 2. All of which he’s doing with an eye to keeping the interface picture manageable to promote scalability, thus also increasing the chances of long-term overall success. To learn more, healthsystemCIO.com recently interviewed Byers for our Podcast series.

Chapter 1

Chapter 2

• Budgeting and project prioritization
• The importance of 100 percent wireless coverage
• Empowering clinicians through BYOD

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BOLD STATEMENTS

Tension is a polite word for when you lose an entire note. The frustration level is very high, and it’s certainly something that is not acceptable to us, so we’re very proud of the infrastructure that we’ve been able to put into place here.

… they’re able to bring their own devices in and access our clinical assets in a secure fashion, and that’s been a very nice physician satisfier.

We probably have about eight virtual wireless networks that we use at the health system to make sure that we keep everything secure.

Gamble:  We talked about some of the projects that you’re working on, so let’s talk a little bit about budget. I’m not sure how it works with your organization, but do you have a process where you sit down with the other leaders and hash something out, or do you find that with so much going on it’s more an ongoing process?

Byers:  Well, for us, we have a capital process that we go through when we submit our capital request to the budget committee in February. The budget committee works on it and then takes it to the board for final approval usually in May or June. Of course, to establish that IT budget I work with the other executives. We work basically from the top down taking a look at the strategic plan. Of course, a good way to summarize our strategic plan is just to take a look at the aim of having the best care for our community at the lowest cost, so we’re looking at projects that can help us achieve the organization’s goals, and that’s essentially the criteria we use to not only determine what will be submitted but what also gets passed on, because, as you can imagine, there are limited funds, but you have a lot of worthwhile projects, so trying to find the ones that provide the best value to our patients is really what that process is about.

Gamble:  I can imagine this is a time where it does get pretty challenging to prioritize what goes to the top of the list in terms of the budget.

Byers:  Yes. Indeed it is, and it’s a bit of a running joke with the executive team about all the capital monies that IT has received in the past couple of years. Of course, keep in mind that while IT receives some money, the fact is pretty much all these projects — with the exception of infrastructure improvements — are all clinical projects. It’s for the good of the entire organization, it’s for the good of our patient population that we do these things, and I’m very fortunate that about a year even before Meaningful Use came out, I sat with the executive team and we laid out the framework that we’re still using. That was our roadmap. It was very close to what Meaningful Use was mandating, so all we had to do was essentially tighten up some of the timeframes. In other words, we were going to start our ambulatory system about 12 months later, just to spread out some of the projects. Of course, Meaningful Use accelerated these timelines for us, but it’s worked out. I have to say we were close enough with all of our different systems, and having an integrated vendor like Meditech, I think, makes it easier as well, so we were able to accelerate these timelines, yet still come away with successful implementations. So I’m very, very glad we had the vision to plan for this about four years ago.

Gamble:  It gives you some validation that this is what you were planning on doing anyway.

Byers:  Exactly, and so we’re still working the plan, of course, keeping a close eye on what’s going to happen with the Stage 2 criteria. While we have not attested yet, we are planning to do so at the end of September, and we feel that we’re in a very good position for even the Stage 2 criteria, but that remains to be finalized.  So we’ll see how that comes out in the end, but I’m still confident that we’re in a good position to handle whatever Stage 2 requires of us.

Gamble:  I want to switch gears a little bit and talk about wireless networking. This is something that you’ve spoken about in webinars I’ve seen and at HIMSS about best practices in wireless networking to improve clinical workflow and ensure high availability for EMRs, and I’m just wondering of you could talk a little bit about that, about some of the best practices in that area.

Byers:  Sure, I’d be happy to share what we’re doing here. As I mentioned, having a brand new hospital opened in November of 2009 gave us the ability to start off with a clean sheet of paper. The wireless that we had deployed at our old hospitals, while we had what we said was a 100% coverage, there were little seams in it if you will, little gaps, and we had deployed bedside medication verification using computer on wheels from Stinger, med carts that our nurses would go from room to room with and, because of our wireless infrastructure, there were places where it would not have coverage. So while they were great in trying to work through those issues, we never really got coverage of 100%. We learned our lesson from that, and we actually partnered with Siemens’ inter-assist for the infrastructure piece in the new hospital. We had it in our contract to have 100% wireless coverage, and that’s what we got.

I like to say wireless is part of our DNA here at the health system. Not only do we use the wireless carts for our medication piece, but we also have Space Labs patient monitoring, some of which is wired, some of which is wireless. We have carts now for our providers in anesthesia. We just rolled out IV smart pumps that are wireless and are in the process of integrating those alarms so that if you think that an alarm from Space Labs, bed exit alarms, we have the GE Telergy, I believe it’s called, nurse call system. All the alarms from all these different systems all get pushed to the nurse’s handset, so that if a patient pushes their call button, for example, they actually speak to their nurse on the nurse’s Ascom phone, and those Ascom phones, by the way, run on our wireless infrastructure. They are 802.11g devices, and so everything we’re doing runs on top of our wireless network, through voice over IP phones, and we could not do that without a very robust, redundant, 100% wireless coverage in our hospital, and we were able to achieve that, and it has helped us be more efficient and provide, I think, better care to our patients because of it.

Gamble:  Right, and I’m sure that’s gone a long way for clinician satisfaction too, just because you’re avoiding the frustration of them trying to document electronically and hitting a dead spot. I’m sure that’s something which can create a lot of tension.

Byers:  Tension is a polite word for when you lose an entire note. The frustration level is very high, and it’s certainly something that is not acceptable to us, so we’re very proud of the infrastructure that we’ve been able to put into place here. Once again, leadership includes having a vision to understand that while infrastructure isn’t sexy, it is something that you need to do right, because all the applications that we’ve added on top of it depend upon the 100% coverage, the near 100% uptime, and we’re able to deliver on that, and I’m very proud of that achievement.

Also, at our old hospital we have guest wireless access and when our physicians would come they would use that guest wireless access. We had bandwidth restrictions on it, as well as limitations on what internal assets were available. Essentially, nothing that we run would be available, and our physicians kept saying, “Hey, we want access to Meditech, we want access to PACS,” different applications, clinical applications and they wanted it over their iPad, they wanted it on their tablets or laptops. So recently, actually in the past six months or so, we rolled out what we call bring your own device, BYOD wireless network for our physicians, and so we are able to secure that, so it’s a very secure wireless network, but we allow them access to systems that do not store data on their devices, so it’s just for presentation.

Same thing with PACS, and for those that are using iPads, we use Citrix. It allows them to bring up Meditech on their iPads and the modules that they use is very point and click and, if you will, iPad-friendly, and allows them to retrieve information, and while it can be difficult, as you know, to answer information using a tablet, such as the iPad, it’s very good at consuming information, and so they’re able to bring their own devices in and access our clinical assets in a secure fashion, and that’s been a very nice physician satisfier.

Gamble:  It’s a separate network that they’re on if they’re using a personal device?

Byers:  It is. So essentially it’s using the same Siemens infrastructure. We just roll out another virtual wireless network for them as we did with our phone system, our IV pumps so on and so forth. We probably have about eight virtual wireless networks that we use at the health system to make sure that we keep everything secure.

Gamble:  I would imagine that this type of BYOD policy goes a long way towards making them happy, keeping the docs happy who want to use their iPads or want to use their own devices.

Byers:  No, you’re absolutely right, and I think what really makes them happy is that they have multiple ways to access the information they need to access, right?  So we want to do everything we can to make that patient information available to our clinicians in a secure fashion, so the more modes we have, the more opportunities we have to do that, the happier your docs are going to be, because really that’s all they want to do. They want to provide the best care of the patient, and we want to give them the conduits to make that happen.

Chapter 3