Greg Kall, System VP/CIO, Summa Health System, Chapter 3

Many times, it’s one key insight that allows all our future plans to be crafted with confidence. For Greg Kall, the insight was that no matter how many of his systems were based on the same platform, there would always be a foreign one to connect with. Based on that assumption, Kall rejected the rip and replace road many of his colleagues are going down, opting instead for connectivity and a march toward as much “sameness” as possible. To learn more about Kall’s health system and the challenges that come with connecting up community docs, healthsystemCIO.com recently caught up with the Ohio-based executive.

Chapter 1

Chapter 2

Chapter 3

• Best practices in vendor contracting
• Getting the ambiguity out
• Bringing a financial analyst past to bear
• Before you buy, find out what’s real
• Understanding studies

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BOLD STATEMENTS

“Look, I know what the contract is talking about in terms of what our fees are going to look like out over time, but this is my understanding of the deal as articulated on the spreadsheet … ”

“I’ve had a nice broad background in healthcare operations and, honestly Anthony, that’s what I think helps me when I’m talking to the board or talking to senior management about system implementations … “

“My recommendation is to really take a look at the study yourself, look at the data yourself and draw your own conclusions, because those studies can get flavored a lot of different ways … “

Guerra: Your profile on LinkedIn mentions a strength in contracting. Anything specific you can share?

Kall: You know, I think if both sides come away unhappy it’s a successful contract.

Guerra: I like that.

Kall: IT contracts, when you enter into a deal with a vendor for IT services, these are typically long-term deals. You’re not changing out an electronic medical record system in two years; you’re usually running that system, easy, 10 years. So as you think about that relationship you really need to keep your eye on the long-term with that contract and make sure that the contract addresses the long-term relationship and kind of spells out how the two organizations will deal with one another, particularly in an industry that is prone to change in terms of ownership and transition. We’ve seen that with Allscripts. We’ve been an Eclipsys shop for years and then it transitions to a new owner. It’s always interesting, and so you have to keep that in mind as you look to the future with these contracts, again, because these aren’t short-term deals. You’re in it for the long haul.

Guerra: Right. It’s interesting because everyone talks about forming partnerships and Kumbaya and let’s all be friends, but there’s an element of the adversarial in these deals. How do you marry those two concepts — to protecting yourself while holding hands?

Kall: You know, at the end of the day, I think everyone tries to be reasonable, and if you can get past the rhetoric and build a structure in the deal that is clear and spells out responsibilities for both sides, I think that’s the place you need to get to. It’s easy in some of these deals to have a fair amount of ambiguity, and one of the things that I try to do, as I’m working through a deal, for example on the financial side, I’ll boil it down to a single spreadsheet and I’ll run a 10-year spreadsheet and say, “Look, I know what the contract is talking about in terms of what our fees are going to look like out over time, but this is my understanding of the deal as articulated on the spreadsheet,” and I make sure that the vendor agrees that this is what we’re really talking about in terms of the fees and the payments. That, for me, becomes the basis for whatever ROI work I do in terms of trying to sell the deal to management and the board, so make sure I have the financial terms described very discreetly on a spreadsheet and then start building my ROI from there.

That’s one of the tricks I picked up in a past life — I was a financial analyst and I did managed care contracting, and so you take the things that you learn in the past and try to move them into your current situation and make those things work. I’ve been successful with that approach, because it really, at least on the financial side, boils down what could be a pretty complicated contract into some simplistic terms that the vendor agrees to and, internally, we agree to.

Guerra: CIOs have many different backgrounds. You have a strong background in financial analysis, there’s some CIOs that have strong clinical experience, some who are even MDs, most CIOs have that strong technology and computer sciences background. So if a vendor doesn’t realize where your coming from and tries to talk past you with some of the financial stuff, you’re in a position to say, “Whoa, whoa, whoa,” whereas others CIOs, if someone tries to speed talk them on the clinical stuff, they’re going to catch that. It’s just very interesting.

Kall: I’ve been blessed to have an opportunity to do many different things in my career. In fact, I’ve been doing IT for about 15 years. Prior to that, I was in hospital operations. I managed EDs, I managed med/surg floors and critical care areas and did that for about 15 years, and I learned how a hospital ran, and it was a great way for me to get a perspective on hospital operations. Then from there, I went into patient accounting and you do run into a lot of CIOs who have had patient accounting experience. I don’t know why folks who have done patient accounting end up in IT, but that, of course, taught me the entire revenue cycle and medical records and that whole component of business. That was the point in my career where I was doing financial analysis and managed care contracting as well.

So I’ve had a nice broad background in healthcare operations and, honestly Anthony, that’s what I think helps me when I’m talking to the board or talking to senior management about system implementations because I can apply it to how this stuff actually will impact the floors, right?  So when we’re doing an ERP deployment, I know how it’s going to impact the end user in terms of the reports they get or how a nurse has to interact with online ordering systems and those kinds of things. It’s been extremely helpful for me in my career to have that kind of diverse background.

Guerra: When we talk about someone trying to fast talk you, do you recall any specific instances?

Kall: I think the biggest place where you see that is the difference between the sales pitch and the reality of what you end up buying. You know, a place we spend a lot of time as we’re going through contract negotiations is really trying to find out what is real and what the roadmap will be for product enhancements or release enhancements over time. I’ve got a great team of people who help me work that stuff through in my project management office.

Guerra: Right. One of the other things I came across in your profile was where you talked about being the principal investigator for a grant to evaluate the impact of EMR, CPOE technology. I don’t know if you will be able to answer this, but I wonder if that kind of work might give you some insight into evaluating a study or a survey. Every day, we see another study or survey come out about EMR effectiveness or costs or impacts, these kind of things, and it becomes so much noise because you don’t know what to believe, and then people take apart the study and question its methodologies. Do you have any thoughts or guidance around reading studies?

Kall: That’s a great question. I was a principal investigator on an AHRQ grant. It was a $1.5 million grant when EMR systems and CPOE systems were beginning to be deployed in hospitals, and there was a lot of research around academic medical center deployments of EMR and CPOE system. Our spin was: let’s take a look at what impact this has on a community hospital, and particularly a community hospital that was kind of an urban inner-city hospital. I learned a great deal about how the whole process of rigorous scientific evaluation happened as a result of doing that study.

To answer your question, the moment a study hits the street there’s so much spin that happens as a result of that study. People have a lot of opinions and they put their own spin on how to interpret the data. My recommendation is to really take a look at the study yourself, look at the data yourself and draw your own conclusions, because those studies can get flavored a lot of different ways, and I think we all need to take a look at the study and internalize it in the context of your own situation because you can’t necessarily extrapolate something that was done in a different situation and say, “Well, okay, that’s going to happen here,” because your environment will be different. There is no one — talking about EMR and CPOE deployments — there is no one situation that is exactly the same in any organization. It’s highly varied, very complicated, and you build a solution that works for your organization that can’t necessarily be duplicated somewhere else.

Chapter 4