Being CIO of a two-hospital system within the massive Catholic Healthcare East superstructure presents opportunities and challenges for CIO Maureen Hetu. On the upside, her facilities are able to afford advanced technologies they would never have been able to obtain on their own, while, on the challenge side of the equation, dotted-line governance and having “multiple” bosses means going out of one’s way to keep everyone informed. But those are challenges she’s taking in stride as Hetu works to deepen the usage of Siemens Soarian clinicals at her hospitals. To learn more about her HIT journey, healthsystemCIO.com recently caught up with the long-time executive.
- Engaging the docs on CPOE
- Developing and rolling out evidence-based order sets
- Order sets and the CMIO
- Resisting local customization
- Are EMRs where they need to be?
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Now the reality is we can’t force, and we would not force a physician to use the order sets, although we want to make the order sets as useful to them as possible.
They are not where they need to be ultimately, but we’re investing in the best technology available on the market right now. And they’re satisfying, for the most part, the current need.
I think that we had a need to get everyone on a level-playing field before we could make major inroads in the industry. The incentive did that.
Guerra: Has engaging with the physicians been more difficult? How does it compare to what you thought it was going to be like when you actually got to this stage of bringing them in and putting them in front of the computer?
Hetu: At this point, everyone is doing it and everyone has to do it, every health system and every provider. So in terms of timing, doing it now is much less difficult than it would have been to do it five years ago. We’re fortunate or unfortunate, depending on how you look at it, that many of the health systems that surround us in our market have already been deploying advanced clinical systems, including CPOE. So I have competitors in my market that have already deployed Soarian. I have already started bringing CPOE live. When the physicians look at it, it is not that much different than what they’re doing at the competitor hospitals. I had already been using Soarian for our clinical data repository, so the physicians are already used to looking at results online using a web-based interface.
So, at this point, I would say it’s a very natural progression. Catholic Health East has been working for the past couple of years to develop evidence-based standardized order sets. We invited the physicians to participate and they recognize, at this point, that this is where the industry is going, and it’s being driven quite clearly by CMS. So they have been engaged very actively in the creation of the order sets and are looking forward to using CPOE.
Right now, they are doing their medication reconciliation online and are able to place some medication orders online through the admission med rec process. They’re doing their discharge instructions online. They’re doing their discharge med rec online. They’re really just waiting at this point for those additional pieces.
Guerra: Do you have a CMIO?
Hetu: We do.
Guerra: Tell me about the CIO-CMIO relationship when it comes to rolling out CPOE and maybe specifically the development of order sets. I’m interested in knowing your thoughts on what the CIO role should be in that process. I would imagine some are tempted to put it all on the CMIO, but what do you think the CIO’s role needs to be in that process?
Hetu: It’s interesting, and it’s a little bit more complicated here because of the CHE dynamic. The order sets are actually being constructed, and I’ll say the order set content. The order set content is being developed from a clinical services group within the system office. So there is a CMIO at the system office and other clinical leaders within that group of nurses, as well as physicians, other providers, who are participating and engaging with the docs in developing the content.
I think that our strategy has been that we’re using things to be able to provide evidence-based content, pull together a group of physicians in that specialty, have them invent the content, develop the standardized order sets and then propagate it out.
As we deal with it locally here, I see it actually being a collaboration between the CMO, so the chief medical officer, the CIO and CMIO. My role tends to be more supportive, but still very much actively engaged.
Now the CMIO is taking the feedback from the physicians and then we try to translate that and make sure that the specific orders that the physician needs, we can structure them appropriately within our applications and make sure that we’re meeting the physician intent as the order sets are developed.
And I’ll say that my role is a little bit different here as well because I not only have responsibility for the traditional IT functions, I also have responsibility for the major clinical ancillary departments – laboratory, radiology, pharmacy, respiratory – also report up through my span of control. So I tend to be even more definitely engaged because there is a significant amount of support that we need from pharmacy, from lab, from respiratory, from radiology to make sure that those orders are appropriate and also to make sure that they translate well through the various ancillary systems involved.
Guerra: How much is the central health system willing to tolerate local customization of these order sets?
Hetu: The philosophy is very much as little customization as possible.
Guerra: Right, yes. (laughing)
Hetu: Absolutely. You can imagine, we have, within the New Jersey market, the four CHE New Jersey hospitals running on a single deployment of Siemens Soarian. So it becomes even more important to try to standardize those order sets, especially within the CHE New Jersey hospitals. So the more that they can be standardized, the better. There are particular services, for example, that one hospital may have and the other doesn’t. Lourdes Camden actually has transplant services for kidney, pancreas, liver. None of the other New Jersey hospitals have transplant services. So they’re very much Lourdes-specific order sets, where your other general types of order sets are not. So we attempt to customize as little as possible.
Hetu: That doesn’t always make people happy.
Guerra: No, because physicians, they all want to practice in their own unique way and they don’t want somebody telling them how they have to practice medicine, right?
Hetu: Right. That’s one of the reasons that we started out with the evidence. The strategy was to use the evidence-based order sets. Now the reality is we can’t force, and we would not force a physician to use the order sets, although we want to make the order sets as useful to them as possible. Obviously we want to provide the most appropriate care for our patients when they’re here.
So we try to make sure that the order set is appropriate. The physician always has the opportunity to either deselect anything that they believe is not appropriate for their particular patient. They can place other orders that are outside of the order sets. So we don’t create the order sets believing that we’re going to tell the doc how to practice medicine. That is not our perspective here. These are really support for the physicians in ensuring that we’re delivering the best care based on the evidence. But it is always at the physician’s discretion.
Guerra: Right. But they know that what’s preselected is evidence-based. So if you’re going to deselect something, you’d probably want to have a good reason.
Hetu: And that’s true, and in most cases you see organizations that will prompt and ask for a reason, which is fine. And then obviously what we’d like to be able to do is correlate that with the outcomes. So if we have a physician that practices in a particular way and they have better outcomes than physicians who are using particular order sets, then that may tell us that we need to relook at that order set because obviously that doc is on to something.
Guerra: That’s the goal of where we all want to go. Are we even close to that?
Hetu: We have a long way to go. I need to get CPOE live first. (laughing)
Hetu: That’s the goal. You always say you need to have the end in mind.
Guerra: Right. Let me ask you this. You’ve been looking at this stuff since the ’80s. Do you think EHRs are where they should be at this point?
Hetu: That’s a tough question. I’ll say that it’s a combination of both. They are not where they need to be ultimately, but we’re investing in the best technology available on the market right now. And they’re satisfying, for the most part, the current need. I think that the current market and the demand is probably short-lived. Many of us will get there. We know that the regulatory requirements are going to continue to evolve. Our own business requirements are going to continue to evolve. The evolution of ACOs drive completely different requirements.
I don’t think it’s the end of innovation. I think that we had a need to get everyone on a level-playing field before we could make major inroads in the industry. The incentive did that.