During the 20-plus years John Lynch has spent in the healthcare IT industry, he’s learned many things, perhaps the most important being patience. Lynch, who recently took on a new role as VP/CIO at Greater Hudson Valley Health System, believes that the adoption of EHRs is going to result in tremendous benefits — but it isn’t going to happen overnight. CIOs, he says, need to view implementation as a journey and set realistic expectations for what transformation will require. In this interview, Lynch talks the importance of having integrated inpatient and ambulatory offerings, why it’s critical for vendors to understand their customers, and why it’s great to strive for flexibility — as long as you understand your organization’s limits.
Chapter 2
- Vendor management best practices
- Moving from implementation to use
- Setting expectations of what electronic transformation will require
- “EHRs are still in their infancy”
- Did MU freeze innovation?
- Business and clinical intelligence
- “You can’t care for patients without money”
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Bold Statements
If you can’t talk the talk, you’re not going to be able to deliver what your customers need. If you don’t understand their business, you’re not going to deliver an effective product. I think Epic has done a pretty good job of that.
The more you embed the concept of Meaningful Use as the primary goal, the better off you’re going to be, and the better off you will be after the implementation. Because as we all know, people only retain a fraction of what they learned getting ready to go live with any large information system, including EHRs.
It is a very transformational process. You need to help set expectations on that. There’s going to be a lot of bumps in the road here. It is new technology and we want to be at the table with our vendor to help them better understand how future development changes to the product can benefit the capabilities of this system.
I firmly believe that if the government didn’t do something here, we would languish in where we are with information technology and healthcare, and I don’t think that’s a good thing. I think putting the carrot and the stick out there is good. You’ve got to push people.
Many organizations that have implemented EHRs at this point aren’t doing enough with that information, and so to really be smart about this, you’ve got to implement some very effective business intelligence tools and some analytics to better understand all this information.
Guerra: Now of course, no matter how much a vendor knows they don’t work in a hospital day to day like you do. So I would imagine there are varying degrees, and when we speak about a vendor, there is no Borg-like collective intelligence that constitutes the vendor. It’s the person that’s come to your office that day or the project manager assigned to your account, and their knowledge and their experience and skills. So they may or may not know the healthcare environment as much as someone else. Certainly we’ve heard in the case of Epic sometimes there are younger folks that come in that know the product but perhaps not the healthcare environment to the degree of someone who’s been in the industry 15 or 20 years. What are your thoughts around a vendor knowing their product but you knowing the healthcare environment?
Lynch: I think it’s a combination of the two, and I do think to make a good decision on vendor selection, you need to pick a vendor that has taken the approach of understanding the market that they’re providing information technology to, and to what extent do they listen to and incorporate the hospital and physician practice industry knowledge into their development and into their hiring practices. I think Epic some others out there do a pretty good job of hiring physicians, nurses, lab techs, etc. — people that are very proficient in that space in healthcare, and melding that with information technology. If you can’t talk the talk, you’re not going to be able to deliver what your customers need. If you don’t understand their business, you’re not going to deliver an effective product. I think Epic has done a pretty good job of that, and I think they want to do more of it and I think they’re always trying to improve in that area.
I get a very strong sense from Epic that they have hired a number of people that have that expertise, and they take the time. They have a practice within their organization where even programmers go out and spend some time in the hospital or physician practice environment so they have a better understanding and appreciation for really what goes on out there. They’re not simply locked up in a closet just writing code. They have a better appreciation for what the true customer needs are. I think the vendors that have not taken that approach have failed in many ways and they’re certainly not leading the pack in terms of the interest in their product.
Guerra: Right. Let’s shift gears a little bit. Let’s talk about the difference between implementation and use. We’ve got Meaningful Use — you said you’re good on Stage 1, which is certainly a nice accomplishment, but things ratchet up now with Stage 2 and whatnot. Give me your thoughts around moving from implementation to use, deepening use, getting those percentages up. It doesn’t end once you flip the switch, right?
Lynch: Absolutely not. Meaningful Use isn’t simply about going after the incentive money. The main purpose of Meaningful Use is to improve patient care, and the government has taken this approach because they understand that healthcare is probably the single largest component of the federal budget. If they can find ways to make healthcare more efficient, they can reduce those costs, and I think they’re right on there. I think having better information tools in the hands of healthcare providers will do that; the ability to avoid duplication of tests, to improve patient safety by improved medication administrative methods. Those will all help improve patient care and safety. I think we’re on track there.
I think what’s important as part of your implementation of an EHR is you need to embed that. That needs to be the primary goal of the implementation. You need to have all of the end users, all of your constituents understand the true meaning of Meaningful Use and why we’re going about this and why we want to implement our EHR in a way that will help us meet Meaningful Use. We want to take a look at all the other initiatives and goals that the organization has from a patient care standpoint, because many of them will mirror, in some fashion, things that the government wants healthcare organizations to accomplish through Meaningful Use. So the more you can align those goals, the better off you’re going to be. And the more you embed the concept of Meaningful Use as the primary goal — Meaningful Use from the standpoint of improving patient care with this technology — the better off you’re going to be, and the better off you will be after the implementation. Because as we all know, people only retain a fraction of what they learned getting ready to go live with any large information system, including EHRs. You have a short period of time and you have much to learn, and so only a certain amount of retention takes place there. A key component is coming back afterwards and revisiting with the vendor how the system is now being used and ways that we can optimize this. And then keep the focus of what we’re trying to accomplish from a Meaningful Use standpoint; improving patient care by using this technology and keeping that focus out front there. And that, I know, has allowed us to continue to be successful even after the implementation. There’s been a lot of excitement here having the Epic EHR, and that’s been helpful because it keeps people’s attention on what we’re trying to accomplish here using this technology.
Guerra: A CIO I interviewed the other day made what I thought was a good point — that you’ve got to set the expectations with the organization that this is a transformational sort of experience, and that it’s not a project. It made me think, don’t make people think they’re going away for one night and take them away for three months; they’re not ready for the trip. Does that make sense to you, that kind of idea?
Lynch: Absolutely, I think that CIO is spot on. It’s a new way. This technology should be an enabler to help improve patient care and safety. That’s how the organizations and leadership within these organizations need to approach this, and the leaders, obviously, within the different healthcare disciplines of the organization. It really will be a transformational tool and it really will help enable improvement in those areas. We have to look at this as a journey. Electronic health records have not been around for a long period of time. They really haven’t. The technology is still in its infancy. If you compare information technology and healthcare to just about any other industry in the world these days, we’re many years behind in terms of the capabilities of our technology. We’ll get there, over time. EHRs are a great step in this process, but they’re still at their infancy. They’re being used for the first time.
We need to understand how to better incorporate this technology because it does take some time away obviously from the caregivers to keep the electronic chart current during the process. But they certainly do see the benefits. The care team now has all of this information available on a real-time basis at any point in the journey of providing care to the patient, and they understand that’s a strong tool. That’s a huge benefit; something that they didn’t have before, either in trying to chase down the paper chart or trying to make sense of what was put in there in terms of the handwriting and how current was the information in there.
It is a very transformational process. You need to help set expectations on that. There’s going to be a lot of bumps in the road here. It is new technology and we want to be at the table with our vendor to help them better understand how future development changes to the product can benefit the capabilities of this system.
Guerra: You mentioned EHRs being at their infancy. A lot of people have expressed concern that with the Meaningful Use incentive program basically lighting a fire under the sails of the vendors, that there’s little incentive, at least for a few years, to innovate or to do much product development other than to meet the certification standards. Do you think that maybe it’s been a negative consequence of the program — that the products have been frozen in place for a little while?
Lynch: Maybe a little bit, but I think it’s a very small piece of what the overall benefit is to making this a requirement. We all know in our personal lives and in other areas of business that things don’t get done unless you push people. I firmly believe that if the government didn’t do something here, we would languish in where we are with information technology and healthcare, and I don’t think that’s a good thing. I think putting the carrot and the stick out there is good. You’ve got to push people. You’ve got to push industries and organizations to get where they need to be, and in healthcare, I think this is really important.
The electronic health record is going to bring a lot of benefits. And we know with the implementation of anything new, there’s going to be bumps in the road. We didn’t get to the moon on the first rocket launch. It’s going to be a journey. We’re going to learn things through the process as in anything else that we’ve tried to do in any other industry, but we need to set the path on that and we need to push people to get there. I think once we get through these initial phases of Meaningful Use, there will be greater opportunities for other development in the technology; but even embedding the requirements of Meaningful Use — that’s a development opportunity. These vendors are in a very competitive market here. There are a number of healthcare vendors that provide electronic health records. It’s not just a handful of them; there are many of them. The competition is robust and the smarter ones are also providing other development in addition to meaningful use these days.
Guerra: Are there any other projects that you want to talk about besides what we’ve already covered that you’re working on at the health system?
Lynch: One of the goals here will be to implement a robust business intelligence product and support group. I think this is true with any healthcare organization that’s gone down the path of implementing an electronic health record. Now we have all of this information and much more information than we’ve ever had before in our hands. I think it’s very true that many organizations that have implemented EHRs at this point aren’t doing enough with that information, and so to really be smart about this, you’ve got to implement some very effective business intelligence tools and some analytics to better understand all this information. Taking a look at the healthcare information that you’re getting out of this system now about your patients and looking at trends — trends in the heath of your community and trends in the way you provide patient care. You will find opportunities to improve that patient care, and that’s what the smart organizations are doing. It’s not just about implementing EHRs. Now you’ve got to take advantage of that information and be smarter about it. I think that’s going to be the next big goal for us.
Guerra: That’s the business intelligence you mentioned, correct?
Lynch: Correct.
Guerra: What about clinical intelligence — do they work together or is that a totally separate concept?
Lynch: No, I put that under the same umbrella. Maybe it’s better termed information intelligence but it’s the clinical, the patient care, and the financial aspects of how you’re delivering care to your patients and how smart are you about running your health care business. You don’t care for patients without money. You’ve got to be smart about the business side. You’ve got to be smart about the clinical side to be the best provider in your area.
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