A lot of organizations talk about ‘building for the future,’ but at Palomar Health, it’s more than just talk. When it came to the design of the new 288-bed Palomar Medical Center, CIO Paul Peabody and his team focused on implementing a solid infrastructure and network that could support not just current technologies, but future innovations as well. In this interview, Peabody talks about the importance of “future-proofing,” what it takes to create a single source of truth for each patient, and his feelings on the best-of-breed approach. He also discusses the dynamics of the CIO’s relationship with the CTO and CMIO, Palomar’s HIE activity, and the organization’s clinical application environment.
- HIE work
- Running a Cerner/NextGen shop
- “Interfacing is never as good as true integration on a single platform”
- “The best of breed approach — it just doesn’t work”
- Career paths — a quick stint on the vendor side
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In the future, looking at the lack of success that I think we’ll see in terms of viable HIEs, we’re going to have to find ways to communicate with each other. And I think that some of these HIE structures are going to be too expensive for small organizations to be able to afford anyway.
Cerner has made some huge strides in terms of the ambulatory side and being able to use the Cerner EHR in a physician office to support that practice. If we could get that level of integration between our affiliated physicians and the hospital records, that would help a lot.
We all know that going through a number of years trying to cobble things together using the best of breed approach just doesn’t work. It only gets you so far; it doesn’t get you all the way.
When you make an investment like that — Cerner’s a good product and Epic’s a good product — why would you throw something out and start over again? It’s unaffordable. It takes too much time.
It was fun in that I was able to go across the country and meet with many of the leading CIOs. So that was really interesting to see some of the things that they were doing. But what I didn’t like was being in five or six cities a week, and at my age, the travel was taking a toll on me.
Guerra: You mentioned HIE work, and I saw that you had signed with a vendor called GSI Health.
Guerra: Tell me about the work you’re doing with them.
Peabody: Well, that’s another area of innovation that we’re working on. There’s a group that receives some grant money and Orlando [Portale] has been working with them. We’re going to use GSI as our middleware to help us format continuing care documents (CCDs) that we can make available to physicians around our community that need to have the information and do it through a direct connection rather than going through an HIE. So for the information that an affiliated physician needs for a given patient, the request will go into the EHR, the EHR will retrieve the information, and GSI will take that information and format it into a CCD format and then route that through kind of a clearinghouse that the physician will access to get at the information.
It’s more of a direct connection. It doesn’t go through an HIE, and I think in the future, looking at the lack of success that I think we’ll see in terms of viable HIEs, we’re going to have to find ways to communicate with each other. And I think that some of these HIE structures are going to be too expensive for small organizations to be able to afford to play anyway, and so they’re going to have to find other ways to do this.
Guerra: If my research is correct, you’re a Cerner and NextGen shop. Is that correct?
Peabody: Yes, we’re Cerner in our hospitals, in the acute care setting, and two of our physician partners use NextGen. So it’s not NextGen across the board, but two of our large physician partner groups use NextGen.
Guerra: Are those owned physician practices?
Peabody: Well, no. In California, you can’t own a physician practice. These are organizations that are affiliated with us and the physicians are on staff, but they’re private physicians. They don’t work for Palomar Health.
Guerra: So it would be nice if they were on the Cerner Ambulatory product.
Peabody: Oh yeah, it sure would, absolutely. Where I came from before I came here, I worked for Beaumont Hospitals for 36 years in Michigan, and we were an Epic customer. Many of our physicians were using the Epic electronic health record, so that level of integration is phenomenal. I’d love to be able to do that here. And we’re looking at some capabilities — Cerner has made some huge strides in that area in terms of the ambulatory side and being able to use the Cerner electronic health record in a physician office to support that practice. If we could get that level of integration between our affiliated physicians and the hospital records, that would help a lot. And we’re trying to integrate as much as possible. We have long-term care facilities — we’re going to bring them up on Cerner. So we’re trying to achieve as much integration as we can, because interfacing is never as good as true integration, being on a single platform.
Guerra: Would the scenario play itself out to the effect that you would do a presentation before these physician groups and almost try and sell, and I don’t mean that in a negative way, the Cerner product, and tell them, ‘here are the benefits that will accrue to us as partners if you would be willing to go on this system.’
Peabody: Well, we might get to that point. I’m hoping that we do.
Guerra: Interesting. I was going to ask you because in my research I saw that you had installed Epic at one of your hospitals and it says that you did it in four and a half months. That’s a fast install, right?
Peabody: It was the fastest at that point in time. I don’t know if anyone’s done it faster since then, but in 2008, that was the fastest install ever for an Epic customer. Beaumont was, at that time, two hospitals: 1,061 beds at the Royal Oak Campus and about 400 or 450 at the Troy Campus, and then we bought a hospital. So we had Epic installed at both of the Beaumont Hospitals. We bought a hospital from Bon Secours, and we had to go in and very quickly get our systems in place because theirs were old. We needed to get them on our platform for economies of scale for supply chain management, for human resource management, and the same patient database so that we could provide services across the continuum of care that Beaumont had established.
So we did it in four and a half months. We brought them up on billing and we brought them up on the electronic health record — all of it in four and a half months. And the same facility we brought up Oracle for supply chain and human resource payroll in two and a half months, so record time.
Guerra: It’s almost like if you haven’t experienced true integration, you don’t know what you’re missing, but you know what you’re missing.
Peabody: Yeah, absolutely I do.
Guerra: Do you wind up telling people, ‘listen, here’s what it could be like.’
Peabody: Yeah, absolutely. We all know that going through a number of years trying to cobble things together using the best of breed approach just doesn’t work. It only gets you so far; it doesn’t get you all the way. So I would like to see that here eventually, but it takes a while. That can’t happen overnight. But we’re going to work our way there.
Guerra: Now when you say ‘get here,’ are you picturing Cerner inpatient and ambulatory or are you picturing Epic?
Peabody: Yes, I am.
Guerra: So we’re not talking about Epic.
Peabody: No, no, we’re not talking about Epic. When you make an investment like that — Cerner’s a good product and Epic’s a good product — why would you throw something out and start over again? It’s unaffordable. It takes too much time. It doesn’t make any sense. Cerner’s a very good product, and so we would like to be able to bring up our ambulatory areas on Cerner as well. I mentioned long-term care — we have plans to do that. We’re looking at bringing our express care centers up on Cerner, on the ambulatory part of the system. And then longer term, we’ll look at physicians, and maybe we’ll do that too. I hope we can.
Guerra: I want to ask you a question or two about your career. Before I do, is there anything else you want to touch on in terms of either projects or thoughts on anything going in the industry?
Peabody: No, I don’t think so. I think we covered what we’re doing here. We talked a little bit about HIEs, and I wish that we were making better progress there.
Guerra: Okay. Our goal with these interviews is we cover the CIO as an individual and that means not just what you’re doing right now in terms of projects, but also your career path and decisions about moving here or there and trying different things. And this is all for the benefit of your peers, as they look at the same questions and choices and things like that. So I saw that you had spent a year with Oracle recently. If you look at your career, it’s almost clear; it jumps at you what happened, but I’m going to let you tell it. You spent many years at a healthcare organization — Beaumont Hospital in Michigan for 36 years, so lots of time there, then a quick year at Oracle, and back into the health system side. So tell me about that dynamic in your decision making to go to Oracle, and then why it seems that you got back to where you belong on the health system side.
Peabody: Sure. I spent 36 years with one organization and I enjoyed my career there very, very much. I had great opportunities. I became responsible for IT at Beaumont when I was 29 years old. I was the CIO there before they were called CIOs for 30 years. I accepted an early retirement. At that point in Michigan in 2008, the economy tanked and everybody was struggling, and a number of us decided to retire early. I spent six weeks doing that, and every day my wife told me about a new house rule that I hadn’t heard of, because I was infringing upon her territory. And I decided that retirement was not something I really wanted to do. Oracle had a long standing offer to come work with them and so I decided to do that. I was vice president of Healthcare Business Development for the North American tech sector of Oracle.
It was fun. It was fun in that I was able to go across the country and meet with many of the leading CIOs — Marc Probst at Intermountain, Martin Harris at Cleveland Clinic, Abdul Bengali at Mayo, and a number of leading CIOs at places like UPMC and Geisinger. So that was really interesting to see some of the things that they were doing. But what I didn’t like was being in five or six cities a week, and at my age, the travel was taking a toll on me. And I didn’t really care for the for profit side of the business as much being in not-for-profit all those years and then seeing the other side of it. It was interesting, but not something that I wanted to do long-term.
And I actually wasn’t looking at the time. I got a call about this job and it seemed to be very challenging; they were right in the middle of building a new hospital. They had a very tragic situation here. The CIO passed away unexpectedly in a boating accident. I met with the CEO and was impressed with his vision. It just seemed like it would be not only a good fit, but a nice place to wind up. Our children are scattered across the country — one in Seattle, one in Florida, one in Chicago, and one in Michigan, so it didn’t matter much where we were. My wife and I just thought it would be a neat adventure to come out to San Diego, and of course you can’t beat the weather, can you?
Guerra: Your wife said we’ll go to any city as long as you don’t stay in the house when we get there.
Peabody: That’s exactly right.
Guerra: I had a flashback too last night, and I wonder if you ever actually heard the phrase, ‘don’t leave it in the sink, you can put it in the dishwasher as easily as I can.’ Do you ever get that one?
Peabody: Sure, absolutely. What man hasn’t heard that?
Guerra: Right, ‘I’m not a maid.’ Anyway, good stuff, Paul. I want to thank you so much. That’s all I had for you today. It was a wonderful interview.
Peabody: Well great, thank you. I enjoyed it.
Guerra: All right, goodbye.