Tom Johnson, AVP & CIO, DuBois Regional Medical Center
In today’s world, logging more than 20 years with the same health system is no easy feat. But what’s even more impressive is when a CIO has spent his entire career with the same organization and played an integral role in its growth, particularly from an IT standpoint. Twenty years after being asked to build a network at DuBois Regional, Tom Johnson is guiding the organization through a major evolution that has included acquiring community hospitals and achieving a successful big-bang implementation of Cerner. In this interview, Johnson talks about the challenges in working with owned physician practices, the paradigm shift that is needed to get patients more involved in their care, how he spends most of his time, and what he’s doing to avoid being pigeon-hold as a technology guy.
Chapter 2
- Looking beyond Stage 1
- Positioning the organization for success
- Engaging patients — “It takes the physicians to get the patients excited about getting involved in their care.”
- Learning from forward-thinking docs
- Saying no to HIEs — “the model doesn’t fit how we practice healthcare in this area”
- Owned physicians using GE
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Bold Statements
We don’t want to just attain minimum Meaningful Use — we want to get the full value out of the system. We want to get 100 percent of all the measures, because that’s what’s going to impact patient care. That’s what’s going to position us for future success.
We’re pushing all the chips to the center of the table. We’re going all in on HIT and really embracing it in every aspect of our organization. Whether it’s required or not, it just makes sense to create a digital hospital, to become one of the safest hospitals we can be, and to be truly integrated.
What what we’re finding is that it takes the physicians to get the patients excited about getting involved in their care. You have to get the doctors excited about it first.
If a doctor is excited and engaged and using the latest and greatest tools in technology to suck the patient in, then you’re going to get a different outcome. But we’ve got a lot of work to change that paradigm — not only for the physicians, but certainly for their patients and families.
Instead of faxing papers or creating this expensive and complicated HIE that neither of our facilities can do well with because of the cost and complexity, we just give access to each other’s systems. It’s the only logical way to do it.
Gamble: I completely understand what you say that the longer a project takes, the hairier things can get. I’m sure it was a huge benefit that you did get it done in that time period. Now you said you attested for Meaningful Use last June?
Johnson: Yes. The government opened up the website on April 17, and we attested in June so a few months after they opened the site, we were almost at the top level of Meaningful Use. We didn’t just go for the minimum for stage 1; we wanted to be 100 percent across the board on every measure, including the menu items, which we were very close to doing. So for CPOE you needed 30 percent, and we were at 98 percent utilization. In many of the items we were bouncing at the very highest top, because we don’t want to just attain minimum Meaningful Use — we want to get the full value out of the system. We want to get 100 percent of all the measures, because that’s what’s going to impact patient care. That’s what’s going to position us for future success.
So when Stage 2 comes out and they raise the bar up another 10 or 20 percent, we don’t have to do anything. We’re already almost at the top percentages. There are things we have to do because of patient portals and some of the HIE requirements, but as far as the other measures, we’re already there. We were there from stage 1.
Gamble: Well, it makes sense, since you know that Stage 2 is coming out and Stage 3 eventually, so why not be ready for those now. If you’re going to do it, do it big, right?
Johnson: Yes, that’s exactly what we did. We want to take that approach of going all in. We’re pushing all the chips to the center of the table. We’re going all in on HIT and really embracing it in every aspect of our organization. Whether it’s required or not, it just makes sense to create a digital hospital, to become one of the safest hospitals we can be, and to be truly integrated, for everyone’s benefit. But focused in the center of all this is the patient. That’s why we’re doing it, and that’s how we’re going to be around for the long haul — because we’re focusing on the patients.
Gamble: Right. One of the biggest components in Stage 2 looks at patient engagement in their health and the use of portals and things like that. What have you done on this front or what are you planning?
Johnson: That is probably one of the most challenging areas. I thought working with doctors and convincing them was going to be difficult, but we have achieved that mostly now. The next, more difficult person to engage is the actual patient. That is a real challenge. When you look at forming an ACO or any kind of shared savings that includes the patient, and you start thinking about population health and how to manage the population’s health from a wellness perspective and a prevention perspective, it really is a true paradigm shift. So as we start to build patient portals, which is what we’re doing now — building portals that engage patients in their care — what we’re seeing is that the real challenge is there’s a huge population that really doesn’t care about that. You have to get people interested. You have to get them excited about it, and that’s difficult to do.
That’s really what we’re focusing our efforts now. I’m trying to reach out to colleagues and work with other organizations that have done a good job with that, and what we’re finding is that it takes the physicians to get the patients excited about getting involved in their care. You have to get the doctors excited about it first. Those are the two problems I see — getting the doctors excited about the technology so that when the patient comes in, they say, ‘Don’t call my office; email my office. If you email me, I’ll get back to you within an hour. If you call, I’m not going to get back to you until the next day. By the way, here’s my secure email address. Here’s my cell phone number. Call me when you have a problem.’ The doctors almost drop over dead when you suggest that.
Taking pictures of their patients every time they come in so that they see it right on the screen and get excited about it and say, ‘Take another picture doctor. That’s not a good picture.’ It’s about getting them just involved with every process of the technology. Having the doctor say, ‘Let’s see what your diet looks like. Take pictures of your food and bring it in so I can see what you’re eating.’ Those kinds of engaging activities are what we need to do to get patients excited about improving their health. But you have to get the doctors excited about it first, and that’s our current challenge.
Gamble: Yeah, I’m sure. I would imagine that if you’re a patient and during an appointment the doctor is showing you different images right on the iPad, I’m sure that that would help a lot. But it’s a matter of getting to that step, like you said, and getting the doctors excited first.
Johnson: Yes. They have to feel very comfortable with the technology, and they have to get excited about the technology so that they can then spread that to the patient. If you walk in and you have a 10 or 15-minute appointment with your doctor and they run through the appointment so quickly you can’t remember what they said and you’re out the door, what do you think is going to be the outcome of that visit? It’s not going to be what you need. It’s not going to be engaging. It’s not going to be excitement and prevention. It’s going to be, ‘we did the bare minimum, we ordered a ton of tests and I’ll see you in six months.’ It’s going to just perpetuate the current problems.
But if a doctor is excited and engaged and using the latest and greatest tools in technology to suck the patient in to being part of the solution, then you’re going to get a different outcome. But we’ve got a lot of work to change that paradigm — not only for the physicians, but certainly for their patients and families.
Gamble: And that’s such a theme across all of healthcare. That is the big question — how to get people more engaged in their health, whether you’re using technology or not. It will be interesting to see how this all unfolds.
Johnson: I just recently met with a physician who was very forward thinking and he said he’s turned it upside down. So when the patient comes in, he asks the patient what their problems are and then asks them what they would do. ‘You be the doctor and tell me what you’d like to do.’ Of course he doesn’t let them do anything that would harm them, but the point of it is it makes them take ownership for their care. If they say, “I need to be on a certain medication,” he’ll say, ‘Why, what’s it going to do for you?’ So that makes them educate themselves, because a lot of them do research before they come in. They’ll get on the internet and they’ll research what their problem is. They’re afraid to ask their doctor, ‘can I try this medication’ or ‘should I do this?’ So when he turns it upside down, the patient says, ‘I’ve researched this. Here’s what I have and here’s what I should be doing.’ If he agrees with them, then he lets them do it, and that gets them excited. That gets them engaged.
But if a doctor just tells you everything and won’t let you make any recommendations and won’t let you say anything because you’re afraid, then they’re not engaged. They just figure, ‘he’s not going to listen to me anyhow. I’m not going to say a word about it.’ So it’s a different approach. I thought it was very interesting that he lets them pretend they’re the doctor to see how much research they’ve actually done and how educated they really are in the subjects that affect them every day. Because honestly, he meets with them 15 minutes every six months, but they live with themselves every day. They know their pains. They know their problems. Who knows yourself better than you? That’s his approach, and I thought that was a very enlightened approach. But he’s the only guy I’ve ever met that talks like that.
Gamble: You have to get him to spread the word a little bit, right?
Johnson: Right, absolutely.
Gamble: One of the other big components of Stage 2 is health information exchange. Are you participating in an HIE at this point?
Johnson: About three years ago, I tried to build my own HIE, and what I found out is it’s extremely complicated and extremely expensive. It just continues to need more resources, more resources, and more resources, and at the end of the day, the model doesn’t fit how we practice healthcare in this area. So we’re not currently participating in any HIEs. We’ve done HIE exchanges of CCDs with other organizations just to prove that we can do it, but because we pretty much own and operate all the healthcare in our region, there’s not really a huge need to do a lot of, let’s say, organic HIE. So if people need access to information, I just give them access to the system. So if a nursing home or another small facility near us, and they say, ‘Hey, we need access to your information. Let’s do an HIE transaction,’ I say, ‘Forget that. I’ll just give you access to the system and lock you down so you get the minimum necessary to treat the patient. You log in and just see it real time.’
So instead of faxing papers or creating this expensive and complicated HIE that really neither of our facilities can do well with because of the cost and complexity, we just give access to each other’s systems. It’s the only logical way to do it. And for our physician practices, they’re almost all 100 percent on our GE system, which we feed with real-time HL7 interfaces. So there’s really not a big need for them as well. We’re trying to not do HIE, because it’s hard to do.
Gamble: It’s a model that’s pretty flawed, as we’ve seen over the last few years.
Johnson: Yes. I’ve studied it for years, and the biggest problem is that everyone’s on different systems with different data dictionaries. They define things differently. They quantify it differently. Too many assumptions are made. You can send stuff through HL7 interfaces that are completely wrong, and the interfaces are all going to say ‘green light, everything matched up.’ So it’s not necessarily safer just because you send it through an HL7 transaction, unless that’s a semantic interface that has mappings to all the data dictionaries or you have all the metadata in context of where this information was captured. And I don’t know of anybody that’s successfully done that yet.
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