As a 200-bed, not-for-profit hospital that isn’t affiliated with a health system, Beaufort Memorial Hospital is something of a rarity these days. For Ed Ricks, being CIO of a standalone brings with it a unique set of challenges — particularly when the organization is faced with a time-consuming CMS audit. In this interview, Ricks talks about the issue he has with post-attestation audits, why Meaningful Use is “backwards,” and how his organization is working to make text messaging secure, instead of taking it away. He also discusses best practices for ending a vendor relationship, what he’s doing with patient portals, and his thoughts on healthcare reform.
- Budgeting physician satisfiers
- Working with Wolters Kluwer’s Provation for order sets
- Parting ways with vendors
- Working with Medseek on a patient portal
- Planning to harness big data
- Prognosticating on healthcare reform
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It’s a matter of removing barriers. With some of these things, you check multiple boxes, like with implementing zero-client devices and virtual desktops. There’s actually a long-term ROI on that. But it also changes the way your help desk people operate; it shifts the focus from break-fix to more strategic projects that they can work on.
We are all being tasked with doing more for less. If we can’t do it for less, then we just have to do less, and I don’t think that’s something that’s even an option. I think we have to do more, and I don’t have more money on an annual basis to do a lot of those things.
It’s not personal; we just have to be successful with what we’re doing. If there’s something that’s better, more economical, more efficient, more effective, whatever the case may be, I think it’s incumbent on us to make some of those tough decisions.
If we can give them some tools that make it easier for patients to become more engaged in what’s going on in their healthcare and better informed, I think down the road it’s going to pay dividends for the hospital and for all the other care providers in the area.
We have historically collected all sorts of data in healthcare IT and not done a good job of turning it in to useful information. I think we’re starting to figure out how to do that from a financial perspective, which is also important, but now we’ve got all this clinical data we’re accumulating from every monitor that we have.
I think this will be the big trend — partnering with all the other caregiving institutions in our community that aren’t traditionally part of a hospital system in many areas, and in fact, sometimes are rather at odds of the local hospital.
Guerra: You talk about all these investments that you’ve made around physician satisfaction and mobility and ease of use. My thought is that I guess you could spend all the money in the US Treasury — not that there’s that much anymore — but you could spend all the money you can get your hands on to make it so they barely had to get out of a chair, but somewhere there’s a line in what you can do and you have to make decisions within your budget on where you need to make the investments. It just seems with these physicians satisfiers it might be hard to make those calls about, is this worth an investment just to make their lives a little easier, or should we just expect them to do this stuff because it’s their job?
Ricks: I think it’s a combination of both. We definitely want to make it as easy as possible to adopt the technology. I think it’s a matter of removing barriers. With some of these things, you check multiple boxes, like with implementing zero-client devices and virtual desktops. There’s actually a long-term ROI on that from a dollar perspective, so that’s always a good thing. But it also changes the way your help desk people operate; it shifts the focus from break-fix to more strategic projects that they can work on. Also, it checks a lot of boxes on the security issues we’ve had and we’ve struggled with as far as generically logged in PCs and knowing who’s accessing their computer at any given time — the potential of protected health information being stored on a device. So we’ve just completely eliminated all those risks and some of those are pretty big ones when you see some of the headlines out there.
Guerra: Right. Let’s talk a little bit about working with ProVation. I saw in a news release that you’d gotten the order set. Tell me about your work in that area.
Ricks: We’re actually just migrating. We used another vendor for probably the last six years that does something very similar and actually with very good success. But an opportunity arose to swap over to ProVation for a few reasons that made sense. One, from a fiscal standpoint, it’s a way that we can be a little bit smarter with our money, which is something we’re looking at for everything. And two, But two, we also have been using UpToDate for a long time. The physicians use that and they actually give CME credits for looking things up while they’re working here that they’re going to look up anyhow and need that help for. There’s a lot of credibility in their eyes for UpToDate that may mean something to them. So ProVation being part of that family of companies, I think that was more relevant.
And then the back end of that — the maintenance of the order sets and everything — that kind of falls on the IT people, so to us either tool was very usable. I think it just made sense for us for a number of reasons to make a change right now. But for sure, our clinicians and our medical staff understand the efficacy of evidence-based order sets and what that means to their practice, and have bought off on that philosophy and actually have some bylaws in the medical staff regulations that are relevant to say they will use them. I think we managed that issue three or four years ago here and kind of worked through it, so now it’s hopefully a tool that’s going to make it even a little bit easier for us.
Guerra: You mention coming off a vendor, switching from a vendor who had done a good job for you for six years. Tell me about ending those relationships when they really haven’t, at least from the way you described it, dropped the ball. It’s just the right time for you to move on for your own reasons. Are those tough?
Ricks: Yeah, it’s always tough. I think you mentioned the word relationship and I think that we do end up with somewhat of a relationship with the vendors we work with, particularly those that we respect. But you also have to look at business models. We are all being tasked with doing more for less. If we can’t do it for less, then we just have to do less, and I don’t think that’s something that’s even an option. I think we have to do more, and I don’t have more money on an annual basis to do a lot of those things. And that’s what a lot of people sort of lose sight of — it seems like the next initiative isn’t much more but it’s additive. It’s going to take more resources and people or money or both. Where is that going to come from and how is that sustainable?
So we’re looking at ways to create efficiencies organizationally and departmentally, and hopefully spend less money and get better tools. I think some companies have figured out the business model around that a little bit better than others and potentially the market will speak and the others will change. But in the meantime, the only way that’s going to happen is if we’re willing to make the changes that can make that happen, and some cases I guess that means changing vendors.
Guerra: A lot of CIOs I speak with say you really just have to be honest upfront, and that’s the best way to deal with it. Don’t try and hide anything, just tell them the way it is and be nice and respectful, but you have to do what you have to do.
Ricks: Yeah, I think so. You don’t want to burn a bridge. I certainly try not to, because you never know what will come around the corner next year. Curiously enough, I’ve made some of those changes away from vendors, or more appropriately, toward other vendors. And two or three years later, the first vendor has another product that actually fits the niche that we have, and we still had a strong relationship, so we’ve brought them back in. So I think you’ve got to be open-minded. If anything else, I think what’s important to me is to try and just remain open-minded and not make just a gross decision about a company because of a past experience. Let’s look at what does it mean today.
Guerra: On the other end, as a vendor, if your services are no longer required, you have to know how to take that the right way, because you could get together again down the road, or at least you don’t want to further injure your reputation by not releasing the company properly and sending them on their way with the data they want and a nice final bill and all these types of things.
Ricks: It’s not personal. It’s hard to feel that way sometimes, but it’s not personal, so you’ve got to maintain that professional relationship and it could pay dividends down the road.
Guerra: Have you ever experienced it where you ended work with a vendor and they didn’t quite handle it the way they should have?
Ricks: Yes, I have.
Guerra: Can you give me any details without going into anything you’re uncomfortable with? Just tell me what happened generally.
Ricks: Generally, I would tell you it was a failed implementation and probably there was plenty of blame to share between the organization and the vendor. But regardless, there were some hooks to get out of the contract based upon some criteria that either was met or not met. So we were able to do it and it was all correct and legal and it worked okay; still the vendor got money, but we ended up not using the product and it just caused hard feelings. And again, it’s not personal; we just have to be successful with what we’re doing. If there’s something that’s better, more economical, more efficient, more effective, whatever the case may be, I think it’s incumbent on us to make some of those tough decisions. It did not go well with the vendor and definitely that’s a burned bridge.
From my perspective, regardless of where I end up working for a long, long time, it’s probably someone I wouldn’t work with again. I do try to stay open-minded, but I think that’s probably the wrong way to handle it from the vendor’s side, even though we were all trying to do the right thing from the hospital perspective in that case.
Guerra: Great, thank you for that. Let’s talk about Medseek, just as a final one in terms of my bullet points of organizations I see you working with. Tell me what you’re doing with Medseek.
Ricks: For us, it’s exciting. It’s something we’re doing for our community, and as we know, that checks a box. Amongst a few tools that Medseek has in their arsenal there, one of the things is a patient portal, and so that’s what we’ve actually purchased from them and we’re working on implementing it now. And again, we’re a somewhat geographically remote community; there are not a lot of hospitals right on our area as there are maybe in some more urban areas. But there’s still a lot of healthcare and a lot of patients, and so we’re trying to build something that’s more than just the traditional patient portal, which was purely hospital based or maybe just even owned clinics if you have those.
We’re trying to partner with the independent practices in the area, and that will be Phase 2 of our implementation, but what we want is truly a patient portal that’s going to gather the relevant clinical information from our community for our patients and let them get it in one spot. I recognize that many of these practices either won’t be able to have something that’s very robust from a portal perspective or we’re going to end up with seven, eight, nine or ten in our small community where a patient might be able to log in to see certain information from physician A or practice B or whatever it might be. We’re trying to help aggregate that into one. I think it’s the right thing for our patients.
And honestly, I think that one of the goals we have is just like everybody, as we’re starting to transition the industry from fee-for-service to something different — population, health management, whatever healthcare reform is going to mean; eventually, we know there’s going to be some sort of change — a key component to anybody’s success is going to be patient engagement in their own healthcare.If we can give them some tools that make it easier for patients to become more engaged in what’s going on in their healthcare and better informed, I think down the road is going to pay dividends for the hospital and for all the other care providers in the area. So we’re excited about that. We’re working on the implementation now. We’ll be live in a couple of months with that, and we’re really looking forward to it.
Guerra: Yeah, we can definitely see that from a policy point of view, patient engagement is going to be big.
Ricks: Right, absolutely. And now you’re seeing the proliferation of mobile health devices that are popping up and some of them are great. In fact, many of them are great, but it’s the same thing — how do you tie them together to be relevant for your organization and for your population? Where do you jump in to partner with people on that continuum? We’ve looked at a number of things and there are a few that are starting to pop up now — some startups that make sense that will get patients or some populations engaged almost to the degree of Facebook, or I hate saying ‘gamification,’ but something instead of the traditional portal where a patient may actually log into it once every trip they have to the hospital to see their new lab results or whatever. Something where patients will actually use it to manage their care, to manage whatever you’re managing for them — if it’s weight gain for patients that have been discharged, if it’s diabetic control, or whatever’s relevant in your area or for your patients.
Guerra: One of the other big areas where we’re seeing a lot of activity is around business in clinical intelligence, and being able to take all the data that’s now in the systems and spit out some useful information and information that allows you to intervene before something goes wrong — indicators and things like that. Have you done much around intelligence?
Ricks: We are planning that. So that’s my favorite new term of the year: big data. I just like it because it sounds cool. But I think that there is a lot of relevance. We have historically collected all sorts of data in healthcare IT and not done a good job of turning it in to useful information. I think we’re starting to figure out how to do that from a financial perspective, which is also important, but now we’ve got all this clinical data we’re accumulating from every monitor that we have, all that stuff is digitized now so it turns into data. And what do you do with that? Who do you partner with? What makes sense? How do you analyze that to bubble things up? We’ve got a couple of things — our ED software package has some data analytics built in that quickly run through some information and bubbles up patients that the doctors need to see more quickly, just do the triage. That’s sort of rudimentary compared to some things that are going to start to pop up, but it’s a start. And I think that’s definitely the future.
Guerra: Yeah, definitely. Any other projects or trends you want to address? That was about all I had for you today.
Ricks: I don’t know, that seems like a lot. There is a lot going on. I think the one thing — and we’re not unique in this — is we are seriously trying to do some scenario planning from an organizational perspective of what is healthcare reform going to mean to us as an organization. How do we respond to that — components of that are-IT related, and components of that are all over our business spectrum. But we’re really literally laying out what we think the different scenarios might be from a financial perspective and how can we put some strategies in place now to help either respond, prepare, make changes today, or be prepared to make changes as we move forward in a number of facets of what we do.
The interesting thing is so much of it revolves around data and getting our arms around the data. I think this will be the big trend — partnering with all the other caregiving institutions in our community that aren’t traditionally part of a hospital system in many areas, and in fact, sometimes are rather at odds of the local hospital. But regardless, we’re going to have to figure out how to work together and share data so that we can make some meaningful decisions to that whole continuity of care for the patient. I think that’s going to be a huge thing for the next three or four years. It makes sense, and I think it’s probably the right thing to do. It’s going to create a lot of efficiencies in the system.
Guerra: The nice thing about healthcare reform is that patient care is going to matter more than volume, than just doing things to patients, and that’s good. So all the scenarios and all the things you want to do around healthcare reform, I think they make you feel good. Does that make sense?
Ricks: It does, and it’s hard because everybody’s got their own personal political beliefs for a number of reasons that I really try to remove that from the equation. I think regardless of your politics, we all know something has to change. The model that we have for reimbursement is not sustainable. You just mentioned we’re almost out of money in our treasury, so I don’t know where this comes from. And so I think we know something has to change and everybody can make a very cogent argument that any of these changes can improve care if done properly. I don’t think you improve care by cutting out procedures and by rationing, all those things. I think it’s by creating efficiencies within a system. And so I think we’re driving in the right direction, but there are so many tentacles you have to reach out to in order to make that happen and still be efficient somehow. Even though healthcare IT is sort of behind the times compared to other industries, some of these areas are really behind, and so it’s a matter of catching up with them, getting them up to speed, getting data that’s relevant, and figuring out how do we get our arms around that and use it to make some smart decisions going forward.
Guerra: I think what you’re saying is that to do a lot of this stuff is to work with outside entities and that’s not always easy. If they’re not on the same page or don’t want to go in the same direction or make adjustments they need on their end, then you’re kind of sitting there. It’s like having a fax machine and no one else that you work with has one. That doesn’t do you much good.
Ricks: Yeah, I think that’s a pretty good analogy.
Guerra: I can’t believe I used a fax machine analogy because I think that dated me, but we’ll just hope the younger folks listening to this can look it up on Wikipedia and find out what one of those was. All right Ed, thank you so much for your time today. I always enjoy speaking with you, and I hope to talk to you again soon.
Ricks: All right, great. Thanks, Anthony.
Guerra: Have a great day.