For David Tomlinson, there was perhaps no better prep course for the CIO role at Centegra than serving as VP of Operations for five years. The role enabled him to obtain valuable experience in change management and build the leadership skills he is leveraging to guide Centegra through an “Amazing Race” to implement McKesson’s Paragon and qualify for Meaningful Use within a short window of time. He recently spoke with healthsystemCIO.com about his strategy to make MU a reality, why his organization decided to outsource, how to structure a solid outsourcing agreement, the keys to successful relationships with executive leaders and vendor partners, and why today’s CIOs must be comfortable with taking risks.
- Managing Meaningful Use
- Going McKesson Paragon — the ‘Amazing Race’
- Filling in the gaps
- Using Dell’s Unified Clinical Archive
- HIE work/physician connectivity strategy
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MU will be driven by the capabilities of whatever product one is using. And so the vendor of choice bares a lot of that burden to have a product that can do it. And then obviously the majority of the burden comes upon the system and our internal team building the system in a way that we could meet post criteria.
We have these proprietary vendors that act as the hat, if you will, to each of these systems, and it’s very hard to get them to talk and share. Frankly, if we were to replace our PACS, there are all kinds of conversion costs and switching costs that we would need to incur.
Whether it be DR Systems or McKesson or GE, it gives us the most flexibility in the future to change if we need to, but also have access to that information and plan for it in a way where we’re paying for storage when we need it, not in advance.
What we’re working to is to get the greater Chicago area hospitals within the network committed, focusing first on the hospital providers, and then create a database where information can begin to be shared on that level.
If you take those on a one-off basis, the developmental work is pretty intense and pretty costly, both for us and for the physicians. So we have a vision and a strategy that we’re deploying, but it’s been an interesting road.
Guerra: I would think one of the benefits of outsourcing would be that things like Meaningful Use would be a slam dunk. You might say, I’m paying for expertise and efficiency in project management so this shouldn’t be an issue. But when we spoke earlier, you mentioned that you’re still working on stage 1 and you’re not sure how it’s going to go. Would you attribute that more to a preexisting situation in the health system that has made it quite challenging for Perot or Dell to get you there? How would you describe the issues around hitting stage 1?
Tomlinson: With stage 1 Meaningful Use there’s a set of criteria, and basically you need to have a system that can deliver on those metrics; to deliver those outcomes to perform in a way that would meet those criteria. At the core of our situation was having a system to be able to do all of those things. So we embarked — I guess three years ago — on an effort to deploy a new clinical information system that would meet Meaningful Use stage 1 and beyond with products that need to be certified. Our initial attempt at that did not work. So then the reason why we’re kind of in what we call the ‘Amazing Race’ here is that back in April or May of last year, we partnered and decided to implement Paragon, which is a McKesson product. Primarily before that in years past, we’ve been a McKesson shop.
We have a best-of-breed model, unfortunately, when you look at some of our other clinical systems that are in the house. And so due to a failed project, we had to make some decisions and we went the direction of working with Paragon. In order to meet Meaningful Use, we need to have that system implemented. Right now we have that as a scheduled go-live in May, which would then give us, hopefully, appropriate time to get to write data so that we can attest at the end of September.
In our circumstance, it was a function of situation, a function of having the product that could actually deliver the Meaningful Use, and having a system designed to do that. So certainly we do believe that there are some economies that we should receive based on experts that we’re partnered with. But regardless of our partner being Dell or Perot or whomever it may be, Meaningful Use will be driven by the capabilities of whatever product one is using. And so the vendor of choice, in my opinion, bares a lot of that burden to have a product that can do it. And then obviously the majority of the burden comes upon the system and our internal team building the system in a way that we could meet post criteria if that makes sense.
Guerra: I have down that you had some GE Centricity in there.
Tomlinson: Yeah, our continuing strategy is that we have GE Centricity Perinatal. That’s one of the niche solutions that we have, and then we will likely implement the Centricity Anesthesia module in the OR later on this year once we implement the Paragon Solution. But we did have some struggles with that product in the past.
Guerra: So you’re going to have Paragon but you’ll still have some GE components in there. Are you going to keep any other clinical products?
Tomlinson: Yeah, so basically Paragon will be our clinical and our financial system. It functions on a single database. It’s going to help us firm our foundation when it comes to an enterprise master patient index concept. But from a clinical standpoint, right now there will be the CPN, the Perinatal, which will be separate from Paragon. We also have Sunquest for our lab system, and that will remain enforced. And we have CVIS, which is also a GE product, for our cardiac imaging, and we currently use DR Systems for our PACS. I think that’s kind of the footprint that we have, and then in terms of future decisions as it relates to the imaging down the road in a couple of years, we’ll figure out how that all turns out.
But DR Systems has been doing a great job. We’ve been using them for many, many years. We’ve had their PACS for seven-plus years; we might be approaching 10 frankly. So from the clinical side, it’s going to be a Paragon-centric with a couple of other software that either we decided to keep or fill gaps in areas in which Paragon has yet to be developed, like anesthesia and perinatal.
Guerra: Are you keeping iMDsoft in the ICU?
Tomlinson: So iMDsoft is a product that we have never deployed, used, or plan to use. It was in conjunction with a project that we are working with prior to this that didn’t work, and so we will not be using iMDsoft.
Guerra: Okay. Recently, I read about a deal with Dell to use their Unified Clinical Archive. Can you tell me about that?
Tomlinson: Yeah. This is something that we began working on early in 2012. We were, at the time, considering perhaps looking at different PACS vendors; that’s kind of an ongoing process that we’ve been in as we kind of grow in our maturity with PACS. We’ve had it for a long time and now it’s all focusing on workflow and efficiencies for the radiologists. But when you look at being able to archive and have access to these clinical images in the future, this all can tie in to big data and clinical informatics or business intelligence. Some of the struggles that we have — obviously, cost was an issue, but also, when we were looking at the different options as we’ve been going through our EMR process, we have these proprietary vendors that act as the hat, if you will, to each of these systems, and it’s very hard to get them to talk and share. Frankly, if we were to replace our PACS, there are all kinds of conversion costs and switching costs that we would need to incur, and then you’ve got the old data getting into the new data.
So we worked with Dell on a solution. Dell was actually what we chose, but we considered other options. But the spirit of it would be to have a unified or a vendor‑neutral archive with this clinical data so that you could have a viewer of any make or model that would be able to have access to all of our clinical images — cardiac and PACS, and in the future we’re going to add others. But whether it be DR Systems PACS or McKesson PACS or GE PACS, it gives us the most flexibility in the future to change if we need to, but also have access to that information and plan for it in a way that is somewhat predictable where we’re paying for storage when we need it, not in advance. Not that you buy another box and then it gives you this capacity for x amount of time, but it just helps us budget and manage our resources a little better. So it was a good solution and we’re nearly complete with that when it comes to transferring or archiving all of our old historical data.
Guerra: I read that in 2010 you signed up with Axolotl, the HIE vendor who’s been acquired, and then that company has been acquired, and all that kind of thing. But tell me about your HIE work.
Tomlinson: We might need another whole hour to talk about our HIE journey. So at a high level, we originally started out with a strategy to try to create our own private HIE due to some struggles that we had with physician adoption, and things around that project did not work. So we shifted gears and we aligned resources and plans with the Metropolitan Chicago Healthcare Council’s (MCHC) approach. They had partnered with Microsoft Amalga, I believe, and they embarked in the spirit of that. What we’re working to is to get the greater Chicago area hospitals within the network committed, focusing first on the hospital providers or the system providers, and then create a database where information can begin to be shared on that level. Then from there, it would go to the physicians, and then ultimately to the patients.
That’s been a process that we’ve been working on for the last year as a region. It has struggled due to adoption and having everybody on the same page and being willing to be a part of this. I view HIE, frankly, as a developmental project. There are all kinds of cost and capital and time required to build these things to work, and it’s certainly been a learning experience. So that is ongoing. But as you know, Microsoft partnered with GE. They came together and created Caradigm, and so that has changed the dynamic as that would likely be the platform that may be the future with the HIE in the Chicago area depending upon a lot of things and how that goes. But it was once Microsoft, and now we’ll have to see what the future holds.
Independent to all of that is what I call Centegra’s physician connectivity strategy. There are efforts to connect our health system information to the local affiliated or strategically aligned physicians. If you take those on a one-off basis, the developmental work is pretty intense and pretty costly, both for us and for the physicians. So we have a vision and a strategy that we’re deploying, but it’s been an interesting road over the last year to two years to see how this all goes and how it will all work out in the region or in the different state HIEs. It will be interesting to see, because everybody is at different levels.