No one can ever say that the leaders at Barnabas Health System didn’t do their due diligence in selecting a next-generation clinicals system. It took more than a decade for the system to decide on Cerner, but when you’re the largest integrated healthcare delivery system in New Jersey, making the right decision trumps making a quick decision. In this interview, interim CIO and CTO Tom Bartiromo talks about the organization’s aggressive schedule for rolling out clinicals, and how they are trying to balance “the power of the big and the agility of the small” and apply lessons learned from one go-live to the next. He also discusses the importance of having strong clinical partners, Barnabas’ long-term goal of enabling data analytics and BI, and going from CTO to CIO.
Chapter 1
- About Barnabas Health
- The Cerner rollout
- Doing due diligence right
- Leveraging Meaningful Use
- Selling the benefits of advanced clinicals
- Binding a health system together with order sets, etc
LISTEN NOW USING THE PLAYER BELOW OR CLICK HERE TO SUBSCRIBE TO OUR iTUNES PODCAST FEED
Podcast: Play in new window | Download (Duration: 17:00 — 15.6MB)
Subscribe: Apple Podcasts | Spotify | Android | Pandora | iHeartRadio | Podchaser | Podcast Index | Email | TuneIn | RSS
Bold Statements
The majority of the time that dragged on our due diligence came down to funding and appetite that ultimately, when you try to package it in a way that makes the most sense, it’s also the biggest number on the table.
We chose to do a one-design, one-build model, so a lot of upfront work came in, which was the major barrier around getting the multi-disciplines together early on to agree, which was no small feat. Even though it’s Barnabas Health in name and brand, we still have six entities.
They’re not shy in any way, shape or form, but they understand that this is where things are going. This is where the industry is going, and we can fight it, but ultimately we’re really just trying to keep engaged about what needs to change, and if it makes sense, then how do we best get there.
What we really want to do is maybe shine a better light on the fact that as a system we can accrue those benefits and pull through benefits for the system to the local entity so you really leverage the power of the system; the power of big and the agility of small.
Giving the go-live support is probably the easier thing, because there’s always a lot of TLC. Its post-go-live that’s usually the higher concern — will we be able to move over to the next facility without leaving someone in a really bad spot?
Guerra: Good morning, Tom. Thanks for taking some time to talk to me about your work at Saint Barnabas Health — I mean, Barnabas Health.
Bartiromo: Thank you, Anthony.
Guerra: I still threw the ‘Saint’ in there. When did they change that?
Bartiromo: That was a little over a year ago.
Guerra: Okay. Like I’ve told you, my wife’s out there.
Bartiromo: Yeah, I know. Internally, we still leak the ‘Saint’ on occasion.
Guerra: Let’s go over the health system a little bit, if you want to give the folks a little background. I know you’ve got about seven hospitals and a whole bunch of other stuff, but give us the highlights and we’ll go from there.
Bartiromo: Barnabas Health is the largest integrated delivery network in the state. We have six hospitals, a behavioral health facility and sub-acute facilities, and ambulatory care a total of around 52 network sites in general, with 22,000 employees and about 230 in the IT organization.
Guerra: Now, you have been there quite a while, correct? Over 15 years?
Bartiromo: Yeah, this is 15 years now.
Guerra: Congratulations, that’s quite nice. And your title currently is senior vice president, CTO and interim CIO, is that correct?
Bartiromo: Correct.
Guerra: Tell me when you took on the interim CIO role.
Bartiromo: That was about September of 2011, and candidly, the conversation has come up a few times internally and I really haven’t paid too much attention to the title. But it is something that we’ll have to be removing the ‘interim’ shortly.
Guerra: That’s good, because we never know. Sometimes people take interim positions knowing they’re interim, so for the greater public this is certainly a position that you’re interested in losing the ‘interim’ and getting that out of the way.
Bartiromo: Absolutely.
Guerra: There was a gentleman named Joe Sullivan there, and he was there for quite a while.
Bartiromo: Yeah, Joe was the CIO when the health system formed, so he was in that position for I’d say about 15 years actually.
Guerra: So you worked for him for quite a while?
Bartiromo: Correct.
Guerra: Okay, and then he moved on, and then you moved up into the position. We’ll go back to that later because that’s all very interesting stuff. But now let’s talk a little bit about the big stuff going on at the health system, which is the Cerner implementation, correct?
Bartiromo: Yeah, absolutely.
Guerra: That’s the big one. Why don’t you give us the highlights, a little bit of background, and then just bring us up to speed on where we are?
Bartiromo: Sure. We had a long-running due diligence for folks that had any involvement internally or externally. It was probably upwards of a 13-year due diligence period for our next-generation clinicals. We were talking with Eclipsys and Cerner on and off for a lengthy amount of time, and right around the time Allscripts picked up Eclipsys, that sort of opened up the door a little bit further for our Cerner discussions, and then we ended up finalizing a deal with Cerner for Millennium on our clinicals and PowerWorks for our ambulatory to drive an integrated strategy between and amongst both. We are now three sites live: St. Barnabas Medical Center, Monmouth Medical Center, and Community Medical Center. Monmouth was our first launch in March 2011, and we’re within two weeks now from our Kimball Medical Center and Behavioral Shoreline that goes live, and then following that will be Newark Beth Israel in April and Clara Maass will round it out in June.
Then also along with that, the FirstNet Emergency Department is going up live with the sites and then we’ll circle back between June and July to implement the FirstNet Emergency Department replacing EDIMS at St. Barnabas Medical Center and Monmouth Medical Center. So the go-live track and implementation schedule remains pretty aggressive, and that’s for all the core clinicals — CPOE, documentation, pharmacy, PowerNote, and CareNet. We have all but the lab at this point.
Guerra: I’m sure you would agree that 13 years is probably on the high side for due diligence.
Bartiromo: Yeah, we really got it really well.
Guerra: How long do you think it should take?
Bartiromo: The due diligence period?
Guerra: Yeah.
Bartiromo: I would give it a good 12 to 18 months.
Guerra: Twelve to eighteen?
Bartiromo: Yeah. The majority of the time that dragged on our due diligence came down to funding and appetite that ultimately, when you try to package it in a way that makes the most sense, it’s also the biggest number on the table. So ultimately that kept deferring and delaying and can we get another year out if it and can we continue to do good soldier work. We did, but ultimately I think with MU and our clinical quality programs, we just needed to move it in that direction. So we would tell our physicians as they would be slow to adopt on CPOE that we were not the first to go up with this, so I think we held out as long as we possibly could.
Guerra: That’s one of the things that Meaningful Use helped organizations with, right? With saying to the physicians, ‘hey it’s not just us now, it’s the government.’
Bartiromo: Absolutely.
Guerra: You don’t have to be the bad guy anymore.
Bartiromo: That’s right. We threw as many hooks as we could into other supporting things.
Guerra: Now in your health system you have a number of hospitals and I was just thinking that I have two kids. You make all the mistakes with the first one and with then the second kid you say, ‘I’m not going to do that again,’ so the second kid has some benefits. I wonder if it’s like that with rolling out these advanced clinicals in hospitals — by the time you get to the fifth one, you certainly have it down better than you did at the first.
Bartiromo: Absolutely. Our hope is that by our last one, it’s a DIY kit that we can move along with. It’s gotten better in some cases and less worse in others, not to set the bar too high. But we chose to do a one-design, one-build model, so a lot of upfront work came in, which was the major barrier around getting the multi-disciplines together early on to agree, which was no small feat. Even though it’s Barnabas Health in name and brand, we still have six entities, seven including behavioral Health and others — multiple entities, multiple personalities and opinions about practice and protocol.
So we bring everyone together to come up with standard order sets and common practice knowing that it can evolve and it can change, but we are going to have to put aside a lot of differences and come together to do this. That was the major upfront lift. That made the implementation cycle, quite frankly, go less worse and with less variability. With our fourth site right now, the teams are much more familiar. They’re much more confident in their implementation and go-live schedule, and we give a 10-day dedicated go live event for each facility. And that typically translates into a pretty significant amount of hours onsite, 24/7, and upwards of 18 to 20,000 hours of support over that 10‑day go live period. So the teams that are doing that are getting better and better at it.
The institutions, each one for the most part is unique. They’re nervous about the change event. They’re nervous about the impact to operations and the clinical staff. But they do look pretty keenly at the hospitals that have gone live before them, and then they go visit during the go-live and post-go live. So by the time it gets to them they have pretty good eyes open about what to expect and what they’re worried about and what they’re confident about.
Guerra: It’s pretty hard to get people to buy into something unless they see the upside, right?
Bartiromo: Absolutely.
Guerra: I would imagine a big part of this is before there’s any kind of rollout, it’s ‘here’s the cool stuff that you’re going to be able to do now’ and hopefully getting them a little jazzed up so that the pain comes with a reason; a benefit on the back end. Tell me a little bit about that dynamic.
Bartiromo: No doubt Anthony, that’s a critically important part. I think one of the challenges we have — we would like to do that even better and we’re always left a little wanting on that — is that in some cases they understand that part of the reasons we need to do it is around Meaningful Use and maintaining our regulatory commitments, which may or may not translate into their perceived direct benefit. But along the way, we still try to bake in the typical challenges around physician order entry and the typical barriers around, ‘that’s really not what I want to be doing. I really just would rather have the nurse do it.’
The nurses have been doing an outstanding job in a major change event and the physicians really are stepping up. There are challenges that are going to continue no matter what, but the medical staff, the VPMAs are all very engaged at the institutions. They’re not shy in any way, shape or form, but they understand that this is where things are going. This is where the industry is going, and we can fight it, but ultimately we’re really just trying to keep engaged about what needs to change, and if it makes sense, then how do we best get there. One of the bigger challenges with that is the institutions were a little bit more used to operating independently, whereas now you take an order set for example — one entity that wants to change an order set has to really get some consensus from the aggregate of the entities. And that’s foreign practice, so that’s going to take some getting used to, but again I think they all remain very well engaged to say this is what’s needed and ultimately it will be for the betterment of them and the health system over time.
Guerra: It’s a good point. I discuss this with a lot of CIOs that are overseeing organizations with multiple hospitals that have been brought together through acquisition, and as you mentioned, these hospitals each have their own culture and you have people that have been there decades. And all of the sudden, it’s the task of the health system to make them feel part of a system when they still just go to that hospital everyday if they’re a nurse or whatnot. Most of them just go there everyday like they always have, and sure, there are some logos that are different, but how do you make them care that now we’re part of a health system and the patient you’re seeing today may be at our other hospital? Do you know what I mean?
Bartiromo: That is a significant challenge and I think it’s ultimately going to be the testament of time. Credibility is earned. They have a lot of local loyalty and entrenchment, which is good, and we don’t want to break that. What we really want to do is maybe shine a better light on the fact that as a system we can accrue those benefits and pull through benefits for the system to the local entity so you really leverage the power of the system; the power of big and the agility of small.
Guerra: When you’re picking the order that you were going to go down in terms of your hospitals, how did you do that? What were you looking for? What are the characteristics in the facilities that were going to go first?
Bartiromo: Well, we started by height. That didn’t last very long.
Guerra: You just threw them in half, right?
Bartiromo: We really came down to about probably two institutions at the time: St. Barnabas Medical Center, our flagship hospital, and Monmouth Medical Center. We had to weigh the differences, the appetite capabilities, and while both were amply capable, Monmouth Medical Center already had a partial Cerner Millennium presence with its pharmacy. When we started to go through the architecture and the domain strategy, carrying on top of that for Monmouth Medical Center made a strong logical first step. And then following beyond Monmouth then was a segue into St. Barnabas Medical Center and then following Community Medical Center.
During the time of the time of the CIS acquisition, we had not yet made the decision to go with FirstNet Emergency Department. So that was a change in some of the road mapping that came into play. Our Community Medical Center is one of the busiest EDs in the nation without residents. So that created some interesting challenges for the facility. Giving the go-live support is probably the easier thing, because there’s always a lot of TLC. Its post-go-live that’s usually the higher concern — will they be okay and will we be able to move over to the next facility without leaving someone in a really bad spot? So in that particular case, the first pick had to do with having an existing Millennium footprint, and the architecture made sense to start there.
Share Your Thoughts
You must be logged in to post a comment.