Bill Rieger, CIO, Flagler Hospital
When he started as CIO at Flagler in 2010, Bill Rieger found himself in an interesting situation. Not only was it his first CIO role, but it was the first time the hospital had named a CIO. Instead of having big shoes to fill, Rieger had “a blank slate,” and he has leveraged that opportunity to help strengthen Flagler’s IT presence. In this interview, he talks about the challenges in migrating from one major system to another, what it was like to take over a department that was lacking in governance, the importance of having a strong CMIO in place, and why communication is absolutely critical. He also discusses his ACO plans, why he’s avoiding HIEs — for now, his social media strategy, and what he’s doing to keep his staff engaged.
Chapter 2
- What Allscripts did right
- Answering to the board — “They trusted me”
- Paul Black’s goodwill tour
- Flagler’s year-long strategic-planning process
- Clinical integration — “It’s our version of an ACO”
- Identifying the right partners
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Bold Statements
To me, that’s the key there. And the one thing I would give them is during this whole process, they’ve been very communicative with me, which has kept a beam of hope on for me with regards to Allscripts.
It has been challenging. It’s been a challenge for our board too, because they trusted us. They trusted me. They trusted the CEO. They trusted the process that we used to select Allscripts. It was a physician-led process, and they really trusted that. And they’re not very comfortable with all these changes.
The last thing I want to see is one less vendor in the HIT market right now. There’s so few to begin with that do what these guys do. We don’t need any less. I don’t care what anyone says about the success of Epic or Cerner. We don’t need less because that’s not going to help anybody.
We understand that there are going to be some at-risk patients that we’re going to have to take in the very near future. We’re not ready to go there yet, but we are ready to partner.
There are certainly a lot of larger organizations around St. Augustine that would love to talk to us about opportunities. That’s not our strategy. It’s not what we want to do. So we’re being creative on what we can do to maintain our ownership and our market share, and we feel that clinical integration is definitely a part of that.
Gamble: You talked about Allscripts. Obviously, they went through some tough times recently. When Paul Black was named CEO, he acknowledged that they have ‘some unhappy clients’ — I think that’s how he put it — and said that’s something they’re going to focus on going forward. What were your thoughts on that? Have they done a decent job of communicating to the existing clients about the concerns that are out there?
Rieger: If we were not in an implementation cycle, I probably would have a different level of communication with them right now. I’m sure that Rick Schooler in Orlando and the people in New Jersey or New York are having some different conversations with them, but right now we’re still focused on implementation.
Have they responded to some of the things we’ve been talking about with regards to the implementation process? Yeah, they have. They’ve been very responsive. I’ve been talking with a couple of executives through this whole process of making this change for several months, and to me, they’ve been very responsive, calling me instead of me having to call them to get information. They’ve been kind of ahead of the communication curve from my perspective. Again, we’re in the implementation cycle, so it may be a little different. I hope it’s similar when we get into normal support mode. But they’ve been very communicative and very responsive to things that I have to say; they have a listening ear, which is good. I hope that continues when we get into normal support mode.
It would be interesting if we were in a normal support mode and we’ve had years of time with Allscripts and had been through multiple upgrades which have been problematic. Would my attitude be the same right now? I don’t know, but I would definitely demand communications. When you stop communicating, just like in any relationship, you know there are problems, because there are obviously things to be communicating about right now. To me, that’s the key there. And the one thing I would give them is during this whole process, they’ve been very communicative with me, which has kept a beam of hope on for me with regards to Allscripts.
Gamble: I imagine that it puts you and the other leaders in a little bit of a tough spot though, just talking about MyWay and the changes there. It seems like it was a tough spot for a lot of people.
Rieger: Yeah, it was. I would say in the very beginning I was probably the biggest Allscripts cheerleader that you can imagine, and for good reasons. I wanted to do the right thing for my community and the right thing for the hospital. I wanted to make it nothing but successful and work with them, and then these changes started happening and this and that. It grows weary on me. It grows weary on the whole leadership team. If it wasn’t for their communication being so good, I probably would be weary — that’s the word I would use, if haven’t said it already enough. But it has been challenging. It’s been a challenge for our board too, because they trusted us. They trusted me. They trusted the CEO. They trusted the process that we used to select Allscripts. It was a physician-led process and they really trusted that. And they’re not very comfortable with all these changes.
And for that reason, actually, Paul will be coming here to talk to our board. So I’m kind of looking forward to that. I look forward to what he has to say there. I’m probably not going to be shocked by anything he says, but I think it is a good gesture that he comes and talks to us. They don’t have too many people that are implementing right now, so they need all the implementations that they have going on to be very successful so they can make some positive buzz in the industry.
I will do whatever I can to partner with them, and we are doing whatever we can to partner with them to make that happen. The last thing I want to see is one less vendor in the HIT market right now. There’s so few to begin with that do what these guys do. We don’t need any less. I don’t care what anyone says about the success of Epic or Cerner or all the other ones. We don’t need less because that’s not going to help anybody. So we’re going to do our part here to really partner with them and help them be successful as I know that they’re trying to help us be successful as well.
Gamble: Yeah. It’s an interesting position for him to step into where he kind of has to do this goodwill tour.
Rieger: Yeah, that’s what he’s going to do. He’s going to do the Florida Swing, much like the PGA tour, and we’re going to be one of his stops on the Florida Swing. I’m sure he’ll be going to others and I hope he does; it’s the right thing to do, and it will help start generating some relationships in the industry. He has some good ones already, I’m sure, with his experience with Cerner. But he’ll be with a different group now and hopefully he’ll be able to do that. He obviously did very well at Cerner and helped that organization go to a good place. So there’s a lot of optimism right now when you talk to some people inside Allscripts who were a little uneasy before. I think there’s a lot more optimism, more thinking of, ‘okay, we have a direction. Let’s go. Put the gas pedal down.’ So that’s kind of the sentiment.
Gamble: Okay, now I don’t imagine that the implementation is the only thing on your plate. Do you want to talk about some of the other projects you’re working on or some of the other plans you have in the works?
Rieger: We just got done with probably a year-long process for strategic planning. There’s a board-level process that we went through. I’ve been through that a couple of different times. At the end of this one, in the last meeting, our CEO made a comment. He went to the Florida Hospital Association (FHA) meeting and the president of the hospital association made in his keynote speech a comment that ‘the one thing we can be sure of is uncertainty.’ So we have this message with us as we go through our strategic planning process, and we come out of it with really two or three key initiatives, and one of them obviously right now is this very capital-intensive EMR project that we’re going through. The other one is regard to market share and some things we’re doing there. We have 85 percent market share in our primary service area, so we’re very good there.
There are some other things we’re trying to do, but the other thing, and it’s our second biggest initiative, is what we call clinical integration. It’s our version of an ACO. We are very aggressively pursuing a clinical integration strategy that we put in place. I’m working directly with the COO of this organization to do that. We don’t have many resources in IS to put toward that right now, but the few resources we do have we’re strategically using and we’re going to try and get some third party solutions in place where they can be hosted and we don’t have to be too disruptive to the project that we’re working on here now.
But we definitely are doing that. We understand that there are going to be some at-risk patients that we’re going to have to take in the very near future. We’re not ready to go there yet, but we are ready to partner. One of our partners that we’re going to start with is probably Blue Cross. That’s the underwriter for our largest employer in town. We’re going to partner with them and partner with our physician group.
It’s really a physician-led effort. The COO this time is in the background kind of helping and coaching and so am I and it’s been a really great learning experience. We’re somewhat getting our feet wet with this clinical integration network but that as soon as the EMR project is done, that’s going to become number one for the organization, because we feel like that’s really what’s going to sustain us as single hospital. There are certainly a lot of larger organizations around St. Augustine that would love to talk to us about opportunities. That’s not our strategy. It’s not what we want to do. So we’re being creative on what we can do to maintain our ownership and our market share, and we feel that clinical integration is definitely a part of that.
Gamble: What’s included in your reach?
Rieger: It’s mostly going to be the physicians that are in our community here, and there are 250 of them. Not all of them will be in there. We’re focusing on strategic relationships. We have primary care, obviously. The primary care practices that we do have good relationships with — we have relationships with all of them but we’re closer with some than others — we’re helping them become a medical home. There’s a designation for that. I don’t remember what it is off the top of my head, but there’s a patient-centered medical home designation. We’re helping them with that. So it would definitely be the primary care practices and myriad specialties, orthopedics obviously will be in there and cardiac specialties will be in there. They’ll be a few others.
We don’t want to be exclusive; we want to be inclusive. We will have some requirements from a technical perspective for them to join the network, and that’s what my subgroup is working on right now. I’m chairing a subcommittee that’s helping to determine all the technical tools that are going to have to be in place and the technical requirements, and helping other groups gather requirements for them as well. But it will be, again, focused on the primary care physicians and then bringing in the specialties as the network decides which ones they want to closely align with.
Gamble: Right. So obviously it’s a long-term type project.
Rieger: It is. I think we have a 60-month calendar right now, so we do want to start with Blue Cross in October of this year. I think that’s going to be our timeline for that. So we do have to get some of the infrastructure pieces in place, and some of the governance things in place — creating their own legal entity and a couple of different things. There are different subgroups working on that, but yes, it really is a 60-month period before it’s its own living, breathing organization.
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