It’s all comes down to timing. The IT leaders at EMH Healthcare had been trying to propel EHRs to the top of the priority list when the Meaningful Use hammer came down, forcing the organization to revive a project that had been pushed to the back burner. EMH had fallen right into “the sweet spot,” according to CIO Charlotte Wray, and began its journey from a paper-based organization to earning Stage 6 recognition. In this interview, Wray talks about what it takes to lead a clinical transformation, her strategy in working with independent docs, how community hospitals can benefit from using consultants, and what EMH is doing to increase patient engagement. She also discusses why it’s critical to market IT achievements, her focus on optimization, and how she has been able to leverage her experience as a clinician.
Chapter 2
- Extending the “olive branch” to physicians
- Stage 1 attestation
- Bringing in consultants — “We realized we had a bandwidth issue”
- EMH’s portal strategy
- Targeting chronic disease patients
- Preparing for ACOs: “We’ve always had to align ourselves with other providers”
- Partnering with CliniSync
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Bold Statements
You have to choose your battles. We’re in it for the long haul, not the short run. So if a specialist wants to use a free solution that he or she believes is going to support them, we’ll work with them closely. We’ll do the best we can to get the information back and forth.
We realized that we had a bandwidth issue. Not only did we need more bodies to get the volumes of work done, but we did not have the internal expertise to get it all done ourselves.
I protected our staff at the bedside and our internal IT and informatics experts to support the live event, and then I bridged some of the war room activities with consultants, because I wanted to make sure the EMH teams were the face of these events.
You have to be multifaceted in your approach to care for those patients. If we can figure out a way to creatively engage them in a portal strategy or an education strategy to help them better understand their disease, it’s going to be better for everyone.
We definitely know we have to exchange not only within our own walls but within our community of physicians and hospitals — employed or independent — to improve care and to decrease some of that variability.
Gamble: That seems like a situation that could get a little sticky. We definitely hear CIOs talks about that when they have specialists that have a specific system in mind and they say, ‘This works a lot better for me.’ That’s a tough battle to fight.
Wray: You have to choose your battles. We’re in it for the long haul, not the short run. So if a specialist wants to use a free solution that he or she believes is going to support them, we’ll work with them closely. We’ll do the best we can to get the information back and forth, because obviously we want to support their work flow so they continue to come here and we support patient care. But when they get to a point where they’re rethinking those decisions if they do, we’ll be here. We’ll be here to help.
Gamble: It’s hard to compete with free, right?
Wray: Well, it’s funny because it’s really not free. Additionally, we did subsidize our physicians. We chose to go at risk with a small amount of money — certainly not 85 percent of physician solution costs, but we did offer a few grand to physicians that were interested in signing a subsidy agreement with us. So we felt that that was something that would be a good olive branch to them and let them know that we were supportive of the huge changes they needed to undertake in their offices as well.
Gamble: Okay. You mentioned Meaningful Use with the physicians. What about from the hospital perspective? You attested to stage 1, correct?
Wray: Yes, we’ve attested two years to stage 1, with the first year being October of 2010. We were very pleased to get over that hurdle. We reattested last year and actually we’ll attest this year as well for the third year at stage 1, which is wonderful for us to be ahead of that curve. It gives us a little bit of time to prepare for the enhanced requirements for stage 2.
Gamble: Okay. I wanted to talk about using consultants. That’s something that you decided to do to help deal with the challenges that community hospitals have, and I wanted to ask you about the kind of the decision process. What was it that made you say ‘Alright, let’s get outside help.’
Wray: We had a challenge. We had to get a lot of work done in a short period of time. We had, at that time, just about 2,400 employees and physicians, and the IT shop at the time was probably about 20. We did not have any clinicians in that department other than maybe one or two nurses that had defected into IT a decade or so before. We realized that we had a bandwidth issue. Not only did we need more bodies to get the volumes of work done, but we did not have the internal expertise to get it all done ourselves. The solution provider has their own flotilla of consultants that they’ll bring in, but the customer still has to do a lot of heavy lifting. So we did supplement our staff with a couple of consulting firm experts, and we use those frugally but very effectively.
I think for me, the decision-making process on who you use is finding someone who you think you can develop a good partnership with, who understands the solutions that you’re implementing, and who you can create a lot of synergy with. A couple of firms that we used were able to provide us with some executive level insight expertise as well as front-line builder expertise, and we found that very helpful.
Gamble: I would imagine one of the issues that was really a concern was managing all the workflow challenges. Is that something that having the outside help assisted with?
Wray: That’s something that we owned. I was very protective of that. It’s interesting because during our first live event, there was an H1N1 pandemic. We were at peak census and we were concerned about could we support the live event. I protected 100 percent our staff at the bedside and our internal IT and informatics experts to support the live event, and then I bridged some of the war room activities with consultants, because I wanted to make sure the EMH teams were the face of these events. We used, at that point, the experts in more of a behind-the-scenes role with some of the last minute break-fix issues and tickets that would come up during a live event.
The doctors and nurses tolerated the change because they knew the person that they were interacting with during the live event — either they had worked with them clinically or they had worked with them in the project, and there was a sense of comfort at that point with the team.
Gamble: Like you said, ownership is a pretty important issue. This is something where long after the go-live, you need to know that the clinicians do feel that ownership and are determined to make the system part of their everyday workflow.
Wray: Yeah, because it is. It’s their new tool; their new stethoscope. It’s quite a challenge.
Gamble: One of the issues that comes up a lot, especially now, is patient engagement, and the challenges that CIOs and other leaders have in trying to boost it. I wanted to talk about what you’re doing on this front. Are you doing anything with portals to try to increase engagement?
Wray: In 2013, we definitely have a patient portal strategy that we will be kicking off. Patient engagement as it relates to Meaningful Use and the utilization of a portal is something that we definitely support, but from a continuum-of-care perspective and from a clinical perspective, patient engagement has been pretty important for a long time. What we know is when you get patients involved in the decision-making processes and when they’re interacting in whatever fashion, be it a portal or whatever, they are more likely to take charge of the decisions and they’re more likely to be compliant with their plan of care or their medical regime. That’s a very important strategy for us.
Gamble: I know it’s hard to generalize, but do you find that there are patient groups who are more willing or are more active in their care than others, and are there particular groups that you think you need to target more?
Wray: I think where we would target would be certain subsets of patients that are more problem-prone; for example, diabetics, patients with heart disease and heart failure, and patients that we know sometimes struggle with readmissions and have complex plans of care. I think that’s where we do the most good because you have to be multifaceted in your approach to care for those patients. If we can figure out a way to creatively engage them in a portal strategy or an education strategy to help them better understand their disease, it’s going to be better for everyone.
As far as overall demographics, I’m always surprised. A lot of times I’ll hear our population is impoverished; they don’t have access to technology, and I certainly see everybody with a smart phone these days. Or maybe we think a population is a little too old and is not tech-savvy. I’m always surprised by what people are able to do and what they’re willing to do if you help them to see the benefit.
Gamble: Yeah, I think that’s really a good point because it is certainly not the same everywhere. It’s almost a dangerous assumption to think elderly patients are afraid of technology, because as you know, a lot of them are not, and some are really starting to embrace it more.
Wray: It’s a daunting task to think that we’re going to need to engage our patients in such a meaningful way in such a short period of time. It’s human nature to list out a lot of reasons why it might not be so easy. I just think we have to be creative. We have to ask them what they think and show them our portal before we go live with it and get their feedback. Because it’s going to be their tool, not ours. So to create a vacuum will be a mistake, and I think what we will do with patients just like we did with the clinical solution. We’ll engage a few patients — some that are tech-savvy, some that are not, some that are frequent flyers, and maybe some that are in target groups that we don’t yet engage with, and we’ll get their input.
Gamble: So along the lines of what we were talking about, that brings up accountable care. I wanted to talk about what you plan to do in that area, but also the challenges for the standalone hospitals. I know that in Ohio, there are a lot of large health systems, so are there challenges being a standalone entering this ACO world?
Wray: It’s interesting because I think healthcare reform is imposing a tremendous amount of challenge on organizations of all sizes. EMH is about $250 million organization which is very small in comparison to some of the larger centers that are in the Cleveland area. We’re blessed to have many great healthcare centers. But even those healthcare centers aren’t big enough, and I think that the one thing that EMH has as an advantage is that we’ve always needed to align ourselves creatively and strategically with other providers of service to make sure we could offer the clinical expertise in our region. So I think it’s going to be a lot more of that for places like EMH. Alignments are going to become more formal, definitely more strategic, and I think more national in appearance versus even just statewide or regional. EMH will definitely become part of an accountable care organization. We will be active participants in it, but EMH is a medium-sized community hospital, so you certainly can’t do that on your own.
Gamble: Right. As far as health information exchange, are you currently involved in any statewide or regional exchanges?
Wray: Yes, we are. We’re actually going live here in a few weeks. We chose to acquire a partnership with the state solution in Ohio which is branded CliniSync, which is the Medicity HIE. A few of our facilities in the region are actually working closely with OHIP (the Ohio Health Information Partnership) to try to convince them that they may even want to consider a portal strategy on top of that for the state. But we definitely know we have to exchange not only within our own walls but within our community of physicians and hospitals — employed or independent — to improve care and to decrease some of that variability.
You’ll have to touch base with me in six months and see how we’ve survived it, because I think that exchange opens up a whole new doorway of challenges for physician workflow in the office setting. We’ll be pushing a lot of information out there. The question is, how do you use that in a meaningful way to make good decisions in the office, at the bedside, and in the ER?
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