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 3
- HIMSS Stage 6
- Celebrating IT success — “It’s much more important than MU dollars.”
- Focusing on optimization
- Closed loop meds management
- From nursing to IT — “I was hooked immediately.”
- Marrying the clinical & IT worlds
- CIO communities — “We can learn from each other.”
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Bold Statements
I think traditionally in organizations, IT has been underappreciated, and EMH has done a good job of trying to make our new group of IT professionals and our multidisciplinary professionals feel valued. We’ve celebrated those successes.
We are focusing heavily on near-miss information because what that’s telling us is these are the mistakes that almost happen. And when you get that detail, you need to analyze it and figure out what’s contributing to that variability and then try to apply that across the system.
These systems are very complex and the decision-making that goes in the clinical areas is very complex, and I think you need to be very sensitive to what you’re impacting and you need to be very receptive to the feedback that you’re getting, because those are the folks that are at the front lines dealing with it every day.
It’s helped our organization knowing that it’s a clinician that’s helping to lead the charge, because I can look at the doctors and nurses in the eye. I’ve worked with them and I can understand them, and I’m now able to look my IT colleagues in the eye and understand them. It’s really the best of both worlds.
We all bring different perspectives and we all have diverse backgrounds and strengths and challenges. There’s not a whole lot of this that requires a recreation of the wheel. I think that we can lean on each other and learn from each other.
Gamble: Is it something where from an HIE perspective, you had a more deliberate approach, like let’s see how things pan out before we make a decision?
Wray: I think it was a task on our list. It was a project that we knew we needed to get done. We looked at a few solutions that were closely aligned with our core systems, and then we came across the state solution that was generously grant-funded, and it was very economical for us. We knew that participating in a statewide exchange was going to be an inevitable activity at some point anyway, so we decided to put our toe in the water there as opposed to purchasing something that may have been sold by one of our core vendors.
Gamble: Right. So in reading up a little bit about EMH, I came across a couple of things. One was HIMSS Stage 6 recognition and another was that one of the medical centers received the America’s 100 Best Hospitals Award, and I wanted to talk about marketing these types of things to the staff and the patients. Is this something where for the staff, you feel like it helps validate the hard work that they’ve done?
Wray: Absolutely. We’re really proud that we were able to demonstrate HIMSS Stage 6 this year, and I’m almost finished with the Analytics survey for the ambulatory providers because I believe they’re right there as well. I think traditionally in organizations, IT has been underappreciated, and EMH has done a good job of trying to make our new group of IT professionals and our multidisciplinary professionals feel valued. We’ve celebrated those successes, and the president of the hospital and the board of directors have engaged in recognition events with us to help them understand how important what they’re doing every day is to our mission, our vision, and the values that we have as an organization.
So we are using that to market, as far as requirement and retention of allied health professionals. And I believe that the communities around us — the patients, the providers, and the insurers — are also a target audience of that media. They need to know that we care enough to invest the resources to demonstrate Meaningful Use, demonstrate Stage 6, and be a recognized hospital as far as quality and clinical care go as well. It’s a little hospital, but we do a lot of great things here. I’m really proud of what we do.
Gamble: I like what you said about IT being underappreciated, because that really has been the case so often. Even something like seeing these awards and recognitions in a local paper or on the news—I would think that makes a big difference.
Wray: Absolutely. And it’s on the website. It’s everywhere. I had a whole bucket full of the Stage 6 pins and we’ve announced at the leadership team meetings that they very much seemed to be proud of what they’ve done, and it’s much more important than the Meaningful Use dollars. It puts us in a position where we can continue to engage in healthcare in the region. Let’s not forget that you have to have these systems. You have to have the basic foundation in order to provide care these days and just engage in healthcare during this time of reform.
Gamble: Absolutely. I know that we’ve talked about a couple of things you have going on, but are there any other big projects on the horizon or anything else that you’re looking in the near future?
Wray: Definitely. I can tell you, it’s probably not one of the most glamorous projects, but one of the ones that I believe right now is extremely important and one of the main focuses this year is optimization, integration and making sure that we have looked at the workflows that we’ve pushed upon our providers and we’ve really done well by them. Have we overbuilt? Is it lean enough? Is it meaningful enough? So we’re doing a lot of optimization activities this year. And that’s not going to get us any awards, but it’s definitely going to do a good job supporting the end users and they continue to adapt technology. That’s one of the biggest ones that’s we’re working on.
Gamble: Right. What are some of the activities that you have in that space, as far as find ways to improve how systems are being used?
Wray: We have user groups we engage with and they have a list of things of they wish they knew then — ideas that they have now that we either didn’t appreciate enough at the time or maybe didn’t have the time to deploy. So we’re really taking a look at all of those ideas. We’re also taking a look at what’s coming down the pike with value-base purchasing and where the data that we have is revealing some vulnerabilities, and we’re looking at how we better support the processes of care surrounding those focal areas.
We have a closed loop medication management system called MAC and we’ve done a good job of decreasing the error rate, which is what you’d expect, but we are focusing heavily on near-miss information because what that’s telling us is these are the mistakes that almost happen. And when you get that detail, you need to analyze it and figure out what’s contributing to that variability and then try to apply that across the system so that you can improve the processes.
Gamble: Right, and those are extremely important. Maybe that’s not going to grab the headlines, but that’s exactly what you need to be doing, specifically in terms of optimization and just making sure you’re getting the most out of these systems.
Wray: Absolutely, and I think that it’s still new. All this automation, these electronic records — it’s still relatively new and the evidence is mixed on what it improves and what it may not improve. But what you don’t want to do is make patients more vulnerable because you’ve built things that don’t protect them as much as you had hoped. These systems are very complex and the decision-making that goes in the clinical areas is very complex, and I think you need to be very sensitive to what you’re impacting and you need to be very receptive to the feedback that you’re getting, because those are the folks that are at the front lines dealing with it every day.
Gamble: The last thing I wanted to talk about was your background. You said that you have a clinical background. I want to ask you about what made you transition into IT and how do you think that having that clinical background has benefited you?
Wray: I’m a registered nurse and I’ve been a nurse for 25 years. I had a variety of roles and the clinical areas that I focused on tended to be very physician- centric and very project-centric — cardiovascular services, radiology, lab. They were areas that tended to have those niche systems that I spoke to earlier. So I had an appreciation for what was available 15 years ago and 10 years ago in those spaces. On a bad day, I’ll joke that I missed a meeting and somehow I was assigned as the nursing director that was going to participate in the vendor selection process. And I have to tell you, I fell in love with it — the vision, the ability to help plan for what would be the single most expensive investment this organization has ever made in its 100-plus years, short of a building, was just very intriguing to me. I was hooked immediately.
It’s interesting because as I have become much more appreciative of the discipline and the science of IT and the requirements of doing things well in this space, I’ve found there are a lot of similarities that you can reapply across the different disciplines with good success. I will tell you, I know enough now to be dangerous, so it’s really about continuing to learn and challenge yourself to appreciate more. It’s a continuous learning process, whether you have a technical background or a clinical background. It’s just crazy the amount of change that’s coming down the pike.
What’s interesting, though, is when you’re deploying all of these strategies and all these solutions on a clinical workforce, it’s helped our organization knowing that it’s a clinician that’s helping to lead the charge, because I can look at the doctors and nurses in the eye. I’ve worked with them and I can understand them, and I’m now able to look my IT colleagues in the eye and understand them. It’s really the best of both worlds, I think, to bring those two disciplines together and apply it to change projects. It’s been a good thing.
Gamble: I would think that’s a really great perspective, having the experience in both worlds — even something like understanding how important it is for clinicians to have information in real-time at the point of care. I would think it gives you a little bit more credibility having the background that you do.
Wray: Absolutely, and when you’re putting together the use cases that define success, you really need to try to find things that are going to improve care, because it’s a lot of money to spend just to throw a computer system in there and think it’s going to be improved care. It’s much harder than just purchasing it, as everybody listening to this knows firsthand. It’s a huge change.
Gamble: The last thing I wanted to ask is, do you have any words of wisdom for other CIOs of standalones, just in terms of navigating all the change that’s going on right now?
Wray: Boy, I don’t know that I have any words of wisdom, but I definitely think we need to interact with each other. We need to actively participate in whatever CIO forums are out there, perhaps like CHIME or HIMSS events. We need to share secrets with each other, because we all bring different perspectives and we all have diverse backgrounds and strengths and challenges. There’s not a whole lot of this that requires a recreation of the wheel. I think that we can lean on each other and learn from each other and I think that’s probably the one thing that I would think would be a very valuable strategy for people like me.
Gamble: Yeah, I definitely agree with that. The best way, I think, of learning anything is asking those who have been there and who are currently there and getting those perspectives.
Wray: Even after you spend three hours with the Meaningful Use regs, you still have to bounce your perceptions off of other people — how are they interpreting this, what are you guys doing, what’s your desktop virtualization strategy. There’s so much to do that we have to learn from each other.
Gamble: Definitely. Okay, well, we’ve touched on a lot of here, so unless there’s anything else you wanted to talk about, I really appreciate your time.
Wray: I appreciate the opportunity, and hopefully I’ve been able to provide a little of our insight here at EMH.
Gamble: Yeah, definitely, and I’d like to check back with you down the road to see how everything is going.
Wray: Hopefully, you’re not talking me off the rooftop, but yeah, that would be great.
Gamble: Alright Charlotte, thank you so much and best of luck to you.
Wray: Alright, you have a great day.
Gamble: Thanks.
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