For years, Massachusetts has stayed ahead of the curve in terms of IT adoption. But when it comes to data exchange, even the Bay State has had its share of challenges — both with the sustainability piece, and with what Joel Vengco considers to be a bigger obstacle: politics. In this interview, the first-year CIO talks about the work his organization is doing with the Massachusetts HIE Highway and the Pioneer Valley Information Exchange, how Baystate is positioning itself for ACOs using elements already in place, why transparency and trust are critical to HIE success, and why sometimes it’s better to bite off a small piece of a project than to try to boil the ocean. He also discusses being a Cerner customer in an Epic world, the steep costs of a rip-and-replace, and the key role end-users play in clinical IT success.
- Vendor/customer relations — “It’s a two-way street.”
- Being a Cerner outpost in Epic country
- Awarepoint for RTLS
- Leveraging a diverse background
- The new CIO
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When you look at the landscape and you look at the decisions that we have to make, it looks like everybody is going Epic, and so why wouldn’t we? Why shouldn’t we? If you guys want to have a presence here in this important part of the country, then you need to work hard at it.
It’s a two-way street. We also, on our side, have to do certain things like have better governance, and have complete focus on the fact that this is an optimization project. It’s not just a ‘catch the problems as they come’ type of thing.
We’ve got a variety of phases that I think we’re going to undertake to go from just tracking equipment to beginning to get sophisticated use of the RTLS technology like temperature tracking and patient flow and capacity management.
The role of the CIO in this next phase of the health system is really a very different role — or it should be seen as a different role. It should be seen as a strategic role. It should be seen as a business leader. It should be someone that understands how to run a business.
It’s not my intent to be somebody that’s just installing stuff and plugging and playing things. I want to help the institution take its current investments and really create something that’s unique and helps drive clinical innovation.
Guerra: Tell me a little bit about the dynamic you have with Cerner right now, communicating your concerns or your thoughts around where you need to go, where the product is, and how it’s being adopted or received by your critical users. Cerner’s a big company. You’re a big health system, but they’re bigger than you are, in a sense.
Vengco: Yes, that’s true.
Guerra: Who has the power? Do you just have to sit there and wait and see what their new releases are? Tell me about that dynamic and that dialogue?
Vengco: That’s happening in real time now. It’s got to be a partnership. I think that’s the first piece of it — with any vendor that we bring in, even the ones that we have now, I’m trying to instill in them that we want to make this a partnership. We can only succeed if it’s a partnership because again, looking at the fluidity of the industry and the space, we have to be able to address these changes quickly. And to be a client waiting for Cerner — or any vendor for that matter — who may be releasing solutions with a significant lag because they’re not living in the market like we are is a big disadvantage. So they need partners of that nature, no question about that.
I think the conversation is also about the fact that we’re in a state that is now largely becoming Epic, and even surrounding areas of where we are — like in Connecticut, Yale-New Haven is going to be an Epic shop. Partners HealthCare in Boston, probably the largest health system here in Massachusetts, is going to go wholesale Epic. I think they need to understand that and they need to understand the power of that influence that I think many states are starting to see with regard to organizations making choices.
I sat with one of their executives at HIMSS and I said, ‘you need to understand that we want to make this work as a partner. But when you look at the landscape and you look at the decisions that we have to make, it looks like everybody is going Epic and so why wouldn’t we? Why shouldn’t we? If you guys want to have a presence here in this important part of the country, then you need to work hard at it.
I hope that that message came across. I think they still think that even some of the small pockets Cerner installs make some difference, but I don’t think that those are as acknowledged as what we’re seeing with the Epic installs across the state, because they’re larger. And Partners is big one. I’d mention a certain number, but that’s going to be a huge number in terms of cost, and that’s really a big broad reach in terms of the state.
Guerra: Have you gotten pretty specific with Cerner in terms of, ‘Here is what I need this product to do. Here’s some feedback. Here’s what I need you to do very quickly’?
Vengco: Yeah. My staff that has been part of this organization even prior to me has actually identified many of those issues. Many of them are very much the same issues. Some have augmented slightly because of the way that accountable care is moving, and there are some new items to the list or different items. But yes, we brought in a consulting firm to help us with the management of that project, if you will. And so there’s the consulting firm, us, and Cerner. We’re providing them a very specific set of, ‘These are the things that need to happen and features that we require.’
But make no mistake — it’s a two-way street. We also, on our side, have to do certain things like have better governance, and have complete focus on the fact that this is an optimization project. It’s not just a ‘catch the problems as they come’ type of thing. It really needs to be seen as a program, as a campaign, as an initiative for the enterprise, and we have to put an investment in it. I think that’s also a wholesale difference from what was done in the past — to really see it as an important, critical strategic initiative for the organization. And our team is looking to do that.
Guerra: There’s one other specific project I’d like you to talk about a little bit, and that’s your RTLS project. I understand you’re using a company called Awarepoint. It sounds like a pretty hard ROI project. It’s maybe a much easier sell than investing in something that makes physician documentation easier. But this seems like a pretty hard ROI. Tell me about this project and why you’ve gone down this road.
Vengco: I think that like many hospitals, we’ve got lots of issues in terms of equipment tracking and just identifying where that equipment is going. We’re losing a lot of equipment quite honestly, and so the first phase of this is really just deploying equipment tracking over the next several months. We haven’t deployed it just yet. We’re actually in the throes of implementing the project. We’re going to be looking to do that at Baystate Medical Center, and then expanding that to our other organizations.
And you’re right — the ROI is almost tangible, because if you don’t lose equipment, you can track it, and you gain things like productivity because you know where to go. Your nurses aren’t going to have to fish for stuff, or for that matter, they don’t have to actually store stuff in a secret place because they don’t want it to be lost or stolen. And so really our first phase objective is really equipment tracking. There’s going to be about 3,000 assets that we’ll be tracking through this project; things like IV pumps and other telemetry devices and even some other devices like perhaps a wheelchair, I would imagine.
But then you can think about how this can go into other phases that include things like the management and the maintenance of some of these devices in our organization and tracking them — not just where they are located, but whether they are being managed and maintained appropriately. We’ve got a variety of phases that I think we’re going to undertake to go from just tracking equipment to beginning to get sophisticated use of the RTLS technology like temperature tracking and patient flow and capacity management.
Those are things that Awarepoint, as we understand it, has expertise in that I think we can rely on. I think there are other innovations that we can certainly look toward that will help in our continued efforts to save on costs and to be more efficient and to really be more productive. We see all three of those being outputs of Awarepoint.
Guerra: One of the interesting things I read in the press release was that missing equipment contributes to operating rooms functioning at less than 68 percent of capacity, and that’s certainly a big issue. Those rooms are so valuable. They need to be used whenever possible. It’s like having a very high-end hotel suite sitting unused. You want that thing booked all the time.
Vengco: Absolutely. That is a huge issue, let alone the fact that it could be a patient safety issue. If you think about flow, you want those rooms just continuously turning over. And as you look at the schedule, the turnover time needs to be much more efficient so that people can get into rooms very quickly and so we don’t have too much lag between surgical events.
I think as it stands, when something like an IV pump is missing or an anesthesiologist’s equipment piece is missing, those things we can’t locate very easily and very quickly and may have to borrow from another OR, which is then going to have the same impact to it because it’s going to be looking to get re-setup for the next surgical event. And so it becomes this cascading issue of, ‘Okay, where’s all the equipment really going, and which room does it belong to, and how can I track it in time so that I can actually set this room up?’ I think that really as far as an outcome, it’s something that we can measure and track, and it’s a nice hard number so we can see if this really made a difference with regard to getting us to more efficient room setup and flow and equipment tracking.
Guerra: We could talk for another hour, but we’re just about out of time. I’m going to ask you one more question and we’ll have to leave it there today. We mentioned before we started the formal interview that we’d met when you were at GE. You’ve got a varied background. There’s entrepreneurship in there; there’s academia; there’s experience on the vendor side running a P&O when you were with GE; and there’s also experience on the provider side at Boston Medical Center, you and partners. You seem like someone with diverse interests. You seem like someone who’s got incredible amount of energy and gets bored easily — at least that’s my interpretation. Tell me how all these experiences set you up to be successful in your role now?
Vengco: That’s a great question, and I think about that often. When I took this position, I thought to myself, ‘what’s really going to drive me in this position and how are the things that I’ve have experienced and learned going to make me happy with this job and make me successful?’ What I realized and fell back on was that the role of the CIO in this next phase of the health system is really a very different role — or it should be seen as a different role. It should be seen as a strategic role. It should be seen as a business leader. It should be someone that understands how to run a business, because ultimately, when you think about capital investment and use and operating dollars, IT just becomes much more of a significant user there. And you need to be able to convince folks that IT is not free and it’s got to be part of the strategic mindset for use of that money.
Ultimately, it’s also about thinking through how you run this organization as a new model for the future, because we’re going to have to take the foundational technologies that we have and the legacy systems that we have and create new products with them or new solutions. It’s not my intent to be somebody that’s just installing stuff and plugging and playing things. I want to help the institution take its current investments and really create something that’s unique and helps drive the clinical innovations that we’re trying to get to through this technology innovation.
That’s really what gets me excited; that I’ve got really around me an environment that I think has a lot of potential. The city of Springfield is, in many ways, a depressed community in that a lot of industry has left, but there’s so much great infrastructure. There’s still a great community here, and it’s a very committed community and region, and you’ve got Baystate Health System, which has an opportunity to really make a difference in this community with its impact on health care.
What I plan to do is take the technology that we have here and really enable this health system to drive its business of health care with insight and knowledge and create the pathway toward innovation. I think that’s really what gets me excited. You talked about the entrepreneurship that I’ve had in the past and my creativity; that path really gets me jazzed up. To that point, I’ve been working with folks around this region as well as at the state level on what I’m calling an Informatics and Technology Innovation Center. It will be adjacent to Baystate and leverage the IP that Baystate has; for example, its data and its environment — the environment being the clinicians and the health plan and the medical groups and the patients — and really use that to drive innovation in this region. It’s about bringing organizations from Boston or from New York or from other places and having these, let’s say, mid-cycle startups or even early stage startups to be incubated or accelerated in this innovation center, because it’s going to useful for health care and for Baystate and for organizations like Baystate to have that kind of solution help drive its clinical innovations.
Those are things that really get me excited. I think ultimately, Anthony, I have been given an opportunity to really create something, and that’s really what it’s about for me — creating something that’s meaningful and that matters. I think the things that are around me here at Baystate really give me that opportunity. There’s some really great DNA here and I hope that I’ll have the ability to actually push it forward and really make a difference.
Guerra: That’s great, Joel. I want to thank you so much for your time today.
Vengco: Thank you. It was a pleasure.
Guerra: Great. I’ll be in touch in the future. Hopefully, we can do some other things together.
Vengco: That’d be great. I would look forward to that.
Guerra: Thanks a lot. Have a great day, Joel.
Vengco: Thanks, you too. Take care.