They’re the words every CIO dreams of hearing: “Thank goodness we had an EMR.” When a new building sustained fire damage a few years ago, it could’ve been devastating. But because Franklin Community Health Network’s last clinic had just gone live, not a single record was lost, and CIO Ralph Johnson was given an opportunity to assess the organization’s disaster recovery plan and to revisit his device management strategy. In this interview, Johnson talks about leveraging partnerships with large health systems while remaining a standalone, why a CIO’s best strategy is to make a recommendation — and then step back, the risk small organizations take on with ACOs, his work with the ConnectME Authority, and why he has no regrets.
- Walking the line: “You can’t tell physicians how to practice medicine. You can provide tools and offer advice.”
- eICU work with MaineHealth
- “We’re very creative and innovative in how we keep our costs down.”
- ACO risks for standalones
- Reducing FTEs to stay under budget
- Weighing M&A possibilities — “The board feels torn”
- Attesting to MU
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I’ve been doing this for almost 30 years now, and what I’ve come to learn is that you cannot tell physicians how to practice medicine. You are providing them tools and offering them advice, but in the end, you’re facilitating their work flow.
If we end up sending that patient another hour and a half away, you think about the burden on the families of having to travel that far. For us, being able to keep those patients in our community is a benefit
Because we’re a stand-alone, $85 million-a-year health system, we really don’t have enough volume to take on risk in an ACO environment. We know that we’re going to need to partner with somebody much larger than us. The question will be how much larger
That’s what’s going to help us become attractive to join or to be part of somebody else’s network in the future — if we can be very efficient and very cost effective.
The board is ultimately responsible for what direction we’ll go, and I think they feel very torn about having this resource in the community and how it should be managed — that we’re not being managed by some big corporate headquarters far away. They want to maintain that connectedness to the community.
Gamble: If it’s something where you really disagreed, that would have been probably handled differently, I imagine, and you would have had to say, ‘I really strongly feel that this is the wrong path.’
Gamble: But luckily it didn’t get to that.
Johnson: No, it didn’t, and we have made some difficult decisions. We also implemented T-System in our emergency department, and that is not integrated very tightly with our Meditech hospital system. There’s a lot of history there that has nothing to do with the vendor. I was quite adamant about what the consequences would be. They accepted that, and it’s one of the situations where I don’t have to remind them when I get complaints.
Gamble: It’s a difficult position for you to be in; you want them to be able to have the systems they want, but you always have to deal with that issue of integration.
Johnson: Right. I’ve been doing this for almost 30 years now, and what I’ve come to learn is that you cannot tell physicians how to practice medicine. You are providing them tools and offering them advice, but in the end, you’re facilitating their work flow.
Gamble: I think that’s a key thing to remember, especially when you’re dealing with specialists and physicians who are at the top of their field and are very good at what they do. I think it’s a fine line that has to be walked by the CIO.
Gamble: Being in a pretty rural area, are you involved in any type of telemedicine efforts at this point?
Johnson: We’re doing a few things. One that we currently use is MaineHealth Vital Networks, which is another good example of collaboration. We have five ICU beds and they are monitored electronically by an ICU staffed by MaineHealth in Portland so that we get intensivists that are actually covering our patients. It’s a cooperative agreement that I believe eight or nine other hospitals are in on, along with MaineHealth. So that’s an active telemedicine initiative.
Our really critical need right now is child psychiatry. We’re in the process of trying to work with a few organizations to see if we can line something up, because there are kids who need help, and need help right away. Getting that help to them is difficult, and it is very difficult to recruit a child psychiatrist. There just aren’t enough of them in the area.
Gamble: I imagine that does present challenges though, as far as getting the technology in place on the patient side.
Johnson: Yes, although things have changed so much over the years. We could do it with something as simple as Skype. Skype is encrypted so we can have ourselves covered from a HIPAA point of view. That’s another aspect of being in a small, rural — we’re very creative and innovative in how we keep our costs down while still taking advantage of the technology around us.
Gamble: You’re forced to really be able to come up with solutions that are going to work within a budget, so it forces you to be a little more innovative, I guess.
Gamble: How long have you been doing the eICU initiative?
Johnson: About six years now.
Gamble: It’s one of the uses of technology that really makes so much sense, especially when you’re talking about the distance between facilities in areas like Maine.
Johnson: We have patients within Franklin County who will drive an hour to the hospital. If we end up sending that patient another hour and a half away, you think about the burden on the families of having to travel that far. For us, being able to keep those patients in our community is a benefit to the community.
Gamble: What type of technology is being used in the eICU?
Johnson: It’s pretty straightforward. There is a mini-server in each ICU room and it operates a camera. There is a hot button, kind of like a red button on the wall underneath the cover; when you hit that, it will alert the eICU that you need immediate attention in that room. We run a dedicated 10-meg circuit so it’s all IP-based. The camera is mounted near the ceiling on the opposite wall near the foot of the bed, and it has a high enough resolution that when it connects, we can zoom in and see the color of your nails in your hand. So they can do some pretty good diagnostics there. In addition, all the telemetry equipment for the heart rate, pulse oximeter, and blood pressure is all being fed real-time over that data circuit to the software that’s run down at MaineHealth. The computer system is doing analytics on the data as it comes in so it can alert the providers down there of any dramatic changes in a patient’s condition.
Gamble: That whole concept is something that’s very interesting to me and is a really interesting use of technology.
Johnson: We’re quite happy with it.
Gamble: You touched a little bit on ACOs before. What are you doing in that area right now or what are you looking to do?
Johnson: I joke sometimes that we’re putting on lipstick to try to look pretty to the other groups. Because we’re a stand-alone, $85 million-a-year health system, we really don’t have enough volume to take on risk in an ACO environment. We know that we’re going to need to partner with somebody much larger than us. The question will be how much larger and how much bigger. Luckily, I get to go to many of the board meetings around this topic, so I know that we’re considering what all the options are. We’re trying to look at what Franklin Memorial Hospital looks like five years from now as we make this transition from fee-for-service to an accountable care model. It’s going to all be about risk.
Gamble: Yeah, that’s such a big issue that we’re seeing with so many organizations right now. With so many initiatives and projects, a big part of it is the risk you’re taking on, especially as a small organization. Do you feel like there’s a little bit more pressure for smaller organizations?
Johnson: I really think our focus right now is on cost. That’s what’s going to help us become attractive to join or to be part of somebody else’s network in the future — if we can be very efficient and very cost effective. I think most hospitals in Maine right now are feeling a decline in volumes and an uptick in charity care and bad debt, and so we’ve been forced to do some major cost cutting these past few months.
Gamble: When you talk about the cost cutting, which areas are being hit the hardest?
Johnson: We’ve reduced 40 FTEs across the organization, primarily in administrative and overhead areas as we’re trying to be more efficient. I know I’m responsible for quality and medical records as well as the IT function here, and across those three areas, I have reduced five FTEs. It’s tough in a small community to be laying people off.
Gamble: When you talk about the future of your organization, it looks like at some point you’ll probably look into some type of merger or acquisition but is this something where you’re really kind of looking to stay independent for the time being? Are there factors that give you hesitancy about joining a bigger system?
Johnson: So there are two answers. I think the board is ultimately responsible for what direction we’ll go. And I think they feel very torn about having this resource in the community and how it should be managed — that we’re not being managed by some big corporate headquarters far away. They want to maintain that connectedness to the community. For me personally, I came from MaineHealth — I was the CIO at Maine Medical Center before I came here, and I came here for a quality of life choice. But I loved working in a larger system, for a larger organization, so I’ll be adaptable either way. They both have their ups and downs.
Gamble: Yeah, and I’m sure it’s something that has to be in the back of your mind, especially as we’re seeing so many mergers and acquisitions with health systems. That’s definitely a trend across the country right now.
Johnson: Absolutely. Like I said, how big is big enough for that risk? That’s what will be interesting to see.
Gamble: In terms of Meaningful Use, where do you stand at this point?
Johnson: We’re actually pretty far along. We qualified in the first year. For the hospital, we received our first and second Medicaid payment and our first Medicare payment. We’re now in the full year process of qualifying for the second year of Medicare. That will close at the end of September. The practices are a little bit slower to come along because we’ve also been focusing on patient-centric medical homes, so that’s competing with trying to qualify for Meaningful Use.