Since becoming CIO at Albemarle Health in 2005, Stephen Clark has made great strides in helping to advance the organization. But for facilities based in rural areas, it’s becoming increasingly difficult to compete, which is why Albemarle is turning to Sentara Healthcare to help strengthen its presence in the community. If the deal goes through, it could be a game-changer, says Clark, who offers his thoughts on the challenges of recruiting and retaining staff in a rural area, the importance of transparency, and the telepsychiatry HIE that is setting the gold standard in North Carolina. He also talks about the hurdles to CPOE adoption, his biggest beef with MU, and the pains of dealing with seasonal fluctuations in patient volume.
Chapter 3
- HIE landscape in NC
- NCHA’s population health work
- CIO collaboration — “We have a very cohesive group.”
- From central PA to coastal Carolina
- The daunting task of recruiting talent
- Uncertain future
- Dreams of sommelier school – “the cork dork”
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As a country and as a health delivery system, we still have not really tackled mental health issues the way we need to. They’re typically not funded or underfunded, and it’s desperately needed.
I’m not going to sit here and play Monday morning quarterback on what decisions were made and everything else, but let’s just say that it didn’t get a groundswell of support.
There’s a lot of activity in the state, but I don’t know if we’ve really come up with a gold standard for the way we’re going to be doing information exchange. It’s been said that what we’re trying to do with this telepsych program is more or less going to be the tipping point.
We’re starting to see some turnover just because of some of the uncertainty of our future. It’s going to be almost impossible to try to recruit people in.
I need to provide leadership here, and I think if staff sees that their leader is picking up my marbles and going somewhere else, that doesn’t really exude a lot of confidence.
Gamble: That’s a really interesting thing not only because some patients have to travel hours just to get an appointment but from everything I’ve been reading, it can take two or three months to get an appointment if you have to show up in person. This just seems like a really good way to use technology to look at this huge problem.
Clark: I would say in the end, as a country and as a health delivery system, we still have not really tackled mental health issues the way we need to. They’re typically not funded or underfunded, and it’s desperately needed. This program does help. It does give services to those that are in crisis, but I don’t necessarily know that it’s being more preventive than it needs to be; that it’s promoting good mental health. That’s still a problem yet to be solved. But in the meantime, we try to look at what’s happening in our emergency departments and what tends to be issues for the community, because when these patients do come in in crisis and they are escorted by law enforcement, law enforcement has to stay there with them until we disposition that patient one way or the other. It’s not only a cost to us as a hospital, but it’s a cost to the community as well.
Gamble: Is this HIE connected to a statewide initiative? I don’t know what the HIE landscape looks like in North Carolina as far as if there is one or if there are a couple different ones. What does that look like?
Clark: Well, that’s a loaded question. There was a North Carolina Health Information Exchange created about two or three years ago out of the Department of Health and Human Services. I’m not going to sit here and play Monday morning quarterback on what decisions were made and everything else, but let’s just say that it didn’t get a groundswell of support. We have a number of large hospitals and systems that are on Epic or implementing Epic, and they all want to be able to leverage that technology for health information exchange. Of course that doesn’t help those of us that are not on an Epic platform, and so we’ve been looking toward solutions that can help provide better electronic commerce.
Now, there are a couple of RHIOs in the state that are serving very specific communities. We’ve been in contact and dialogue with them. There’s one in the western part of the state called DataLink. There’s one down near Wilmington, N.C., called Coastal Connect. There’s another one, I believe, that Novant runs for their system, which covers a fairly broad geography. And the North Carolina Hospital Association is facilitating an exchange as well, but in addition to exchanging data as a byproduct of an HIE, really what they’re looking for is basically to help facilitate population health information so that they can advocate for the hospitals in the state.
The bottom line is that there’s a lot of activity in the state, but I don’t know if we’ve really come up with a gold standard for the way we’re going to be doing health information exchange. It’s been said that what we’re trying to do with this telepsych program and the health information exchange is more or less going to be the tipping point that’s going to at least adopt a certain standard around how that’s going to be done. I have yet to see that. It’s yet to be proven out, but certainly as we’re looking at bringing on 80 percent of hospitals in the state on the telepsych program with the health information exchange, it’s going to set a groundswell of people adopting a certain standard.
Gamble: You touched on a little bit on the fact that there are a lot of needs as far as mental health goes. Depending on how this HIE shakes out, do you think it could be something that other states start to look at as a model?
Clark: Well, I don’t know. A lot of states do look at what we’re doing in North Carolina for some things. For example, I know that there are a lot of things we do around surveillance that I think a lot of other states are looking to North Carolina to see how we’ve done that. We do have a very cohesive group of CIOs in the state. We have an organization called NCHICA (North Carolina Health Information and Communications Alliance). They deal with a broad range of information needs for various stakeholders in the state. We do have a CIO roundtable as part of that where we meet quarterly and talk about things that are going on that are compliance‑related and things that are specific to North Carolina — how are we solving these problems in various other settings that we might be able to benefit from?
It’s a very congenial and collaborative group. We’ve set the pace for a lot of things related to HIPAA privacy and security. We have a very strong group of multi‑disciplines from around the state, and it warms the cockles of my heart when I see competitive systems sitting around the table trying to solve the same problem. They’ve got some real solid commitments from various professions around the state and various organizations to make it happen. So we do have a good story to tell in North Carolina, but there are some opportunities as well. I think other states are probably a lot further out of the gate on the health information exchange than we are here in North Carolina, but we’re going to catch up.
Gamble: I have to tell you, from talking to CIOs across the country, it’s not an uncommon thing for states to have not just multiple HIEs but ones that are aren’t really active. The picture is just not that clear in a lot of states, at least not at this point. So the last thing I wanted to touch on a little bit was your career path. You’ve been at Albemarle since 2005?
Clark: Yes.
Gamble: How did you come to that CIO role? What drove you to the organization or to the area?
Clark: Career-wise, I was at a point where I was ready to move up from let’s say the director level to more of the top IT guy, if you will, at an organization, and moving to a smaller community or smaller organization was appealing to me. I grew up in Central Pennsylvania, which is also very rural as well, and so rural communities aren’t anything that’s new to me, and there was an opportunity here. And I like being close to the water, so those are the things that attracted me here.
It’s been an interesting ride. I have worked in larger organizations. Before I came here I was with Christiana Care in Wilmington, Delaware, which has a very large IT department. I think there were about 300 people in the IT department when I left. Before that, I was with what’s now known as VCU Health System in Richmond for about 13 years or so. I’ve worked in larger organizations, and so it was quite a shift.
Some of the challenges that I have had — in addition to securing capital and operating funds, which I think I’ve garnered some success with — is just recruiting talent. This is not a community that has a base of readily available IT talent, let alone IT talent that understands and knows healthcare. Some of it has been ‘grow your own.’ With some of it we’ve been lucky and have been able to recruit some good people, but by and large, it’s been a tremendous challenge. We’re at a point now where we’re starting to see some turnover just because of some of the uncertainty of our future. It’s going to be almost impossible to try to recruit people in, so we are looking at doing some strategic outsourcing in some areas to keep things going, and we’ll provide some additional resources once we start our transition planning.
Gamble: That’s a really common thread we hear, just with being able to either recruit or hold on to good people, because sometimes once they get to a certain point they want to move upwards, and that’s tough. We’re finally starting to see some emphasis on building the work force, which is a positive thing.
Clark: Right. Now as far as my own career, I’m probably about 10 years from retirement. I don’t know what the future is going to be for me with Sentara or anybody else. Like I said, it’s been in the back of my mind, but I need to provide leadership here, and I think if staff sees that their leader is picking up my marbles and going somewhere else, that doesn’t really exude a lot of confidence in leadership. So I’m trying to hang in there, but the future is a little uncertain for me. I like being in that executive leadership role. How does the expression go? ‘It’s good to be king.’ I’ll look at other opportunities when the timing is right, unless something develops at Sentara that’s attractive to me. We’ll just have to wait and see. Time will tell.
Of course, these types of things are always an opportunity to reassess where one is in their journey and see if maybe there’s like a different course that you want to take totally unrelated to IT and healthcare. I have been seriously thinking about going to Sommelier School and branching out to doing more things with wine. I’m quite a wine aficionado. That may be something that I may consider doing at some point in time before I hang it all up and sit in a rocking chair.
Gamble: Is that a hobby of yours right now — one of the things you do to break away from work?
Clark: Oh yeah. They call me the cork dork. I’ve got a reputation around town. I usually get phone calls from colleagues saying, ‘Hey, can you recommend a wine? I’m doing this.’ Actually, I have two adult children who are in their 20s. Their birthdays are on the same week in August, and I’m taking them to Napa and Sonoma Valley next month for their birthday, so they’re going to be able to spend a week with the cork dork out in California wine country.
Gamble: That seems like a really nice way to spend a week. Now I have to ask — you said you’re from Central Pennsylvania. Where are you from?
Clark: Well, I grew up in Sunbury. I do have family that works at Geisinger Medical Center, so I’m very familiar with those folks up there.
Gamble: I asked because I went to school out there. I went to school at Bloomsburg.
Clark: Okay, I went to Mansfield. That’s where I got my undergrad.
Gamble: Right, part of the Pennsylvania state school system.
Clark: I’m a product of public education.
Gamble: I am too, so I certainly won’t knock that.
Clark: Where are you originally from?
Gamble: New Jersey.
Clark: Okay, but you went to Bloom.
Gamble: I did, and I really liked it. I actually spent more time in Pennsylvania after school. It was a good experience — very different from New Jersey, and different from being right outside New York.
Clark: Right.
Gamble: Well, I don’t want to take up too much more of your time, but I really appreciate you taking the time to speak with us. It’s been really interesting. You’re doing some great stuff there.
Clark: Thanks, I appreciate it.
Gamble: Unless there’s anything else you wanted to add, I’ll let you go, but thanks so much.
Clark: No problem. Call back if there’s anything else I can help you with.
Gamble: I will. Thank you.
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