Although Steve Shirley believes the 30 years he spent in banking was a “great prep career” for health IT, he admits he still had a lot to learn when he took the helm as CIO at Parkview in 2009. So he decided to start rounding to strengthen his knowledge of all things clinical, and he hasn’t stopped. In this interview, Shirley talks about the paradigm shift required to migrate to Meditech 6.0, how he’s working to bridge the gap between the IT and clinical worlds, his mobile device management strategy, and the “progressive” HIE landscape in Colorado. He also discusses his journey from board member to CIO, and what Parkview is doing to bolster the healthcare workforce in the Pueblo area.
- CoRHIO’s progress
- Case management & frequent ER flyers
- Six Sigma black belt
- 30-year prep course in banking — “We were change merchants”
- Joining Parkview’s board
- Clinical rounds — “You’ll never find me in my office”
- Building the Pueblo workforce
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In the early days, not a lot of value was seen by doctor’s offices, labs, pharmacy, and anybody that might access it, because there just wasn’t enough saturation of the market. But now that we’re all on it, we’re starting to see some exciting stuff.
We’ve gone into the ED looking at workflows and process flows and how we can triage different levels of patient acuity to try to move things quicker through that process. All those things are going to be beneficial as we keep moving down the road.
I found that every time I’d leave a board meeting, I was so excited and so keyed up about what was happening in healthcare.
Banking is a great prep career for healthcare, because in the banking universe data security was infinitely at a higher level. The rigidity of regulatory oversight was very, very extreme, and so a lot of things we did in the banking side have translated for me very nicely into healthcare and what we’re trying to accomplish here to protect patient data.
Because people are so bright and intelligent, they figure out their own work around, and so oftentimes, problems don’t get reported until frustrations arise. It’s amazing — as you round, you find little things here and there that can be fixed in five minutes.
Our CEO has such a phenomenal commitment to the employees and to the patients. He’s one of those guys you’d go through a brick wall for if you could.
Gamble: One of the other topics I wanted to touch on was HIEs. Parkview is involved in CORHIO, correct?
Gamble: How long has that been? Is that something you’ve been involved with for a while, and how has it worked for you? Is it fairly successful? I know that with HIEs and RHIOs, there is a pretty huge variation with success rates.
Shirley: There really is. We’re fortunate. It’s my own opinion, but I think we’re fortunate in Colorado because we have a very, very progressive HIE with CORHIO. It’s been fun to watch that growth because we’ve been live with the system shooting data up to CORHIO for almost two years. The penetration rate across the state is now to the point where every major hospital is live with CORHIO.
In the early days, not a lot of value was seen by doctor’s offices, labs, pharmacy, and anybody that might access it, because there just wasn’t enough saturation of the market. But now that we’re all on it — in Pueblo, for example, both major hospitals are on it as well as the community health center —we’re starting to see some exciting stuff. As an example, the data that we send up every day, when the community health center pulls it down, it helps them to manage cases for frequent visitors to the ER. And they’re also their patients, so that’s very good for us.
We’re starting to see many more doctors’ offices pulling the data in. The obvious result of that is less redundant testing and less rescheduling of appointments. It has really gone well, once we’ve started to get the mass number of hospitals going live and getting that data flowing. There’s a lot of work to do — we still don’t do meds rec or anything like that on the system, but everything that we’re moving across, which is all the rad reports and lab and transcription and those kinds of things, just works really well.
Gamble: It’s a good thing to hear because you have 50 different states with 50 different models and there are states where it’s just been a struggle. It seems that CORHIO is one of the success stories, so that’s a good thing.
Shirley: Yeah, I feel the same way. The folks that I work with at CORHIO are just some of the brightest people and they’re very passionate about what they do, and so it’s made the project go very well.
Gamble: You talked about the high number of patients who use the ER for primary care. When you talk about trying to cut down on that and avoid readmissions, it’s such a huge thing to tackle. What are you doing in that area or what plans do you have?
Shirley: We’re a 350-bed hospital, so when you translate that to the number of ER visits, it’s pretty high for us. Things like the community health center piece will prove to be very valuable for us. A significant number of their patients are also coming to our ED, sometimes two and three times a week. So as this thing ramps up more and more, they are starting to get very active doing case management to reduce those visits.
The other thing we’re doing is that our ED staff, along with some folks from IT, is really starting to look at workflows. We have a performance improvement team here at the hospital called A1PEX (A1 Patient Experience), along with Six Sigma black belts and people highly trained in performance improvement, so we’ve gone into the ED looking at workflows and process flows and how we can triage different levels of patient acuity to try to move things quicker through that process. All those things are going to be beneficial as we keep moving down the road with this thing.
Gamble: It’s an enormous undertaking but obviously one that you have to take steps toward.
Gamble: Okay, so talking a little bit about your own background, you mentioned that you were on the board of Parkview a few years ago, and that was prior to becoming CIO. Before that, you were in the banking industry?
Shirley: That’s correct. I actually spent just shy of 30 years in the IT side of banking. Four years ago this week, I had the opportunity to join healthcare.
Gamble: So you already had somewhat of an interest in healthcare, I would imagine, being on the board.
Shirley: It’s a great story. In 2007, the CEO of the hospital come to my bank and asked me to be on the board, needing some IT representation. I found that every time I’d leave a board meeting, I was so excited and so keyed up about what was happening in healthcare. It just made everything so much fun to do. The hospital decided to bring in a CIO — they hadn’t had one for a while, and so after I’d been on the board right around three or almost four years, the CIO position became open. I applied and had the success to be able to be the guy picked for the job, so that was good.
Banking is a great prep career, I think, for healthcare, because in the banking universe data security was infinitely at a higher level than it has been in healthcare. The rigidity of regulatory oversight was very, very extreme, and so a lot of things we did in the banking side have translated for me very nicely into healthcare and what we’re trying to accomplish here to protect patient data. The other thing is in banking, to use the old cliché, we were change merchants. We very quickly had to fly through new product opportunities and things just stay in a very competitive position. That’s kind of helped also in the healthcare side, not that they weren’t willing to embrace change but certainly understanding what it looks like and how to shift cultures to accept change has been fun for me to get involved with.
Gamble: That’s really interesting. It was a bit of risk that the organization took and a risk for you, but obviously it has worked out. How was the learning curve as far as taking on a CIO role?
Shirley: Interestingly enough, since I had been a CIO across my last few banks, there was just a whole lot of it that was very much the same as what I experienced in banking. I think for me, the most critical piece was really to begin to understand and embrace the clinical side and how the physicians, nurses, all the ancillary departments fit together. In my opinion, healthcare software is much more complicated than banking software. And so I think for me that was part of the learning curve, just to understand the wealth of different software packages and interfaces and the flow that goes through a hospital from admission back into the revenue cycle side. That was a bit of a curve, but it’s gone very well.
Gamble: As far as getting familiarized with the clinicals, were there people that you turned to? Did you have go-to people you could pick up the phone and talk to when you had questions? How did you do that?
Shirley: I’m one of those guys that you find in my office very seldom. I round the entire hospital, as do all senior managers, but I round in patient rooms and in every clinical department, just spending time with folks and talking about their issues and their flows and things that concern them and things they’re excited about. I also have a very strong group of folks. The department directors in each of the areas are very willing to sit down and help a nonclinical guy pick up some information. It went well from that perspective.
Gamble: And do you still do a lot of rounding?
Shirley: Absolutely. It’s the most powerful thing I do, in my opinion.
Gamble: That’s the best way to know what’s going on and really get the pulse of the staff, and even the organization.
Shirley: It really is. And I’ll tell you, it’s amazing the little things you see. It was no different than in my banking world where folks have a problem with a system or a problem with software, and because people are so bright and intelligent, they figure out their own work around, and so oftentimes, problems don’t get reported until frustrations arise. It’s amazing — as you round, you find little things here and there that can be fixed in five minutes that help somebody out and make their day a little brighter. It’s been fun.
Gamble: That’s a very interesting perspective. I don’t get to talk to a lot of CIOs who came from banking, so that’s pretty cool. Now long have you been in the Pueblo area?
Shirley: It’s interesting; I’m one of those people who have had a lot of job opportunities outside, but I have literally been in this community my entire life outside of college. That’s probably another value I have going for me — when you live somewhere so long and become involved in the community, you tend to know a whole lot of people. And so I think that’s been very advantageous for me, because interestingly enough, I used to bank this hospital from the IT side and so I knew a whole lot of the folks and have worked with them for many, many years. It all played into a nice picture.
Gamble: From some of the background reading I did, it seems like Parkview is really invested in the community and building the work force. Being somebody who’s been a local for a while, I’m sure that’s important to you as well.
Shirley: It is. Parkview today is the largest employer south of Colorado Springs in Colorado. We are certainly, in this county in the southern half of the state, the biggest employer. There’s a lot of responsibility that goes with that to take care of those lives and their families, so we’re pretty proud of that fact. We continue to grow so it’s interesting in times with challenging reimbursement issues and payment systems.
Gamble: As your organization grows, it’s smart to make sure you’re building that work force and giving people an opportunity to work right in the area.
Shirley: It is. It’s important. I think today, we enjoy about a 70 percent market share in our city, and so we’re certainly finding the best and brightest whenever we can. Our CEO has such a phenomenal commitment to the employees and to the patients. He’s one of those guys you’d go through a brick wall for if you could.
Gamble: That’s a good thing. Hopefully, you’ll never have to.
Shirley: Hopefully, I’ll never have to.
Gamble: Alright, well I don’t want to keep you too much longer, but I want to thank you so much for your time. I hope to check back in with you in a little bit and maybe talk a little more about all the good work you’re doing there.
Shirley: That would be great. For me, it’s one of those things where I wish I could have been here 20 years ago, because it’s absolutely the most incredible thing I’ve done career-wise. And so it’s a lot of fun to come to work everyday.
Gamble: You picked an interesting time though to be in this field.
Shirley: It’s interesting; people have told me I’ve picked the perfect time to leave banking and the worst time to enter healthcare. So it’s kind of a mixed bag when you look at it.
Gamble: I guess it all evens out.
Shirley: There’s no question about it.
Gamble: All right, well thank you so much, and we’ll catch up with you again soon.
Shirley: That sounds great.
Gamble: All right, thank you.
Shirley: Thank you.