Most people would be surprised to learn that UMass Memorial Healthcare was a late starter in the EHR game. But while the organization is behind the curve in some respects, it’s leading the way in others, boasting innovative initiatives such as a diabetes-focused portal and an eICU. In this interview, CIO George Brenckle talks about what’s like to play catch-up, how UMass become a best-of-breed shop by default, his three-pronged approach to ICD-10, and the momentous task of cleaning up data . He also discusses his social media strategy, and his “backyards without fences” leadership philosophy.
- Pushing the envelope
- Partnerships with independent docs & community facilities
- “I never wake up in the morning and say, ‘what am I going to do today?’”
- Social media support
- His leadership philosophy: “Backyards without fences”
- Slowing down change
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You can improve quality of care, you can improve your reach, and you can improve your efficiency and effectiveness with some focused initiatives at the same time you’re building that core infrastructure.
How do we provide the things that help us incorporate that information and don’t require a clinician to go to multiple systems to pull together everything he needs to appropriately treat the patient? We’re not there yet. We’re on that journey right now.
It has to be a partnership between the two organizations. I think the marketing and communications groups have to play a major role in how you use this technology.
It’s about trying to make sure we don’t become too hierarchical and too concerned with things like, ‘I can’t do that because that’s someone else’s turf.’
When you follow those rigid rules of chain of command and you don’t go outside of your area or your silo, that doesn’t position an organization to change rapidly. That actually slows down change.
Gamble: That’s something that obviously can make great strides in terms of patient engagement and portal use, and hopefully can be applied to other specialties or in other areas as that becomes a requirement.
Brenckle: Correct. So that was something that’s kind of nice, and again, it’s an example of where we pushed the envelope a little bit. It doesn’t get away from the fact that we still have some catching up to do on the core infrastructure, but you can get some benefit out of things if you pick your moments. You can improve quality of care, you can improve your reach, and you can improve your efficiency and effectiveness with some focused initiatives at the same time you’re building that core infrastructure.
Gamble: And like you said, having the link with Allscripts is key. It could be something that’s a best practice that other organizations can piggyback on.
Brenckle: That is one of the challenges. And again, if you take the single vendor approach where everyone uses one system and everything is in one system, that’s an advantage. We, by definition, ended up where we’ve got a multi-vendor environment, so part of what we have to recognize is that we have got to make sure we can move information and provide it in the appropriate setting for the appropriate physician.
That in and of itself is a challenge, but also when you look at our environment, I mentioned all the parts that make up the healthcare system, but in addition to that, we have a very large independent physician community in the area, plus we have multiple community health centers in the area that all use different systems, yet we’re engaged and we partner with them in the treatment of patients. So how do we provide the things that help us incorporate that information and don’t require a clinician to go to multiple systems to pull together everything he needs to appropriately treat the patient? We’re not there yet. We’re on that journey right now. I think we’re slowly beginning to make things better, but it’s the challenge we stepped up to, in fact, when we made the decision to be a multi-vendor environment.
Gamble: I’m sure in a lot of ways it would be easier to just have that one system across the board, but that comes with a huge set of challenges, too, one of them being that you’re going to make some people pretty upset who are happy with the systems that they have.
Brenckle: Correct. If you’re a closed system; if you can be totally vertically integrated and say everything is within my control, and therefore, if it’s my patient, they’re in my single-vendor system, and if they’re not in my single vendor system, it’s because they’re not my patient and I never see them — that’s great. But when you’re in an open system where you’re treating a patient and his primary care doctor may be outside your system and you need to collaborate and communicate well across that boundary, you need to be able to pass information back and forth. So health information exchange is critical for us.
Gamble: Now at this point are you involved in the state HIE?
Brenckle: We’re working with the state HIE and we’re also in the process of building the capability for us to manage our patients — being a multi-vendor environment, we need to have a place where we can pull together and aggregate all the data, whether it is collected in the ambulatory setting, collected in one of our emergency rooms, or collected at a community health center. We need a place where we can pull that information together and get a single view of the patient.
Gamble: That’s the big challenge, I guess, right?
Brenckle: Yes. I never wake up in the morning saying, ‘What am I going to do today?’
Gamble: I can imagine. Another issue that a lot of CIOs are struggling with is patient engagement; not only what needs to be done right now, but what’s going to be required down the road. I know that there are some organizations that are looking to social media to increase patient engagement and I know that that can be kind of a sticky issue. Is that something that you’re dealing with at this point or are looking into?
Brenckle: Actually we’ve done some stuff with social media, and not necessarily with IT. This has been in partnership with our marketing department. I have someone in the marketing department I work with, so we have a Facebook presence and we have a Twitter presence. He and I participated in a community panel in Boston where we talked about using social media in healthcare. It was fun, because he and I were a partnership and they asked me what I did with social media. I explained that I have a Twitter account and I have 30 followers, which is pretty interesting considering the fact that I’ve never actually tweeted — I don’t know why they’re following me because I’ve never said anything.
But very much, it has to be a partnership between the two organizations. I think the marketing and communications groups have to play a major role in how you use this technology. We did two things; one of which we looked at from the standpoint of, with social media being out there, what are the issues and aspects and what do we need to tell all our employees about the appropriate use of social media. We’ve all read the stories of nurses or clinicians who have taken pictures of their patients and posted it on their home Facebook page, so we’ve done a lot to say, here’s the appropriate use of social media and here are the do’s and don’ts of social media from the employee standpoint. And then the other part of it is, how do you use it from an organizational standpoint?
Gamble: Yeah, you really have those two different components that need to be addressed.
Brenckle: That’s correct. The interesting thing about it is that from the organizational standpoint of ‘these are tools that are out there,’ the marketing department doesn’t really need me to support Facebook or Twitter or those kinds of tools. So again, it’s been something that we’ve started to work into, but it hasn’t necessarily something that’s been driven by IT. It’s just we’ve played a supportive role.
Gamble: And like you said, even though it’s not driven by IT, it is something where it’s smart to know what’s going on and to have some sort of involvement.
Gamble: So I wanted to switch gears a little bit and talk about leadership. Last year, Anthony Guerra, our editor-in-chief, spoke with Karen Marhefka, who was with UMass at the time. She talked about your leadership style and said that you use an expression called ‘backyards without fences,’ and I wanted to just talk a little bit about that and how you approach being a leader, especially with having a particularly large IT staff.
Brenckle: Right. What I mean by that is, again, it’s fundamental of the fact of being a relatively flat and matrixed organization and people feeling empowered to talk to who they need to talk to and do what they need to do in order to help us move our work forward, and allowing people that flexibility. Generally it’s about trying to make sure we don’t become too hierarchical and too concerned with things like, ‘I can’t do that because that’s someone else’s turf,’ — that type of thing. The goal was to create a collaborative environment and encourage people to reach out and work with their peers, both within the department and outside of the department.
The interesting thing about it, I found, is that there are two reasons to put fences up: One is you don’t want anyone in your backyard, and the other is you’re afraid to go in anyone else’s backyard. And I’ve actually found the second part to be more of a problem than the first. I’ve actually found people have been okay with people reaching out to them, but the scary part is reaching out to someone else. And so it’s a little harder to go into someone else’s backyard and introduce yourself than it is to be open to someone coming into your backyard. It’s a question of who makes the first move.
Gamble: Absolutely. I think that in a lot of organizations it’s easy to get tied to the whole idea of the chain of command: ‘this is what you do when you have this question.’ It seems like it could be very effective to open that up a little bit, but I guess it has to come from the top-down.
Brenckle: Yes, and you need to set that example. You need to encourage it where it happens and you need to reward people for reaching out, because the worst thing is you do it and then you get your hand slapped, and you’re not going to do it again. Being relatively open and being willing to move in that direction is important. When you think about going through a period of rapid change, which clearly all of healthcare is doing right now, you can’t afford not to do this, because when you follow those rigid rules of chain of command and you don’t go outside of your area or your silo, that doesn’t position an organization to change rapidly. That actually slows down change. And so I think the necessity of this across healthcare right now is really important.
Gamble: It helps people become open to different ideas too, and different approaches, especially when, like you said, you do have the all hands on deck right now.
Gamble: Well, we’ve covered a lot. I didn’t know if there was anything else you wanted to talk about, but I think I got through most of my questions. I just wanted to thank you again. I really appreciate you taking the time to speak with us. It’s very interesting to get your perspective and hear about everything you’re doing up there.
Brenckle: Thank you.
Gamble: Hopefully we’ll be able to catch up down the line and see how everything is going with all of your big projects.
Gamble: All right, well, thank you and enjoy the rest of your day.
Brenckle: Okay, I’ll talk to you later.