Starting a new CIO role just as an organization is going live with an EHR system can be a mixed bag. On the one hand, a lot of the heavy lifting is done; but on the other hand, there’s an intense post-go-live period during which the staff needs constant support. For CIO Jeff Brown, who joined Lawrence General in 2012, this tumultuous time was an opportunity to leverage the skills he learned working in other areas of the industry. In this interview, Brown talks about his exciting first year as CIO, the pressure to do more with limited resources, his plans to develop an integrate care model, and why he still sometimes needs a “phone-a-friend.”
- The “transformational” Mass HIway
- Merrimack Valley’s single-node model
- The MU 2 Bucket
- Eyeing 100% CPOE adoption
- Optimization steering committees
- Starting CIO role as Paragon went live
- “Boots on the ground”
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The Merrimack Valley Collaborative could ultimately move to what they call a single-node model where one of the entities will decide to hold all that data and be the administrator and the agreed upon arbitrator of how that data is going to be parsed and shared within the community and with other institutions.
HIE and interoperability and data sharing is an evolution. It takes years to establish and it takes years to figure out the business models and the financial viability on how to make it sustainable.
We have multiple optimization teams that are constantly trying to improve the system, make it easier for physicians to order, build out robust order sets, and find ways to introduce more complex and more helpful ways of clinical decision support.
Over time, as we provide better support and better training and we target specific department and hospitals for training that meets their specific clinical workflows and needs, I think we’ll continue to see that climb in adoption.
There’s that very intensive three-to-six-month window where it’s still boots on the ground; it’s having the teams and the vendor that went through the implementation still being around and still being kept on their toes to make sure that those things can get addressed very quickly.
Gamble: Not only are there different HIE landscapes in every state, but also within some states. In terms of the Massachusetts HIway, is it a collection of smaller HIEs or regional HIEs? Is that how you would describe it?
Brown: I think the Mass HIway and the work that they’re doing is really incredible. I do think it’s transformational and it’s going to benefit the state, the providers and the patients who everyone is trying to serve. I think there are various models that are forming. Some of the large, leading academic medical centers in downtown are finding ways to house the data and host it locally with robust data use agreements. And I think what you are going to see throughout the state — just like what’s happening in our Merrimack Valley community — is we’re going to start off small and each one of the partners is going to be responsible for sending that data directly from their own institutions up to the HIway. I do see a day where the Merrimack Valley Collaborative could ultimately move to what they call a single-node model where one of the entities in the Merrimack Valley will decide to hold all that data and be the administrator and the agreed upon arbitrator of how that data is going to be parsed and shared within the community and with other institutions within the state.
But again, that maturation process will take time. And I think there’s a lot of governance and structure that needs to be put in to place around what are the administrative rules and policies that we can all agree on; what are the data governance structures and decision-making bodies; what are going to be the data use agreements that are put in place; what are all the standards around nomenclatures and terminologies; and how do we want to collectively agree to view all this data — not only within our own Merrimack Valley HIE, but as we send and receive data. So I think we’re off to a great start and it’s a great first step. I think we’re in the same position that a lot of other hospitals throughout the country are in in saying let’s find a way to effectively and efficiently begin data sharing across the state HIE, and then let’s find ways to really optimize that and then really expand our reach.
Gamble: And it’s something that really is going to be an ongoing thing for quite a while, because you have to figure out how this is going to be done at each individual level. I think we have to get ready for a long ride with that.
Brown: Exactly. I think HIE and interoperability and data sharing is an evolution. It takes years to establish and it takes years to figure out the business models and the financial viability on how to make it sustainable. And at the same time you’re going through that evolution, you’re constantly having to adjust to the changing business demands and the markets of the healthcare industry in general. And so as you’re trying to climb that HIE mountain, you’re also adjusting to change your trajectory and how quickly you should move.
Gamble: Very interesting stuff. Now as far as some of the other initiatives on your plate — because I’m sure you’ve got a full plate — where do you stand with CPOE?
Brown: I put CPOE and a lot of these other initiatives into the Meaningful Use bucket. In terms of physician order entry for Meaningful Use Stage 2, the goal that everyone is going to be shooting for is increased adoption and adherence to things like medication orders and departmental orders. Here at Lawrence General, we’re constantly striving to increase the level of adoption and usage around our physician order entry system, and that’s not always an easy project to tackle. And so behind the scenes, we have a whole CPOE steering committee and team, and we have multiple optimization teams that are constantly trying to improve the system, make it easier for physicians to order, build out robust order sets, and find ways to introduce more complex and more helpful ways of clinical decision support.
Like most other institutions, we have a strong partnership with our hospitalists here and our physician leaders. We meet weekly on ways to continually try to improve our CPOE system and the level of adoption. It’s really about meeting the demands and the needs of the physicians and clinicians in our hospital. And so as a CIO and from an IT perspective, we’ve really forged a great partnership and are working hand in hand to make that successful.
Gamble: In terms of CPOE and getting those adoption numbers up, what would you say is the biggest challenge?
Brown: I think the biggest challenge for us specifically as an institution is that physician order entry is still relatively new to us. We’ve only been live for a little over a year and a half. We’ve had great success on the adoption front and with the engagement from physicians, but we are not at a 100 percent physician order entry adoption, which is where we’d like to be.
Again, I put it into the same bucket as many other things — it is an evolution. And so I think over time, as we provide better support and better training and we target specific department and hospitals for training that meets their specific clinical workflows and needs, I think we’ll continue to see that climb in adoption.
Gamble: It’s certainly something that’s a challenge for a lot of organizations. Now when did Lawrence General go live with McKesson Paragon?
Brown: It was approximately a year and a half ago.
Gamble: Right when you started a CIO?
Brown: Yeah, I was in the fortunate position where when I started here CIO back in April of 2012, they had basically just gone live.
Gamble: That is an interesting spot to be in, one that I’m sure has pros and cons.
Brown: Right. For someone who has been through many implementations at many different kinds of facilities, the good news is that I was prepared for what that classic six-to-eight month post-go-live window looks like. I understood what the challenges were going to be around system performance and uptime and really learning the culture of the vendor and how to manage that relationship, and then knowing the importance of how to set up both IT and clinical informatics teams that were going to be needed in the short future to really work on optimization. The good news is all that structure and function came together very nicely in a very collaborative and efficient way.
Gamble: One of the big issues with going live, I’m sure, is change management — getting people used to a different system and dealing with some of the workflow challenges. How did you address that?
Brown: There’s that three-month intense period that happens after go-live where I think frankly both the vendor and the client always try to do their best to nail down all the main workflows and life cycles that occur between documentation and all the different types of orders. But it’s the 80/20 rule, and so you’re left with that 20 percent that’s going to need to be quickly modified and managed and optimized. And so I think that like most other implementations that happen at any organization, there’s that very intensive three-to-six-month window where it’s still boots on the ground; it’s having the teams and the vendor that went through the implementation still being around and still being kept on their toes to make sure that those things can get addressed very quickly. And so rapid change cycle and change management processes need to be put in place to tackle the very critical components that effect quality, patient safety, or financial risk to the organization.