Many people talk about the need to be flexible and able to quickly adapt, but to Paul Foelsch, it’s more than just words. Throughout his 13-year tenure as CIO at Mercy, he’s had plenty of practice, whether it was developing a disaster recovery plan during the 2008 flood, learning that McKesson was shifting its focus to Paragon — just as his team was implementing Horizon, or moving to Iowa, only to find out there was no local HIMSS chapter. Each time, Foelsch has been able to adjust his strategy. In this interview, he talks about the major decision his team faces, the organization’s focus on patient engagement, and why CIOs must be willing to look outside the industry for solutions.
- Piloting HIE
- Challenges with patient matching
- Mercy On Call
- Working with RelayHealth to connect docs & patients
- Patients embracing technology — “There’s going to be more of a demand for that.”
- Lessons learned in disaster planning
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One of the challenges has been in being able to match patients. Obviously that’s a major challenge in any health information exchange, but we’ve been able to bring in appropriate technologies and vendors to get some of that in place.
Physicians can call in and say, ‘hey I have a patient I need to refer for X, Y, Z condition,’ and be able to make the connection. So that’s one area that we’ve focused on for a number of years, and judging from the call volumes, that’s been very successful.
The patient is the driver on that, allowing the relevant information that he or she selects to be available for the physicians to review. So if they want to limit mental health visits, for example, that could be suppressed. The patient controls that.
One of the things I’ve always focused on and stressed has been having contingency plans — keeping the options open and having business continuity plans in place.
As with any type of event, we did major debriefs afterwards and looked at what worked, what didn’t, and how could we improve that.
Gamble: As far as connecting with other organizations throughout the state, what do you have in the way of Health Information Exchange?
Foelsch: Iowa has a health information exchange initiative in place and we’ve actually been working on that in various forms for a number of years. There are several pilots in place — and I’ve been on a few of the work committees for those — and we’re hoping to have that expand out during this next year. At this point, it’s been a little limited. One of the challenges has been in being able to match patients. Obviously that’s one of the major challenges in any health information exchange, but we’ve been able to bring in appropriate technologies and vendors to get some of that in place. I anticipate that we will begin participating in that sometime during this next year.
Gamble: Is there one statewide HIE in Iowa, or are there a few regional ones?
Foelsch: Fortunately, we have one in the state.
Gamble: That makes it easier, I would guess. It’s funny, you feel like you’re doing a checklist of the eight million things you have on your plate, but what about patient engagement? This is something that we hear a lot. Is it really a big priority for you right now? What are you doing to kind of get patients more involved, whether it’s through the website, portals, or other things?
Foelsch: We’ve actually been able to do a number of things. I would say it really focuses in three major areas. First, our longest standing patient outreach has been a program called Mercy On Call. It’s a call-in center manned by registered nurses, who have at their fingertips a lot of resources for medical conditions as well as access to scheduling and availability of appointments for various clinics, procedures, and so forth. They handle a wide range of calls, day and night, and interact with patients all around the area. It could be someone who says, ‘I’m new to town and I need a family practice primary care physician, but I’d prefer someone who specializes in this or that or is male or female,’ and the nurses there are able to direct them to the specific clinic. Sometimes new parents call in and say, ‘my baby is crying. He looks like he’s red in the face and running a temperature — what do I do?’ The nurses are able to advise them and say, ‘have you tried this?’ or ‘bring him to the emergency room right now,’ or ‘yeah, that can probably wait until tomorrow.’ They’re able to advise and help the parents talk with a specialist directly if need be. Also, they can just answer general questions.
One of my own experiences with this happened when I was doing some project work in my garage. I happened to cut myself on an old nail and was like, ‘Hmm, how long are tetanus shots good for? So I called them up and I said, ‘by the way, how long are these shots good for?’ They told me and I said, ‘Okay, good. I had one three years ago. I’m still good.’ And I just got a Band-Aid and continued working. So it’s a wide range of things like that. Sometimes just that they’re able to provide referrals as well as the surrounding areas. Physicians have a hotline they can call in and say, ‘hey I have a patient I need to refer for X, Y, Z condition,’ and be able to make the connection. So that’s one area that we’ve focused on for a number of years, and judging from the call volumes, that’s been very successful.
Our next area has been our website. We actually won an Aster award last year for our updated website providing information on specialists and programs for the community. We have a very strong maternal-child program, for example, that provides different free classes to expectant parents to help get them ready and make sure they have everything they need to be successful. So that’s been one area.
The third, and this is particularly moving toward the PHR, has been one of the aspects of our RelayHealth program. RelayHealth, which is one of the McKesson products, provides not only connectivity from physician to hospital and physician to physician, but also from the hospital and the physicians to patients. There’s a secure log-in feature with the ability to communicate with the physician directly and say, ‘hey, I need a follow up for such and such.’ And this is the same platform that also allows the patients to be able to enter their own medical information. So for example, a patient might say, ‘In addition to my prescriptions, I’m also taking this vitamin or that vitamin,’ and that helps the physician be able to look for any contraindications from that aspect as well. It’s all set up securely, and the patient is the driver on that, allowing the relevant information that he or she selects to be available for the physicians to review. So if they want to limit mental health visits, for example, that could be suppressed. The patient controls that. That’s one area we’re working on, and we’re looking at doing a big push and expanding that during the next few years.
Gamble: Have you been able to get a read on what the traction has been like for the portal at this point?
Foelsch: It’s been relatively slow at this point. But I think the uptick, particularly as we increase advertising efforts, both our own and information at the national level, is going to pick up quite a bit. I think all the noise about the health exchanges is going to add to that. There’s a lot of talk on the healthcare situation. I’ve noticed over the last few years that with the average individual, whether it’s the patients, employees, staff members, or physicians, there has been an increased comfort level with technology. If you look at iPads and smart phones, 10 years ago that was unheard of, but now people are comfortable with it. Even at younger and younger ages, I see kids using the smartphones and accessing things, and I think there’s going to be more of a demand for that as we go forward.
Gamble: Oh yeah. There’s an entire generation that doesn’t really know anything but having access to all this information online. It’s going to be an interesting thing to watch in the next few years.
Foelsch: That’s for sure.
Gamble: Another area I wanted to touch on was disaster preparedness. I read about some flooding that had affected your area pretty badly a few years ago. Is this something where you have a pretty good plan in place for events like flood? When there are events like that, does it force you to reevaluate your strategy a little bit?
Foelsch: I’ve been here a number of years, and one of the things I’ve always focused on and stressed has been having contingency plans — keeping the options open and having business continuity plans in place. We had a very large flooding event in this area in 2008. Fortunately, the hospital itself is situated on high ground, so we were not directly affected. We were able to be a resource to other providers in the area who were not so fortunate.
From a technology standpoint, we are able to maintain functions throughout. One of the issues was that a lot of our connectivity went through an adjacent town, and their central office went underwater. All of the sudden we lost half our internet capability and part of our phones at one point. We were able to reroute, fortunately, and by having multiple sources and connections, we were able to maintain our service even if in somewhat of a degraded mode.
But we were able to maintain service. We were able to get bills out, keep the phones going, and keep the connections going. We were relied even more so on those connections because we found that a number of staff were cut off because some of the roads and bridges were closed in the area. We found that some key staff were left remote. Fortunately, we were able to maintain our connections and we were able to have a number of people work remotely on some of the key business functions and work functions. And so we were able to ride through that.
As with any type of event, we did major debriefs afterwards and looked at what worked, what didn’t, and how could we improve that. A couple of things that we have done is strengthened and expanded some of our connections. We actually have three different routes for phone and internet connectivity right from our main campus. We’ve also set up fiber to a remote site so we’re able to have a cold site ready to go at short notice if, heaven forbid, we had a problem here on site. Or, we could set up and host alternative sites as well. We’re always improving and always trying to make sure that we have not only one backup, but multiple backups and different options. So yeah, we have major floods. We had a tornado a few years before that went through part of downtown. And so we were able to respond to these things, and basically, with redundant systems, we’ve been able to maintain the connectivity and the communications, which is so vital during these times.
As part of overreaching state initiatives and national initiatives and homeland security, we’ve been active participants in working with various state local agencies for emergency response. We’re a vital part of that network. Each of these groups has been working on simple things like making sure all the radios were on the same frequency for communications. Something like that you’d think somebody would have done before, but now, different services have different radios. Whether it’s police, fire, or EMS, everybody is now on the same frequency — literally and figuratively.
Gamble: That’s a good thing. And like you said, it boggles your mind a little bit that it wasn’t in place before, but good that it is now.