Timing really is everything. When Bill Neil started as CIO at Indian River Medical Center in early 2011, his first order of business was to create a roadmap for the organization to become completely electronic. But just as they were get started to implement McKesson Horizon, the announcement came that changed everything. Neil and his team decided to take a leap of faith and go with Paragon, and it’s a decision he’s never regretted. In this interview, he talks about what it was like to hit the ground running as IRMC’s first CIO, the challenges he faces in managing a patient population that fluctuates by season and is heavily Medicare/Medicaid, what his team is doing to cut costs, and his advice for new CIOs.
- Imprivata SSO
- Revising the roadmap
- IRMC’s “Heart and lung transplant”
- Fine-tuning Paragon
- Marketing to patients in the practice setting
- Preparing for MU audits — “We’ve documented everything very well.”
- No plans for M&A
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When the announcement came out, there was a tough decision to be made. We could have stayed with Horizon, we could have jumped to Paragon, or we could have changed vendors entirely.
That also gave us an opportunity to do what I call a ‘heart and lung transplant’ of the organization. So when we went live with a big bang on May 21st, that meant everything.
I had to learn the environment pretty quick, and at the same time you have life changes because you’re moving, and it’s just everything at one time. But it worked out very well. I’ve been very fortunate.
We do a lot of marketing with flyers on how you can create your own portal, how you can interact with your physicians, and where you can schedule appointments and ask for prescription refills. The nice thing is that because it’s all Internet-based, they can interact and get to that information no matter where they are.
We have documented everything very well — from every core measure to every menu item itself, and what we’re doing around it. I’ve had independent HIPAA assessments and risk analysis done by an outside party. I think we’re in good position to withstand any kind of audit.
Gamble: Talking about single sign-on, which is something that I think must be one of those easy wins — well, maybe there are no easy wins, but relative to some of the other initiatives that you put in.
Neil: Yes. We use a product from Imprivata. We’ve also, besides just actually single sign-on, meaning you put in your user ID and your passcode one time for an extended period of time, we also have what we call tap-and-go devices. It’s not a true biometric, but it is not a true RFID either. It’s similar to RFID. What it does is you simply take your ID badge, you tap the device, and it automatically logs you on. The first time you do it, you do have to put in your passcode, so it’s a dual authentication. After that, you’re good for a select period of time where you just have to tap in, tap out. That helps out a lot with some of the physicians’ frustration with so many systems being used.
Gamble: Okay. So you started in February of 2011, and it seems like you jumped in right away with the decision to go with Paragon. Did you know going in that this was going to be a big thing on your plate and you were going to have to dive right into it with starting the CIO role there?
Neil: It was. During my interview process, I had a good feel for where we were in our hospital with automation, and where we needed to go. At that point we were still going down the McKesson Horizon product path, but at the end of 2011 when the announcement came out, there was a tough decision to be made. We had a choice. We could have stayed with Horizon, we could have jumped to Paragon, or we could have changed vendors entirely. But we brought in the McKesson folks. We brought in the Paragon side of McKesson and we brought in the Horizon side. We were all in one big room — myself and the rest of the C‑suite — and we just talked through it to see what made sense for us. We were one of the first actual Horizon migration customers to Paragon, and so far it’s worked out very well for us.
This also gave us an opportunity because my road map was to focus on the clinicals, and then some time later — maybe three or four years later — start looking at our financial systems and see what we need to do there to replace those. But Paragon is both a clinical and a financial system, and so it includes all your general financials, your billing systems, everything. That also gave us an opportunity to do what I call a ‘heart and lung transplant’ of the organization. So when we went live with a big bang on May 21st, that meant everything we had, except for HR and pay roll. Everybody changed over at that point.
Gamble: I imagine that that was a nice plus in choosing Paragon just because, like you said, it would be a whole separate process for financials.
Neil: That’s correct. The nice thing with it is it’s a single database. Their objective, in my understanding, is to compete with the Epics of the world, and this is going to get them that advantage to do just that.
Gamble: So you really had to hit the ground running.
Neil: Yes, I sure did. I had to learn the environment pretty quick, and at the same time you have life changes because you’re moving, and it’s just everything at one time. But it worked out very well. I’ve been very fortunate. I have some very good staff here. We’ve made some changes in staffing over the years, and we’re doing well.
Gamble: Since going live in May, has your been largely on seeing that implementation through and resolving any issues that have come up, or are have you moved on to some of the other priorities as well?
Neil: It’s a combination of both. We have identified some workflow issues that we’re addressing. We’ve identified challenges with some of the physicians — the infrequent admitters — that we’re addressing. We’re still kind of fine-tuning the Paragon processes, primarily in the ED and OR areas, and so we’re still working in that sense. The other thing, like you said, is that we still have other projects. I do have new releases of Paragon that we’re going to start rolling out and start testing. We do have to be at that point for Meaningful Use Stage 2 to make sure all our core measures and everything are where they should be. We still need to monitor all that.
Another project we’ve been working is for a local community health information exchange. We’re using McKesson’s RelayHealth product, and that’s going to be our patient portal and our means for exchanging data with physicians in their offices and other areas for CCD information, regardless of what system they have — whether it’s a McKesson system or not. We’re working on that as we’re talking as well.
Gamble: Patient engagement is such a huge issue and something that is at the forefront of a lot of people’s minds. What type of strategy are you using to try to increase those numbers? I can imagine it’s challenging with any patient population, but maybe particularly challenging for yours.
Neil: What we’re doing is marketing it in our physician practice groups. We do a lot of marketing with flyers on how you can get in to create your own patient portal, how you can interact with your physicians, and where you can schedule appointments and ask for prescription refills. The nice thing is that because it’s all Internet-based, regardless whether it’s in-season or not, they can interact and get to that information no matter where they are.
Gamble: You talked about a local community HIE. Is that something that you’re also looking at on the state level?
Neil: Yes, we are.
Gamble: That’s something that’s so interesting — and that’s a nice way of putting it. But with the different states, you seem to have a different picture everywhere.
Neil: I know. I’m familiar with New Jersey’s exchange. They seem like they’ve gone a long way. I’m not sure how well it’s working, but I’m very familiar with that. I understand too that they actually use RelayHealth for their core component.
Gamble: They do. They have the primary HIE, which is starting to really pick up some traction. And that’s great, but it’s all about taking that next step, which is sustainability.
Gamble: You had mentioned before that you have a lot of Medicare and Medicaid patients and mentioned some of the challenges that come with that. Have you had any kind of audits at this point or is that something that you are bracing yourselves for?
Neil: Audits in the sense of RAC audits?
Gamble: Not necessarily RAC audits, but Meaningful Use audits.
Neil: We have not had a Meaningful Use audit. There again, we just attested recently for Stage 1.
Gamble: Is that something that you imagine will be another priority to prepare for that?
Neil: We are prepared for that now. I’ve been reading a lot of the articles around how they’re addressing the audits and what they’re asking for. We have documented everything very well — from every core measure to every menu item itself, and what we’re doing around it. I’ve had independent HIPAA assessments and risk analysis done by an outside party that takes me out of it, so it’s outside party seeing these things. I think we’re in good position to withstand any kind of audit.
Gamble: Just in terms of the Medicare and Medicaid patient population, what are some of the biggest challenges from your standpoint?
Neil: I don’t think there are any real challenges from my standpoint. I think it’s more from a financial standpoint. We are a break-even organization. We do not necessarily have a margin set that we focus toward. One thing I guess is nice about Medicare and Medicaid is you know what you’re going to get paid, and so you just have to manage to it. In that sense, it’s a plus.
Gamble: You’re a community hospital and you talked before about some of the foundations that you have and the campaigns. Going forward, is it something where you think that the organization might look to do any affiliations? We’re seeing so many community hospitals in danger of being swallowed up. Is that something that’s a concern or something that’s not really on your plate right now?
Neil: That is not on our plate right now. It’s not really a concern of us. Like I said, we are the only hospital in this area other than Sebastian River Medical Center, which is about 10 miles north of us.
Gamble: That’s a unique model you have. I’m sure being a no-debt organization has it’s plusses.
Neil: That helps out as well. We have a strong foundation — Indian River Medical Center Foundation — that helps us through philanthropy.