Anne Lara, CIO, Union Hospital of Cecil County, Chapter 1

It’s been quite a year for first-time CIO Anne Lara. After taking the helm last December, she assessed the organization’s needs and crafted a five-part strategy to take Union Hospital to the next level. The first priority was to upgrade from Meditech Magic to the brand-new 6.1. But instead of starting from scratch, Lara quickly figured out that the best way to navigate tricky waters is with help — in this case, from the only other organization to adopt 6.1. In this interview, she talks about what it takes to create true partnerships, the fine line CIOs must walk to secure devices without hampering users, her plans to expand telemedicine programs at UHCC, and how she’s working to foster innovation and keep her staff motivated.

Chapter 1

• About Union Hospital of CC
• Creating affiliations to improve patient care
• Being an early Meditech 6.1 adopter — “We’re willing to take the risk.”
• Customizing the surgery module
• Staff exchange with Frederick Memorial
• The 5 I’s — from implementation to industry expertise
• PHI education

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Bold Statements

The thought process was that we are forging new ground. We’re willing to take the risk and the adventure and the energy it would take to bring a new product to the market.

Meditech’s been a partner with making sure that, as we’re building the system, we’re building the right fields and we’re collecting the right data moving forward.

When they went live, we had a number of our clinical analysts actually go down to help provide support, because they knew the pieces and parts of CPOE. And when we go live in February, they’re going to be sending some clinical application specialists up here.

The fifth ‘I’ is all about being industry experts and making sure the HIS team has the knowledge, has the training, and has the skillset they need to keep up with the fast-paced world of health IT.

It’s all about education. The first thing that we did is we wanted to foster and create a better awareness of the importance of protecting health information.

Gamble:  Hi Anne, thank you so much for taking the time to speak with us today.

Lara:  I’m happy to.

Gamble:  To give our readers and listeners some background, can you tell us a little bit about Union Hospital of Cecil County?

Lara:  I sure can. Union Hospital of Cecil County is a small, 122-bed community hospital located in Cecil County, Maryland, which is the northernmost county in the state. We border the State of Delaware as well. Our mission is to serve the community of Cecil County. Our core values are all about caring and compassion, shared learning, leadership, and integrity, and we take our commitment to the community very seriously.

Gamble:  In addition to the hospital, do you have any clinics or physician offices?

Lara:  We actually have a number of owned physician practices, a number of primary care offices, some specialty offices, etc. And because we’re so community-oriented, we also partner with some non-employed physician practices to better serve the community. We have a wound care center. We have an affiliation with Christiana Care in Delaware to provide radiation oncology services. We have a credentialed and certified Stroke Center. We also partner with the University of Maryland to provide eCare, which is a remote intensive care monitoring system. And so we reach out and branch out as we can to serve the community.

Gamble:  It’s the idea that if we can’t provide it for you right here, we’ll figure out a way to get you the care you need.

Lara:  That’s correct. Another affiliation, and a close working relationship we have, is with the Community Health Department. In fact, a number of our clinicians actually provide free services for the clinic on a weekly basis. Folks can come in and be seen by a physician. I think it’s every Wednesday that we have physicians, advanced practice nurses, and support staff available at the Cecil County Community Health Department for folks that may not have the dollars to see a physician. We provide that service also in conjunction with the Community Health Department.

Gamble:  All right, so obviously a pretty full range of services there.

Lara:  Correct.

Gamble:  Now to give us an idea of the IT environment, what system are you working with in the hospital as far as EHR and things like that?

Lara:  The EHR system we have is Meditech Magic. That serves as both our clinical information system as well as our revenue cycle management system. We are in the process of upgrading to Meditech 6.1, which is a brand new platform for Meditech. We are one of two early adopters of that software. We’re in the throes of preparing for the implementation with a go-live date of February 1, 2014. Our physician practices currently use Allscripts as their EMR, and we also support that application.

Gamble:  Okay, when you said 6.1, it raised an eyebrow. In terms of making a decision like that, did you have some hesitancies being only one of two organizations to adopt it? What was your thought process?

Lara:  I think the thought process was that we are forging new ground. We’re willing to take the risk and the adventure and the energy it would take to bring a new product to the market. There are lots of advantages of being a beta or an early adopter in that you work very closely with the vendor. Meditech’s been a great partner to work with in terms of identifying the requirements of the system and the workflows of the system. And you can also give the vendor feedback that might help other customers down the road. Their surgery module is brand new, so we’re actually going to be the first one to bring the surgery module up. Again, we’re very excited. It’s a lot of work and a lot of energy, but again, it’s a great partnership with Meditech, and we’re working really closely and really hard to realize our go-live data on February 1.

Gamble:  With the surgery module, is that department pretty excited about getting this type of solution?

Lara:  They really are, particularly from an intraoperative perspective. In most facilities, it’s still a very much a paper-driven environment. And it’s a really hard transition to go from paper to an electronic system, but the OR staff has been very involved in identifying the requirements and fine-tuning what Meditech needs to do for their actual modules. They’re very excited.

The way that they actually work is they have what they call reverse WebEx’s where Meditech gives us the code and the features, and we’re trained on it. The OR team will actually configure the system and then they’ll show that back to Meditech and say, ‘This is how we configured it. This is what we’re thinking about in terms of workflow.’ There are some really good-looking records where you can link anything that happens intraoperatively to one record so that the ease of workflow and ease of documentation is right there. And again, everybody’s on board. The physicians are really excited about it too.

Gamble:  With 6.1, does it help as far as meeting Meaningful Use working with something that’s already certified?

Lara:  Actually, we were very fortunate. The Meditech Magic system we have was also certified for Meaningful Use. We successfully attested for our 90 days, and we are in the process of getting ourselves ready. We’re going to attest on November 4 for our annual attestation for Meaningful Use Stage 1. We’re planning to attest for Stage 2 Meaningful Use on our 6.1 application, and we’re hoping to do our 90 days in September of next year. And again, Meditech’s been a partner with making sure that, as we’re building the system, we’re building the right fields and we’re collecting the right data moving forward.

Gamble:  Have you been in touch with other Meditech CIOs just to check in and share best practices, things like that?

Lara:  Sure. Meditech provides a lot of opportunity for that. We’re fortunate in that Frederick Memorial Hospital was their first 6.1 live customer, and they went live in July. We’ve reached out to the CIO and the clinical applications director there, and we’ve had a really good working relationship with them. In fact, when they went live, we had a number of our clinical analysts actually go down to help provide support, because they knew the pieces and parts of CPOE. And when we go live in February, it’s an in-kind situation. They’re going to be sending some clinical application specialists up here to help us with our live. We have a good working relationship with the Frederick Memorial staff.

Gamble:  I’m sure that will help a lot. You want as many hands on deck as possible.

Lara:  Exactly.

Gamble:  Okay, so that’s a pretty big thing on your plate. What are some of the other pressing initiatives?

Lara:  I actually started as a CIO here in December of last year and did a pretty rapid assessment in terms of what the needs were. I call them my five I’s. The first one, of course, is the Meditech 6.1 implementation. The second one is information security, which is on everybody’s watch list. We wanted to make sure we had all of the pieces and parts together from a system perspective to make sure we were ensuring protection of PHI.

The third ‘I’ is all about infrastructure. We’re taking an opportunity with our new Meditech 6.1 implementation to make sure that from a hardware perspective and an infrastructure perspective, we have all those pieces and parts together. With that in mind, we had an opportunity to create a new disaster recovery site. So we have a new disaster recovery site that we’re in the process of building and configuring. We hope to have that live and operational by December of this year or January of next year at the latest. So we have that going on.

Then comes the fourth ‘I’ that we have an eye toward. Because my area of responsibility includes not only HIS but also HIM, ICD-10 looming on the horizon is a priority. And so we’re readying ourselves for ICD-10 implementation. The fifth ‘I’ is all about being industry experts and making sure the HIS team has the knowledge, has the training, and has the skillset they need to keep up with the fast-paced world of health information technology.

Gamble:  That’s a pretty full plate with those five I’s. Okay, so you talked about the disaster recovery site and said that you hoped to have that ready for November or December?

Lara:  December of this year or January of next year.

Gamble:  Where is that right now in its progress?

Lara:  We’re right on target. The actual building is up. The fiber is being laid. We have all the pieces and parts of the servers and the racks — they’re being configured and built as we speak, so we’re right on target.

Gamble:  Okay. And you mentioned security — like you said, this is something everybody’s concerned with and is a priority for all CIOs. And when you have clinicians using mobile devices, that’s a little bit more of a security concern. What’s your strategy there?

Lara:  It’s all about education. The first thing that we did is we wanted to foster and create a better awareness of the importance of protecting health information. To that end, we started doing presentations. We created a new position called information security analyst, and so my HIM director, who’s also our chief privacy officer, and our information security analyst, take turns providing an overview of information security at each of our new employee orientations. That’s one thing we did.

We also started doing frequently asked questions on a monthly or every other month basis about simple things like making sure you log off your computer when you’re finished. Make sure you lock your computer when you walk away. Make sure that when you’re printing something that you know what printer it’s going to. We have some FAQs that go out on every other month basis to educate the staff.

From a technology perspective, we have Air Watch, which is a mobile device management system. We’re in the process of implementing and testing that. In terms of identifying those mobile devices that either are hospital-owned mobile devices or devices that folks bring in from the street, we want to make sure that we’re protecting them and making sure folks aren’t taking pictures that they shouldn’t be taking. We’re in the process of rolling out the AirWatch product across the system.

The other things we’re looking at is of course we do encryption of all of our laptops; all of our devices. We make sure folks know the importance of encrypting emails, especially when they contain protected health information. We make sure that all the requisite firewalls are in place to make sure we’re doing everything that we can to protect data. And not only are we putting those pieces and parts together, we’re also monitoring and identifying opportunities for improvement.

Chapter 2