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.
- Securing mobile devices — “PHI has become quite the commodity.”
- ICD-10 taskforce
- eCare with University of Maryland
- Partnering with AT&T for remote monitoring
- ROI & patient outcomes — “You have to look at things differently.”
- From bedside oncology nurse to CIO
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You don’t want to lock things down so tightly that it becomes a burden to use the technology, yet at the same time, you want to create and foster an awareness of the necessity of protecting PHI.
If we can make patients more compliant with their medication regimes, one could argue that they would stay out of the hospital and there would be fewer reimbursements.
ROI isn’t necessarily the upfront cost, but what happens on the backend. There are less hospital-acquired conditions. There are fewer readmissions, and people hopefully would be healthier. You have to take a look at it differently.
They needed somebody with my background and my qualifications to work for Siemens and help develop an oncology clinical information system. I had no idea what that meant, but I took a risk and I jumped in.
It’s a nice blend because it brings together all of my experiences from a healthcare perspective, a nursing perspective, and a systems perspective. So it’s a really good fit.
Gamble: It’s a fine line you have to walk because you want to take all the security measures, but then you also want to encourage the use of devices.
Lara: Oh sure. You said it very well — there is that very, very fine line. You don’t want to lock things down so tightly that it becomes a burden to use the technology, yet at the same time, you want to create and foster an awareness of the necessity of protecting PHI. For example, if someone has email on their phone and they email back and forth about patient information, we want to make sure that information doesn’t get in the wrong hands. One of the things that we encourage and that we’re mandating is that mobile phones always have a password to get on them and that the information on their hard drive or the phone is encrypted so that if the phone does get stolen or lost, it’s going to be a little bit more challenging for someone to get in there and get that PHI. Because as we all know, PHI is becoming quite the commodity. People want to get their hands on names and insurance information and all sorts of things because there’s a good market out there for that. And so we’re trying to walk that fine line and just create a very thoughtful awareness of it.
Gamble: It sounds like you’re being proactive and taking a more preventative measure and hopefully not have to deal with something like this after there is an issue.
Lara: That’s correct.
Gamble: You mentioned ICD-10, which is of course another huge priority, and this is something that falls under your purview as well. Where are you with that process?
Lara: Fortunately, I have a very proactive director of health information management, and she has already made sure that her coders have been trained and certified from an ICD‑10 perspective. We’re actually doing some dual coding now; we’re doing ICD-9 and ICD-10. We have created a task force that meets on a monthly basis. It’s a cross-functional or cross-disciplined task force looking at what we’ll have to do from an ICD-10 perspective to ready the organization. She’s been providing physician offices with information and with some training. She actually had all of her coders participate in an assessment to make sure they had the skillset that they need from a pathophysiology perspective, a medical terminology perspective, etc. Again, it’s all about creating awareness. She actually created a hospital intranet site that talks about ICD-10 and why this is important. And we’ve attended a number of programs that have been offered by HIMSS on ICD-10.
Gamble: You can’t really get enough education on that.
Lara: It’s incredible, isn’t it? And who knows what the long-term ramifications are going to be. There’s so much learning that’s going to be happening. Next October is going to be a really fun time.
Gamble: Sure. Okay, so you have all of that. Does your organization participate in any telemedicine-type initiatives? I know you mentioned something with University of Maryland.
Lara: We do a couple of things. We do eCare, which is an electronic intensive care, remote monitoring system that we’ve been participating in with the University of Maryland probably for the last three or four years. And that works out really well because being a small community hospital, we don’t have an intensivist on site 24/7, so having the availability of an intensivist remotely actually has helped our patient care. The system works really well; it’s a good partnership. We also use telemedicine from a radiology perspective. We have radiologists who work remotely, and they’re able to take a look at CAT scans and read them remotely.
One other thing we’re exploring that we haven’t fully implemented yet but I’m working with the Cecil County Health Department to take a look at, is whether there are any opportunities to use remote medication management. There’s a company called INRange that has a Remote Medication Management System. We know that medication compliance has a direct link in terms of how well you’re doing from a disease state perspective, and if we can make patients more compliant with their medication regimes, one could argue that they would stay out of the hospital and there would be fewer reimbursements. So we’re in the process of evaluating that and perhaps rolling that out.
The other thing that we’re doing is we’ve been having ongoing conversations with AT&T, which has a ForHealth vertical that’s all about remote patient monitoring in the forms of physiological measures like pulse oximetry, blood pressure, and blood glucose. That information can be easily taken directly from the device and keyed into an electronic system where someone can keep an eye on that remotely, or the patient has a more active role and interacts with the device and gets coaching messages and help with self-management. We’re exploring all those pieces and parts. We haven’t actually implemented them yet, but they are definitely on our radar screen.
Gamble: That’s so interesting because I’ve heard people say that when it comes to really getting the most out of mobile devices on the patient care side, that we’re just scratching the surface. It seems like there’s so much potential there.
Lara: There’s an incredible amount of potential there. It’s about figuring out how the technology fits in. Both INRange and AT&T have really good models that we’re exploring. If we don’t get a chance to roll it out this year, it’s definitely on next year’s radar screen.
Gamble: Right. It’s something that a lot of organizations want to do. It’s just a matter of figuring out the big question of how to pay for it and make it sustainable.
Lara: Yeah, and I’m putting my CIO hat on here, but one could argue that if you focus on the patient outcomes and less about the reimbursement piece, I think it comes together a little bit more clearly. If your goal is to help patients self-manage with an eye toward helping reduce readmissions and helping to extend the time between physician visits or hospital visits, then if you think about that from an outcome perspective, that’s good. Your return on investment isn’t necessarily the upfront cost, but what happens on the backend. There are less hospital-acquired conditions. There are fewer readmissions that you have to worry about it, and people hopefully would be healthier. But you have to take a look at it differently. It’s not just about that fee-for-service mentality. How does it contribute to the whole overall picture?
Gamble: Absolutely. There’s a need to look at it more in the long-term picture and like you said, if you look at preventing readmissions then this is something where it makes sense from a financial perspective.
Lara: Exactly. We have to think differently about what we’re doing and how we’re doing it.
Gamble: So now you started as CIO there in December of last year, correct?
Gamble: And this is your first CIO position.
Lara: It is. That’s correct.
Gamble: Where were you before that?
Lara: I’ve been very blessed in my journey. I started out way back when as an oncology nurse. I started as a bedside oncology nurse. I loved oncology. I went ahead and got my graduate degree and became an oncology clinical nurse specialist. I worked in healthcare doing program management and patient care. I managed a very large radiation oncology site for quite a while, so 26 years of my career was in direct patient care and in nursing — specifically on oncology nursing.
And then what happened was while I was radiation oncology director, one of our vendors, Siemens, was rolling out a computer information system. I was really jazzed about it and there just happened to be an opportunity that they needed somebody with my background and my qualifications to work for Siemens and help develop an oncology clinical information system. I had no idea what that meant, but I took a risk and I jumped in. I worked for Siemens for about 8 to 10 years in a few different capacities, learning more about software development, and learning more about trying to gather customer requirements. I worked in that area for a while, and then I went over to regulatory affairs and quality systems in the medical device world, where I learned a lot about what the FDA did from a diagnostics perspective.
I did that for a little bit of time, and then I had another opportunity — and again, there have always been opportunities. I’ve never left a job that I wasn’t happy with. I’ve left because there were other opportunities that came my way. I worked for about two and a half years for a start-up company called WellDoc, which is a mobile health information technology company. They developed a product called Diabetes Manager, which was a class 2 medical device, so given my background, I came on as their VP of Regulatory Affairs Quality Systems and helped develop their Quality Management System and got them through a couple of FDA inspections.
And again, I was quite happy with what I was doing there. That’s where I got the introduction to mobile health. And so I just happened to be on the HIMSS website and I saw a position for the CIO at Union Hospital, and it kept coming to me. I thought, ‘this sounds like something I might be interested in.’ I interviewed for the position, and thank goodness, the folks here liked me. It was a great opportunity, and I’ve been here ever since. It’s a nice blend because it brings together all of my experiences from a healthcare perspective, a nursing perspective, and a systems perspective. So it’s a really good fit.