Frank Fear, VP & CIO, Memorial Healthcare, Chapter 2

Being CIO at a community hospital has its advantages and disadvantages. On the one hand, smaller organizations can be more nimble and implement change at a faster pace. On the other hand, there are fewer resources, which means less room for error. In this interview, Frank Fear talks about the need to be willing to “stick your neck out” and be innovative, while also recognizing that if something isn’t working, you need to shift gears — quickly. Fear also discusses his enterprise application strategy, the “secret sauce” when it comes to portal adoption, Memorial’s efforts to create strategic partnerships, and his role as staff motivator.

Chapter 1

Chapter 2

• Being a smaller organization — “We can be a lot more nimble”
• Minimizing failures through risk analysis
• Enterprise vs best-of-breed
• Strategic planning — “It’s not all CIO-driven”
• Upgrading to Meditech 5.6.6
• Getting “creative” with portal adoption

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Bold Statements

We don’t have a huge IT department and the folks we do have need to focus on certain projects. It would be great to do everything for everyone, but we have to be a lot more focused.

When we determine that something isn’t working and it’s not providing the value we thought it would, we have to change gears. We just can’t keep going down that same path.

I come to the table and I articulate and indefinitely drive decision making, but when you get that pushback, it’s our board, our medical executive committee, and our key medical staff leaders who drive that. And it isn’t easy, because the best-of-breed products are specific for those workflows and they’re very attractive.

How do we get those patients enrolled and then using the portal? I think it really is going to come down to the providers embracing the portal and making it part of how they deliver care.

Fear:  When we have to implement a change to 35 providers, it can go a lot quicker than when you’re implementing thousands. It’s just the nature of it. We can be a lot more nimble when it comes to our size. The flipside of that is honestly we don’t have the access to capital like a large organization does. We need to be a lot more prudent with our decisions. We need to do a little more risk analysis. With the decisions we make with the capital that we have, we have to take educated, calculated and innovative risks. We have to minimize our failures. And we all have failures — we may not admit it, but when you’re innovative and you’re putting yourself out there and doing different things to attract providers and patients, you have to stick your neck out there. Certain things aren’t going to work, and you have to recognize that and change gears quickly.

For our sized environment with our capital, we have to minimize those, whereas a larger organization that has a lot more resources can make a mistake and it’s not so painful. That’s some of the downside of being our sized organization. I want to make sure I paint an accurate picture that our challenges are resources, capital and people. We don’t have a huge IT department and the folks we do have need to focus on certain projects. It would be great to do everything for everyone, but we just have to be a lot more focused than maybe a larger organization that has a lot more IT staff.

Gamble:  That’s an interesting point you bring up, talking about how when you don’t have as big of a budget, there’s a bigger price to pay if something doesn’t work out. I imagine you have to be a little more selective or maybe just have a certain amount of confidence before going forward with any initiative.

Fear:  It’s key that we try and clearly vet out new technologies. And like I said, it’s not an exact science. We make mistakes, but it’s key that when we determine that something isn’t working like we thought it would, and it’s not providing the value we thought it would, we have to change gears. We can’t keep going down that same path and either losing money or spending a lot of time on it. We have to shift gears and do something different. And that’s sometimes tough to do, but it’s important. And I’m not saying we’re great at it but it’s an emphasis of focus; that we need to move in different directions.

I’ll tell you though, going back to the whole discussion around enterprise systems, it helps when you’re building a module on an existing enterprise system in that a lot of the risk is somewhat mitigated, because you have an enterprise system that’s tried and true and you’re building on that. So when you’re talking about an ED module, it’s taking many of the existing components from our enterprise system, and the risk goes down quite a bit because those components are tried and true. They work well. We have a good idea what it’s going to look like in the end because we’ve been using some of those tools, and that really, really helps.

For example, we had implemented bedside medication verification (BMV) in 2005. Back in 2005, that was innovative. We looked at many different systems for that. We already had an electronic meds administration record at the time, so we started looking at BMV it was, ‘Wow, where do we go? Look at these really innovative technologies that had handhelds.’ And again, back in 2005 the whole idea of a handheld was pretty cutting edge. Now it’s pretty standard stuff. But we did our risk analysis, and it came down to all these different components that were going to be used for BMV. One of them already we’re utilizing today with our electronic med administration record. We’re just layering on top of that, and although it may not be the best of breed and it may miss some of the functionality, when we do our functional analysis review, it hits on all the critical core things and has some of the nice-to-haves. It doesn’t have all the nice to haves and it’s less expensive, and that risk analysis becomes a lot easier than going out with a vendor who only does bedside medication verification. Maybe they’ve only been around for a couple of years and it’s a niche product for them.

I’m not saying we go with enterprise all the time, but it has helped us to be really innovative and reduce our risk, because we’re implementing modules that are built on enterprise modules that are tried and true. That’s helped us. It’s helped us do innovative things and not have those moments of, ‘Uh-oh, we need to back out of this.’ We’ve had some in the past — I’m not saying that we haven’t, but it really has reduced the chance of that based on some of those strategic directions of trying to go enterprise whenever possible.

Gamble:  I’m sure it’s easy to fall into the trap of getting the niche systems, especially in specialty areas. I imagine that that’s tough sometimes to stand your ground and keep with the strategy of the enterprise system.

Fear:  I’d like to stand here and say, ‘It’s the CIO driving all this,’ but it really comes down to our board and our medical staff. They’re the ones that provide an absolutely critical role in driving these key strategies. I come to the table and I articulate and indefinitely drive decision making, but when you get that pushback, it’s our board, our medical executive committee, and our key medical staff leaders who drive that. And it isn’t easy, because the best-of-breed products are specific for those workflows and they’re very attractive. The sum of the parts with an enterprise system, I think, from our organization’s standpoint, is much more powerful than having one good part. That’s what we’ve stood firm with. And again, it’s not easy, and we’ve had pushback, but those key leaders and our medical staff and board have been very supportive and kept that strategy.

Gamble:  Okay. And you said that you have Meditech in the hospital?

Fear:  Yes.

Gamble:  What version is that?

Fear:  We’re on Meditech Magic. We’re on the latest version. Actually, we’re goingt to 5.6.6 Magic next Wednesday. It’s probably easier to list the modules we don’t own than the ones we own, but we own ED, all of inpatient nursing, CPOE, pharmacy, lab, rads, payroll, financials and registration — almost everything Meditech offers, we’re a customer of.

Apart from we did make one decision to move into a little bit different enterprise document management system. We wanted an enterprise document management system that crossed the entire organization and wasn’t just hospital focused. We decided to go on a little bit different direction with enterprise document management so we’d have a true enterprise system for our document management. It’s the same philosophy in that we decided not to go with the Meditech and Allscripts systems for that because they were focused just on their areas and not the entire continuum of documents throughout the enterprise.

Gamble:  Where do you stand with Meaningful Use? Have you attested to Stage 1 at this point?

Fear:  We attested to Stage 1 and my team is right in the process of pulling all the data together to do our second year of Stage 1. Our deadline is November 30, so we’re actively working on that. And 5.6.6 that goes live Wednesday will be the update that meets Stage 2 Meaningful Use, so we’re positioning ourselves for next year to attest to Stage 2. On the physician office side, we go live with the Stage 2 Allscripts product in a few weeks. I know we’ve got quite a bit of work to do to implement some of the pieces in both systems to meet Stage 2 Meaningful Use, but we’re on our way. We’re on our way to meeting Stage 2 Meaningful Use. We’re shooting for January 1, but it’s a tough road. There’s a lot to do. We’re targeting January 1 to start our period of meeting all the Stage 2 Meaningful Use requirements, but we’re realistic in that there’s a lot there to get done with 50 percent of patients being enrolled in the patient portal. That’s a lot more than technology; it has to do with workflow. It’s a shift in how providers interact and use the patient portal with their patients, and it’s not an overnight change. We’re realistic in that we may be waiting until second quarter too for Stage 2 Meaningful Use and meeting all those requirements.

Gamble:  I guess that really have to have some leeway in there. So you say, ‘Okay, let’s just shoot for January, so at least when we do inevitably have some delay, at least we’re still on a good track.’

Fear:  I think more specifically by mid-December we’ll have all the technologies in place. Now it’s about trying to hit all the numbers. And I’m not worried about CPOE — we’ll hit that number. Patient portals concern me because now we’re talking about the patient having a major part in us achieving Meaningful Use. In Stage 1, you’d offer discharge instructions to the patient electronically, and there was no threshold for who had to take you up on it. With Stage 2, now there’s a threshold for who takes you up on it. I have to be creative in figuring out ways to get people enrolled — 50 percent have to be enrolled and 5 percent have to be using it. And so how do we get those patients enrolled and then using the portal? I think it really is going to come down to the providers embracing the portal and making it part of how they deliver care. Just a simple example is, ‘Ms. Gamble, I’m giving you these lab tests for whatever potential issue. Please go look on the patient portal and we’ll talk about those results that you see in the patient portal when you come back for your follow-up appointment.’

So that, I think, is how we’re going to get there. But that isn’t an overnight change. Of our mix of physicians, there are a quarter that really are excited about the patient portal, probably half that are lukewarm about it, and then a quarter that are really greatly concerned about patients interacting with their data and misinterpreting it, causing more anxiety and more phone calls. The research really doesn’t show it though, and I’ve tried to attack it from that standpoint for that group of providers that are concerned about their providers getting access of their data due to anxiety and phone calls. I just don’t see it in the data; actually, the data show that it reduces phone calls. People aren’t calling and saying, ‘Where are my lab results?’ They’re just going online. I don’t see where anxiety is produced, but I definitely respect our provider’s viewpoint.

We’re still on the infancy of this patient portal. We don’t know where it’s all going to land in the end, but we do know that 50 percent of patients need to be enrolled and five percent need to be using it. I think the secret sauce is going to be getting the doctors to incorporate it in their standard care workflows, and we’re not there. I’ll be totally honest with you. We’re not there, but to get to that; to get to those thresholds, I think we’re going to have to somehow get there.

Chapter 3