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.
- Selling “lukewarm” docs on portals
- Relying on physician leaders — “That’s where you make progress.”
- A “shift” in patient engagement
- Memorial’s innovative culture
- CIO’s role as motivator
- Independent, but with strong affiliations — “We’ve made really strategic partnerships.”
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That’s primarily where you make progress — one of their peers that they trust is saying, ‘hey, I’m getting fewer phone calls and my patients just go online and look at their labs.’
As a healthcare culture — not just at Memorial, but nationally — we’re just not there. The physicians, the payers, and the facility have a lot more leverage and momentum in how change happens than the patient does right now.
It’s fast paced and we’re pressured to deliver, but I like being in that environment rather than one where you’re not feeling the pressure to innovate.
We’re independent, but we’re not able to deliver all this on our own. We’ve made really strategic partnerships with folks and invested in partnerships to provide care that on our own we may not be able to deliver at the same level.
Fear: One of the strategies we’ve done in our environment to try to get to 50 percent is we have one patient portal that goes across the entire continuum. You show up on the ED, that data is in that same patient portal. You go to inpatient, that’s in that same patient portal. You go to outpatient in our Allscripts physicians office EHR, all that data is in the same patient portal. You go to your surgeon, and all that data goes in the same patient portal. I am offering to the patient all these different areas if you want to get enrolled. You may get enrolled in ED and then you go see your primary care, and because you got enrolled in the ED, that’s going to count for primary care as well because they’re all using the same patient portal.
That’s one of my strategies as well. And it’s going to help us, but I don’t think it’s going to get us to 50 percent. I could be wrong. Maybe that really will be end up being a great decision. From the patient’s standpoint, you go to one log in, you don’t have to remember 16 passwords and there’s all the data. You can see everything — ‘I was in the ED and they admitted me and here are the meds I was on, and then I followed up with my primary care the next week later.’ There’s the office visit and there are the meds they ordered. It’s good for the patient. Patients don’t want to have to log in to four different portals. They want to go to one and see the whole record. And so it’s good for the patients, but I’m also hoping it will help our enrollment numbers. But the proof is in the pudding and we’re not there. We got a ways to go, but our strategy for 2014 is to get there, and we’ll have all the technology in place here by the end of the year.
Gamble: I think that you really nailed it when you said that it has to be driven by the physician practices. When you talk about how you have that 50 percent of docs who are lukewarm about it, it’s a numbers game. I imagine that you really have to try to target them, and if you could at least turn half of them, that helps a lot. Do you find that you rely on physician leaders to communicate this point and work with the docs on this?
Fear: Absolutely. That’s primarily where you make progress — one of their peers that they trust is saying, ‘hey, I’m getting fewer phone calls and my patients just go online and look at their labs.’ Some providers are like, ‘If you don’t hear from me, that means your labs were normal. If you hear from me, that means we got to have you come in and talk more.’ They don’t say it that raw, but that’s the gist of how their workflow is. Now they don’t have to have the anxiety that patients are out there looking up at results. If they have a concern, they’ll follow up. It reduces the risk of them missing an abnormal result that they may need to follow up on if the patient is looking at it.
It’s all about getting the patient to be more involved in their care, and that’s a huge shift in medicine. Up to this point, the doctor has owned a majority of what happens with the patient’s care. The doctor will say, ‘I’m going to refer you to this doctor for your surgery.’ And there are exceptions where patients say, ‘No, I want to go to this surgeon,’ but right now majority will say, ‘Okay, I trust you. You’ve been my doctor for 10 years. If you say to go to that surgeon, I’m going to go to that surgeon.’ Doctors drive that. That, I think, is going to change a bit with the Accountable Care Act and patients paying out-of-pocket a little bit more for care and making more active decisions. But basically, the provider’s driving that. Right now the reality is that providers drive a majority of the care. Providers talk to providers, and that’s where we think we’re going to see some more and more change in behavior.
Another driver will be as the patients are getting more involved and have more decision making, they’ll drive some of that. They’ll say, ‘I want to look at my stuff online.’ But as a healthcare culture — not just at Memorial, but nationally — we’re just not there. The physicians, the payers, and the facility have a lot more leverage and momentum in how change happens than the patient does right now. That shift is coming, but we’re far from your typical industry like banking or retail where the patient is the primary driver of where decisions are made or how innovation is implemented. Anyway, I know I’m tangenting off into many different other things, but yes, the providers are going to be the major drivers when they talk to other providers and say, ‘This is working. You should try it.’
Gamble: I guess you have to try to create the right forum for that to happen so they can talk about the really practical stuff like how are you incorporating this into your workflow.
Fear: We have an all-provider dinner at least twice a year where they just casually have dinner and talk, and I’ll talk about our steering committees that we have. We have a vice president of our medical group who’s a practicing physician — she spends a quarter of the time on administration and then the rest as physician. She’s actively out there working with our docs, promoting these sorts of things and driving some of the change. That’s been our governance structure and how we’ve gotten some things done. And also administratively, we’ve made some decisions to put physicians in leadership roles to try and drive these changes.
Gamble: Now you’ve been with Memorial about 10 years or so.
Fear: Yes. My eleventh year is going to be in January.
Gamble: Nice. That’s a big milestone.
Fear: I really enjoy the environment. It’s a very innovative culture. I enjoy being in an environment where we can make rapid change and we have good governance. The board and med exes and the executive team are all very supportive of innovation. They really want to impact the business process, and they look to IT to enable a lot of that. It’s an exciting environment to be in, and I enjoy it. It’s fast paced and we’re pressured to deliver, but I like being in that environment rather than one where you’re not feeling the pressure to innovate. So yes, I’ve spent quite a few years here, and I enjoy it.
Gamble: From looking at your LinkedIn page, it seems like you’ve had that progression where you started out as network analyst or senior network analyst, and then moved up from there. Do you think that’s given you a unique perspective rather than just coming in at the CIO level?
Fear: I think in my role as CIO and vice president of IS, one of the most important things you learn is that it’s less about understanding the technology and more about relationships. When you’ve been in a place for 11 years, you build pretty strong relationships with folks at all different levels. And it’s not provider relationships, it’s at all the different levels. My major role is to work with people and motivate them and get them excited about implementing this stuff and get them fully engaged to where I get the discretionary effort that’s the key to getting a lot of this done.
I need my folks fully engaged — not partially engaged, and definitely not disengaged. I try to get them excited and motivated and get that discretionary effort where really their heart’s into it. With a lot of folks I was their peer or I worked for them and had that dynamic, and then as I’ve been promoted, I’ve just really tried to foster and nurture those relationships. And then of course in building a lot of systems with providers, I’ve developed relationships with them and also the board, which helps. But relationship building and trying to get folks engaged when you’ve been in a place for a while is just a nice advantage to have.
Gamble: I can imagine. Memorial is an independent hospital, so in some ways I’m thinking it’s becoming a little bit more difficult to remain that type of organization. You see all the M&A going on everywhere in the industry. What are your thoughts on that?
Fear: Let me take a step back before we talk about full mergers. I say we’re independent, but we have very important, strong partnerships with different healthcare organizations in our community. Our cancer center has partnered strongly with McLaren, which is a hospital system in Flint, on a special oncology radiation system — I think there are three in the world. So now we have radiation oncology on site in our community, and that wouldn’t have been possible without that partnership with McLaren. Our cardiologists are all from a partnership with an organization in Lansing within that Sparrow network. Our pathologist is a partnership with another organization in Flint, and stroke is another example of partnership that we’ve made.
And so yes, we’re independent, but we’re not able to deliver all this on our own. We’ve made really strategic partnerships with folks and invested in partnerships to provide care that on our own we may not be able to deliver at the same level we do if we partner with an organization that has expertise. We’re independent, but we have a lot of different partnerships with other organizations to deliver care. As we potentially look at fully merging — and our board has looked at that — that’s still definitely on the table.