It’s been a decade of change for Peconic Bay Medical Center, from the organization itself — which has evolved from a community hospital to a health system — to its home, the East End of Long Island, which is one of the fastest growing areas in New York. A key component in this expansion has been a shift in how IT is viewed. As CIO, Artie Crowe has played an instrumental role in changing the perception of IT from the department that fixes what’s broken to one that helps shape the strategy of the organization. In this interview, Crowe talks about what it takes to lead an evolving IT department, why his team almost threw in the towel on MU Stage 1, why customization is sometimes the best solution, and the secret sauce to boosting clinician satisfaction.
- Challenges with device security
- The “easy win” of guest wireless
- Customizing NextGen for docs
- Nearly delaying MU 1 — “Taking penalties is not a popular subject”
- Diving and conquering big projects
- Frequent team meetings
- CEO support — “It’s definitely a shot in the arm.”
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When a clinician walks up anywhere in the building and they get the same platform over and over again, it helps build adaptability and buy-in. They like being able to see the same thing over and over; they’re creatures of habit that way.
When you put very highly skilled, intelligent, conversational people in a room, all of whom have their own idea about what the best solution is, somebody at the end of the day is going to feel like, ‘I guess my opinion didn’t count.’
The project really wasn’t being driven by a defining source. We were trying to buy off huge chunks rather than chip away at each little piece so that there was a means to an end. And so we changed our approach.
It stresses the resources when they keep seeing deadline dates — ‘We have to have this up by then and testing has to be completed by this date or we’re not going to make the next thing.’ We did have to do quite a bit of stress management for the team.
It’s really getting people to give the time. And these days most people don’t have the time, but we certainly found a way to make it, because it’s very, very important.
Gamble: As far as just the data security, what are you doing at this point?
Crowe: Data security continues to be an ongoing challenge. At the bedside and when you’re on our hard-wired network, the nice part of what we’re doing is we deliver our desktops virtually. We use VMware, and that allows us to really provide a consistent platform that we can limit and manage really, really well, because we don’t have to manage a hundred different PCs. We’re really delivering one PC to a hundred different areas.
So from a security standpoint, we give the end user who’s logging in access to only what we really think they should be accessing. It’s very auditable and it’s manageable. If there’s a new request for an application they want to add to the desktop, it gives us a chance to test it in our test environment and then know it works before we deploy it, instead of breaking someone’s PC or them getting frustrated because they get the blue screen of death or any of those types of things associated with deploying new software. We deliver a clean, consistent, friendly, familiar model for them. When a clinician walks up anywhere in the building and they get the same platform over and over again, it helps build adaptability and buy-in. They like being able to see the same thing over and over; they’re creatures of habit that way. That was very easy for us.
In terms of our wireless infrastructure and its upgrade, we are currently looking at and are about to deploy some solutions related tracking software for any mobile devices used in our facility. So if it’s lost or stolen, that allows us to track it down, blank it out, and make it inaccessible. But in terms of the technologies that are coming out to help support that endeavor, we’re still looking at our best options. We started with the tracking system, but that’s one of our struggles. I would have to be honest and tell you that just controlling who’s got something in their pocket that we do or don’t know about is difficult. It’s definitely difficult. We use very secure, encrypted passwords for our wireless infrastructure that make it easier for us to do that, but of course we do want to know who’s got what in their pocket when they come in the building.
Crowe: We were also able to develop and deploy a guest network, which we didn’t have previously, as part of our upgrade. Our patients and visitors can use the guest network, which is completely separate and devoid from our clinical network, as a service convenience.
Gamble: That’s something that seems like a fairly easy win in that it’s something that can go a long way towards patient satisfaction and getting those numbers up.
Crowe: Right — consumerism in healthcare. They’re looking at things like that. I don’t want to make a hotel comparison, but it’s like, ‘Wow, you mean if I’m a patient there and I want to have my surgery there I can have wireless network and I can still access my email?’ Believe it or not, patients look at that as deciding factors when they decide where they’re going to have their work done. So yes, definitely an easy win for us on that.
Gamble: Are clinicians using any of heir personal devices?
Crowe: There were, which is always a struggle. When we clamped down the wireless network access piece, we had been systematically logging and taking information from each personal device the physician wanted to use, only allowing them access once we had that information and we had loaded on the tracking software. But again, it’s not easy. It’s just not easy.
Gamble: With the physician practices in the primary care network, what type of EHR system are they using at this point?
Crowe: They use the NextGen product, which they’ve been using for several years. It’s been enhanced several times and customized. One of the challenges with that is that any EMR comes out of the box delivering whatever its basic package is, but we have a very eclectic group of physicians — from primary care to orthopedic surgeons to general surgeons to urological surgeons — that all need a different look and feel to their software, or are looking for different clinical needs in the EMR when they’re using it. So we’ve had to do quite a bit of customization over the last two years to get them comfortable on it. And now we’re working on the exchange of information from that NextGen environment to coincide with the hospital’s environment, from interfacing with the radiology and laboratory systems, all predicated on meeting the Meaningful Use objectives.
That’s been good — a little bit of struggle, but good. With the customizations, the NextGen adoption has become much more widespread. And again, realizing that we needed to invest some money in the NextGen product to ensure that we had user satisfaction has helped our business model. If doctors see fewer patients because they’re frustrated with the EMR, or they’re scheduling fewer patients because they know there’s going to be downtime while they figure out how to find their way through the screens, things like that, and you can make it easier for them by customizing it, then they’ll see more patients. They’re happier in general. And it just helps the whole business model at the same time, so that’s why we did that investment.
Gamble: As far as working with those physicians and with specialists, do you have meetings with particular representatives to try to make everyone happy?
Crowe: Yes, similar to the group we have that meets on the hospital side, we meet monthly with those docs and their office managers and their medical assistants to do sort of a user — I won’t call it a forum, but it’s a conversational meeting we have once a month to go over things like, ‘What’s still out there? What do you need? What would you like? How is this going? How is that going?’ That meeting used to be a lot more heated two years ago, but it was really the genesis of the formation of that forum that allowed us to have a lot more smiles and a more congenial banter at our current meetings than we did two years ago. Listening to the users is what’s really helping us to be successful.
Gamble: Right, which I’m sure that can’t be easy. You are dealing with a lot of different needs, but I guess its all baby steps to figuring out something that works at least somewhat for everyone.
Crowe: Absolutely. When you put very highly skilled, intelligent, conversational people in a room, all of whom have their own idea about what the best solution is, somebody at the end of the day is going to feel like, ‘Gee, I guess my opinion didn’t count.’ It’s hard to massage those relationships to make sure everyone feels like they were a contributor. But at the end of the day, when we develop whatever we’re going to use as our solution, it’s really based on a lot of input from a lot of different places, and it’s sort of the best fit based on trying to meet everyone’s need. But as you well know it’s very difficult to meet everybody’s needs with what you do.
Gamble: In terms of Meaningful Use, I know that when you and I had our initial conversation you talked a little bit about how at one point you were almost ready to just pack it in and take the penalty. Can you tell me a little bit about that?
Crowe: That’s true. When we focused on the Meaningful Use objective, we had a little delay and had trouble getting some resources in-house and finding resources. Everyone’s fighting for the same ones. It was a little bit of a challenge, and we just kept falling further and further behind in trying to meet deadlines. It actually caused us to delay by almost a full year what we thought was going to be our initial attestation into Meaningful Use Stage 1, which put us right up against the wall as to the deadline for the last chance to submit for MU 1.
We really struggled because, again, there just were not as many resources as we needed initially. The project really wasn’t being driven by a defining source to keep everyone focused. We were trying to buy off huge chunks rather than chip away at each little piece so that there was a means to an end. And so we changed our approach to one of, if we look at the big animal, we’ll never going to be able to get it done if we keep looking at that as the goal. We needed to have little wins along the way, and they’d all add up to being the big victory. By changing that mindset, getting the right resources, and then focusing the group, we did manage to get it done, but there was a time when we said we may have to take the penalty.
But with the investment on our side, when you’re investing millions of dollars, which is what we’ve done, which many healthcare organizations are doing, taking penalties is not a popular subject. But the group really knuckled down and decided that we weren’t going to fail this. We’re going to get it done. And so we structured the build and the deployment to be much more manageable. The process lacked some steering in the beginning, but obviously we were able to accomplish it.
Gamble: It can be really tricky with timing and where you are with a major implementation. That’s a lot.
Crowe: Absolutely. It stresses the resources when they keep seeing deadline dates — ‘We have to have this up by then and testing has to be completed by this date or we’re not going to make the next thing.’ We did have to do quite a bit of stress management for the team, because they were definitely under the gun. But thankfully we have a top notch group of folks that really were able to help us get this done.
Gamble: It seems like it really would be a challenge to keep the staff motivated especially when you are dealing with something as big as Meaningful Use. Did you have to go the extra mile a little bit especially the people on your immediate team?
Crowe: Yeah. Food works great, by the way. But it was really regular meetings. Sometimes we were meeting two and three times a week, which might seem excessive initially, but they wanted to feel supported. They wanted to feel like they weren’t in it alone. Because when you’re building software applications and doing all kinds of things, sometimes you get lost in a sea, ‘I wonder if anyone knows what I’m really doing.’ And so just being visible and being available to them was critical.
And we made it truly multidisciplinary. The group grew, I’d say, threefold in size from when I joined the team to what we actually went with over the long haul. There were representatives from nursing, from pharmacy, from the therapies, radiology, laboratory, etc. Everybody would commune weekly, sometimes twice a week, to make sure that we were touching on everything that we needed to do, and that there were no missed opportunities. And the build team really appreciated that there was this collaboration going on, that they weren’t making decisions for groups by saying, ‘I hope they like this,’ or ‘I’m not sure what they need.’ They felt that things were more meaningful for them as they built them. So it’s really getting people to give the time. And these days most people don’t have the time, but we certainly found a way to make it, because it’s very, very important.
Gamble: I’m sure that there are times where you do want to have fewer meetings, but when you’re right in the thick of it, that’s when it’s really important to make sure everyone’s on the same page.
Crowe: Prioritization is the key to success these days, because we’re all doing a lot more things than we ever did before — sometimes with less people and less time. And so we made our Meaningful Use project our number one priority from a clinical perspective. And it was driven by our CEO, Andy Mitchell. He’s a very techie person, very innovative. He’s definitely a visionary. We all enjoy working for him. He’s a terrific person. His personal commitments — coming by, sitting in on meetings, giving input, and committing dollars and resources to things when they were most desperately needed was a big boost for everybody. It was definitely a shot in the arm.