Sonya Christian, CIO, West Georgia Health System
Sometimes it’s the experiences that happen early in one’s career that end up having a profound impact. Long before she was a CIO, Sonya Christian had mentors who helped her understand that “the business that we’re doing is healthcare. It’s not necessarily the business of IT.” Now she is a mentor herself, and believes the onus is on CIOs to help build the next generation of leaders. In this interview, Christian discusses her top priorities for 2014 — including expanding data exchange efforts and increasing portal adoption. She also talks about the benefits of being an early adopter, how her team is looking to cut costs, and her passion for healthcare.
Chapter 2
- Patient portal focus groups
- Stage 2 reporting requirements
- Partnering with API Healthcare to cut costs
- “We actually changed our methodology.”
- Role of analytics in population health management
- No ACO plans — “A lot of it has to do with our geography.”
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Bold Statements
We’ve done a lot of community focus groups that were not necessarily targeted at the portal itself, but what the community needs, and the information we’ve gotten back are things we’ve kept in mind as we’ve designed and implemented our portal.
I believe the biggest challenge for us will be boosting the numbers in the patient portal but also the public health interfaces. We’re actively working on those right now, just making sure that our technology is compatible.
It’s easy to get busy. It’s easy to have other priorities, and unless you have that reminder there to flag you, you might not pay as much attention to that particular project.
You may have disparate HIS systems both on the hospital and on the ambulatory side, and being able to pull population health information across that continuum — I think that’s going to be our next big challenge.
Gamble: With the portal strategy, is this something where you had specific either clinicians or even patients to kind of act as users and test out the system? What was your strategy with that?
Christian: We worked with several clinics on the ambulatory side who are early adopters with our portal and we used them as a proof of concept area, and then we rolled it out to additional locations. We’ve done a lot of community focus groups that were not necessarily targeted at the portal itself, but what the community needs, and the information we’ve gotten back are things we’ve kept in mind as we’ve designed and implemented our portal as well.
Gamble: Just from talking to CIOs all over the country, that’s unfortunately something we’ve heard very often, that there are a lot of organizations that struggle with adoption, or at least their numbers aren’t quite where they’d want them to be. It seems that maybe going right to the source is a good way to do that, but this is something that’s certainly a challenge across the board.
Christian: I think that it is, and I’ve talked with a lot of other healthcare organizations. I’ve heard people say, ‘we’ll get our employees to sign up first.’ I’ve had people say they were going to give away gift certificates, those types of things, from the population of users who sign up for patient portal. And we’ve heard various ones talk about doing it while the patient is in-house — some utilizing their healthcare teams, and some utilizing their patient registration staff. There are a lot of different approaches, but we really feel that the biggest tie-in is while we are doing the discharge, providing the discharge instructions, making it a part of that process.
Gamble: You said February is what you’re looking at for that in the hospitals.
Christian: We’ll probably have a soft go-live in January, and basically that means we’ll be in the system live. We’ll be testing out different components of it, but we won’t begin really pushing with the general population until the February timeframe when we can do some marketing strategies around it.
Gamble: So all things considered, you seem to be in pretty decent shape for Stage 2 and getting all those checkmarks done for that.
Christian: I think we are. I believe the biggest challenge for us will be boosting the numbers in the patient portal but also the public health interfaces. We’re actively working on those right now, just making sure that our technology is compatible. Yes, we’re using a certified EHR, but we’re also working with a different vendors and different groups on the receiving end of those interfaces, and so that’s just a little bit challenging — not impossible, it just takes time and resources.
Gamble: What about reporting requirements? Is that something that you’ve been able to work through?
Christian: We have. The three sets of reporting requirements that we used for Stage 1 included ED Throughput, stroke measures, and VTE measures. We plan to use those same three areas but just add some new quality measures to those, because there’s not a lot of difference between the Stage 1 and Stage 2 quality measures.
Gamble: So much of the emphasis is on being able to realize any kind of increased efficiencies, cost savings, things like that. Can you talk a little bit about what you’re doing in terms of workforce management solutions and if this almost be one of the quicker wins, if there is such a thing?
Christian: I don’t really think that there is any such thing as a quick win. I will tell you that in late 2011, we began working with what we called our Project Greyhound, which was a cost savings program. We looked at supply chain management as a way to save money. We began to look at labor expenses — how we used our staffing, the experience level of the staff that we had in place, all of those types of things. And we felt like overtime might be an area where we could really drive down some costs, and so beginning in March of 2013, we have been pushing for a decrease in the amount of overtime that we’ve used in our organization.
We have worked with API Healthcare as our vendor to help refine our processes. We did an assessment to define what our potential problems were. We made a list of barriers to our success, and we worked through trying to remove some of those barriers. We decided that there were some opportunities for improvements in workflow, and then also an increase in compliance, both with time and attendance and the use of staff scheduling, and then of course to measure the success. That was the plan that we actually undertook. We began that in October of 2012 and really pushed it through so that the month of March was our actual beginning point for measurement.
Gamble: And like you said, there really is no such thing as a quick win, but in comparison to some of the other initiatives, is this something where it is a little bit quicker or easier to achieve some type of results and identify improved efficiencies and things like that that can help the overall bottom line?
Christian: I think it is. We actually changed our methodology for calculating hours per patient day. Like a lot of other organizations in the healthcare arena, we had traditional use midnight census for counting our hours per patient day, but when you do that, it doesn’t take into account the turn you have during the day with people being admitted and people being discharged. And so the calculation that we’re using now takes into account the actual hours that the patient is on the nursing unit and only those hours are included in our hours per patient day for tracking our productivity.
Gamble: Right.
Christian: Another thing we did is we wanted to increase our end-user ownership. And so we put some business analytics tools out for our managers. But we didn’t just throw the tools out there; we set some dashboards that identified the different areas we wanted them to look at. One of those obviously was the overtime hours — the percentage of overtime that was being used in their department. And then the other thing that we were looking at was productivity, which the productivity is based on volume against budget. We looked at both of those areas as ways that we could do that.
And we wanted to change the culture so what we would do is, at agreed upon times, we would send out alerts and notices to the managers to tell them or to remind them to take a look at their business analytics products, because it’s easy to get busy. It’s easy to have other priorities, and unless you have that reminder there to flag you, you might not pay as much attention to that particular project, so we worked with them. We have had some decreased overtime hours as a result of that. I will tell you that the months of July, August and September for us have spiked here at West Georgia, but March through June, we actually had lower than baseline overtime hours during that timeframe. And it looks like we peaked in August, and I expect October and November results to be even better.
Gamble: Okay. So it was giving you information that you didn’t have before, which is always a good thing when you’re stretching every dollar.
Christian: It certainly is, and we’re comparing this against three years’ worth of data. You’re trying to reduce your head count as an organization, but if you reduce your head count too much then you generate more overtime, and so you spend more dollars even though you may have reduced your overall FTEs. It’s a fine balance between that.
Gamble: What about on a larger scale — what are you doing with analytics at this point, or is that something you’re looking at for down the road?
Christian: We actually are using analytics. Those are the things we use to measure our Meaningful Use criteria and that type of thing. Obviously, we can look at some disease states. We’re looking at VTE and stroke as part of that. Also, we have our core measures — our acute myocardial infarction and our CHF or heart failure patients, pneumonia and joints, hips and knees and surgical site infections. Those are all things that we use analytics for, but I think the big challenge for analytics is coming about when you begin to aligning yourself with other independent facilities and you’re looking at quality across the continuum of care from organizations that are not owned by the same entity. You may be affiliated, but you’re not owned. You may have disparate HIS systems both on the hospital and on the ambulatory side, and being able to pull population health information across that continuum — I think that’s going to be our next big challenge. I would share with you that West Georgia right now has been looking at several different types of analytic solutions that will build on to what we already have in place.
Gamble: Are you part of any kind of accountable care organizations at this point?
Christian: We are not. We have elected not to do that. A lot of it has to do with our geography. We don’t have another hospital within a 40-mile radius of our organization, and so that decreases that need to a certain degree. But I think you’re going to see more and more alignment with other community hospitals, just so there can be some sharing of resources and synergies between those organizations.
Gamble: Right.
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