With October looming and organizations devoting more and more resources to prepare for ICD-10, there’s an opportunity being missed. Spencer Hamons believes it’s time to share responsibilities with the end users; after all, they’re the ones who will soon realize that “their job is going to fundamentally change.” In this interview, he talks about the unique perspective he has as both CIO and COO — particularly when it comes to initiatives like ICD-10; the infrastructure challenges that come with being in a remote area; how he is able to leverage the COO title to his advantage; and why CIOs must be willing to be frontrunners when there are no leaders to follow.
Chapter 2
- Contingency plans for Internet down time
- Donning the COO hat for ICD-10 — “I’m more concerned with operational piece.”
- Helping end users realize “their job is going to fundamentally change.”
- The mantra of the 90s
- Eyeing the CEO title — “I don’t know too many CIOs who have made the jump.”
- Engaging patients in the PCP setting
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Bold Statements
Everybody wants to try to sell you on something cloud-based, but when you start looking at the risks, sometimes it’s just not acceptable.
Let’s get that responsibility back out to the end user. I don’t need to be defining the workflow of how my folks do their day-to-day business. I need to be ensuring that they’re meeting all the requirements and that they’re meeting our business needs.
If I try to stay more in the COO hat with the knowledge that I have on how technology can enable it, I find that I get better integration between the technology staff and my business leaders as we’re trying to come up with solutions.
One of the things we’re still working through is how do we not only get people signed up for using our patient portal, but how do we get them to actively use it? How do we create value, especially on the hospital side?
Gamble: Having gone through this, have you had to set up disaster recovery plans and contingency plans?
Hamons: We definitely have some disaster recovery plans in place for some point-to-point microwave connections, and we’re doing some coordination with some local folks here in that regard. However, it’s difficult to get vendors such as Verizon to buy in to bringing in some sort of redundancy to an area that really has a low subscriber rate compared to their much larger markets. Everything from handheld radios and repeaters are being considered. We don’t even have a local pager provider in our area, so even the concept of going to pagers requires you to dial long-distance, which isn’t available whenever our internet goes down. With everything, we’re considered how we can do things in-house.
Gamble: It’s really interesting. I’m on the East Coast in New Jersey, and these are situations that we don’t really even hear about. It’s always good to hear about these different experiences.
Hamons: The challenge comes when you’re dealing with vendors; if you look at how many vendors we deal with that are from San Francisco Bay area, LA, Boston, or New York, they come in with these preconceived notions that everybody has the same type of connectivity and the same services as they do in their areas. And everybody wants to try to sell you on something cloud-based, but when you start looking at the risks, sometimes it’s just not acceptable.
Gamble: Sure. Just thinking about 24 hours without Internet — if you talk about 24 minutes, in some areas, they can’t even comprehend that. Now, as far as some of the other big health IT priorities on your plate, how are you positioned with ICD-10?
Hamons: For me, it’s a little bit of a different story because I’m not only the chief information officer here; I’m also the chief operating officer. Whereas a lot of folks are looking at ICD-10 as being a technology issue, I look at ICD-10 as being both the operational issue and the technology piece. Putting in the capabilities of doing ICD-10 is really not that difficult, especially if you have a vendor that’s committed. In our case, athenahealth is committed and Meditech is committed to providing ICD-10 functionality, and we partnered with the right people like IMO to be able to do the mappings and all of those types of things.
Honestly, I’m more concerned with operationalizing ICD-10 and how are my departments that are going to be responsible for dealing with this, going to implement the workflow processes necessary for ICD-10 to really move forward? Those are more my concerns. Right now, we are in the midst of doing training, and honestly, I think we’re going to see that as these departments and physicians that are going to be responsible for doing a lot of this begin to see the impact that ICD-10 is going to bring to their day-to-day duties, we are going to really see a change in how the workflow works. I think it’s going to fundamentally change the way that we deliver care and do our day-to-day jobs in those operational areas.
Gamble: Is there anything that can be done to try to help ease that adjustment, just as far as getting them ready for the changes in workflow?
Hamons: Personally, I think a lot of it has to do with education. And again, I think it’s the end user that’s going to have to look at it and come to the realization that their job is going to fundamentally change. The responsibility in my case, as the COO and as a member of our ICD-10 steering committee, is to bring those folks in and say, ‘now that you’ve gone through the education; now that you have a true understanding of what is happening, where do we need to start making changes in your workflow?’ Let’s get that responsibility back out to the end user. I don’t need to be defining the workflow of how my folks do their day-to-day business. I need to be ensuring that they’re meeting all the requirements and that they’re meeting our business needs. If you were to take the analogy of my housekeeping department, I don’t need to define how they terminally clean the room; I just need to define what the expectations are in the end, and let those folks determine their own workflow. And I come out with a better product in the end and I come out with happier employees.
Gamble: That’s a good analogy. When you talk about the steering committee, have you had pretty decent participation and interest among the users, and is there that acknowledgment that they’re the ones who are going to be responsible for making the change?
Hamons: With the ICD-10 steering committee, our participation has been outstanding. Our CEO is an outstanding leader and he does a good job of making sure that he participates, and he expects the rest of the executive team to participate. Honestly, whenever you have that type of commitment, everybody else that’s expected to be there realizes those expectations and they put an emphasis on it. We’ve had our ICD-10 steering committee going for about the last 10 months, with excellent participation and really great outcomes. People are meeting their deadlines. They’re doing the things that they’re responsible for — getting in the questionnaires, getting in plans, etc. And so I really see this moving forward. If you look at a lot of what my peers are doing, I think we’re ahead of the game.
Gamble: Right. Now that is just one particular instance where you talked about what it’s like to have that dual role of COO and CIO. That to me sounds like something that’s really got to be an interesting perspective. Just to give a little bit of background, were you hired for both roles or how did that come about?
Hamons: I’ve been doing the CIO role for about 16 or 17 years now and I realized I was one of the folks that understood the business necessity behind what we were doing. Technology for the sake of technology was the mantra through the 90s, and I’ve been lucky to be able to see that shift to where technology as a business enabler was what was really important. And as I’ve seen that shift and gotten involved at the business level, I realized that I had the skills to be able to manage those business areas. That, to me, was what drove me more toward the operation side and not just sticking within technology.
When I was hired on here at Taos Health, that was one of the reasons I was brought on. Our CEO, Peter Hofstetter, is approaching the end of his career. I would venture to guess there are somewhere between five to seven years left in his tenure. I’ve started looking at doing the COO role and also eventually moving into the CEO role, but knowing that I would need somebody to mentor me to be able to do that. Honestly, I don’t know too many CIOs who have made the jump to CEO. And so it’s been a great relationship to be able to run operations here and at the same time have a mentor like Peter, who is willing to bring me in and say, ‘Look, you made a mistake on this one,’ or, ‘maybe we need to approach this in a different way.’
And honestly, it’s difficult. With healthcare reform and everything else that’s happening and the uncertainties with payers here in New Mexico and the financial struggles, it’s a lot more difficult to manage operations when you’re doing it on a shoestring budget than when you’ve got every position and person that you could possibly imagine.
Gamble: I can only imagine. Do you find that there are times when you have to sometimes wear that CIO hat and then sometimes wear more of the COO hat, depending on the situation?
Hamons: There are times, although I fight against that struggle as much as I can. Again, going back to that whole concept of technology for technology’s sake, I am a huge proponent that technology folks have to be here to enable business innovation. That’s the reason that we’re here. If I start wearing the traditional CIO hat and I start talking with my technology jargon and getting into the weeds of technology, people — especially the IT folks — tend to lose the focus that we’re here to develop the business. And so if I try to stay more in the COO hat with the knowledge that I have on how technology can enable it, I find that I get better integration between the technology staff and my business leaders as we’re trying to come up with solutions.
Gamble: There certainly seem to be a lot of synergies between the two roles. Even when they are more separate in the traditional way, there are a lot of ways where you could see benefits from having that involvement with both areas.
Hamons: Yes, absolutely.
Gamble: Where does your organization stand with Meaningful Use?
Hamons: We’ve done all of our stage 1 Meaningful Use attestations. We’re in the midst of stage 2 now. It’s not necessarily challenges in the technology; it’s really challenges in getting everything done correctly. One of my big pushes with the staff here is I don’t want to do Meaningful Use just to tick something off of a checklist and say, ‘yes, we met this goal.’
If you think back to Meaningful Use Stage 1 with medication reconciliation, that is a big piece of the patient safety issue. That’s the whole reason that medication reconciliation came up. I did not want to go down the path of saying we’re going to hit these Meaningful Use metrics for med reconciliation and we’re going to check it off our list and go forth and conquer. I would rather say we’re going to spend an extra three or four months and really change our clinical workflow. We’re going to make medication reconciliation fully useful. And we’re going to figure out how we’re going to do integration between our Meditech system and our athenahealth system so medication reconciliation that happens in the hospital is shared with our primary care physicians that are out in our community. By doing that, we ended up creating a system that was much more robust. It may have delayed us a month or two in being able to attest for stage 1, but it was the right thing to do.
Gamble: It makes sense positioning that as something that’s going to improve the quality of care; this is going to make us better as an organization. And yes, it is also part of the requirements, part of that checklist but it goes beyond that.
Hamons: Yes.
Gamble: With stage 2, one of the things I can imagine would be challenging is the patient engagement piece, especially for an organization like yours where you talked about not always having readily available access to the internet, and also having a geographically dispersed patient population. How is this something that you’re going to tackle?
Hamons: It’s difficult. One of the things we’re still working through our processes on is how do we not only get people signed up for using our patient portal, but how do we get them to actively use it? How do we create value, especially on the hospital side? We see value for our outpatient clinics; that’s not a difficult sell to make. But with hospital care, we’ve seen this huge shift from inpatient hospital care to outpatient care, and we want to drive our patients.
Let me give you an example. A patient goes into a clinic and they need some lab work done. The lab work gets sent to the hospital, they get their blood drawn, and the lab gets resulted. We send that lab result back to the primary care physician, and it is the primary care physician who needs to look at that result and discuss the result with that patient. That’s really where that patient encounter should happen. We want to see the patient looking at those results through the individual clinic’s portal to use their information to create another appointment and ask questions of their physician. There really aren’t a lot of things that should happen with the hospital on that type of encounter. The question comes back to how do you drive that patient interaction at the hospital level, when really the whole point that we’re looking at is driving that patient interaction at the primary care level? So yes, it is a challenge, and it is one that we have not overcome by any means.
Gamble: Is this something where you can draw upon some of the experience you’ve had working in Alaska? You talked about working with some of the remote patient populations there — are there some best practices or lessons that you’ve been able to apply or at least would like to apply?
Hamons: There are some things that we’ve been able to apply when it comes to doing registration and enrollment into the portal, but not anything that I’ve been able to really do when it comes down to actual meaningful usage of the system.
Gamble: That seems to be really a challenge for a lot of the CIOs we talk to once you get outside of certain areas, and something I think we’re going to be hearing a lot more of in the next couple of months moving closer to Meaningful Use 2.
Hamons: Yes, I completely agree, and I think it’s going to be something that we’re going to hear a lot more conversations about.
Chapter 3 Coming Soon…
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