Kent Hoyos, CIO, Pomona Valley Hospital Medical Center, Chapter 1

In an environment where everything seems rushed, Pomona Valley decided to take a different approach to adopting an EHR. Although the contract was signed in 2004, it wasn’t until 2012 that the 453-bed hospital went live on Soarian, and according to CIO Kent Hoyos, it was well worth the wait. In this interview, Hoyos talks about the “building block approach” that his organization took, which involved adding people and technology in waves, ensuring support was available and everyone felt confident before taking the next step. He also discusses his strategy for keeping clinicians engaged, how he hopes to optimize the system, and the importance of consistency on the leadership team.

Chapter 1

• About Pomona Valley
• Soarian in hospital, NextGen in ambulatory
• “Building block approach” to implementation—“We tried to really roll it out in intelligent blocks.”
• Contract provision with Siemens
• Financials in late summer/early fall
• West Coast user groups

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Bold Statements

We signed to move to Soarian in ’04, and we did not move until we were comfortable with the system and we had built up our staff so that we could that we could take the items on it and make sure that we could do it right.

We did have a provision in our contract that we didn’t have to put it in until we were ready and Siemens was ready with three live sites like ours. Because we signed for clinical, financials, CPOE — the whole gamut, there were a lot of things that needed to be in place.

We did a couple of things that might have veered our course just a little bit. Some of the measures that you have to do, that you have to check the box with, we probably wouldn’t have done.

I think learning from others and building the community and making sure that we could work together with the community and learn from them and not step into the same holes they did — that really did work to our advantage.

Gamble:  Hi Kent. Thank you so much for taking the time to speak with us today.

Hoyos:  Not a problem, my pleasure.

Gamble:  To get things started, can you tell us a little bit about Pomona Valley — what you have in terms of bed size and ambulatory, things like that?

Hoyos:  We are a 437-bed, not-for-profit community hospital. We are a tertiary center for our NICU, and we’re number 3 in the state of California for births. Actually, I think we’re four this year. Cedars finally went ahead of us. So we have a lot of moms and babies. We do heart surgery, the normal book of business. Other than that, we have a center of excellence with heart, we have a regional kidney stone center that’s outpatient, and we have four family practice residency sites. We’re a family practice residency teaching facility affiliated with UCLA. We have I think seven physical therapy offsite locations also. Do you want me to get into our systems?

Gamble:  Yes.

Hoyos:  We’re a Siemens Soarian site. We have been with Siemens for over 30 years in total. We’ve been live on the clinical side with Soarian since October 2012, and we have continued to optimize that and bring other applications live.  We’re CPOE completely through them. We have their imaging system, so the EDM system, pharmacy, lab, radiology and PACS.

And then ambulatory site we’re NextGen ambulatory. We’re going to be going live with the critical care module next week, and we have our financial go-live later this year. On the financial system we’re currently on Unity, which is one of their older platforms. So we’re going to be getting off of that.

Gamble:  What’s the timeline for that?

Hoyos:  We think its late summer. In either August or September we’ll go live. Right now we’re in the middle of defining that.

Gamble:  You said you’ve had Siemens Soarian for since 2012 or so.

Hoyos:  Yes.

Gamble:  What was in place prior to that?

Hoyos:  We had Unity Clinicals. Basically, what we had was just the results going across. We did do orders from the unit so they could put in a lab order and they could view results for labs, radiology, those kinds of things. So we had a portal view to get your results and look at those either here or away from the hospital.  But that was really our first foray into clinical documentation for the nurses, with the exception of the women’s center items. We have QS there and Centricity there for fetal monitoring.

Gamble:  Is this something that was in the works for a while? Because that’s pretty big going from the environment you just talked about to having one system.

Hoyos:  We had kind of a building block approach. We described it as building a pyramid with the CPOE at the top. I think the reality of it today is that it is kind of like the great pyramids where we’re adding these other blocks like HIE and the community strategy with that, and our ambulatory strategy, and deciding and how do we kind of move forward with those items.

We signed to move to Soarian in ’04, and we did not move until we were comfortable with the system and we had built up our staff so that we could that we could take the items on it and make sure that we could do it right. I think it was accepted exceptionally well because of the way we went about it — the building block approach where you’re adding specific things. When we first signed in ’04, we barely had anything online. Then we came up on PACS and we came on with a more functional kind of a dashboard look for where they could get to their records a little bit easier and they understood that — the doctors and the staff. Then as we moved forward with this, we brought our staff into the process, we brought our doctors into the process, and really kind of laid it out as ‘this is when we’re going to go live with our clinical documentation,’ then ‘this is when we’re going to go live with our CPOE.’ We tried to really roll it out in intelligent blocks where if we wanted to look at something first, we would put it in an environment where wasn’t a lot of transfers. We’d test it there and then we’d roll it out to the house. Those types of things.

So it was planned since ‘04. We did have a provision in our contract that we didn’t have to put it in until we were ready and Siemens was ready with three live sites like ours. Because we signed for clinical, financials, CPOE — the whole gamut, there were a lot of things that needed to be in place. So now on the clinical side, we’re really happy with it. On the financial side, I think we’re developing confidence in our go-live. I think the financial system go-live, for whatever reason, is a lot more tenuous, obviously because the whole revenue cycle of the hospital is in danger. But we’re getting close to being able to move forward with it in the next couple of months.

Gamble:  Was it part of the strategy not having to implement anything too quickly just because of all the challenges that come with that as far as workflow and the change management piece?

Hoyos:  Yes, it was. I think that when we signed in ’04, the product wasn’t there yet. There were a couple of sites it was running on and they were really installed by Siemens. Since then, it’s become something that anybody could put it in themselves, but it took a while to be able to get to that level. It’s an excellent product now.We have full functionality on all these things, and it’s really shown that if we had waited, certain things we couldn’t have done. We wanted to make sure that they were there for them so it wasn’t, ‘Yeah, it doesn’t do this kind of thing.’ It was kind of both things, and then with the government saying they’re going to pay us for it, it ended up just falling into our lap.

Now would we have had the same pressure and time to do things? I think we would have been close. It just worked into the timeline for us. I think we did a couple of things that might have veered our course just a little bit. Some of the measures that you have to do, that you have to check the box with, we probably wouldn’t have done. And I think that most people would say that. Some of those are just, ‘you need to check the box, so we’re going to go do that right now.’

Since then, we’ve attested and got Meaningful Use money. The one thing that happened to everyone was the new rules where you have to do the upgrade to stay on the latest certified version. It kind of slows down the momentum when you’re trying to optimize your system. That’s been kind of a challenge for us too.

Gamble:  But you were able to see this up and running at other sites and just kind of have that peace of mind before taking the next step.

Hoyos:  Absolutely. It really did work to our advantage, all of that. I think learning from others and building the community and making sure that we could work together with the community and learn from them and not step into the same holes they did — that really did work to our advantage. So we’ve been very active in the West Coast user groups since we went live and right as we were going live, to make sure that we could spread our experience to them also so that they could learn from us. In this community, our success breeds success for others, and that’s how we’re looking at it right now.

Chapter 2