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.
- Building the IT team & infrastructure
- Physician Care Connect Committee
- Achieving a “flawless” go-live
- Focus on optimization
- Attesting to stage 1, year 2
- Frustration with ICD-10 delay
- “We’re not moving at a pace that feels very safe.”
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We tried to tie things together so that they all had to perform and be part of it. As they brought things back and we built them or they tested them or whatever, we had certain milestones that were met and then they’d get paid instead of just getting paid by the hour.
It’s really about the processes and the buy in and the people that are involved in making sure that you’re meeting what the business needs are of those end users.
When we put PACS in, the ability to take on new modalities and the report turnaround time was seen right away. It’s kind of the poster child for what value is in IT.
We wanted it in; we didn’t want to have to change once we were on it, and we spent a lot of money getting ready for ICD-10 and getting people trained. We would have been fine going forward.
You want to be able to get these systems in and you want to be able to tweak them so that they really hum. It really doesn’t make a lot of sense to slam it in and move on to the next thing and not be able to look back.
Gamble: How long have you been there? I know you’ve been there for quite a few years.
Hoyos: I’ve been here for 20 years. I came from the data side of this. I was a decision support analyst and then director, and then I moved into IT in 2000 and took over as director, then CIO, and then vice president and CIO.
Gamble: So once it was decided that you guys were going to go with Siemens and make the change to one system, I can imagine there were a lot of things that had to happen on your side as far as building the infrastructure and getting a team in place. Can you just kind of walk through some of that?
Hoyos: When I came to IS in 2000, I think we probably had about a dozen people. We now have right at 60. We went up to 70 at one point in time. We think we can run it with 60 right now. There was a very large swing as far as all types of IT folks. We had a couple network people and a couple of analysts and then helpdesk staff and those kinds of things way back when. Now we have a team of about 20 analysts, we have an infrastructure team of about 10, and then we have helpdesk and PC techs. We have liaisons that go out in the community and help bridge the gap for our physician offices and make sure that they can use the system and are dedicated to IS, and we also have a part-time informatics team.
So one of the differences on our install than most is that we require some of our informatics folks to still be nurses so that they can take that back to their environment and make sure their unit is using it to its best and that the unit knows that they can go to that person, they can bring it back to us if there’s issues or if there’s something that needs to be changed or those kinds of things. That was one thing.
And then on the physician side, we currently don’t have a CMIO, but we built a team of doctors along the way — the PC3 doctors is what we call them (Physician Care Connect Committee). We wanted the doctors to be very engaged in this, and so instead of just appointing people, we had them interview for it. We said who wants to be part of this, and so we got the young and up-and-coming doctors involved in this, talked to them about it, and they said they wanted to apply. We interviewed a lot of physicians. Some didn’t end up being on the committee because they couldn’t commit to the timeframe.
We had them really involved from the beginning. We told them what was expected. We paid them based on milestones as we met certain milestones along the way, and we tried to tie things together so that they all had to perform and be part of it. As they brought things back and we built them or they tested them or whatever, we had certain milestones that were met and then they’d get paid instead of just getting paid by the hour, those kinds of things. And it wasn’t a ton of money, especially for a physician, but it just kind of kept them engaged and involved, and to this day we still have that committee and we’re trying to figure out how we’re going to move forward in the future with them. I think we need a CMIO. We have the chair of that PC3 committee, but I think that we need probably a commitment of a doctor that is probably a part-time CMIO. That’s kind of how we built our team.
Then as far as the network, the network grew, our technology grew, and we went into a wireless environment. We had to have the staff to really support that additionally on the different applications. We’d grow those applications; we’d bring in a little bit more help along the way with each one of those. So when we built our document managing system in 2008, we added a couple of people because it was on the front-end and the back-end, and it was our electronic medical record at that point in time. So we kept rolling, adding people, adding technology and making sure that we can support it along the way.
Gamble: I’m sure that’s something where having the nurses and physicians so heavily involved has benefited you.
Hoyos: Absolutely. It’s not about the technology. I think there are a lot of systems out there that can do it, but it’s really about the processes and the buy in and the people that are involved in making sure that you’re meeting what the business needs are of those end users.We’ve never looked at any of these as IT projects, and housewide, I think we’ve been pretty fortunate to keep that voice going that way.
Gamble: Now when you did go live with Soarian, did it go fairly well or was kind of rocky in the beginning?
Hoyos: It was flawless. It really was. It was flawless. The day of go live was the only issue we had along the way. Our users were very accepting of it and very ready for it. We had excellent training. We had the support of our chief nursing officer, which really helped a lot. One of the things that we did was if they didn’t go to training, they weren’t allowed to practice; the nurses couldn’t come to work. It really helped to have that kind of commitment from all levels throughout the organization.
And really, once we started, we haven’t looked back. I think that we’re only looking forward at what can we add that’ll make it better, make a better experience, provide value to the organization in total, that kind of thing. One of the key things that I’m working on really now is some of the value proofs — making sure that we’re using the system and taking advantage of the system in a way that provides value to the organization.
Gamble: Really just looking to optimize and making sure that you’re getting the most out of everything it offers.
Hoyos: Yes. We’re in California, so we’ve had mandated ratios for a while. There’s not a lot of getting rid of staff and things like that. It’s really about how do we make the staff more efficient and make it work for you. So that’s really been key. And in terms of the patient safety things that happen; when we put in Med Administration Check in 2010, the safety of drug delivery was obviously seen right away. When we put PACS in, the ability to take on new modalities and the report turnaround time — because we’re using voice recognition — was seen right away. It’s kind of the poster child for what value is in IT. It’s really easy to see. You used to have all these librarians and those kinds of things. Where do we have those advantages that we can provide in using the technology? Are they as easy to find? Sometimes they’re not. Sometimes you’re so focused on the end goal of going live and getting these things out that you don’t take the time to do the time studies and those types of things and the measurements that really do prove the value. I think that we see it a lot and we understand that it’s there, but we’re really trying to be more formal in documenting that right now.
Gamble: Okay, so now in terms of Meaningful Use, you attested to Stage 1?
Hoyos: We attested to Stage 1 last year, so in 2013- 2014, we’re attesting to Stage 1 again, and we’re going to be doing that in July, and that’s because of when we chose to take our upgrades with the timing of things. Stage 2 we have some reservations, as everyone does, in moving from stage to stage, but it’s really about the quality measures and electronic submission of that than anything else, just because it’s a lot of moving parts and there’s a lot of process that goes along with those.
Gamble: I think that that’s a gentle way of putting it. There are definitely a lot of concerns about Stage 2 just because as you’d expect everything gets kind of amped up.
Hoyos: That’s very true. I think that in our case, with ICD-10 there was a lot of pressure on the financials to move forward and get it in before ICD-10, and it was a little bit false on the pressure. We wanted it in; we didn’t want to have to change once we were on it, and we spent a lot of money getting ready for ICD-10 and getting people trained. We would have been fine going forward, we feel.
And I don’t have an HIM director right now. We have an interim, and so it allows me to get the department right and kind of move forward that way and hopefully not have two hits on the revenue cycle. Any implementation of the revenue cycle is going to have some kind of a hit, and we’ve all read what ICD-10 was going to do, so that kind of helped us little in delaying that part of that a bit. So that was good, but I think we all wanted the Meaningful Use to be delayed, not ICD-10.
Gamble: Definitely. It’s going to be interesting to see how things go this summer, but that was a sentiment that we’ve heard a lot.
Hoyos: We’re not moving at a pace, in some of these areas, that feels very safe. You want to be able to get these systems in and you want to be able to tweak them so that they really hum. It really doesn’t make a lot of sense to slam it in and move on to the next thing and not be able to look back and see how to fix it, which is what it kind of feels like. We need to be more thoughtful in the whole process I think than we’re being right now.
Gamble: Yeah, the pace of change really is so fast right now and I think that puts a lot of pressure on leaders and CIOs. Does it put added pressure just in terms of your own staff and not trying to have everybody so overwhelmed when you have so much to do in shorter timeframes?
Hoyos: Yeah, you can feel it. I think that some of the staff feel it more than others, just like anything. Some people just thrive on change and they love to be right in the middle of it, and with others, there’s a little bit of pushback and it’s not for them. So we try and look for the right fit on what kind of application they can be over or what kind of a project they can be on, those types of things. I think you have to watch it and you have to really be aware that we’re moving at a pace that isn’t comfortable for everybody because it is so fast. And that’s a very difficult thing to do.
The other side of it is keeping good people here. It’s becoming a little bit harder all the time because there are so many people that are in demand because of the environment we’re in right now with all the different changes and everybody putting in systems. It makes it difficult to keep good people. I think that we’ve done pretty well. There’s a few where you don’t blame them for doing that, but I think if the environment wasn’t what it was, they would have stayed here. But they could go out and they could make a little bit more money or whatever it is that they needed in their own personal life.