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.
- Physician documentation — “We don’t want to roll it out in a way that flips over the cart.”
- Lack of a statewide HIE in California
- “It all falls on the hospitals”
- Dipping their toes into the ACO waters
- Consistency in leadership
- “It really truly feels like a community hospital should.”
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As we move forward with these things, it’s got to be done in a way that we’re not jeopardizing any care or safety issues, and done in a way that really is a value-add rather than a different work shift.
It’s really about engaging with our physicians and our community so not every doctor has to have its own patient portal. We need to provide that for the community.
Basically it’s all dumped on a hospital — that’s what it feels like from where I’m sitting when there’s not something done at a state level that meets the need of the entire community.
We’re very stable in our leadership, which is very different than a lot of places, and I think we’re all here because of what we really provide to the community.
When I look on the outside, I see that there are a lot of people moving around, and it’s always intriguing what’s making them move. It feels like a lot of times it’s a cultural fit.
Gamble: Talking about the pace of things, I would imagine a lot of it is making sure that you’re getting the value out of these systems and doing everything you need to be doing before you crank it up again.
Hoyos: It’s very true, and I think we’re really looking at physician documentation as the next-level thing that’s going to help us along. The doctors are doing all their ordering and those kinds of things and they do minimal documentation in the system, but in terms of full physician documentation, we don’t want to roll that out in a way that flips over the cart — because it could, really easy. I think that’s one where we want to be very thoughtful in our processes, understand how we engage the doctors with our PC3 group and others, and move forward a little bit cautiously and in the right environment to start with, so that we can get the wins. Otherwise it can make all the work you did bad, and it can take a turn that we don’t want to take.
What we’re doing is about patient safety. It’s about our customers, and by ‘customers’ I mean both sides — our physicians and staff, and our actual patients. But as we move forward with these things, it’s got to be done in a way that we’re not jeopardizing any care or safety issues, and done in a way that really is a value-add rather than a different work shift, or maybe even more work than what was done before, if it’s done wrong. So it’s tough.
Gamble: It’s a tough line to walk. I don’t know if you had mentioned anything before about care in the community or accountable care. Is that something that you’re involved with at this time or looking into?
Hoyos: We’re looking into it. We have an insurance company that was spun off from the hospital 25 years ago or so that is really just in the senior line of business right now. We have a very strong IPA that our physicians are associated with, and we just did our strategic planning for the organization. There’s not a California HIE out there, so what we have to do is really look at providing a private one — one that is Pomona Valley-branded, to help our community out. With the ACO idea, we have our toe in the water I’d say, and are looking at that and how we’re going to move forward with it, but it’s really about engaging with our physicians and our community that way so not every doctor has to have its own patient portal. We need to provide that for the community.
And how do they make the right decision on an HIE strategy when there isn’t one in the community? Well, they need to come to us. It’s a really an odd thing when you think about it, because we’re in a very urban area. We’re 30 miles outside of LA; it’s not like we’re living in the suburbs or a rural area where there’s just the catchment hospitals to take for emergency services or something like that. We provide care all way from the ocean out to Palm Springs. It’s a lot of people, and there’s not one HIE where we can pass on the data. It’s something we need, and we think that it’s the right direction. There’s just not a complete path to get there, so we’re going to step in there on our own and provide it for the community.
Gamble: That’s really surprising. When you told me that I was very surprised.
Hoyos: It’s odd. People on our board don’t understand it; that’s what they’re talking about. There’s not a sustainable HIE. There’s one that wants to flourish out here. It doesn’t have legs yet. It will probably be something we’ll connect to at some point, but it won’t meet the need for Stage 2 for us right now, so why are we going to there?
Hoyos: It’s a step 2, not step 1.
Gamble: Interesting. It boggles the mind a little bit when you talk about HIEs and how much it can differ from one state to the next or one area to the next. It’s really pretty inconsistent.
Hoyos: Basically it’s all dumped on a hospital — that’s what it feels like from where I’m sitting when there’s not something done at a state level that meets the need of the entire community. So it pushes it down to the hospital because we have deeper pockets than the doctors, and so we’re really kind of put on the spot to make that happen. I think that we’re better set up to do that. We have an overall commitment to the community and our medical staff instead of a proprietary kind of a thing for a physician, but it doesn’t feel real good when you’re the one footing the bill when you see what has to get paid to make those kind of things so that they can join with us, and hopefully they do.
Gamble: That’s a tough situation. Are you in touch with other CIOs in the area just to see what they’re doing, what their strategy is with HIEs?
Hoyos: It’s something we’ve talked about at length. The larger ones we’ve talked to, the ones that want to get off the ground and get moving are just not quite there for us yet for our community.
Gamble: So now having spent as much time as you have there, you know this is an industry where there’s a lot of movement. Seeing how long you’ve been there, that is pretty rare. I can imagine it’s been interesting from your perspective seeing all the changes in your organization. I’m sure you’ve had some ups and downs, but that’s got to be a really interesting perspective having been there at one organization.
Hoyos: At our hospital, our CFO and our COO have both been here for over 35 years. Our director of our satellite division, which has the family practice residency and the different satellite facilities reporting to him including radiology, he came up as a respiratory therapist, and he’s been here over 35 years. Our CNO who came up through the ranks has been here over 35 years. So we have a lot of longevity here. Our VP of finance came here a few months before me. We’re very stable in our leadership, which is very different than a lot of places, and I think we’re all here because of what we really provide to the community. We are a not-for-profit. We act like one. We turn away no one — ever. That’s the way we’ve been kind of born and raised, and I think that that’s part of its culture. It really truly feels like a community hospital should, I think. That’s part of it.
Growing up around that, I think that’s a big part of it. I look around and see others and it varies because I think that there’s a different mission. I think that some missions can be a little bit more bottom-line driven than ours. We have a family-oriented culture. My wife works here; she’s a nurse and a discharge case manager. Actually, she started here a little bit before me. She went to work for the IPA for a bit and then came back. So on the books it doesn’t look like she’s worked here as long, but she’s actually worked for the organization for over 27 years.
Hoyos: It’s pretty normal, so I don’t see it internally that much, but when I look on the outside, I see that there are a lot of people moving around, and it’s always intriguing what’s making them move. It feels like a lot of times it’s a cultural fit, and other times it’s wanting to move up and wanting a bigger facility.I think that for me it’s really the fact that the work that we’re doing is for the community. And I’ve been tied to this community my whole life, so it fits me very well.
Gamble: I would think that for the staff, seeing that kind of stability on the leadership team has to be pretty encouraging.
Hoyos: I think it is overall, but I’m sure there are those out there saying, ‘would someone move on so that some of these slots can open up too?’
Gamble: Yeah, that’s true. We talked about a lot of the things you have going on. I don’t know if there’s anything else we missed, just as far as some of your bigger priorities for the next year or so, or things you’re just starting to look into.
Hoyos: I don’t think so. Those are the big things. Engaging the physicians and making it easier for them to be a little bit more mobile — those are always intriguing and we’re always looking at how do we do that without buying them stuff. That’s difficult. Those are things that we talk about and that we roll out in pieces and test them. I think strategically, it’s the HIE and the patient portal that are really going to drive us over the next few years.
Gamble: Right, and it’s setting up for the next stage of Meaningful Use.
Gamble: Okay, well I think we’ve covered everything. I’d definitely like to speak to you again down the road just to see how everything’s going.
Hoyos: You’re totally invited whenever you want.
Gamble: Okay, great. Thank you so much for your time. I appreciate it and I enjoyed hearing about everything you’re up to there.
Hoyos: Glad I could be here to have the discussion.
Gamble: Thank you, and best of luck going forward.