Dan Waltz, VP & CIO, MidMichigan Health, Chapter 1

There are few tasks that can better prepare one for the CIO role than leading an Epic rollout at organization like the University of Michigan Health System. It was the path that Dan Waltz took, and it has helped him enormously at MidMichigan, where he has held the CIO post since January. One of the most valuable lessons he learned? Letting physicians vent and not taking it personally. In this interview, Waltz talks about the importance of clinician engagement, how his leadership philosophy has evolved, his long-term goal of getting to one integrated system, the benefits of using consultants, and what he believes is the toughest part of being a CIO today.

Chapter 1

• About MidMichgan Health
• Affiliating with University of Michigan Health System to “share our strengths.”
• Allscripts in practices, Cerner in hospitals
• Outsourcing to Cerner
• “We’re looking at various ways to centralize most of the services.”
• HIE mergers
• Getting docs on board with data exchange

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Bold Statements

Because of the fast track of trying to get the system up and in very quickly based on the Meaningful Use requirement and things like that, I think it was basically the route of least resistance.

When your outsourcing site is responsible for disaster recovery and backup, a lot of times in hospitals they can’t afford to fund those kind of efforts or don’t fund them enough. One thing about an outsourcing contract is that it can’t be cut. It can’t be compromised.

We’re trying to convince the physicians, and it’s been very slow to bring them up. I think we’ve only got several offices up right now with the viewer.

We’re not sure exactly how and which software they’re going to end up using. If they switch to Medicity, we don’t know what that means in terms of converting the data we already have, or how we have to change the feeds to the Great Lakes HIE.

Gamble:  Hi Dan, thank you so much for taking the time to speak with us today.

Waltz:  Hello, how are you doing?

Gamble:  Great, thanks. To give our readers some background, can you just talk a little bit about MidMichigan Health — what you have in the way of number of hospitals, ambulatory, things like that?

Waltz:  Sure. We have four hospitals in the area. We cover about 16 or 18 counties in mid-Michigan and we have around 5,000 employees. We have around 500 physicians and advanced practice providers. Last year our annual gross revenue was around 1.1 billion. Actually, our balance sheet is really strong, $590 million. We have a total of 402 hospital beds at four medical centers, 185 licensed nursing home beds, and 20 licensed assisted living beds; so it’s a pretty diverse system. One other thing is we are in talks with another health system that’s much smaller than us, and so we’re looking at the M&A activity as well.

Gamble:  You’re affiliated with the University of Michigan Health System. How does that work?

Waltz:  The way that works — and I was actually working at the University of Michigan Health when this all went down — is the University of Michigan has a 1 percent interest or affiliation into Mid-Michigan. My understanding of the deal is that they could have up to 20 percent over five years depending on how things go. So we are looking at having access to their specialists and being able to refer people to them, and they’re looking at some of our nursing beds homes and our assisted living beds and things like that. We’re really trying to share our strengths.

Gamble:  Is this something that’s fairly new, the affiliation?

Waltz:  Yes. I think it happened late last summer in 2013.

Gamble:  You’re still trying to iron out what exactly it’s going to entail?

Waltz:  Yes. We have a number of conditions of use and clauses in the contract that we’re all working on.

Gamble:  Like you said, the goal is to be able to use both of your strengths to provide better coordinated care?

Waltz:  Absolutely, and we’re able to because we’re referring more patients to the University of Michigan. It’s nice to have the University of Michigan logo on our health system.

Gamble:  Sure. Now does Mid-Michigan Health also have physician practices that you own or are affiliated with?

Waltz:  Yes. We have employed physicians. My understanding is we have around 200 employed physicians. We are using Allscripts Enterprise or Allscripts TouchWorks for the practices and specialists.

Gamble:  What about in the hospitals — what are you using there?

Waltz:  In the hospitals, we’ve been running Cerner and we’re coming up on the latest release in the next couple of months. We actually outsourced the entire hardware/software system to Kansas City and Cerner, and then we have staff onsite that configure and manage the software remotely.

Gamble:  Obviously I can see why you would want to do that, but was this decision difficult to come by just because you do have to spend those funds? Was it just a matter of wanting to make sure that things were done right and having the expertise in there?

Waltz:  My understanding — and this decision was made prior to me arriving — but I think because of the fast track of trying to get the system up and in very quickly based on the Meaningful Use requirement and things like that, I think it was basically the route of least resistance.

Gamble:  And the agreement is still in place for outsourcing?

Waltz:  Yes. I think we have a five-year agreement with Cerner. We’re running some of their other software pieces like the surgery software and several other hospital outpatient department pieces with Cerner.

Gamble:  Okay. How long has the system been in?

Waltz:  Let me think. I think the system went in sometime early last year.

Gamble:  So it’s still fairly new. Do you know what was in place previously?

Waltz:  I really don’t.

Gamble:  As far as the status now, you said that you’re looking at an upgrade in the near future?

Waltz:  Yes. We’re upgrading, and I will say just one more thing on the outsourcing piece. One of the nice things is that when you outsource Cerner or when your outsourcing site is responsible for disaster recovery and backup, a lot of times in hospitals they can’t afford to fund those kind of efforts or don’t fund them enough. One thing about an outsourcing contract is that it can’t be cut. It can’t be compromised. And so actually, in some ways, it’s a nice safeguard.

Gamble:  How does that work in terms of meetings? Is it similar to how you would do it with your own staff, as far as meeting with the Cerner employees who are working on the implementation?

Waltz:  Yes. We have an onsite representative from Cerner here and we have weekly calls. Our hardware and infrastructure team is in constant contact with them about the health of the connections and the network speed and all that kind of thing. And then our applications managers and our configurers who do that work use a support line whenever necessary, but we do our own work on the Cerner platform. We do the various configurations and optimization things onsite with our own staff.

Gamble:  You said you have Allscripts in the physician practices?

Waltz:  Correct. Yes, we have Allscripts Enterprise, or I think they’re calling it TouchWorks now, and I think that was put in sometime in 2011.

Gamble:  What about the affiliated practices?

Waltz:  They’re all running the same software platforms at this time. We have one organization network converting the lab system over still, but we’ll be on one lab after that conversion.

Gamble:  Is that something where the health system was providing support for that?

Waltz:  Yes. Most of the support for the IT is central out of the Midland hospital here, and we’re looking at various ways to centralize most of the services.

Gamble:  What about health information exchange? Are you part of the Great Lakes HIE?

Waltz:  Yes, we are. That was one of the conditions of use with the University of Michigan. We originally were going down the path prior to Meaningful Use with dbMotion with Allscripts and using that as the HIE community platform. Once we signed with University of Michigan, we began sending information to the Great Lakes Health Information Exchange. We’re working with our community physicians to get them set up so they can review and look at information from that exchange.

Gamble:  Is it pretty robust at this point in terms of the number of systems that are participating in it?

Waltz:  No, not at all. We’re trying to convince the physicians, and it’s been very slow to bring them up. I think we’ve only got several offices up right now with the viewer.

Gamble:  That tends to be a pretty slow process, especially when you’re talking about, among other things, constrained resources.

Waltz:  Yes.

Gamble:  That HIE as a whole, Great Lakes, is that something where there is a good amount of participation among other health systems?

Waltz:  Well, it should get better because GLHIE (Great Lakes) and MHC (Michigan Health Connect), I think they merged just recently in the last month. The issue though is that Great Lakes is using the Optum platform and MHC was using the Medicity platform. We’re sending information to the Optum platform right now, and so we’re not sure exactly how and which software they’re going to end up using. If they switch to Medicity, we don’t know what that means in terms of converting the data we already have, or how we have to change the feeds to the Great Lakes Health Information Exchange, which we call GLHIE affectionately.

Gamble:  Nice. It seems like it can never be easy with these state HIEs.

Waltz:  No.

Chapter 2 Coming Soon…