Any CIO worth his or her salt knows the importance of getting physicians engaged; the big question is how to do it. In his three years at Thibodaux Regional, Bernie Clement has learned that there is no easy solution, but if you want to get clinicians on board with change, you have to seek input when designing processes and implementing systems, be transparent, and be patient — eventually they’ll see “the light at the end of the tunnel.” In this interview, Clement talks about how his relationship with Meditech has improved, the work his team is doing with analytics, and why some vendors just “get it.” He also discusses his career path, the most challenging — and rewarding — aspects of being a CIO, and why you’re only as good as the organization you work for.
- About Thibodaux Regional
- Meditech in the hospital, eClinicalWorks in clinics
- MU as “a key driver”
- CPOE steering committee
- Focus on physician engagement — “They want to understand why we’re changing something.”
- Data analytics with Health Catalyst
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They’ve been a really good partner. I like the changes they’ve made as an organization. They really seem to be embracing the need to be more of a consultant to assist you in transforming your processes instead of just being a software vendor.
The nice thing is you can see the light at the end of the tunnel and no one feels there’s a train coming at them. I think everyone is starting to see how all these pieces can fit together.
We’ve really tried to work hard to design these processes with the physician and the patient in mind. And I think they’ve seen that. They’ve seen that we’re honest.
We’ve been pretty good at analyzing what’s in the hospital, but we know we’re going to have to come up with ways in which we can really start to perform some population management and be able to bring some of this physician practice information into the data warehouse.
Gamble: Hi Bernie, thank you so much for taking the time to join us today.
Clement: Glad to be here.
Gamble: To get things started, can you give us some information about Thibodaux Regional, just in terms of bed size and what you have in the way of clinics and ambulatory.
Clement: Absolutely. Thibodaux Regional is in Thibodaux, Louisiana, a community tucked away roughly between Baton Rouge and New Orleans. We’re a community hospital of 185 beds. We have a total medical staff of about 144 physicians — about 25 of those are employed — and a full-feature regional medical center. I believe those are the key aspects of it.
Our employed doctors include internal medicine, orthopedic surgeon, cardiovascular surgery, and neurology. We also have pulmonologists, radiologists and anesthesiologists. We have an endocrinologist starting as well; we’re very excited about that to get endocrinology here in Thibodaux area. We’ve had to get that expertise outsourced in the past and we’ve had people going out and about for those services. We also have a pretty full-featured neurology and neurosurgery specialty as well.
Gamble: I’m sure any time you can keep people in the network, that’s a plus.
Clement: Yeah. The difficulty is to send people out. It’s not like we’re sending them across town; in the past they would have to go to New Orleans or Baton Rouge. So we feel pretty confident that we’ll be able to provide some excellent services here, including cancer care as well. We’re very satisfied that we can really offer all the services we need for our community.
Gamble: In terms of the clinical application environment, what do you have in the hospital?
Clement: Meditech is our main system. We’re running Meditech Client/Server 5.66, and we pretty much have all the applications that they have to offer. They’re our main provider. For our PACS system, we use Novarad; we’re very happy with them. We are deploying Health Catalyst as a data warehousing solution. We’re currently underway with that deployment as well. We use OBIX in our family birthing area. In our clinics, we use eClinicalWorks, and we are leveraging a statewide HIE for our community-based health portal of opportunities there, as well as interchange between our clinics and the hospital.
Gamble: You said you’re on Meditech Client/Server 5.66. When did you upgrade to that version, and is there anything planned for as far as upgrade in the near future?
Clement: We upgraded to 5.66 this spring, mainly to get us to a point where we are fully Meaningful Use-ready and ICD-10-ready. There were also some nice features in the 5.66 regarding the discharge process and helping us get to electronic integrated discharge process, and also some key features with the quality dashboards that are now available through the frontlines. We think it’s very important to get the information on core measure adherence and quality measures to our nurses and our staff, and we’re looking forward to being able to do that here in the upcoming months and rolling out some of that functionality.
Gamble: As you said you’re positioning for Meaningful Use?
Clement: Yes. It’s been a key driver here for us. We met Stage 1 for the first time last year in the July quarter, and now we’ve wrapped up and we’re in our attestation period for the second year of Stage 1 right now.
Gamble: You’ve been CIO there since 2011, correct?
Clement: Feels about right; yeah, three years.
Gamble: Was Meditech already in place at that point?
Clement: Meditech was in place. We needed to get a few upgrades underway, but Meditech was our core HIS. I think they’ve been here since about 2000. They’ve been a really good partner. I like the changes they’ve made as an organization over the last few years. They really seem to be embracing the need to be more of a consultant to assist you in transforming your processes instead of just being a software vendor. They seem really eager to partner and to focus more on the clinical transformation aspects of what their system can provide to us.
Gamble: You talked about having that discharge functionality. How has that worked with the Meditech system — is there some kind of interface with the clinics with eClinicalWorks?
Clement: It’s getting there. The key thing right now is getting all of our physicians and the rest of our clinical staff all communicating in a common place to coordinate the discharge process. It does have the capabilities to send out the health summary once that process is concluded. We had that process worked through. We’re not sending that information out just yet. We’re working on interfaces with our statewide HIE to kind of act as our HISP so that the discharge summary information can then go out to the clinics that would then be taking that patient on after they’ve been discharged.
Gamble: Obviously, there’s a lot of moving parts in making that happen.
Clement: Yes, but the nice thing is you can see the light at the end of the tunnel and no one feels there’s a train coming at them. I think everyone is starting to see how all these pieces can fit together. I know it’s been a rough journey the last few years; there’s been a ton of change, not only for hospitals but especially for our physicians. I think people are finally starting to see the benefits of all these systems; that once they can really talk to one another beyond just the four walls of each institution, we can really make some improvements in patient care, reduce some costs and reduce some redundancies, but also coordinate care better across institutions.
Gamble: There’s so much emphasis on that now. How has that worked as far as getting the physicians on board? I can imagine that that’s been a big effort for the last couple of years.
Clement: It has been. Our physicians have been very patient and very willing to change. You have physicians who will always want to be sure that’s what’s best for their patients, and we understand that. They’re very busy and we can’t slow them down, so we’ve really tried to work hard to design these processes with the physician and the patient in mind. And I think they’ve seen that. They’ve seen that we’re honest in wanting to do that, and so they’re willing to work with us there.
Gamble: Are there certain committees that are set up or meetings just to keep the communication flowing?
Clement: Absolutely. We have what we call the CPOE Steering Committee. It was made up of about six of our physicians representing different specialties, as well as all of our key people on our executive team. We’ve been meeting every other week. The funny thing is we’re finished with CPOE, but we’re still meeting as we talk about physician documentation needs and interoperability needs. They’ve been key to really giving us good feedback and also being spokesmen out in the rest of the medical staff.
We have a person who I guess you can best describe as a physician IS adviser. He’s a practicing physician, but also has been a key person for us to bounce things off of with our medical staff. Beyond that, we’ve tried to always have a monthly physician IS meeting; it’s a very open forum. The entire medical staff is invited and we’ve tried monthly to have that opportunity for them to come give us feedback as well as for us to keep them updated.
One of the nice things that’s also helped is that in our medical staff meetings that we have every other month, IS has been a constant theme. I’ve had the opportunity to go update our medical staff there. And in our medical executive meetings, IS has had a presence there as well to keep them informed. I think keeping them informed and helping them with the big picture and being willing to understand their aspects of things is really a key in making these transformations work.
Gamble: Absolutely. It’s such a key part having that physician engagement and it sounds like you guys are really dedicated to keeping that going.
Clement: We obviously can’t do it without them. If you attempt just to tell them what they’re going to do, you’re going to fail, and if you don’t think through your processes, you’re going to fail.At the end of the day, these physicians are scientists, and they want to understand why we’re changing something and be sure we’re changing it for the better for the patient.
Gamble: You have to be able to speak their language — at least to some degree, right?
Clement: Yeah, and one thing that has helped us tremendously with that is the makeup of our IS department. We have a woman who we call our physician liaison, and she’s a nurse by trade. She’s run our ICU Critical Care Department and is very well respected by the physicians. She knows clinical processes very well. She knows how to be a leader. She knows how to have crucial conversations with physicians when the time calls for it. She’s very well respected by the medical staff and all clinical leadership, and has made a big difference.
Gamble: Okay. So you mentioned briefly before about Health Catalyst and the data warehouse. I just wanted to talk a little bit about that as far as what you have going on there and what the plans are for being able to utilize this data.
Clement: We’re still through the deployment process right now, but we realize that if we just stay status quo, it’s not going to work. We’re seeing reimbursement shrink. We’re seeing the added focus on quality and the necessity to be a top performer, and we think bringing Health Catalyst in will help us do that. They have some unique ways in which to bring data to a format that can be analyzed very well and be shared. They also have some good change processes that involve physicians in reviewing the data and seeking out best practices and really moving the dial on quality and cost.
Their late-binding approach, I think, will help us bring different data sources together. We’ve been pretty good at analyzing what’s in the hospital, but we know over time we’re going to have to come up with ways in which we can really start to perform some population management and be able to bring some of this physician practice information into the data warehouse as well.
While we use eClinicalWorks for our employed doctors, that’s really a fraction of our overall medical staff. Many doctors have chosen different EMRs in their clinics. We need to come up with a data warehousing approach a new vendor who can bring all these different sources together and really help us to be able to understand some population dynamics. Once we get Health Catalyst up and running with the hospital data, we’re looking forward to finding ways in which we can bring the physician information into the fold as well so we have a pretty complete view of our community and our patients.
Gamble: I would think that for the physicians it’s really exciting knowing this is going to happen; that they’re going to have this unified view and be able to have data at their fingertips. I would think that it’s a nice thing to be able to tell the physicians this is what we’re working towards.
Clement: Absolutely. When people first heard what we were doing — that it initially sounded like it was just hospital data, our physician feedback was, ‘this is fine, but in the hospital you’re only seeing a part of that patient’s care.’ I think the hospital has had enough open-mindedness to realize that it can’t just be about the hospital.It’s going to take some time; it’s pretty difficult to comingle all these different data sources together. But knowing they understand our bigger vision is to be able to give our physicians a complete view, they’re very engaged by that.