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.
- Louisiana Health Care Quality Forum
- Leveraging HIE “as a hub”
- Why “some EMR vendors get it”
- Benefiting from the ICD-10 delay
- “You’re only as good as who you work for”
- Recruiting from Nicholls State University
- Making passion a core value
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A lot of these clinics are still strapped with finding ways to pay their EMR vendors for that half of those interfaces. We’ve found that to still really be the struggle.
They can’t necessarily give things away that cost money to develop. So I understand that aspect of it, but there has to be a middle ground somewhere.
I think we’re going to have a very nice intuitive stack of technology for our physicians, but it’s going to take a little while as all these companies learn what it takes to have a physician really using the computer at the point of care.
You’re only as good as who you work for. Even if you were to get the best IS people together in a department, you’re still limited by the organization.
Gamble: Another way of bringing the different data together would be the HIE. Is it the Louisiana HIE you’re involved in right now?
Clement: Yes, the Louisiana Health Care Quality Forum in the state manages the HIE. Orion is the solution that they have in place. As with most HIEs, it’s a matter of really engaging and having some value add. They’re continuing to work with more hospitals and clinics in the state to get them onboard as well. We’re currently exchanging data with the HIE, but it’s been a little more difficult to get our physicians onboard as well.
The big difficulty really is around the cost of interfacing. While the HIE, through grants and whatnot, is able to help out with the HIE side of the interface, a lot of these clinics are still strapped with finding ways to pay their EMR vendors for that half of those interfaces. We’ve found that to still really be the struggle. While the ARRA incentive funds really helped the physicians get their EMRs purchased and deployed and offset those cost, now they’re realizing there’s additional cost with these interfaces. That seems to be our key barrier right now and really being able to leverage the HIE as a hub to exchange orders and results and to exchange CCDs and whatnot. That’s our next big hurdle we need to figure out.
Gamble: That’s a tough one because, like you said, these physicians are already dealing with a lot of costs and they have some assistance through ARRA, but there are still financial concerns. I’m sure that’s a tough sell. They understand why the HIE is beneficial, but that’s a big piece of the puzzle.
Clement: It has been very interesting. Some EMR vendors get it, and while they made their money on the software license and whatnot for that EMR, some of them have said, “Look, you may have to pay a little bit for the development fees, but we’re not really going to charge you anything exorbitant when it comes to these interfaces.” Then you have other vendors who have taken a different route. They gave some pretty good discounts with the EMR to get them into physician offices, but now when the interfaces come around, they want to charge some limiting fees that really create a barrier for these physicians.We’re hoping that through that common hub with the HIE, we hope they can work with some of these EMR vendors to try to somehow create some economies of scale and to lower some of these interface fees that, as I said, are really the last barrier to good interoperability.
Gamble: It seems like it just makes good business sense. They don’t want to lose these clients.
Clement: Yeah, but on the flipside, I understand where they are as well. They can’t necessarily give things away that cost money to develop. So I understand that aspect of it, but there has to be a middle ground somewhere to be able to have this greater good put out there for our patients.
Gamble: Yeah, exactly. That’s the big question. Now, are there any other projects on your plate right now?
Clement: There are always several. I think the ICD-10 delay really helped us. We’re working through Meaningful Use and working through all these things we’ve been discussing, and so we still need to turn our attention to be sure we’re fully ICD-10 ready. I think we were very close before the delay, so there’s no reason for us to believe we won’t be ready. But there are still some tasks to do there — some upgrades and some system optimizationon that aspect of it.
We went live with our patient portal as part of our Meaningful Use requirements. I think we can do more there, as well as look to how we can really further leverage social media as a whole to outreach to our community and to our patients. We want to do more work there as well. I mentioned the interface needs of our physicians — that’s a big one, and really just continuing to make the system useable for our physicians. With simple things like logging in and logging out as easy as possible, making remote access easier for our physicians, making documentation easier and dictation easier, I think there’s more we can do there. And even looking at device options for our physicians, I think we’re very young in this space. We constantly hear from physicians, ‘it would be nice if you can do this or that.’ I think we’re going to have a very nice intuitive stack of technology for our physicians, but it’s going to take a little while as all these companies learn what it takes to have a physician really using the computer at the point of care.
Gamble: Now, with the patient portal, are you seeing some decent traction, or has it been a bit of a challenge getting the patients engaged?
Clement: It’s been a real good start. We’ve had physicians very interested. Initially the concern was, will older people really take to this and really want this and what we’ve seen is you have a lot of the coordinator of that elderly person’s care getting what’s called proxy access to their records where the record is set up to so their loved ones can have access, if allowed, to their care providers. Half of our requests for enrollment have been the sons and daughters of elderly people.
We’ve only been live with it now for about three weeks, but we’ve seen good traction. A lot of people are interested and want to give it a try. We’ve been pretty enthused by how we started.
Gamble: It’s good to hear. Obviously, that’s something that we hear a lot as being a challenge. But if you can get off to a good start, that’s half the battle. You just have to try to find a way to keep the momentum going.
Gamble: I read that Healthcare IT News had named your IT department one of the best IT departments for smaller size organizations, and I’m sure that that was something that was really nice to have. I wanted to talk about your staff and what are the challenges for having a smaller staff and how you’re able to keep people there and keep them happy.
Clement: It’s definitely not easy, but I will say it starts with working for a great organization. I think IS-wise, you’re only as good as who you work for. Even if you were to get the best IS people together in a department, you’re still limited by the organization. We have a hospital that really values employees but also really knows how to plan, and I think that makes a big difference. One of the most difficult things in an IS shop is when you have an organization that changes the compass on you daily of what’s a priority.This place has really taken extreme efforts to plan their years and to be successful and to understand how to invest in IS. I think that’s made a huge difference here.
You mentioned I’ve only been here three years. When I got here, we really had the right pieces in place. I mentioned the person we have as our physician liaison. We have two other people who are in IS that are of a clinical nature, but then we have very technical people. We have older people and we have very young people. One of the nice things is that we have a university literally in our backyard — Nicholls State University — and we’ve had a real nice flow of interns from the IS curriculum there come here and end up working for us and really adding value.
One of the most difficult things with having young people work for you is that while they’re usually technically pretty strong, sometimes you might not get that work ethic. Or you may get people who are too willing to change things without enough thought, or you get people who don’t really grasp the need to really deliver excellent customer service and understanding what we’re really here for.
We’ve been blessed. We have some young guys here that haven’t reached 30 yet but are mature beyond their years. They work very hard, but they’re also very customer service-oriented and understand the importance of change management and how not to go break things in the middle of trying to fix things. That’s been a blessing.
When I got here, we had some processes we had to improve a little bit. We put a little more focus on project management, a little bit more focus on change control but really all the pieces and parts were here, and I think the hospital does a great job of helping people see the bigger picture of why we’re here. We really try to focus on hiring people who understand that at the end of the day, we’re trying to get patients better — even in IS we have a role to play there, and I think that’s really benefited us. People tend to see the bigger picture and want to work hard — not out of fear, but because they really love this place.
One of the neat things they did here last year was they made passion a core value here at the hospital, and really made a big deal out of it. We capture passion stories of employees who went above and beyond for the patient, and now we do that here in IS as well. We mine out the stories of when someone has went above and beyond, and it really makes for a great culture of people who want to go out there and do more for the patient.
Gamble: Right. How far away are you from the bigger cities?
Clement: We’re about an hour away from New Orleans, and an hour way from Baton Rouge.
Gamble: Is that something that has been a challenge just that there are more jobs and more options in the city, or has it not really been an obstacle?
Clement: It hasn’t really been an obstacle, to be honest with you. I was living here and driving an hour back and forth to New Orleans, and when the opportunity came up here, I loved the idea of not having to make that drive. I think the town is big enough to have the expertise locally that you need and that you can grow. We do take advantage of a couple of outsourcers that are in the area, some IS shops that give us supplemental labor. They’ve been a big help for us. Whenever we really needed very specialized help they’ve been there, but we’ve been able to grow the people that are local to really be a value add here for us.
Gamble: You talked about having the university nearby. That sounds like something that’s definitely been a benefit.
Clement: It’s been great. I like the relationship we have with Nicholls State University. We used to have one intern here every semester, now we’ve grown that to two part-time interns every semester. Some of our folks are getting their MBA over there or who got their undergrad over there. We have a good relationship with them and that’s really helped us fill in the gaps and have a nice feeder process going into the department.
Chapter 3 Coming Soon…