Bryan Bliven, CIO, University of Missouri Health Care, Chapter 2

Bryan Bliven isn’t surprised that the pace of attestation to Meaningful Use stage 2 has been somewhat slow. “It’s a different feel and it takes a different type of rigor to manage it,” said Bliven, which is why his organization opted to do a practice run before successfully attesting in the first quarter of 2014. In this interview, he talks about the unique partnership between MU Health and Cerner that enables his team to provide feedback on the solutions they use; his role as executive director of the Tiger Institute; and the approach his team used in attaining HIMSS Stage 7 recognition. Bliven also opens up about what it’s like to be a young CIO, and why he thinks MU Health’s patient portal will be “a game changer.”

Chapter 1

Chapter 2

• The “game-changing” patient portal
• Cerner EHR & GE scheduling
• Improving care transitions — “We’re not just doing this for MU.”
• Stage 2 practice run
• Slow progress of MU 2 — “I’m not surprised.”
• New ICD-10 strategy
• Foresight with new building design

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Bold Statements

We find a lot of folks without a chronic condition to manage really don’t have a need to log in, but functionality such as online scheduling can be a benefit.

We had to almost sell the idea that we’re not just doing this for Meaningful Use; we’re going to reduce faxes and we’re going to improve our communication processes.

We didn’t really even consider taking a quarter off and trying again. We felt early on and had made the decision months before that if we don’t up our numbers and hit it on the first quarter, let’s just keep going.

The nature of the objectives in Stage 2 where you’re relying on outside organizations and you’re relying on your patients to actively view and log in and send a message potentially on their system, it’s a different feel, and it takes a different type of rigor to manage that type of project.

Gamble:  What were some of the processes that you put in as far as patient engagement?

Bliven:  Patient engagement is one of our strategic items as well. We really feel that patient portal is going to be a game changer for us, if we have it implemented correctly with the appropriate functionality to make it easy for our patients and potential patients to work with us. We want to build in key functionalities like online scheduling. We use Cerner’s patient portal, and as I mentioned, we use GE scheduling. And so we had to create a custom view within the Cerner portal and work with GE to open up their API so that we could schedule directly via our online portal.

To promote those things on the floors, we have set up physicians that are going to go around and educate patients on the portal. We have internet-enabled TVs in the room so we can have them log in and educate them on how to use the portal and what it’s for before they leave the hospital. That was one of the processes that we implemented. It was about marketing a plan and trying to create new functionality that would really add value to patients. We find a lot of folks without a chronic condition to manage really don’t have a need to log in, but functionality such as online scheduling can be a benefit where they don’t want to potentially call the clinic but they’re able to log in and do that online.

Gamble:  That’s certainly been a challenge for a lot of organizations to meet those numbers. You also talked about transitions of care and you mentioned some of the organizations you work with and the challenges there. Is that something you’ve been able to address, if so, and how?

Bliven:  We implemented the HISP technology within our Tiger Institute and HIE as well. It was really figuring out who in our region did we had the majority of transfers with and setting a priority and helping them implement the technology — either our technology or another provider — and making sure that they were putting the processes in, because it was a little early in our region.

We had to almost sell the idea that we’re not just doing this for Meaningful Use; we’re going to reduce faxes and we’re going to improve our communication processes and open up the doors for this type of communication. It was really educating and then working with them and helping them overcome any hurdles that they would have to get the technology implemented. In terms of processes, we had to work on how we were going to send the information and create some knowledge transfer there. It was a lot of point-to-point education and working with folks to ensure that we could enable that flow.

The problem the previous quarter was that we underestimated the amount of time it would take for some of those organizations in our region to actually implement the technology. They weren’t able to receive the data during that first quarter. So once we had it rolling in the second quarter, we were very confident that we would hit the numbers.

Gamble:  As far as that first attempt at MU 2 where you didn’t hit the numbers, what do you think was the biggest takeaway from that? Maybe you can offer some advice for CIOs who are having a tough time with Stage 2.

Bliven:  We were lucky enough or had enough foresight to plan that we would have a couple of takes at it. And the timing of ICD-10 moving back, we were well down the way of moving forward when that announcement came out, so it was monitoring our processes. We had that cushion, so we didn’t have to force really unnaturally to try to achieve the result. We were able to build our momentum up. That really helped us to be able to make it that next quarter, and we just continued our efforts. So what was going to be 90-day period, we just extended out and saw that our numbers just continued to rise. Having that time and just the ability to not cause a fire drill around it to force us to try to make the numbers was, I think, the key for us to be able to move forward with it.

Gamble:  So it was taking some of that pressure off and just having the extra time cushion.

Bliven:  I would add too that we had a great executive task force. There was leadership involved in helping us make decisions around moving forward. We didn’t really even consider taking a quarter off and trying again. We felt early on and had made the decision months before that if we don’t up our numbers and hit it on the first quarter, let’s just keep going. So we’d keep the processes in place and inform everyone on how we’re going to do that, and I think that helps us to gear up for October 1 when we’re going for a full year.

Gamble:  Are you surprised that the MU-2 numbers just aren’t where they were projected to be by this point?

Bliven:  Not really. I think that we took that aggressive stance and we’re backing into that ICD-10 date. There was a lot of uncertainty, and it’s a lot of effort if you’re going to try to undertake both at the same time. We had been through beta partnerships with both GE and Cerner, had early versions of their ICD-10 compliant code and were already working on that well in advance, but we still wanted to be pretty conservative about the amount of time we would have where we didn’t have to focus on the Meaningful Use measures. We wanted them ingrained by that time so we could focus more on ICD-10.

Those two programs together just take up a ton of resources, and there’s a lot of opportunity cost in there. A lot of organizations are gearing up for reimbursement reform and trying to turn the corner on so many different things that it’s really difficult to prioritize those when they’re all big boulders of initiatives that you’re working on, so I’m not necessarily surprised.

I think too that the nature of the objectives in Stage 2 where you’re relying on outside organizations and you’re relying on your patients to actively view and log in and send a message potentially on their system, it’s a different feel, and it takes a different type of rigor to manage that type of project, so I’m not really surprised. It definitely felt quite a bit different, Stage 1.

Gamble:  A far as ICD-10, is it something where you picked back up with that at a certain point? How did shift your strategy once when it was delayed again?

Bliven:  The main thing that we held off on was physician training. That piece was obviously going to be in full swing by now, but we were really getting ready to push that forward when the announcement came out, so we decided to hold off on that. On the technical side, we kept going. We are dual-coding still a small amount. We’re still getting practice with that and working with our coders on that process, and so it does give us some time to look at additional tools that might help with the physician documentation portion of it and education. We’re evaluating whether we can prioritize some of those projects that maybe we couldn’t have fit in previously, but we really kept going on the remediation.

We have a long history here of using technology. The EMR’s initial database was built in the late nineties. We have a long history with the GE system as well, so it was going back and making sure that all of our custom code is corrected. That just gave us some time to continue that remediation — we didn’t stop it. But as I mentioned, the physician education piece is something where we did take a break, and we’re planning to roll that back in October of this year to give us a full year.

Gamble:  I saw on the website that you had a new patient tower that opened last year, and I wanted to talk a little bit about that and the use of smart rooms. This is some really cool stuff and it’s one of those smart uses of technology that you want to boast about or brag about. It’s something that looks like was maybe a result of the partnerships that you have.

Bliven:  Yeah, we’d love to give you a tour of it. When we have visitors and we love giving tours. We’re very proud of the new building. It looks great. The staff did a wonderful job in the design, and I think people love working in that new environment. It’s also allowed us then to retrofit or remodel our existing or previous space, which was in need of some upgrades. We bought a 50-year-old building. The partnership had just been established, and the footings were being poured on the building.

There was a focus on technology with the partnership, and we were able to be right there with the architects and designers at the outset, and technology was something that was sought through the entire time. We were able to get power where we would need it, data, network, dual redundancy, closet space — all that infrastructure. We really wanted to make sure and say if we’re building this up, let’s make sure that it has the technology bandwidth to last for a long period of time where we don’t have to go in and tear off the head walls to redo changes for technology. We were very careful about that design; tried to have as much foresight as possible.

There’s a lot of modular designs so that the rooms could be very flexible. They can be an ICU room. They can be a med surgery room. The head walls are configurable and modular so you can change them in and out. We’ve already taken advantage of that; through different moves that we’ve had to do, it allows us a great deal of flexibility. If we need to remodel an area, having the space allows us to do that very easily.

It was exciting and there was an evaluation of the types of equipment that were going to be going into the patient care tower. It’s all fitted and we’ve retrofitted our entire campus with RFID to track our assets and some of our technology such as our smart pumps. There was a focus on device integration; wanting to have the monitors’ vital signs and telemetry, everything integrated into the EMR, and focus on having as much as we can. That’s really the enabled smart room from the clinician side.

On the patient side, it’s about Internet-enabled TV that has access to their chart. Through education orders that are placed in the EMR, it’ll flow to their myStation unit in the room, and they can view the educational items and it’ll flow back to the chart and show those are completed. They can see information about the hospital menus, etc., in addition to playing games and watching TV. So it was a great project — a lot of new devices and a lot of new equipment went into that, and it was pretty fun for us to get to install them and play with some of the new toys.

Gamble:  I’m sure. It’s interesting that you’re doing that the same time you’re retrofitting older buildings. Quite a contrast there.

Bliven:  Yeah, the layout and the approach to the rooms is not very consistent. So when we go back into the space, there were some constraints around the building. We couldn’t do everything that we were able to do in the new patient care tower from an infrastructure standpoint, but the layout of the rooms and the technology is very similar. You really can’t tell if you go back and forth from our retrofitted or rebuilt rooms to the new patient care tower. It’s a very similar look and feel now.

Chapter 3 Coming Soon…