Rick Follett, CIO, Good Samaritan Health System, Chapter 1

With the exception of the rare CIO who has called one organization home, most have spent time in consulting. It was a path Rick Follett took, but the move wasn’t permanent, because he learned that “when you’re a CIO, you’re an owner. When you’re a consultant, you’re more of an advisor. In this interview, Follett talks about the lessons he learned in holding different IT positions and what it was like to come full circle with Good Samaritan. He also discusses the challenge of continuing along with the current strategy while the organization is in talks to affiliate with a larger system, his plans with population health and data analytics, and why getting buy-in can be much easier with clinicians than IT staff.

Chapter 1

• About Good Samaritan
• Looking at a potential merger to “take advantage of scaled economies.”
• McKesson Paragon in hospital, Medent in ambulatory
• Data integration through CCDs
• MU as a top priority
• “Drilling deeper” to manage population health
• Patient portal “proxy access”

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Bold Statements

We will have the opportunity, especially in the IT area, to collaborate more on infrastructure and on some of the applications where we’ll be able to aggregate data and do a better job at population health management.

They have done a terrific job of adopting and adapting to the electronic world within that system, and it’s very well-supported.

We can send a single lab feed to that vendor and they distribute it to the ordering physician and any of the other 19 practices who may have ordered that test. So it does help us as a small community hospital to conserve on some of the expenses we might otherwise have.

You can buy the tools, but they are only tools unless you have good qualified people who can drill into the data and find meaning and especially to do predictive analytics.

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

Follett:  You’re quite welcome, Kate. I’m glad to be here.

Gamble:  To start things off, can you tell us a little bit about Good Samaritan Health System — what you have in the way of hospital beds, ambulatory facilities, things like that?

Follett:  We are a community hospital with about 192 beds, and that includes a rehab portion of the hospital. It’s a full-service hospital because we are the only acute care hospital in the county. We do provide virtually all services to everyone in the area. We have about 40 outpatient facilities that involve either a physician’s practice or some type of clinic or diagnostic testing, whether it’s radiology, lab, or cardiology. So it’s a fairly full-service offering for the county.

Gamble:  And you’re in Lebanon County, Pennsylvania?

Follett:  That’s correct. We are not far from Hershey where the chocolate is made. That’s probably the best landmark I can give most people.

Gamble:  So it’s a fairly rural area?

Follett:  It is a rural area; a fairly largely farming and retirement community. We have an elderly population here. It’s a very popular place to retire to because cost of living is low and crime rates are low. We have many farmers in the area. It’s a really pretty countryside, especially if you like outdoor activities.

Gamble:  Are you still an independent hospital?

Follett:  We are currently independent, but we are in discussions and due diligence with a larger system to affiliate. The intention would be to continue to have our own board of trustees and C-suite managing the hospital, while taking advantage of some of the scaled economies and some of the opportunities with population management with a larger system.

Gamble:  Is it more the idea of creating a strategic alliance?

Follett:  It’s probably a little bit closer than the strategic alliances. We will very likely be in a position to share not just our data but best practices and even some levels of governance.

Gamble:  Being in your position, I imagine that that’s an interesting thing to be going through that process. Is this something that you’ve experienced before?

Follett:  I have at another organization that went through an actual merger years ago. I’ve had that experience. What’s different this time though is this is not exactly an merger where there is a single entity that evolves from it, but rather we will have the opportunity, especially in the IT area, to collaborate more on infrastructure and especially on some of the applications where we’ll be able to aggregate data and do a better job at population health management across a larger population.

Gamble:  It sounds like a good opportunity for IT. Now, to give a little bit of the lay of the land, let’s talk about the clinical application environment, first in the hospital. What do you have in place?

Follett:  Our major healthcare information system is the McKesson Paragon system which is a full-fledged electronic health record and we’ve done, I think, a very good job of implementing the features of it. In addition to that, for our ambulatory environment, we use a regional electronic health record called Medent from Community Computing Services out of New York. Between the two of them, we have pretty good integration such that records from the ambulatory visit can be sent through CCD or CDA into the Paragon system. And most every practice in our area is using the same ambulatory system, so there’s a great opportunity there to collaborate on patient records. It’s much easier to exchange information with those providers as a result of that common platform.

Gamble:  How long has Paragon been in place?

Follett:  We went live in 2009. In 2011, we went live with the CPOE portions and those things that we added to the application in order to pursue the government stimulus program referred to as Meaningful Use. We went also went live with barcode medication administration at the same time. At that point, we completed the closed loop medication management for all of our inpatients.

Gamble:  What about Medent on the ambulatory side?

Follett:  All of our practices share a single instance of Medent. They have also kept pace with the same things, although their requirements for the stimulus program were a little bit different, with electronic prescribing being one example. But they have done a terrific job of adopting and adapting to the electronic world within that system, and it’s very well-supported.

Gamble:  Do you have physician practices that are owned as well as affiliated with the system?

Follett:  Yes. We actually employ more than 50 physicians in a variety of practices. We have a family practice residency program in addition to our own family health clinics. We have specialties such as cardiovascular surgery, general surgery, vascular surgery, digestive health, and some other services that are more community-based.

Gamble:  As far as using Medent, that’s not one of the larger companies that are used more on a national scale. Is that something that that’s worked out well for you though having it something that’s more regional?

Follett:  Actually, in our case I think it has worked out very well, largely because there are so many other practices in the area who’ve adopted the same application, which gives us an opportunity to take advantage of some of the offerings of the vendor for information integration. For example, we can send a single lab feed to that vendor and they distribute it to the ordering physician and any of the other 19 practices who may have ordered that test. So it does help us as a small community hospital to conserve on some of the expenses we might otherwise have to go through in order to distribute that electronic record.

Gamble:  Looking at the potential merger, is it something where you know at this point whether or not you would have to switch out your major systems, or is that something that’s yet to be determined?

Follett:  That’s yet to be determined. We are at a point where we can discuss some due diligence questions, but that type of planning requires us to get past some government approvals before we can really get into that level of detail.

Gamble:  Let’s talk a little bit about your plan, whether it’s a 3-year plan or a 5-year plan, and some of the larger things that you’re addressing or looking to address. What’s at the top of that list?

Follett:  At the top of the list are any of the things that are necessary to remain in the stimulus program for Meaningful Use. We are actually just about to conclude our Stage 2, first year at the end of September and we’ll submit our attestation documentation for that. Going into next year, we’ll start to ramp up for those things that may be required for stage 3. I think probably the biggest will be around how we manage population health and what kind of tools we might need for drilling deeper into the data we already have and are collecting through our electronic health record; to be able to identify those classes of acute care and chronic conditions that we may be able to intervene and improve our performance on population health management.

Gamble:  You alluded before that managing population health is something that certainly would be a little easier if you were able to align with another organization. I can imagine as a small hospital that has to be challenging, just from a resource perspective.

Follett:  You’re exactly right. You can buy the tools, but they are only tools unless you have good qualified people who can drill into the data and find meaning and especially to do predictive analytics where you can forecast when somebody will need a service before they actually become acutely ill. Those are the kinds of things that I believe being a member of a larger system, they can dedicate the resources to determining how you go about doing that, because we’ll be doing it on a larger scale with a larger population, and it becomes more economical to do that. In the interim though, until such an affiliation is complete, we’ll continue down our path and our strategic plan where we would adopt the relevant tools to do that on our own.

Gamble:  I imagine it’s a pretty big priority, especially when you talk about a population where there are more elderly patients looking at chronic care and things like that.

Follett:  That’s very true.

Gamble:  Now, as far as patient engagement, is that something that you’ve been addressing? What is your strategy there?

Follett:  We have been addressing that through a patient portal and have been very fortunate. I’ve heard of other hospitals that have had to take extraordinary measures to get patients to actually access it and use it. Although our numbers aren’t really great, we have not had much difficulty getting people to access them. I think it’s especially important for elderly patients who have a younger family member who wants to help guide their care. I think we’re finding too that there are more people who are looking for that proxy access for their aging parent. The portal has actually helped them to be a little bit more connected to what’s happening with the elderly parent’s health services.

Chapter 2