Rick Follett, CIO, Good Samaritan Health System, Chapter 2

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

Chapter 2

• The “welcome delay” of ICD-10
• Dual-coding, clinical documentation improvement efforts
• Revamping the HIM department
• Outsourcing IS to McKesson
• “Health IT is a calling, not a career”
• Managing overachievers

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Bold Statements

The delay has benefited us, although it did cost us more money because it does tend to elongate parts of the project where you have outside resources engaged.

They’re fully committed to our community, so it hasn’t been a really tough sell. They do tend to work very well with us, and I think that’s been really the secret to such a successful program.

As it stands now, unless you’re in an ACO, you may take steps to prevent somebody from becoming acutely ill, but there is virtually no reimbursement for that.

Because McKesson’s such a large company, when there are openings, they do have a tendency to be able to attract individuals who we might not otherwise have visibility to because of their size.

Gamble:  As far as Meaningful Use Stage 2, what do you think were some of the more significant challenges?

Follett:  I would say in part because we chose the Observation Services Method, and we do not have our EHR fully live yet in our emergency department, some of the CPOE numbers that are counted regardless of the setting in which it occurred, as long as they are in an inpatient observation patient, are radiology orders very often executed in the emergency department before admission. That’s been one other area where we had to keep a close tab on how well we’re doing and whether we are remaining above the threshold. It’s been a challenge, but we’ve been able to do it.

Gamble:  What’s the status at this point as far as having that ER system up?

Follett:  Just last year we changed the physician group that manages patients in our ER, and that delayed our implementation of the electronic health record there. So we’re in the process of doing that right now and hope to, by the end of this calendar year, have them live on all the aspects that will ensure that we’ll have CPOE for the full services that we provide in inpatient.

Gamble:  As far as ICD-10, what’s your strategy, and was it affected by the delay?

Follett:  At first I was a little disappointed by the delay, but honestly, with Meaningful Use Stage 2 and our due diligence efforts, it was a welcome delay. It enabled us to take some of the pressure off as we were revamping portions of our HIM department. We had a project underway more than a year ago; we brought some outside services in to help manage the project, do the gap assessment, and lay out what systems needed to be upgraded and at what release level they would become compliant with that plan in place and other projects underway. For example, we added a system for computer-assisted coding and are now in a position where we can begin to dual code both ICD-9 and 10, and we will have a much longer history and experience with that one year delay. So it’s not so much under the gun as it would have otherwise been.

In a sense, I would say the delay has benefited us, although it did cost us more money because it does tend to elongate parts of the project where you have outside resources engaged. So it cost a little bit more but in the end, I believe it will have been worth it.

Gamble:  That’s an interesting thing to deal with. As a CIO, I would imagine you have this delay and you’re operating under the assumption and telling your staff that is the drop-down date and it isn’t really; so I’m sure that puts you in an interesting spot.

Follett:  It did at first, but I think everybody adjusted very quickly to a little bit less pressure and concern for this coming October 1st. Especially in the HIM department, they are in a better place knowing that they have a little more time and can be more confident with the dual coding results that they get. I’d be remiss if I didn’t mention too that there was a clinical documentation improvement effort underway for the last two or three years leading up to this to enable dialogue with the documenting physicians to ensure that they knew how to fully explain what it is they’re doing or the condition of the patient so it meets the documentation rules and enables us to succeed with an ICD-10 code.

Gamble:  Was the clinical documentation improvement effort something that was driven by the clinicians?

Follett:  That as actually driven by our HIM department.

Gamble:  Okay, and you said that that was recently revamped. Can you talk a little bit about that?

Follett:  We had a period of time where the project was warming up and it became very successful. And in fact, in spite of what it cost us to do that, it improved our documentation to the point where we saw reimbursement improvements as well. So it was definitely worth the effort.

We went through a period of some turnover. I think when we announced that we were going to seek affiliation with a larger system, there were a few folks here who took that as an opportunity to look elsewhere. The revamping is really more about the rebuilding of staff there and putting the project back on track.

Gamble:  In terms of the relationship between HIM and clinicians, has that gone pretty well? If HIM says ‘we need to improve this,’ is that received well enough by the clinicians?

Follett:  Generally, yes. We have an excellent relationship with our clinicians. Most of them are credentialed only at our hospital, and they’re fully committed to our community, so it hasn’t been a really tough sell. They do tend to work very well with us, and I think that’s been really the secret to such a successful program.

Gamble:  What about data exchange with outside organizations — are you involved in any HIEs at this point?

Follett:  Not with an HIE. We instead use the direct messaging method and are communicating directly through HISPs with our community physicians and one other hospital where we’ve done some testing — a larger hospital that does have the trauma centers where we might occasionally send a patient who needs that level of service.

Gamble:  Are you doing anything with telehealth or remote monitoring, or do you have plans to do anything on that front?

Follett:  We’re not doing anything at this time, but that will become part of the discussion when we reach that level of planning with affiliation. Personally, I would prefer to look to the methods, the standard, and the infrastructure that the larger system is using and simply replicate that.

Gamble:  It seems like there are so many organizations that want to do it, but it’s just having the resources to be able to have a successful telehealth program, and of course the funding.

Follett:  I believe any telehealth project is going to be very likely tied closely to efforts for population health management as a way of perhaps monitoring and even predicting when somebody may be going in a direction where an interventional service could prevent a more acute outbreak of whatever their condition is.

Gamble:  It’s one of those really cool uses of technology that will be great to see come to fruition a bit more.

Follett:  It is, and I’m hoping that as accountable care and other healthcare reform efforts take shape, that there will be some better way than simply the accountable care organizations to be rewarded financially for taking those steps. Because as it stands now, unless you’re in an ACO, you may take steps to prevent somebody from becoming acutely ill, but there is virtually no reimbursement for that.

Gamble:  Have you looked into joining an ACO?

Follett:  I think we’re too small of a scale to take the lead on something like that ourselves, and would be a good reason for the affiliation.

Gamble:  I wanted to talk a little bit about leadership and staff management. There are so many organizations around the country, especially those on the smaller side, that have some difficulty with retaining and recruiting top people. Is that something that’s been a challenge for you?

Follett:  Yes and no. We have outsourced our IS department to McKesson, so they provide almost our entire IS department. There are a few select positions that are hospital employees — mine being one of them, and another person, who is our physician informatics manager, really helping to bridge that technology to the actual patient care use of the technology. That’s been a very successful approach, but within the IT department, because McKesson’s such a large company, when there are openings, they do have a tendency to be able to attract individuals who we might not otherwise have visibility to because of their size.

Gamble:  Then as far as just being able to hold on to people, do you have any programs in place whether it’s education or anything like that?

Follett:  Much of that we rely on McKesson for, but we do encourage certain aspects of some kind of a work-life balance, which is always challenging in this field, especially as the pressures for increasing automation are greater and greater, and we simply don’t have enough qualified staff across the country to meet everybody’s needs.

McKesson’s been very good about rewarding their staff for excellent performance. We do tend to recognize those people who’ve gone above and beyond frequently, and have educational opportunities built into their staffing plan. They’ve done a fairly good job of keeping people employed. We’ve had some turnover, and when we’ve had that turnover it hasn’t always been negative for us. They usually are able to replace the person with somebody equally qualified, and occasionally someone with a bit more experience.

Gamble:  You mentioned work-life balance — that’s something that I can really imagine is a challenge with all the pressures to do so much. Has that been a challenge for you personally?

Follett:  It has. I think if I reflect on the staff too, I want to point out that those who work most closely with the clinicians and the patients are more likely to see the benefit of their activities and their efforts. I’ve heard others say that healthcare IT is a calling, not a career. I think that’s especially true for those of us who get to work closely with clinicians and patients.

For those who are more on the technical side, managing servers and computer technology, they rarely get a chance to get that close to a patient. So it’s very important for us to keep them aware of how well the patient experience is benefited by their efforts and the work that they do. In terms of work-life balance, I have five grandchildren, and so I think they help me. I have a picture of them on my desk, and it helps me to remember that there is life outside of the office.

Gamble:  That’s great. I spoke with a CIO a little bit ago who said if you can make sure you have some kind of work-life balance, it’s a great example for your team. It almost gives them permission to say, okay, I’m going to take some time off, or I’m going to leave at this time.

Follett:  Absolutely. I occasionally worry about the overachievers who really give it their all. I occasionally have to remind them that it’s time to take a bit of a break, or we have to plan some gap in their responsibilities to allow them time off so they can recharge and refuel. I think it benefits them personally, and I do care very much about that. And when they come back and they feel refreshed, I think everybody is better because of that.

Chapter 3