Mark Zirkelbach, CIO, Loma Linda University Medical Center
It’s hard to say which is more challenging — implementing an EHR system or the optimization phase. Although there are many moving parts during a rollout (particularly when it involves five hospitals), “it’s a fairly finite set of work” with a hard deadline, whereas optimization never really stops. But to succeed with either task, a CIO needs “an exceptional team,” something Mark Zirkelbach is lucky enough to have. In this interview, he talks about what his team learning by going big bang with Epic — and what he might have done differently, the fine line between fixing a system and optimizing it, the challenge of prioritizing when there is so much to be done, and why today’s IT leaders “need to be a little more entrepreneurial.”
Chapter 2
- Prioritization — “Just keep working the top 10.”
- Macro process owners
- Implementation vs optimization
- Governance changes — “Our disciplines are being reinvented”
- “Hairy” timing of MU with Epic go-live
- Population health & MU attestation — “There’s a convergence there.”
LISTEN NOW USING THE PLAYER BELOW OR CLICK HERE TO SUBSCRIBE TO OUR iTUNES PODCAST FEED
Podcast: Play in new window | Download (Duration: 13:30 — 12.4MB)
Subscribe: Apple Podcasts | Spotify | Android | Pandora | iHeartRadio | Podchaser | Podcast Index | Email | TuneIn | RSS
Bold Statements
We’re putting a lot of energy into making sure we’re process-oriented and that the changes are made to workflows within these processes. That’s a big mindset change for all of us.
You can get through that with some blinders on. You can look at dates and milestones and meetings that have to occur, and even though it seems like it’s never ending, it’s a fairly finite set of work. Once you go live, all of that changes
Our disciplines around those sorts of things — which were fairly straightforward and worked reasonably well before — are all being reinvented or refined, and leadership and operations has found that it goes much better if they take more of a hand in those discussions, those activities.
There is a different construct or framing around Meaningful Use versus value-based purchasing — the communications have been different and the activities have been different around it, and now we’re trying to bring those together.
Gamble: When you talked about some of the requests that were made, was it through champions or super users, or did it go through certain channels as far as people making requests for modifications?
Zirkelbach: Yes. We did have a process at go-live and post go-live. It’s built around the different application areas and there’s a prioritization process; I almost call it like a risk management model — how significant is the impact to quality? Is there a regulatory driver? There’s some weighing that goes on, and you just keep working those top 10 and trying to make sure that the top 10 issues are always being addressed.
That worked reasonably well. But the governance structure around focusing on what we worked on and what was important to the organization is what we’re refining now. We want to make sure there’s a good comprehensive view of standards of care around access and documentation and quality outcomes, and that the changes to the system that support those things are given a much more holistic view before we start to make them.
We’ve created a role here we call macro process owners. The macro process owners are really the key business owners of a particular area. One macro process owner for us is access, and so there’s a person that’s responsible for that process and they have a subgroup that evaluates what the organization is trying to do in terms of moving things forward, what we have to do from a regulatory perspective, and the different projects that are coming up, and making sure that the things we take on are something that the operation can support and implement in a sustainable way, and not just change requests that come from different parts of the organization.
That’s a big deal for us. We’re putting a lot of energy into making sure we’re process-oriented and that the changes are made to workflows within these processes. That’s a big mindset change for all of us.
Gamble: Sure. In terms of the optimization that’s the focus right now, are there any particular aspects of that, or is it just trying to get improved use out of the system?
Zirkelbach: I think every area has a list that they would say would be really helpful, but I’d say the patient movement around CPOE is an area where we’ve put a lot of energy in trying to make the system easier for our clinicians to understand. It’s just a very different mechanism to be able to either give a verbal order or to write out an order. That’s been one area that we continue to focus on.
Nursing documentation is another area. It’s one of those areas where there’s a lot of scrutiny around care plans and regulatory reviews. We’ve tried to make sure that it accommodates all kinds of requirements, but also is something that nurses can do in an efficient manner. And then revenue cycle and access — we’ve put a lot of energy into those areas to try to make sure that the system is efficient for charge capture, scheduling events, authorizations, those sorts of things. We still have a lot of work in front of us in that area too.
Gamble: It’s interesting because in one way you want to say the hard part is over because you have this implemented, but I’m sure that certainly is not necessarily the case.
Zirkelbach: Both parts are hard, probably for different reasons. I’ve heard and used any analogies and none of them really work well. Just getting a system live and making sure that all these changes are communicated and all the touch points and stress that goes along to hitting a date. It’s all about a date and a budget and trying to make sure that all the mechanics around that happen. That is very hard. There’s no denying that. But maybe the easy part of that is you can get through that with some blinders on. You can look at dates and milestones and meetings that have to occur, and even though it seems like it’s never ending, it’s a fairly finite set of work. Once you go live, all of that changes, and basically everything is fair play — problems with the system, the need to optimize and add departments and new partners, it’s just on and on and on. Transitioning from that go-live mindset to being able to have dialogue about a bunch of different things that you could do but you know you won’t do them all — having structure and having teams that are used to that is also very hard, but in a different way. They both represent challenges you have to be prepared for to be successful.
Gamble: I like the way you put it about how it’s a change in the mindset. I’m sure that’s something where leadership has to really own that and guide the rest of the organization through that.
Zirkelbach: Yes, and our leadership was phenomenal in terms of providing us the support — the air cover — and helping with the messaging of, ‘We’ve got to get this done,’ even if it conflicts with other things that people want to do. They were great. I couldn’t ask for more support.
But what we all learned together is these systems — and we call them transformational in nature — really do tug at the leadership and at the operation in a much more significant way in terms of ownership and having a hand in what happens. Not to say that we didn’t have this going on before, but when mostly everything is automated and it’s all integrated and you’re part of a complex system, the operation just has to take more time in understanding these workflows, and even the data and the analytics. We’ve discovered that we move pretty quickly in implementing the systems, and when we try to do analytics afterwards, the meaning of the data has changed a bit from what it used to. There are more people involved in entering the data, and so our disciplines around those sorts of things — which were fairly straightforward and worked reasonably well before — are all being reinvented or refined, and leadership and operations has found that it goes much better if they take more of a hand in those discussions, those activities.
Gamble: In terms of Meaningful Use, how are positioned?
Zirkelbach: We’re on target. It’s a multi-faceted answer. The eligible providers are doing well. We’ve worked very hard. Of course, a lot of this happened right in the midst of this project, and so there was a bit of a scramble to try and make sure we were organized and we were meeting all the requirements to do our attestation. It was the same with the eligible hospitals, but we’re doing fine. We’ve attested for stage 1 and we’re right at the edge of being ready to do stage 2.
Gamble: If you’re right in the middle of an implementation, I’m sure that that can get hairy with dealing with all the requirements and preparing for the next phase.
Zirkelbach: That’s a very good way to say it. It’s very hairy. We just had a meeting last week about Meaningful Use and the data validation has to occur there, and value-based purchasing and core measures, and how there’s a convergence going on. I think, at first, it probably was maybe unintentional, because these things are typically driven by different areas, but the people that are involved are seeing that it’s some of the same data, and it’s some of the same processes that generate this data. And so converging our teams and our processes so we maybe only have to address something once has been really challenging, because those have been dealt with by different areas in some cases.
Although our quality team seems to be one of the areas where they deal with all of it upstream where that data are created, there is a different construct or framing around Meaningful Use versus value-based purchasing — the communications have been different and the activities have been different around it, and now we’re trying to bring those together. That is very complex, and there are many other things that swirl around that in terms of just trying to manage information, trying to coordinate care, creating registries around different populations, and doing population health. All those are all very demanding from a data perspective, and the discipline to do that well is demanding also.
Gamble: When you talk about the wholeness institute, I would imagine that this is something where the goal is to be able to take care of the whole patient in a better way, and maybe help with some of the care transition challenges that I know a lot of organizations are going through just keeping track of patients once they leave the hospital.
Zirkelbach: We’ll certainly be addressing that, but I think with the wholeness institute, this is all fairly new and evolving. In the discussions that I’ve been involved in, it’s much more about trying to help people stay healthy, and if not healthy, then to get to a healthy place. That tends to be not only population-based but also individual-based, and we may be at risk for these individuals or they may just be in our community, and we’d want to try to have services or information that could be useful for anyone in any particular situation. So it’s much more about the whole person and whole-person care, and really trying to stay healthy and get healthy. There’s much more emphasis on that, and creating professionals that have much more training and preparation for that kind of focus.
Gamble: It’s something where there’s certainly a lot of demand for it. It should be interesting the next couple of years to see how it pans out. As far as accountable care, are you involved in any ACOs at this point, or is it something that you’re looking at for the future?
Zirkelbach: We are certainly looking at it, and I believe January 1 will be our first formal ACO that we’ll be participating in. We’ve been studying it and looking at it and trying to prepare for it for the last several years. We’re not involved in it or as far down the road maybe as other organizations. Hopefully we’ll learn from them and be able to apply some of those lessons to our experience.
Share Your Thoughts
You must be logged in to post a comment.