Every time Michael Skvarenina tells a fellow CIO about WebHIS, the homegrown HIS that has been a staple at Holy Name, the reaction is the same: shock, followed by awe. Shock that a forward-thinking organization opted away from an established solution, and awe that the staff has been able to maintain and improve the system through the years. In today’s complex, fast-moving environment, using a customized system that lacks vendor support or user groups might seem a little too out of the box, but, according to Skvarenina, that’s precisely the idea. In this interview, he talks about the benefits and pitfalls of developing in-house, the next steps for WebHIS, the problem with patient portals, and the mantra that guides his organization.
- Multiple patient portals — “It’s really not user-friendly.”
- Acting CIO for nearly a decade
- From vendor to provider side
- “I’ve never let go of software design and development”
- WebHIS blog
- “With passion, anything is possible”
- Holy Name’s development “Dream Team”
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You really should just have a single portal that does all the functionality. Portal developers are trying to standardize and come up with a way of launching each other’s portals to make that seamless, but it’s just not complete yet.
It’s not just a clinical information system. It does financial reporting. It does data analytics. It does payroll. It does our time and attendance application. It’s a telephone directory.
Once they get over the initial shock, they are quite impressed that we’ve been able to develop a system, maintain it, and keep it going all these years.
If you can dream it, if you can think of it, we can do it. And it really has to do with passion — the passion to do your job, and the passion to take care of patients, make them better, and get them out the door faster.
I can make very quick changes that really can make a big impact on how someone uses the system. I don’t think you get that from a vendor commercial product.
Gamble: What about on the patient side — do you have a portal?
Skvarenina: Holy Name is part of Jersey Health Connect, which is the North and Central Jersey health information exchange, and that exchange provides the patient portal. So in general, yes, we have a portal because we’re using the Jersey Health Connect portal.
Now that’s another challenge. If you want to talk about challenges, we now have three portals that are active. We have the Jersey Health Connect Portal, which is our main portal for patients, and the cancer center has their own portal, because those patients have a specialized need for care, and a generic portal from Jersey Health Connect does not provide things like the patient’s care plan and specialized treatment plans that are part of the cancer center portal. So there’s that, and then there’s another portal that we’re looking at putting in.
One of the things I think is going to be quite challenging in the future is that you really should just have a single portal that does all the functionality. Portal developers are trying to standardize and come up with a way of launching each other’s portals to make that seamless, but it’s just not complete yet. That’s going to be a challenge for the next few years.
Gamble: That’s a significant challenge we hear from so many people, especially in those cases when you are dealing with more than one portal, and patients are expected to keep multiple ones updated. It’s tough.
Skvarenina: It’s very problematic, because even for our hospital website, we want to put a launch page there for the patient portal, and now we’re forced to say, ‘if it’s hospital, it’s this, if it’s canter center, it’s that.’ It’s really not user friendly.
Gamble: In terms of your own background, when were you named CIO at Holy Name?
Skvarenina: I was named CIO really about three months ago. However, I’ve been unofficially doing that role for almost 10 years now. It’s been a long time. My prior title was assistant vice president of information technology, but I really report to the CEO, and have been doing that for many, many years. He would, in general, referred to me as the CIO but I didn’t officially have the actual title.
Gamble: As far as having the position at Holy Name, I can imagine that was an interesting transition going from the developer side to the having this leadership role.
Skvarenina: The real history is we started in 1986, but in 1992 is when I officially became an employee of the hospital. The hospital hired me away from Spectrum, and I became the program and development manager and started to manage the rest of the developers.
In 1995, I became the director of information systems and started to take on more responsibility. There were a number of changes that have happened since 1995. I’ve been in the leadership role for a very long time here, but I’ve never let go of the software design and development. I do have a blog, it’s WebHIS.blogspot.com, and there I talk about the history of Holy Name and history of WebHIS. It’s quite interesting, and some of the newer information is actually stored out in the blog.
Gamble: I did want to talk a little bit about that, because when you have a blog, you’re being pretty transparent, at least to a certain extent. Is that part of your leadership style, to be open with the staff and patients?
Skvarenina: The purpose of that blog was to bring more awareness to WebHIS. From what we’ve been hearing out in the field, the physicians, the users — anybody that really sees it always talks about how great it is and how we should be marketing it, all these nice, positive things. I thought it would be a good idea to really get the story out there for anybody to learn more about it, and that was really why I started the blog back in 2012.
What I tried to do there was really start from the beginning and talk about how WebHIS was born; give the history of the evolution of how it went from green screen to the web interface. And really the intention now is just to try to keep folks updated on anything that’s major. One of the last posts I posted there was about our 24-team achievement for certification.
Something quite interesting that just recently happened with a consulting company is we were talking about WebHIS and trying to define what it is, because they had called it a clinical information system. I said it’s not just a clinical information system. It does financial reporting. It does data analytics. It even does payroll. It does our time and attendance application. It’s a telephone directory — we use it to search who’s in the hospital at this time, and then we can click on that person’s name and send them a page. So it’s actually more of a platform. The next blog post that I’m working on is actually called WebHIS: The Platform. I thought that was quite an interesting way to refer to it, but it’s not just a clinical information system; it does a lot of things for Holy Name.
Gamble: When you talk with other CIOs and other leaders, especially in different areas, are they sometimes surprised that you have this system just because it is a rare thing.
Skvarenina: I think the initial reaction is shock. As you said, nobody really believes that it’s even possible. I don’t know if it is something that is possible today if you were to try to start, but because of the history of it, it’s been since 1986, it’s really a solid real application and once they get over the initial shock, and then I talk to them about what it does, and you throw out CCHIT or ICSA Labs, that adds a lot of credibility because you can’t achieve certification without a real system.
I go to the Jersey Health Connect board meeting — I’m a board member for that organization, and we do talk about WebHIS sometimes. Once they get over the initial shock, they are quite impressed that we’ve been able to develop a system, maintain it, and keep it going all these years.
Gamble: Sure. So one last thing I wanted to talk about was that one of your blogs talked about an ad campaign for the organization that said, ‘With passion, anything is possible.’ You talked a little bit about that. Is this something that has impacted your strategy?
Skvarenina: Absolutely. That was a tagline that my CEO had once said: ‘With passion, anything is possible,’ and that was really for the hospital itself, but thought it’s the same thing with IT and WebHIS. There has really been nothing that WebHIS has not been able to do. I think the reason for that is we’re all passionate about it.
I’m looking at that post now that you mention it, and I’m seeing in there that I talk about the dream team. We’ve had people call the developers the Dream Team, because if you can dream it, if you can think of it, we can do it. And it really has to do with passion — the passion to do your job, and the passion to take care of patients, make them better, and get them out the door faster. It’s all about passion.
Gamble: Right. If you want something enough, you will find ways to make it happen.
Skvarenina: Absolutely, and again, I don’t like to bash the vendor systems, but some folks feel that the vendor systems are not always developed by the end users. They’re developed by developers that have ideas but don’t know healthcare well or don’t know how things really work.
Here, as we develop applications, they’re developed not in a vacuum, but with the end users. We meet with them, we collect their input. What I do frequently is I walk the floors. I’ve been in the nursing units and I see the users using our system. Sometimes I will see them use something a little bit difficult and I see that they’re not using it as it was designed, so I will say, ‘Excuse me, physician, can I show you this?’ I’ll show them something and they’ll say, ‘Wow, that’s amazing. I didn’t know that.’
Also, just by observation, I’ll see something that they’re doing that I know we can do better. And then from that observation, sometimes — and again, we’re talking about the low-hanging fruit — I can make very quick changes that really can make a big impact on how someone uses the system. I don’t think you get that from a vendor commercial product, because you don’t have that single person who is passionate about their product.
Gamble: Absolutely. That has to be one of the big benefits, I would think, of having the WebHIS system. So we’ve definitely covered a lot. We covered the points I wanted to talk about, so unless there was anything else you wanted to add, I wanted to thank you so much for taking the time to speak with us today.
Skvarenina: I think we had a good conversation. I really thank you for your time.
Gamble: Thank you, and I hope to catch up with you again down the road.
Skvarenina: Very good, thanks.