The changing landscape of healthcare has meant a shift in strategy for CIOs. Whereas aligning with community health centers and physician practices was once merely on the radar, it’s now a top priority. New payment models and looming federal mandates have made care coordination vital — and that’s where Access comes in. “Care coordination is what we do,” says Julie Bonello, who is leveraging her past experience as a hospital CIO to lead the organization through a dramatic transformation and position it as a key partner to a dozen hospitals. In this interview, she talks about building an IT team from the ground up, her strategy for retaining top talent, and what’s next for CIOs.
- Access’ Epic journey — “We embarked on a complete system strategy.”
- Building an IT team from the ground up
- 3 years to Stage 6
- Change management — “We knew we would face difficulties.”
- Community provider portal
- Epic’s practice management system
- Her ever-evolving strategy to recruit & retain staff
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To build a workforce and an interdisciplinary team to support the kind of culture and mission we had here was very exciting.
We went through many changes in course during those three to four years. We knew at the beginning that we would be doing that, and it was approved and expected, which I think is huge. So we knew that we would face difficulties.
Our patients understand how they can use it to support their care plan. And so while it would be great just to get many immediately activated on the patient portal, we want to make sure they use it.
We were unable to initially hire Epic-certified people because the demand was so great. So we had a very good strategy for choosing applicants who had strong aptitudes but they were initially just starting out their career.
Gamble: In terms of the EHR System, you’re using Epic, correct?
Gamble: When you arrived, I imagine that there were things that had to happen in order to implement that, just in terms of getting the infrastructure in place. Can you talk a little bit about that process and what was required?
Bonello: Sure. It’s really an incredible journey we’ve gone through here. It’s really amazing. When I came to Access, a former colleague had called me and asked me to provide some guidance, which I did. And then the CEO called me, and I drew on a napkin the strategy they needed to pursue. When I took the position, Access had signed a contract with Epic, but actually had no IT department. Prior to me joining, Access had a small decision support team with a data warehouse, because we used the outsourced systems from another hospital. So in 2009, we embarked on a complete system strategy for every single thing — not only Epic, and moved our organization.
I was really excited, because to build an IS organization from the ground up; to build a workforce and an interdisciplinary team to support the kind of culture and mission we had here, was very exciting. So within three years, we got everything implemented and got to stage 6 adoption under HIMSS. And it’s really, I think, due to the strong workforce that we were able to build and the strong organizational structure and support that we had over the five years. This is an organization that prior to 2009, really had no systems in place.
Gamble: That’s amazing.
Bonello: It is amazing.
Gamble: It’s interesting because we hear people talk about what it’s like to build a new facility from the ground up and what that means as far as being able to get things how you want them and not have to retrofit. I can imagine that there are similarities when building an IT department from the ground up.
Bonello: Right. We spent a tremendous amount of time choosing the right people and defining the correct structure for this organization, because every organization is different, and so we knew we needed to manage change very actively. We knew we needed to get the right people in positions here, and it was hard because we’re an FQHC, and a lot of organizations don’t know FQHCs. So it was hard to actually hire certified Epic people when we began.
Gamble: When you talk about managing change actively, that’s another thing that really can be very difficult. How is your team able to do that?
Bonello: Managing change was something that we dealt with at the senior leadership level. We went through many changes in course during that three to four years. We knew at the beginning that we would be doing that, and it was approved and expected, which I think is huge. So we knew that we would face difficulties. I think that’s enormous.
I also think that the mission here is so pervasive, and that’s a strength. Here, our providers are employed. They were thrilled to have an electronic health record, and they have been very supportive and engaged. Everyone in our health centers was very excited. I think we even had patients wearing t-shirts celebrating our electronic health record implementation when we went live. That’s the kind of environment we have. That’s a plus — a huge plus.
Gamble: I’m sure when you get that level of engagement when people don’t feel like something is happening to them but that they’re part of it.
Gamble: Now as far as the hospitals you work with, are they on different systems? Are many of them on Epic?
Bonello: I would say most of the hospitals — most of our closest partners — are not on Epic. The biggest implementation piece for us with these hospital partners initially has been to implement the community provider portal.
Gamble: Have you had a pretty decent level of participation?
Bonello: We have. I’ll use our pilot hospital as an example. You look at some of the quality metrics in terms of care coordination that both of us want to meet, and you take a look at the workflows in transitioning care for our patients and then you look at where it breaks. We implemented the ability for all of labor and delivery at the hospital to gain access to our system for all prenatal records, if they weren’t already in the chart. We provided the ability for scheduling mom and baby follow-up appointments right away. And every month, we meet to take a look at our deliveries to see if we’ve met our quality metric goals between both partners. We also put it in the ER, and that’s been a harder workflow to accomplish than on a particular unit. So every hospital is different in the way they want to use it, and now we’re rolling it out to discharge planning.
Gamble: It’s obviously such a huge focus. When you talk about making that available in labor and delivery, that makes a lot of sense, because you have people who regularly are going to a physician practice and know that they’re going to be admitted to a hospital, so it seems like a good place to really try to build that usage.
Bonello: Yeah, the care team is very much defined. So I think that was a good pilot to hit our care metrics. Plus, we’re always concerned about our new baby care.
Gamble: Have you run into challenges with patients who don’t have internet access?
Bonello: We haven’t. We’re rolling it out slowly — the patient portal — because we want to make sure our patients understand how they can use it to support their care plan. And so while it would be great just to get many immediately activated on the patient portal, we want to make sure they use it. Our providers have been really sitting down and helping the patients work through how they can use the portal for their care. Different providers, based on different chronic diseases, use it in different ways, and that’s been pretty fascinating.
Gamble: That makes sense because you can have a certain number of people sign up but you really want them to using it on a somewhat regular basis.
Bonello: Absolutely, and you want to make sure that when you roll out your patient portal, it’s an extension of your electronic health record. So you really want to make sure that you have the same clinical protocols to manage and monitor that tool and how it’s used for patient engagement as you manage and monitor your electronic health record and all your documentation and care model protocols. So it’s something that requires a lot of attention to make sure that it can really be used for engagement.
Gamble: In talking about the initial Epic implementation, which as we said was unusual circumstance because you were building up an IT team that hadn’t been in place. Were there challenges you ran into once you went live, as far as no longer having that close level of support from the vender, or not as close, and having to get used to this new environment; these new workflows?
Bonello: I would say we had two challenges post live. We went through a series of rollouts. The first challenge we faced was a very different healthcare marketplace with Accountable Care and the economy. Our uninsured rose significantly around 201, and so we decided after the initial rollout of 15 on the record and on practice management, to get everyone up on practice management before we rolled out the rest of the health centers on the electronic health record. And we did that to stabilize our reimbursement workflows and processes.
While we did that, we actually, for a year, outsourced our revenue cycle department and rebuilt the revenue cycle department at the same time we were implementing the Epic practice management system on people who could all be trained on Epic at the same time they were starting their job. That was really huge and it was a change that we didn’t foresee, but it was a very wise decision and very successful. That was the first one.
The second one probably is the changing landscape for IS staffing. We initially started with having to build our own talent; as I mentioned, we were unable to initially hire Epic-certified people because the demand was so great. So we had a very good strategy for choosing applicants who had strong aptitudes but they were initially just starting out their career. We made them sign a two-year agreement, and at the end they’d usually go on to consulting jobs. So we had to reframe our recruiting and retention strategy midway through, and we probably still change it every year.
Gamble: I guess that’s something that has to be a continuously evolving process.