For Chad Brisendine, there were a few selling points during the interview process with St. Luke’s six years ago, but by far the most compelling was the organization’s readiness for change. And it’s a good thing; when he took over as CIO, there was a lengthy list of tasks to attend to — including an ‘aging’ data center and an infrastructure that needed revamping. But although the challenge was a daunting one, Brisendine was up for it, and the hard work he and his team put in has paid off. In this interview, he talks about the virtualization project that turned out to be a game changer, what he’s learned about change management, and the prioritization challenges facing CIO. He also discusses the Epic transformation he’s currently leading, and the career path that brought him to the Lehigh Valley.
- Change management — “It has to be operationally owned and supported by IT.”
- HIMSS stage 2 to stage 6
- Leading change “can be daunting.”
- From Christus to St. Luke’s
- Virtualization — “A must-have in today’s environment”
- Switching to Cisco’s platform
- “Assigned accountability” to increase portal use
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It comes down to the CIO having key relationships within the business, being transparent, and communicating effectively in talking about who owns what.
As you get adjusted to any culture, you begin to understand what needs to be done, who does it need to be done for, and how do you go about that. It can be pretty daunting
It’s a very long process to figure out what can get virtualized and what can’t, how do you work through it and what gets transitioned, etc. But in this day, I think virtualization is a must have in today’s environment with all the functionality it brings and the cost reduction as well.
The more information that we can provide to the patient and the more comprehensive information that we can provide to that patient, the more they’re going to want to get into it.
Gamble: One of the biggest issues that we encountered in speaking to CIOs is change management and the challenges you face, especially as the new CIO, in wanting to lead all of this change. Can you talk about what was required from a leadership perspective in handling that in a way that made it a little more palatable for the staff?
Brisendine: Basically it comes down to the CIO having key relationships within the business, being transparent, and communicating effectively in talking about who owns what. Change management has to be operationally owned and supported by IT. Our physicians drove a lot of the changes that we needed for Meaningful Use. Our nurses drove Meaningful Use. IT supported it. We put the systems in place. We helped train. We helped to design training, we helped design workflow, all the components, but we’ve had a very high success rate with all of our work effort because of the operational ownership and leadership ownership.
At the time, only had about half of our hospitals even had what I guess you’d considered stage 2 of the HIMSS model. So not only did we basically bring up the hospitals all the way to HIMSS Stage 6, we brought up all six hospitals to HIMSS stage 6 on the same system. That required a lot of leadership commitment, ownership and work, and that was what my team did with the other executives within the organization. We’re really big on sponsors and really engaging with those sponsors and having those sponsors play a big role in the programs that we initiate.
Gamble: I would think that’s one of the key points in emphasizing that things aren’t being done to people and getting away from that mentality of this is what we’re doing to you.
Gamble: So for you coming in, I guess that it had been established that this is what the organization wanted to do. I can imagine that was a little bit daunting now, or was it something where you were up to the challenge of coming in as the new CIO and leading this significant change?
Brisendine: I don’t know. I definitely had my challenges within the first year. I think as you get adjusted to any culture, any organization, you begin to understand what needs to be done, who does it need to be done for, and how do you go about that. It can be pretty daunting, especially when the list is fairly long. As you know from talking to a lot of CIOs, the amount of volume of activity is just the busiest I’ve ever been in healthcare IT in 17 years. We have a tremendous amount of stuff that we have to do for change management and organizational change and leading efforts, and so it’s really just working with the executive team to prioritize what’s important and focus on that.
But yes, I think changing a job doesn’t matter how complex or how easy it is. You’ve got to work through the culture, the relationships, the people — any CIO or any major leader that changes is going to have to work through that. So that’s what I focused on a lot in my first year was the people and the culture and how we were going make the changes that we needed to. I was up for the task to do that and looking to break out on my own and try to do it on my own to see if I could be successful or not.
Gamble: When you talked about some of the goals of transformation, you talked about virtualizing the environment. I wanted to talk about t as far as what was required to get that infrastructure in place and that journey of going virtualized. You said you’re at 98 percent right now?
Brisendine: We have a couple thousand virtualized servers.
Gamble: If you could just kind of walk a little bit through that process and what was required.
Brisendine: Basically, I had a good experience from Christus, where were very early adopters of virtualization technology — and a lot of technology, to get a good idea of what works and what doesn’t work on virtualization, and basically what are all the core points. I was fortunate enough to get to bring in some very seasoned technical people. It’s a very long process to figure out what can get virtualized and what can’t, how do you work through it and what gets transitioned, etc. But in this day, I think virtualization is a must have in today’s environment with all the functionality it brings and the cost reduction as well.
I think really our major difference was actually picking the servers. We knew we were going to go virtualized and we knew we were going to try to get above 90 percent, and I think we’ve gone much further — VMware tells us it’s much further than what we thought we would get as far as our virtual environment. I think really the challenge was figuring out how do we keep the total cost of the data center down. We knew virtualization would provide us flexibility from a number of variety of places. It was really more of the server infrastructure where we decided to change, and we actually made a switch to Cisco UCS.
As part of that transition, we really looked at what is the cost to maintain servers within the environment and what does it cost to maintain storage within the environment as well. So we looked at tiering our storage and replication within our storage and we made a lot of decisions around that, which helped us decrease the cost of running the data center and run it more efficiently and effectively. On our server side with the Cisco UCS platform and the availability structure it has within it, it increased our availability, and we have a lot less networking infrastructure that’s required behind it, so our cost to actually configure the network side of the server went down because of the way that it is designed. So those are really two core major decisions that we had.
The other was what tiering do we want on all the systems and how much of it do we want to run out of each data center. In the way that we’re designed, we can failover to each data center or in some cases, some of our systems were actually running both systems out of two data centers. So in the event that we have our A side of the data center go down, our B side of the data center is running and we have tier 1 applications that would run out of that data center. So a lot of those components were really the major challenges with the design of how we wanted to deliver the overall infrastructure within the environment, if that makes sense.
Gamble: Right. So you talked about Meaningful Use, which is obviously a big priority. Have you attested to stage 2?
Brisendine: Yes, we did attest to stage 2.
Gamble: Okay. One of what we’ve heard to be significant challenges with stage 2 is patient engagement. I know that you have the patient portal, so I just wanted to talk about what your strategy has been there and what kind of traction you’ve seen.
Brisendine: We had a number of challenges with the overall way that the portal could work. The challenges was with the way it was reporting. Basically, on the ambulatory side, the workflow is fairly good for patient engagement because you get the document out there and you can provide the visit summary at the end. It’s a more frequent visit. They’re a little bit more engaged on the ambulatory than they are on acute.
Getting the acute numbers was actually challenging. We had a whole group brainstorming a million ideas to try to figure out different ways. We have about 18,000 active accounts on the acute side; just to give you a little bit of breadth of the HIE, we have about 11 million documents and results within our Health Information Exchange, and we have about 120 built interfaces within that. We have about 56 community practices that are providing and sharing data to it, and we probably have about 15 that are in the pipeline. So we’re continuing to grow what I call the foundation of what can be shared within our community portal. And that’s important because the more information that we can provide to the patient and the more comprehensive information that we can provide to that patient, the more they’re going to want to get into it.
A lot of patients have a community provider, maybe a primary care physician that has some other EMR, and so their information gets generated from that. But the patients don’t want to go to that EMR, then go to the St. Luke’s Ambulatory patient portal, and then go to the primary care that’s affiliated but doesn’t have the same EMR, to the St. Luke’s employee provider that has a different portal, and then one that has an acute portal.
So we decided to lay a portal on top of our HIE probably about three years ago and started building the foundation, and then when we lay the portal on top of it, our initial focus was when the patient left the hospital, the CCD document would get pushed out and then we would have people calling the patients and we would try to call the patients and we would try to hunt them down. We even provided all kinds of education material when they left and when they came in for registration. We were collecting emails, and we were doing a bunch of things that weren’t working to get our percentage up.
And so we decided to hire nurses to go into the patient rooms upon discharge and then set up their accounts with them and educate them and actually get them into the system. We ended up doing that, and our percentages went out of the roof. In the first part of our attestation we were not hitting the mark, and then when we changed that during our attestation, we actually saw our numbers jump up. We ended up getting over 25 percent to basically view clinical information within the patient portal for our Meaningful Use attestation, which you’d almost have to double the number because a number of discharges that we had in the first part that were missing.
We’re continuing to do that program where we have basically assigned accountability. We’re actually in the process of moving from nurses to full-time employees, which will have people going around the patient rooms upon discharge and sharing the CCD and talking to them about it and talking to them about the patient portal and showing them the features and functions in that as part of the discharge process. That’s basically how we’re working it.