Gene Thomas can tell you the precise date and time his team ‘flipped the switch,’ going from three EHR systems to one. It was a big move, one that Thomas believes has placed the organization on the right track. But it’s also a move that required a great deal of planning and discipline, and came with challenges no one could anticipate. In this interview, he shares some of the lessons learned in leading a big-bang implementation, what it will take to go from stabilization mode to optimization mode, and the many hats CIOs must wear. Thomas also talks about the his team’s big plans for analytics (and what they’re doing to set the stage), his thoughts on patient engagement, and how he has benefited from his previous career experience.
- The evolving CIO role
- “Analytics is not the answer; it’s a large part of the answer.”
- Data-driven decision making
- Selling the board on analytics — “It’s important to build consensus.”
- The CIO’s many hats
- Portal adoption is “fundamental and pivotal in terms of population management.”
- Learning from Google, Apple & Walmart
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You don’t really want to do this, in my opinion, without analytics, because it’s not really effective — it’s a kind of a shotgun as opposed to a rifle.
In our selection process for analytics, we reached out and asked various procedural areas to come up with scenarios — what would you like to see that you’re not getting today, or what do you want to make sure you’re going to get if we moved to a new system?
When you build consensus, be careful — if you build it, they will come. They’re hungry right now and they’re coming in and saying, ‘can’t you please give me this data?’
A patient’s a consumer too, the last time I checked. We know a lot of how those patients react, their behaviors, etc., and that’s what marketing is — addressing the behaviors and the desires and the wants and the needs of a consumer.
Gamble: Looking at analytics and first getting the data to where you want it, what would you say are some of the biggest goals you’re looking at as far as being able to leverage that data to improve care and improve the patient experience?
Thomas: That’s a good question and I guess I would ask you, how much time do we have?
Gamble: Right, it’s not a quick question.
Thomas: It’s an important one. You’re right, it’s not a quick one, but it is important. I’ll preface it by saying that the role of the CIO is important, and while it’s about the bits and the bytes, and it’s important that people like me have people in place that understand that, in my opinion — and it doesn’t mean others agree — the CIO’s role is different than it was a decade ago. I picture my job as to put the infrastructure in place to have a stable environment, to provide care, but to make sure the right information is at the right provider at the right time and the right venue of care. But I need to make sure we’ve got the data so people can look at outcomes, medication use, and utilization and say, how do we take patients that we can predict are at risk and do earlier interventions? How do we change from a hospital that takes care of sick people to a system that prevents illness? Population management — how do we get people in plans of care that allow us to have dialogues, whether it’s lifestyle or different interventions, before it becomes an acute high-cost event?
Analytics is not the answer; it’s a large part of the answer. Our ED has 85,000 visits a year, there’s a good percentage of those ED visits that are either primary care or the unmanaged manageable condition. You don’t really want to do this, in my opinion, without analytics, because it’s not really effective — it’s a kind of a shotgun as opposed to a rifle. But with analytics, you may be able to rifle shot and say, who are the people that are coming in with these unmanaged manageable conditions and what could we do to prevent that? And again, I’ll go back to the fact that we’ve got a footprint.
So if we know a lot about that patient and we could find the patients that have a high likelihood of coming into the ED with an unmanaged manageable condition, we can do something hopefully prior to the high cost event that’s first and foremost best for patient. It’s good for our community as a community hospital because it provides us not only access efficiency, but also financial efficiency. And I’ll tell you, I think it’s good for you and me and anybody else that might hear this that we as taxpayers, in large part — and the government’s the largest payer — pay the burden for those high-cost ER visits, when in fact, if people were managed differently it just wouldn’t cost the taxpayers as much. And so analytics in my mind is critically important. I would not have recommended that we pick a vendor as robust as Cerner if we weren’t going to do analytics at the same time.
Gamble: It’s a huge investment and it’s such a big initiative to go to this single integrated system, and you want to make sure that you’re really going to be able to transform the data.
Thomas: That’s right. Data should drive decision making. You have the human element, but in terms of pointers, you want the data to be able to drive what makes sense to do or think to do or test to do.
Gamble: It’s interesting. There’s so much potential for data when it comes to things like reducing readmissions, but then also just improving population health. I know that in your area, you’re dealing with a good amount of chronic disease patients, and so I’m sure this is definitely a priority.
Thomas: You’re exactly right with the composition of some of our patient population, but also we’re community-based hospital, not-for-profit, safety net provider, and a good percentage of our volume is Medicare/Medicaid and the uninsured. And so I got back to, best for the patient, best for the community, best for the institution that is there to support the community, and best for the taxpayer.
Gamble: When you talk about the CIO role and how it’s evolved, something like investing in a data warehouse platform and analytics and things like that, might not always be the easiest to sell right now when so many organizations are dealing with tight dollars. I can imagine as a single hospital system, you’re dealing with that too, but is this something that can be a difficult thing to sell to the board and as far as making analytics a key priority?
Thomas: Yes, it can be. And I’ll tell you, some of my colleagues have had a harder challenge than I did. I’m fortunate; my colleagues in the C-suite understand this. What we did do is in our selection process for analytics, we reached out and asked various procedural areas to come up with scenarios — what would you like to see that you’re not getting today, or what do you want to make sure you’re going to get if we moved to a new system? We actually came up with scenarios that engaged a good cross section of the procedural area directors and managers, and they gave us scenarios. We actually gave those scenarios to Health Catalyst and the other finalist vendors.
And I’ll tell you, what was impressive about Health Catalyst is they said, ‘Gene, no problem. We’ll come back and give you not just answers to your scenarios, but if you’ll give us access to your data, we’ll sign the right business associate agreement. We’ll come back and show you your data based on these scenarios that you’ve asked us to provide.’ And they actually were able to do that in about three or four weeks.
We did spend a good bit of effort building consensus and engagement on analytics. We did spend a good bit of time and I spent a good bit of time sharing with the C-suite and then of course with the board, here are the benefits other institutions have realized when they’ve used analytics. There’s good data out there from a variety of sources that show if you put in an EMR and use the analytics — and HIMSS, of course, does this with their adoption scale — here are the benefits other institutions have enjoyed by doing this. We spent a good bit of time (1) making sure we believed it, and of course I did, probably based on background. And then (2) making sure we explain to the board why do we want to include this in this project as well.
But I would say it’s important to build consensus. Now I would also caution when you build consensus, be careful — if you build it, they will come. They’re hungry right now and they’re coming in and saying, ‘can’t you please give me this data?’ And while we’re doing it, I’m just saying there’s more requests than I have the capacity to fill right now, and that’s actually a good thing.
Gamble: That speaks to what you were saying about role that the CIO plays in building this case and having the business acumen that maybe before wasn’t such a big priority for CIOs. Do you think that that’s something that’s almost become a requirement?
Thomas: I do, and part of it depends on the organization and how it’s structured. Certainly for a non-profit standalone system like us, it is. You have your larger systems that have executives in transformation roles and other type of roles. For an institution like us, you don’t really have the budget to have multiple people at the C-level in that area. So I think that the CIO has to wear the hat of CIO and chief analytics guy as well. But yeah, I think at this point, the CIO is a little bit like human resources in that you now touch everyone in the institution, from the cash register in the cafeteria, to the surgery suite, to an ambulatory clinic. And so the CIO has to understand revenue cycle, has to understand the business processes, and has to understand patient engagement because a lot of that is electronic, not all of it, but a lot of it. You have to understand Meaningful Use. So I think you clearly should understand fundamental business metrics and the business side of healthcare metrics and the metrics that are associated with patient care, because you can help provide the data that allows the end users to do something meaningful with that data.
Gamble: Yeah, that’s a lot of hats.
Thomas: Yeah, but that’s what makes it rewarding.
Gamble: As far as patient engagement, have you been able to see some traction from the portal or is it still early?
Thomas: I would say based on where I wanted it to be, it’s still early in terms of numbers, but yes we have seen traction. I’ll tell you one of the interesting things, and it’s a little bit of cautionary tale. It takes a burden off parts of the organization, it’s a good thing. So patients are now able to see select parts of their medical record through the portal. What they’re saying is ‘I’d like to talk about it. Is this still accurate? Is this still an active problem?’ Things like that. But it’s engaging them, and that’s a good thing.
And if in the rare event, just like a credit score, you find something wrong in the medical record, you want that corrected. We all want that corrected. The last thing a provider wants is to have a patient that has inaccurate or not quite accurate information on the medical record. So that’s actually beginning to take some traction. A long way to go there, but I think in general as a country, and in certain areas based on demographics, it’s going to take longer than other areas. But I would consider it fundamental and pivotal in terms of population management.
Gamble: A lot of organizations are kind of in the early stages or just dealing with the challenge of getting patients to not just sign up for the portal, but to stay on it. And in some cases, dealing with one portal for a physician’s office and one for the hospital, and sometimes even more. It’s definitely a tough one.
Thomas: Again, I’ll go back to again our service distribution. We’ve got a little bit of an advantage that some patients get all their care within our system, because we’ve got the client footprint. So when we sell the benefits of why do you want to have your care at Memorial, one, there’s not that many other options in our geography, and two, you’re underneath one umbrella. Here are my thoughts on the patient engagement and patient portal, with more of the patient engagement topic in my mind. Patients are consumers too. The industry knows how to treat consumers, largely consumer facing industries. I’m talking everything from Sony to Google to Apple to Wal-Mart to Target. In my opinion, we need to treat patients the same way in terms of engagement, retention, satisfaction, etc.
My point is, we understand how consumers react, right? That’s what VPs of marketing — which I was one — do. A patient’s a consumer too, the last time I checked. We know a lot of how those patients react, their behaviors, etc., and that’s what marketing is — addressing the behaviors and the desires and the wants and the needs of a consumer. Well, it’s not that much different in healthcare.
Gamble: Right. As far as Meaning Use, how are you positioned at this point?
Thomas: I’ll represent the institution by saying I think we’re positioned well. We were an early striver. We achieved Meaningful Use stage 1 in 2011. We are on Meaningful Use stage 2 on our inpatient side and with our eligible providers, so we’ve received and attested for all of the incentive dollars on the inpatient side of the house and with our eligible providers. Now we’re in Meaningful Use stage 2 and no longer in the incentive phase, but in the penalty phase if we don’t achieve. But we’re meeting all the requirements and measures, and have from day one.
Gamble: Were there challenges just as far as the big EHR transition this past summer?
Thomas: There were, but again by the time we did that, we were in our final year of inpatient Meaningful Use. That finished in October and we were in our final year, which finished in December, for our eligible providers. We just had to make sure that we combined measures of our legacy systems with measures out of the Cerner system and we did that. It took some manual processes, but we did that pretty easily. I shouldn’t say that. The people that did the work would say ‘Gene, that’s not true. It wasn’t easy.’ But we were able to accomplish it.