Call it history repeating itself. In the fall of 2013, Anne Lara and her team were knee-deep in plans to become one of just two organizations (at the same) to migrate to Meditech 6.1. A year and a half later, Union Hospital of Cecil County is at it again, paving the way by going live with Meditech’s scribe functionality. In this interview, Lara talks about what it takes to be an early adopter, the biggest hurdles with attesting to stage 2, how her team is partnering with DataMotion to enable direct messaging, and the complexity of HIE when you closely border two states. She also discusses the culture change needed to increase patient engagement, her key concerns as CIO, and why she feels “very positive” about where the industry is headed.
- Big concern: infrastructure
- “I need to make sure my data is backed up and available.”
- Securing wireless devices
- Recognizing IT’s “unsung heroes”
- Creating opportunities for staff to “shine and grow”
- MU: “It’s taking the industry to a place it wouldn’t have gone.”
- Population health & “Comparing apples to apples”
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We need to make sure those things that are patient care-critical are always operational from a wireless perspective. So we’re always looking at ways to improve, enhance, and make sure that we’re prepared for what’s coming next.
HIM and HIS departments are kind of the wind beneath everybody’s feet. You don’t necessarily know that they’re there unless something goes wrong.
I feel very positive about Meaningful Use. I know it’s sometimes challenging and time consuming to try to figure out how to meet the requirements, but I think it’s taking the industry to a place it wouldn’t have gone
It’s proof that sending that information from one EMR to another one works. So now we have to make that even more meaningful in terms of how can you consume that information; how can you present that data in such a way that it’s meaningful to the individuals that are looking at it.
Gamble: That’s a really interesting initiative. It’s one of those things where you have to lay the groundwork and go from there. But you’re talking about changing the culture, changing the way patients relate with clinicians. To me that’s an approach that really makes sense like, okay, we’re going to start here.
Lara: And build on it.
Gamble: That’s great. It’s very exciting.
Lara: We’re really excited, and it’s been a great partnership with our case management group. They’re really excited. They’ve embraced the concept too, and again, the feedback that we get has been positive. We actually have a weekly call with Vivify just to make sure we’re doing what we need to do. If there’s any problems or questions, the folks at Vivify are there to help us with that too, so it’s a great partnership. The industry is so replete with all sorts of folks to work with. I’ve met a lot of really good folks in the industry that are all trying to do the same thing in our own little way. Vivify through their technology, AT&T through their data use plan, DataMotion through their secure messaging, CRISP, etc. It’s a great time to be in healthcare.
Gamble: Definitely. Did we touch on most of what you’re focused on for the next year or so? I know there’s so much going on.
Lara: I think so. The other thing that always from a CIO perspective that maybe doesn’t keep me up at night, but I always have to be kind of worried about, is the infrastructure to support all this stuff. It’s all well and good to make use of Bluetooth technology or wireless technology, but one of the other things that I’m always cognizant of is I need to make sure that my data is backed up, my data is going to be available, and my system is working and operating the way it should be from a performance perspective. The most recent statistic I’ve heard is that there are three wireless devices per individual now, so I need to make sure our other focus for this year is making sure that our wireless infrastructure is set up to support end-users and support the technology, because everything, if you look at it, everything is wired. My IV pumps are wireless. We have a new program that the nursing department has set up called TeleSitting. So rather than have an individual sit with a patient that may have a potential for falling, it’s kind of like a remote patient monitor in the hospital. We have like a camera on wheels that gives audio and visual cues, and we have folks watching via monitor what’s going on the patient, but that’s a wireless device too. So we need to make sure those things that are patient care-critical are always operational from a wireless perspective. So we’re always looking at ways to improve, enhance, and make sure that we’re prepared for what’s coming next. So infrastructure is really, really important.
Gamble: Absolutely. Without that, all these cool things don’t do much good.
Lara: That’s exactly right. And they’re foundational. Information security is always very foundational for us too. And again, it’s important and why is it important? Well, it’s important because we’re responsible for making sure that patient information is kept confidential where it needs to be. We’re responsible for the health and the wellness of the hospital’s infrastructure — we don’t want nasty bugs or hackers to get into our system. And finally, from a Meaningful Use perspective, the government is really honing in on that information security piece and making sure that you do your security assessments routinely and that you’re mitigating any vulnerabilities. That’s one of the requirements that you have to attest to. So it’s really, really important.
Again, infrastructure information security is always foundational. And I think I mentioned this before, but my staff is extremely, extremely important to making all of this work — making sure that they’re up to speed from an industry expertise perspective, making sure that they’re challenged, making sure that they feel engaged, and making sure they realize how important they are and what a difference that they’re making. Because sometimes HIM and HIS departments are kind of the wind beneath everybody’s feet. You don’t necessarily know that they’re there unless something goes wrong. So it’s making sure that they understand how important the things that they do are. I call them the unsung heroes; from an infrastructure perspective, from a data perspective, from a data governance perspective, they’re it. That goes with all these wonderful things that we’re doing. We couldn’t do it without a very, very dedicated and engaged staff.
Gamble: I guess the big question is, what are some ways to try to make sure that they are engaged and they are feeling that appreciation?
Lara: That’s a great question. One of the things we do is look for opportunities to have them shine — are there special projects that they can work on? And there’s plenty of special projects. Is there a way to take a look at some of the daily things they’re doing that maybe they shouldn’t be doing, like password resets, for example. Do I need somebody on the phone helping to reset a password, or is there technology out there that can help free that individual up to do other things where they can kind of grow and divide.
I think recognition is big — calling them out when they’ve done a good job. Union Hospital does a really nice job with employee recognition, but we also try to do it in the department also and recognize when someone kind of goes above and beyond. It’s really hard in my group because everybody goes above and beyond. And I’m just not saying that, but again just doing that, and trying to get us on the radar screen. This the third year we’ve been voted one of the best IT shops from a hospital perspective, so we’re really excited about that, and we say that proudly. You just always have to be on the lookout for ways to make people feel good about what they’re doing.
My philosophy in life is I want people to jump out of bed in the morning and say, ‘I have to go to work!’ It’s the little things. It’s making sure that maybe they get face time with the executive team, as kind of scary as it sometimes is, and maybe they’ll talk to the leadership team about what they’re doing. It’s just looking for those opportunities where they can shine and grow.
Gamble: I saw that Union was recognized as one of the best hospital IT departments and that I’m sure is just a really nice validation. It’s a really nice way of showing them, ‘you guys are doing a great job.’
Lara: Exactly. They should be proud of what they do. It’s not an easy job — folks usually don’t know you’re there unless something goes wrong. And I say that to people, you’re doing a good job. And they great customer service skills. Again, I’m very, very fortunate; very, very lucky.
Gamble: Okay, well, the last thing I wanted to do is get your take on where the industry is headed with Meaningful Use. Obviously, there have been some bumps in the road, but in general, what are you feelings on this direction that the industry has taken in the last couple of years?
Lara: I feel very positive about Meaningful Use. I know it’s sometimes challenging and time consuming to try to figure out how to meet the requirements, but I think it’s taking the industry to a place it wouldn’t have gone unless there were Meaningful Use. I think the whole incentive program I think has worked really well. What I’m finding is folks are actually getting the actual meaning and learning how to use their EMRs in a meaningful way.
CPOE is very, very important. CPOE is one of the ways that we’re reducing medication errors, and looking at making sure that med reconciliation is done. What does that mean? It’s taking a step back and saying it’s not just about collecting the data providers; med reconciliation is all about making sure that somebody is looking at the number of medications the patient is on at every opportunity. I don’t want to say forcing, but that part of the Meaningful Use criteria is making folks take a pause and say, ‘does Mrs. Jones really need to be on these 50 medications?’ So again, it’s looking at those pieces and parts and making us think critically about some of the decisions we’re making.
Some of the things we’re looking at in terms of VTE or stroke or AMI — they’re all clinically driven, and are using the EMR to help with decision support or having the providers actually take a pause and say, ‘hmm, I wonder did I really order this anticoagulant when I should not have?’ It’s really helping us use the system in a meaningful way, but it’s also geared toward helping patient outcomes.
It’s also requiring us to become a little bit more standardized in terms of data and data collection. So as we move forward with population health or data analytics, we’re kind of comparing apples to apples. We know what practice is, we know how to compare it to best practices, and we know where there’s a gap and we know where there’s opportunity. So I think it’s driving us in that direction.
In terms of the whole concept of transitions of care, I think we’ll get there. I’m not quite sure we’re there yet. The CCD document is a great document, but is very long. It has a lot of the extraneous information. We’ll figure it out. But it’s a step. It’s proof that sending that information from one EMR to another one works. So now we have to make that even more meaningful in terms of how can you consume that information; how can you present that data in such a way that it’s meaningful to the individuals that are looking at it. I think there’s going to be more and more patient engagement and tools to support patient engagement, which ultimately are going to drive cultural changes to make the patient and the consumer know that it’s their responsibility to know about their health and their wellness. So I think there’s more to come. I see good things happening, and we’ve only just started the journey.
Gamble: I think that’s a really great perspective. It’s good to keep that in mind. We hear so much about all the challenges, but it’s great to get that big picture perspective and look at how we’re changing things.
Lara: Exactly. And again, it’s going to be interesting to see. I know ONCHIT just came out with their interoperability proposal, and interoperability is really, really important, because as you said, how do you share the information? Are we ever going to get to the point where proprietary information is in this format? I’m not quite sure, but at least we’re addressing the concept. At least we’re addressing the issue.
Because again, going back and putting it down at the patient or the consumer level, five different patient portals for one individual is a lot. So what can we do to interoperate the information that’s in all those patient portals so that the information is there in one place, and it’s there when either the patient needs it or the provider needs it? There’s a lot of things going on, a lot of things that are happening that I think are going to lead us down a good path.
Gamble: I think so too. Alright, well that’s a pretty ideal way to wrap things up, I would say. Thanks so much for your time. It’s been really great to follow up and hear all the progress you’ve made. It sounds like you’re doing a lot of great things.
Lara: Kate, it’s always a pleasure to talk with you, and I look forward to the next time.
Gamble: Definitely. Me too. Thank you so much.
Lara: Thank you. Take care.