As an internal medicine physician, one of the most important lessons David Bensema learned was that if he was going truly engage with a patient, he first needed to establish trust. As CIO, he employs that same strategy to engage with physicians — something that doesn’t always come easy, even for an MD. In this interview, Bensema talks about what has surprised him most during his first year as CIO; the tough part when it comes to creating a task force of the “best and brightest”; and the strategy his team is using to roll out Epic across 7 hospitals. He also discusses why he doesn’t like the word ‘optimization,’ how he keeps the end user’s needs as top priority, and the one thing that needs to change when it comes to CIOs and project planning.
- Leading EHR selection process as CMIO
- Heavy physician representation
- “Lean” 175-person Epic team
- Frustration with poaching — “It’s keeping that vision in front of myself and helping others see it.”
- Epic rollout: “Operationally led, IT supported”
- Challenges with clinical summaries
- Broadband Internet — “We are struggling as a state.”
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We needed to get on a unified system. We needed to get away from the incredible disparity that we had in our system, and we needed a partner that was going to be able to grow with us.
We took a lot of highly experienced people from within our system. We had tremendous support from our leadership — that doesn’t mean we didn’t cause pain and we didn’t cause angst.
I know there’s something great coming. It’s keeping that vision in front of myself and helping others see that vision.
They were brought on because of their personal technical expertise, and also because they had been identified as somebody within the system who could get their head up and function as a CEO and take that broader view.
The 50 percent mark is a tough one to keep up. Getting everyone to focus for three months was one thing; getting everyone to do it as every patient, every time is still a lift.
Gamble: In terms of the selection process, this was a few months after took on the CMIO role, so I wanted to talk about what that process was like. First of all, the way things happened, was it outlined that this was going to happen right away and it was going to be a significant part of your role?
Bensema: No. I live the true IT life. Most things come by surprise. When I took on the CMIO role I was being brought on because obviously Meaningful Use was becoming an increasingly heavy lift. I was asked to help with physician engagement and with development of additional order sets and I-forms within our existing EHR to help our hospitals achieve Meaningful Use targets, and so I came in with that in mind. One month later, our CIO left the position and we had an interim appointed. A month after that we’d had a review from an outside consulting group and they pointed out what was obvious, which was that we needed to get on a unified system. We needed to get away from the incredible disparity that we had in our system, and we needed a partner that was going to be able to grow with us.
And so we started a search process in early October of 2013, and I was privileged to have the opportunity to help put that group together. I was also privileged that I was given a lot of leeway. Mr. [Stephen] Hanson, our CEO, the board and the leadership of Baptist Health all allowed me a lot of opportunity to put together a task force in a way that reflected my heart as a physician. I was also a nursing assistant in 1980-1981, so I have a heart for that whole spectrum of bedside care. But I also ran practices from 2006 to 2013 so I understand some of the front office and back office functions. And so we put together a task force of 36 individuals, 17 of them physicians, which was the largest physician involvement percentage-wise that we’d had in our system in my knowledge since 2001.
We started with four products. After initial demonstrations and responses to RFPs, we quickly whittled that down to two and set up site visits for members of our team. Each site visit had nine members of our team. Over the course of the site visits, I think all but three of the 36 had an opportunity to participate in a live site visit. We would come back and report to the task force as a whole and began to define and discern what would be our choice, what would be our recommendation to the board. In March as we were solidifying that, we began to put together the total cost of ownership assessments for both finalists. We actually started that in about February, because by late March we had that largely refined, and in April we came before the leadership of the organization and presented our recommendation.
We received requests for some clarification and some further detail in the budgeting process and some further detail out of the total cost of ownership assessment. And in May of 2014, we presented the recommendation to the board and received approval of the Baptist Health board to move forward with the selection which was, of course, Epic. That began the very rapid process of contracting, getting the agreement signed — that on July 17, and by July 27, we had our initial meeting with our Epic team. My team of IT leadership, particularly Trisha Julian, our executive director for the integrated ERH implementation, did an amazing job of interviewing over 450 individuals in the course of two weeks. We made selections, made job offers, and we had them onsite all together by July 27, and sent them to start their credentialing training at Epic three days later.
Gamble: How many people did that end up being?
Bensema: For the Epic team it was 175. Again we’re a system of 17,500, plus or minus a couple hundred end users employees, and so 175 is still a pretty lean team.
Gamble: Right. And I’m sure that it was important just as in the selection process to get the different areas represented.
Bensema: Absolutely. And of course Epic will tell you — and I’m sure that Cerner and others will tell you — when you’re going to put in a large scale implementation, you go for the best and the brightest. So we took a lot of highly experienced people from within our system. We had tremendous support from our leadership — that doesn’t mean we didn’t cause pain and we didn’t cause angst, but we had tremendous support from the presidents in each of the hospitals and in the markets. We got the right people on the team and it’s been proven out by the fact that we’re hitting our milestones. We continue on satisfactory status on our progress reports and we remain on track for good install status. Just tremendous group of people.
Gamble: I’m sure that couldn’t have been easy conversation some of those times about having to give up some of your top people, but like you said, this is what you needed to do to keep things on track.
Bensema: Yeah. I know you love Sue and I know that Sue really helped develop your nursing workflows. That’s why we need her on Epic.
Bensema: And that poor chief nursing officer who lost Sue lost somebody that they probably had 15 years invested in and depended on hugely. I’m aware of that. I honestly feel that pain of having done that, and I have to keep focusing on the fact that what we’re doing is creating a better experience for everyone in the future as we come onto a unified system, and that we don’t have as many workarounds and we don’t have as many information drops. I know there’s something great coming. It’s keeping that vision in front of myself and helping others see that vision.
Gamble: Right. Now when you talked about the task force you put together, that seems to me like it was also a pretty high number of physicians. Who else was represented? What about IT — how much of the group did that make up?
Bensema: Myself, if you could call me IT at that time, three months into it, and a physician of 16 years practice, and Mike Brown, our executive director for operations in IT. That was it. Two IT people. We had one of the clinical information technology directors, one of the CIT directors, a CNO, we had a nursing VP who had ED, lab, and radiology. We had people from imaging, people from physical therapy. We had members from lab. We had back office function, so we had finance, revenue cycle folks. We had physician billing office represented. We had the physician employment arm in terms of administration represented, as well as a number of the physicians were involved from the physician employment group.
We also had, as I emphasized earlier, some of our independent affiliated physicians on that task force, so broad representation. Thirty-six is never going to represent everybody, but they were told that they were brought on because of their personal technical expertise, and also because they had been identified as somebody within the system who could get their head up and function as a CEO and take that broader view and work for the good of the entire system. They were encouraged and they did a very good job of going back, and, where we lacked representation, they sought input and did a great job of presenting the process to their colleagues in their hospitals and making sure that we were getting feedback throughout the system.
Gamble: Right. And certainly a lot of focus on usability and the experience that people are going to have using the system.
Bensema: Exactly. The focus was on the end user experience. We have eight principles for our Epic implementation. One that we had adopted before we even started the task force, and we’ve carried over, is operationally led, IT supported. That’s kind of been the mantra of the department through that process, and then it became the mantra of the department formally when I took over as CIO in April of last year.
Gamble: Right. You mentioned Meaningful Use and the role you had with physician engagement. First, where does the organization stand now in terms of Meaningful Use attestation?
Bensema: We are in year two of Meaningful Use Stage 2 in six of our hospitals, and year one of Meaningful Use Stage 2 in Richmond. We have successfully attested in all of the hospitals, both for the stage one phases, and for this past Medicare fiscal year, for Meaningful Use Stage 2 again in six of the hospitals, and Meaningful Use Stage 1, year two in Richmond. So we’ve been successful. We are continuing to move apace, looking, like everyone else, for some help and hope from the CMS that they are going to go with the three-month reporting period this year. That would certainly make our lives easier. We have the same struggles as the rest of the world remembering and focusing on getting the printed summary of care document in the hands of greater than 50 percent of patients. That’s more of a complication in the hospital than in the physician offices, because the checkout process is a little more consistent, whereas in the hospital or in a hospital-based experience whether it’s an imaging study or an inpatient stay, it’s harder to hardwire who’s in charge of making sure that gets in the patient hand. We’re seeing this with all of our colleagues across the country that the 50 percent mark is a tough one to keep up. Getting everyone to focus for three months was one thing; getting everyone to do it as every patient, every time is still a lift.
Corbin, Kentucky and Madisonville, Kentucky have low penetrations of broadband internet access. They’re rural areas, and we are struggling as a state. In fact, we just had an announcement of a partnership with an Australian venture capital firm by our state to put broadband in all 120 counties by 2018. That will help us immensely, but in the meantime we have a lot of folks that don’t have internet in the house. But, surprisingly, we’re hitting that 5 percent viewed and accessed mark across our system, which we’re grateful for. Twenty-five percent would be a lift. The 2018 Meaningful Use Stage 3 current recommendations are a preliminary announcement; if they stick with the 25 percent, it would be quite a lift for our system.
Gamble: It’s certainly not the just your system. I think that’s something that scares a lot of people. That’s a huge number, especially when you’re dealing with all of the challenges of patient engagement, whether it’s not even having access to the internet or just not using it consistently.
Bensema: And empathy in every role is very important. I was an internal medicine physician, and obviously empathy there is a huge part of what I did every day. I would hope that policymakers view their policy recommendations in an empathetic manner and realize that not every place is Lexington, Kentucky, with a university or with a very highly educated workforce and a high avidity for technology. Many of our sites are not that, and you just have to have empathy for the hospitals and for the patients to understand that this is not where they are — not all of them. They’re not all ready to have electronic communication with us. I think more than some of my physician colleagues would contend, but fewer than CMS and policymakers have assumed. So hopefully they’ll continue to hear us on the comment period. We certainly are commenting.