For the past few years, health systems across the country have been stuck in constant implementation mode, and Chesapeake Regional Medical Center is no exception. So when the organization made the decision to migrate to Epic, leadership decided to leverage the expertise of a seasoned user, which would enable Chesapeake “focus on innovation instead of just putting in systems.” In this interview, Deans talks about his team’s Epic rollout strategy, their big plans with big data, and their “dynamic” multi-year business plan. He also discusses his leadership style, why it’s important to strive for perfect, and why anyone who isn’t nervous about ICD-10 is either “very impressive or naïve.”
Chapter 2
- Focus on analytics — “Information is what you need to focus on the running the business”
- Enterprise 5-year IT strategic plan
- “Each year you have to reassess it and be willing to move and change.”
- Communication strategy
- Timing of MU & Epic go-live
- ICD-10 – “America is not prepared for it.”
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Bold Statements
We have a whole lot of data. What we don’t have a lot of, unfortunately, is information, and there’s a pretty significant difference between the two.
We are anxiously awaiting our implementation just for that perspective. You’ll already have an integrated database on the back end, now it’s putting visual dashboards in front of nearly every user to understand what they themselves, individually, are doing, versus just at the higher level.
You must be as much operationally focused as you are technologically focused, because the two go hand-in-hand today more than they ever have before.
We will forever have Meaningful Use requirements on us going forward. So you wouldn’t have to necessarily time go-lives surrounding that per se, because like accreditation and all the other regulatory requirements we have to meet every day, it’s a forevermore thing.
I’m less worried about the education and more worried about the software and processes that are embedded in the software. And it’s not just any particular software — it’s all the moving parts and components and pieces that healthcare has. That’s really where I think I’m worried.
Gamble: As far as data management, I wanted to talk about some of the work you’ve done there and your strategy for dealing with these huge amounts of data that everyone’s working with. I want to talk about your strategy there.
Deans: If you’re referring to clinical data repositories, that’s a major component for us. Certainly it exists today and we’ve had focused there for quite a while, because I think one of the problems with healthcare is we have a whole lot of data. What we don’t have a lot of, unfortunately, is information, and there’s a pretty significant difference between the two. So we put a lot of emphasis and focus there historically, because information is what you need really to focus on running the business. So with our current partner, we’ve had a clinical data repository in for six to seven years, and we had a bit of one prior to that with the predecessor and have done a lot surrounding that. We’ve tried to make a move toward data analytics and what I would call evidence-based management of the business, beyond just evidence-based clinical efforts. That is paramount to us.
Part of our future-forward movement has included pretty strong requirements whichever way we would have went, and we need to sustain that and, in fact, want to grow it. So we’ve made sure that has been part of our go-forward plans with Epic. I think one of the differentiators between them and some of the other providers of systems and software out there is that they themselves are no longer necessarily fully focused on builds and screens and fields within those screens. I attended their user group conference last summer. I’ve been engaged with Epic off and on for a half dozen years or more, and with others who have as well, and you can really see the movement of them as a company. It would appear to me that their focus is also on business information now, no longer just building software. I think they’ve tackled the building software piece. If you look at especially their 2014 release that’s out now and the 2015 soon to come forward, you will see a significant difference with them in the use of data analytics. It’s prevalent not just in the executive or the management suites, but you’ll see it all the way down at the line level and the bench level within the organization through the toolsets they’re inserting and injecting as capabilities into the software. We are anxiously awaiting our implementation just for that perspective. You’ll already have an integrated database on the back end, now it’s putting visual dashboards in front of nearly every user to understand what they themselves, individually, are doing, versus just at the higher level.
I kind of jumped forward there, but jumping back, part of our strategy has been just that. We have been interested in data analytics and business intelligence for quite a while — perhaps even before it was a buzzword out in industry, because everybody seems to be using it now. But we’ve really had strong focus, and it’s not easy to get to, because when you’re trying to correlate for business purposes things that occur on your clinical side all the way back to your financial side, linking it with GL and all the subcomponents and parts that you have to touch — especially when you’re in a model of best of breed, or even a best of suite where you still have disparate capabilities — it’s not easy to do. It’s not easy to do within an organization, let alone the broader national perspective of trying to link it more broadly. But we’ve had some reasonably good success.
In the last year or so here at Chesapeake, data analytics really has come to fruition. We have, in fact, established a data analytics division whose sole focus is that, and it has impact on our business decisions. And so if there’s a business venture we’re focused on or expansion of a service line, we will go to the analytics team and they actually assist in the creation of the pro forma that drives some of those decisions. I’d love to say we’ve been doing this for a decade; it is relatively new, but it is something we’ve been doing for probably a good half a year to a solid year now, based on the work of the prior years in aggregating data. And so it’s paramount for us going forward that we continue to do more of that, and we’re pretty excited that Epic will supplement and complement that mental model that we have.
Gamble: It’s pretty obvious that every initiative, every priority is all part of a strategic plan. I had seen in some of the materials you sent me about the enterprise-wide, five-year IT strategic plan. I wanted to talk about the primary goals of that and how that has shaped things, and whether it might be really challenging to try to stick to a certain plan or vision with everything that always comes up.
Deans: I think that’s right on. It’s a really good question. For every organization, to be successful you really have to have a multiyear business strategy, or a strategic plan as most call them, at the corporate level — so that’s across all service lines, across all business disciplines. Most of us have some formal mechanism whereby we go through and establish that. You really, as a subset of that, should have an annual operating plan that really is the tactics that bring that business strategy together. So that’s at the corporate level; that’s at the highest level of the organization. Many of the subdisciplines, IT being one that’s very important along those lines, should have strategic plans themselves, and these should be subsidiaries to your corporate and business strategic plans. That’s what I’ve tried to do historically both at current organization, as well as prior organizations, to put those together.
When you build an IT strategic plan, you have to figure out what’s right for your organization insofar as how far out you look. Is it a five-year plan? Is it a three-year plan? Or is it some combination in between? I think you also have to be prepared to be very dynamic with that plan, so just as your business strategies are going to change year-to-year in healthcare and you should be reviewing those, your IT strategic plan has to move and be flexible along with that. We can put a three- to five-year plan together, but what we currently perceive as a strategy three years out from now may not necessarily actually be that strategy three years from now. So each year you have to reassess that and just be willing to move and change appropriately — and that’s not just you and the IT division. In information technology, we’re no longer just technology. I think to lead a technology and infrastructure group, you must be as much operationally focused as you are technologically focused, because the two go hand-in-hand today more than they ever have before. I think at the last user group we even heard Judy Faulkner of Epic in her presentation onstage to all the Epic users, quote the notion that technology drives business just as much as other factors drive business. I think that’s right and I think that’s true, and we’ve seen that in the last handful of years. So I think you’ve got to have that focus.
With your plan, if your business strategy even moves slightly, you have to be mindful and very aware of that as the leader of the technology group, and make sure that you are adapting appropriately. Presumably, you’re embedded with your business strategy already, so it’s not that you’re been informed that there’s a change, but you are part of that change from the get-go, and so all moving parts move simultaneous to that.
As far as how you present the plan, let’s say you’ve gone through that process and you’ve developed a strategic plan. Everybody’s going to have a slightly different model of how they get there, and in most cases it should involve all the divisions throughout your organization where you lay the business plan out. You interact with each of the divisions, you probably have a couple of advisory councils that comprise all the appropriate stakeholders, and then you determine what do we have today and what we do need to have in order to achieve the business focus that’s before us. And so you have some type of model that surrounds that.
Once you have that, then comes the communication part. Your planning should include your marketing department, your communications folks, etc. Different organizations do it differently. I’ve done some pretty cool stuff over the years. For example, at a prior organization when we developed our five-year IT strategic plan, we crafted it with a special name. We called it our e-revolution, if you will. We created what would looked like the New York Post newspapers that went out with a color multi-page document that would fold over in half and looked kind of like a newspaper. We disseminated that throughout the entire organization. It was a multihospital facility, so it didn’t just stay in the primary organization. It went out across the board, across the enterprise, and as well as out to the clinics. It really walked through what typically is a pretty strong business-looking strategic plan, and turned it into kind of a USA Today presentation where we listed many of the major initiatives. We had paragraph summaries of what they were and what they were for.
I had a great leader once that taught me at an early age in my executive career to make that I used “plain English,” and that has stuck with me since. And they were spot on with that — we can pretty easily get into the geekiness of what we do. And I say the word “geek” as a term of endearment. So we’ve got to make sure that we convert that to plain speak as much as we possibly can. That was a mental model there. It was a presentation of what the plan was to where anyone throughout the organization could pick this us up, read it, and understand and say, ‘That makes complete sense. I’m excited about that.’ That was really the intent there.
So there’s the creation of the plan, and then there’s really the communication and the advancement of it once you’ve got it. And it should never be a stagnant document that once you create it, you stick it on a shelf and rarely look at it again. As I mentioned in the beginning, it really needs to be dynamic and ever moving based on the environment you’re in.
Gamble: Yeah. There’s a very definite theme about just the need for agility and to be willing to reprioritize or just make changes or tweaks along the way just to keep up with everything that needs to be done.
Deans: For sure.
Gamble: Okay. You touched a little bit before on Meaningful Use. Have you attested to Stage 1 and Stage 2 at this point?
Deans: Yeah. In our organization, we have done Stage 1, year 1 and Stage 1, year 2, and we are now nearing the completion of stage 2. The target there as the end of the month of September, because as you know in stage 2, it’s a full-year model instead of 90-day windows, and you’re forced to fit into the federal fiscal years. But yes, by the end of September of this calendar year, we’ll complete stage 2.
Gamble: That’s interesting timing, which I guess it is always is, with the big focus on Epic and moving toward that date for next year.
Deans: It’s interesting you bring that up. We had a pretty significant conversation around that. And at first we were a little bit concerned, and we said, do we try to time a go-live of Epic on the first day of the new Meaningful Use federal fiscal year? Also, by the way, there’s that little thing called ICD-10 going on October 1 as well. And so specific to Meaningful Use, after thinking through that, it kind of dawned on us — I wouldn’t say it was an ‘a ha’ moment, but somebody made the point and said Meaningful Use is forevermore. So if you conceivably look toward the future of what we do, we will forever have Meaningful Use requirements on us going forward. So you wouldn’t have to necessarily time go-lives surrounding that per se, just because like accreditation and all the other regulatory requirements we have to meet every day, it’s a forevermore thing.
We certainly consulted with some others out there to get their perspective and input, and we felt pretty comfortable with the fact we didn’t necessarily have the time it with the start to each of those cycles, because we’re going to change systems out over the course of the next several decades and, like I said, forevermore. It’s just a fact of life now. It’s not a special onetime event as I think maybe the first couple of years were.
Gamble: What about ICD-10 — how are you positioned for that?
Deans: That’s an interesting one. We’re nervous. I think anybody who isn’t nervous is either to me very, very impressive or perhaps naïve. I’m a little bit nervous about but I think you have a lot of folks in industry, even all the associations that we are a part of, that are very supportive of continuing with the go-live with no further delays. I don’t necessarily know that all of us in the actual hospitals necessarily agree with that. I would tell you that if you were to really dig deep, you would find there a lot of entities that are not yet ready for ICD-10 — this is from your payer’s side, all the way across through the software and the coding side that hospital across America use.
We’ve got a game plan, and should the deadline continue with October 1, we’ll be ready. Are we comfortable with it? Honestly, no. And I think if anybody told you they were comfortable with it, kudos to them. But I would challenge them slightly and really dig deep. It’s a nervous tension. I don’t know any better way to describe it, but I would tell you America is not as prepared for it based on those I’ve spoken to, and I’m talking many, many like hospitals as what we would see in some of the press releases that come out. I’m probably one of the few that will say that publicly, but I think that’s the legitimate story, even if that’s not necessarily what’s being reported.
Gamble: Are you referring to mostly just the complexity involved or just having the staff educated and prepared, especially when there have been stops with this before?
Deans: Certainly the education as a component — that portion I’m not as scared or worried about. We educate daily, weekly, monthly. Education of staff across various aspects really is kind a fact of life for healthcare. Certainly there are challenges there in how do you get every single entity out there prepared for that. But I’m less worried about the education and more worried about the software and processes that are embedded in the software. And it’s not just any particular software — it’s all the moving parts and components and pieces that healthcare has. That’s really where I think I’m worried. Again, I think readiness is not where it ought to be kind of across the nation, and I hope that it’s not a big blowup if we do go live with October 1 as it’s currently scheduled for. A lot of folks had been working for years on education and all of that, but I think actually once you have all those moving parts interoperating, I’m nervous there, more specifically.
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