When Patty Lavely stepped into the CIO role at Gwinnett two years ago, one of her top priorities was to build a strong relationship with the CNO. It was something she had admittedly struggled with in the past, but one of the many lessons she learned during her time in consulting was that relationship management is an essential skill for today’s CIOs. In this interview, she shares more takeaways from her time in consulting, including how to build trust, and how to avoid the common trop of hiding behind bureaucracy. Lavely also discusses leading a major EHR selection process, how the organization revamped the security process by reassigning responsibilities, and the “daily challenge” CIOs face with prioritization.
- About Gwinnett Health System
- Navigating a major EHR selection process
- Strong demo participation — “We’re trying to obtain as much input as possible.”
- Acquiring primary care practices
- Georgia’s HIE model — “A network of networks”
- Challenges of attesting to MU 2 with Horizon
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The amount of change that will occur as a result of this implementation is probably the largest scoped project that Gwinnett has ever encountered. And Gwinnett has built new hospitals, but if you think about just changing everything in the existing organization, pretty much all at the same time, it’s major.
The state really has started to create an HIE that’s very valuable to us. Their model is sort of a network of networks and they really want to connect local or regional HIEs together versus individual hospitals or providers.
Some of the functionality required for Meaningful Use — and this has become more problematic as we move to stage 2 — is not well thought out in how the capability was added. It makes the workflows very awkward and not intuitive, and that has been a challenge for us.
We’ll go right into a stage 3 environment and have to keep all those numbers up for the transition, so that’ll be interesting. That will, I’m sure, require a lot of planning around that transition.
Gamble: Hi Patty, thank you so much for taking some time to speak with us today.
Lavely: You’re welcome. Thank you.
Gamble: To get us started and get a little bit of background information for our readers and listeners, can you just talk a little bit about Gwinnett just as far as number of hospitals, beds, things like that?
Lavely: Gwinnett Health System has two hospitals, 553 beds, and we also have inpatient rehab and a long-term care facility, as well as numerous ambulatory offerings with outpatient surgery, outpatient imaging. We have our first multispecialty center and we employ several specialties and primary care. As of last year, we began our first year with family medicine residency program. This year we have our first year with our internal medicine residency program, so we’re very excited about those two new programs.
Gamble: And is that affiliated with a university?
Lavely: It is not. It’s a Gwinnett Health System residency and we work with a couple of the universities around the state of Georgia, but we take residents from all over the world actually.
Gamble: Great. Is that something that you hope to continue to build?
Lavely: We do plan to expand it, yes.
Gamble: And you’re located in Georgia, what type of area?
Lavely: We are in the metropolitan Atlanta area, northeast of the city of Atlanta. We’re in Gwinnett County, which is a fairly populated county of almost a million residents.
Gamble: In the hospitals, what type of EHR system do you have in place?
Lavely: We currently have McKesson Horizon Clinicals, which are going to be sunsetted in 2018, so we’re in the process of making a selection to replace our enterprise system right now actually, as we speak.
Gamble: At what point of the process are you in right now?
Lavely: We are still narrowing it down to vendor of choice. We had all of our demos over in April and May, and we are scheduling site visits for July. We plan to be down to two vendors by the end of this week actually.
Gamble: So that’s big. What type of group or committee do you working on this?
Lavely: We have a steering committee which is made up of really our executives and a couple of physician leaders, and it is chaired by our system chief operating officer. And then under that steering committee is the selection team, which is really a multidisciplinary team of people at the director level, some vice president and executive level, as well as some subject matter experts that are not necessarily in a formal leadership position, but have become leaders in the organization. We have approximately 30 people on that selection committee and I believe we have probably upwards of 200 people attended our demos, so it’s a pretty broad process. We’re trying to obtain as much input as possible.
Gamble: Right. That certainly makes sense, but I would imagine it can get difficult because when you have so much input, it can tougher to make a decision.
Lavely: Well, it’s harder to work through all the data and really determine what the favorite was or what the issues are. And we’re also finding that because of all that input, another one of the challenges is we have a lot of follow-up requests and so we’re having to circle back with the vendors to follow up. Because we had so many disciplines represented, they weren’t all equally demoed, and so we’re working on that follow up now.
Gamble: That’s always an interesting thing. You don’t have a bigger decision than that. With so much that goes into it, I can imagine that’s a very big focus right now.
Lavely: It is, and I think the amount of change that will occur as a result of this implementation is probably the largest scoped project that Gwinnett has ever encountered. And Gwinnett has built new hospitals, but if you think about just changing everything in the existing organization, pretty much all at the same time — we’ll phase in some things — it’s major. People are really starting to gain awareness of just how big this is and I think that there is a desire to really spend the time and the effort to do it — I was going to say right, but maybe as well as possible. Because there are always some bumps.
Gamble: Now at this point, what systems are in the ambulatory setting?
Lavely: We have NextGen as our standard practice management EMR for employee physicians and for our residency clinics, but because we are in an acquisition phase, we have acquired practices and we still have their products. We have a pretty large cardiology practice that uses a niche product called GEMMS and then we have two other EMRs that came along with the practice, so we really have four. We have two that in the current standards environment were considered go-forward, which was NextGen and GEMMS, and then the other two were to phase out. But at this point, we are looking to replace both NextGen and GEMMS with our enterprise solution. So we’re hopeful that the end of the implementation, we’ll have one ambulatory EMR, which would be new for us.
Gamble: That is certainly a tough thing when you’re talking about the cardiology practice and meeting that needed as well. I’m sure that’s tough.
Lavely: It is, and we have to determine if the vendors can actually meet that need. We’re not quite there yet, although we had some favorable results from the demos as far as the cardiologists go, so I’m hopeful.
Gamble: And then as far as the practices that you’ve been bringing on board, is that happening pretty frequently? What’s kind of your strategy there?
Lavely: We are focusing this year on primary care. We had planned to add, I believe, four practices this year. And the practices in this area are small; they’re really one to three providers for the most part, thought there are some larger ones. So when I say four practices, that may be four providers or that could be eight providers. The numbers aren’t large, but the work effort to bring on a practice is pretty similar. So that is our focus. We have added some other specialties, but our focus really is on primary care.
Gamble: Is your organization participating in a health information exchange at this point?
Lavely: We have developed a private HIE for Gwinnett. It’s called GMC Help Connect and we’re in the process right now of connecting to the Georgia state HIE.
Gamble: What’s the state HIE there?
Lavely: It’s called GaHIN.
Gamble: Is it just a matter of getting the data exchange within the system to a certain point before going outside of it?
Lavely: Well, yes, that’s part of it. We use Relay Health for our health information exchange, and initially when it was implemented, it was used for just distributing results to our physician community. And so we replaced faxing and mailing with the results distribution capability of RelayHealth. Then we began adding providers, including our own and our community providers, to the health information exchange, which provides them with a patient portal for their patients. We can also clinical summaries or CCDAs and we can also do secure messaging between the practices.
We’re still adding on there, but we do have all that going. The state, probably in the last two years, really has started to create an HIE that’s very valuable to us. Their model is sort of a network of networks and they really want to connect local or regional HIEs together versus individual hospitals or providers. Some of our major metropolitan hospitals are already connected to the state HIE, and that, once we’re connected, will allow us to share medical records. So we’re very excited about that opportunity.
Gamble: That’s a strategy that makes sense. There’s been so much talk about the HIEs over the years and really wanting them to be structured in the best way not just for sustainability, but really being able to facilitate that data exchange. That seems like a sound strategy.
Lavely: It is. I was on a very early planning board for the state of Georgia very early, probably eight years ago, and we spent several years developing what the model would look like. It has evolved and it has changed some, but at that time, all of the stakeholders felt very strongly that it should be a public-private entity versus part of a governmental agency, which it is. They were able to do that. And then this idea of a network of networks, because we really felt that at the state level, that’s not where the healthcare is delivered. It’s delivered locally, and so the HIE really needed to be local, and the state could facilitate connecting and then maybe doing some things like access to the Medicare or Medicaid information system, which it does. It’s actually connecting us to Social Security for processing disability claims. So there’s a lot that it’s doing that’s more appropriate for a statewide HIE. Where the actual healthcare is delivered locally, we’re actually handling the exchange between our providers. So it makes sense, and they’ve done a great job.
Gamble: How are you positioned as far as Meaningful Use at this point?
Lavely: We are in our reporting period for stage 2, which we really hope becomes 90 days. But we’re doing pretty well. We started a little late. I think this is our third reporting year, so we’ve done pretty well. Our physician practices actually just had their first year; they’re two years behind the hospitals.
It’s challenging though, the fact that we’re with a software vendor that is not a go-forward product, and so future enhancements for that product are regulatory only. And some of the functionality required for Meaningful Use — and this has become more problematic as we move to stage 2 — is not maybe well thought out in how the capability was added. It makes the workflows very awkward and not intuitive, and that has been a challenge for us.
Gamble: I can imagine.
Lavely: We haven’t really even started talking about what that looks like, because we should be at stage 3 by the time we convert to a new system. We’ll go right into a stage 3 environment and have to keep all those numbers up for the transition, so that’ll be interesting. That will, I’m sure, require a lot of planning around that transition.
Gamble: Yeah. When you talk about some of the workflow challenges that the physicians are dealing with, how are you working to try to resolve it, at least for the time being?
Lavely: We have an informatics group that leads all of our efforts around developing new workflows and optimizing existing workflows. We actually call them our CPOE operations team because that’s what they came out of. It’s a multidisciplinary team that really looks at all workflows, whether it’s Meaningful Use or CPOE — they just kept that name. But they’re such a great resource for any process that we funnel everything to them. And then from a physician medical staff standpoint, we do have a group that we call IPAC; I believe it stands for information systems physician advisory committee — we took the ‘s’ out because IPAC sounded better. We meet monthly and we can sometimes bring issues to them that we can’t get resolved outside out of that group.
Gamble: And that group, would they deal with some of the concerns with Meaningful Use on the physician practice side?
Lavely: They do because they’re made up of hospital-based and practice-based and actually private practice and employed practice physicians. But if it’s very specific to our employed practice docs, we have a group of just employed practice physicians that we go to because that’s primarily right now NextGen.