CIO George Hickman On Standards

George ‘Buddy’ Hickman, EVP/CIO, Albany Medical Center

Whenever an organization’s core vendor is acquired, there’s going to be some trepidation. But when a CIO has the opportunity to sit down with leaders and talk about the intended roadmap, those fears can be quickly assuaged — especially when that group includes John Glaser and Kent Gale. In this interview, veteran CIO George Hickman discusses his feelings on the Siemens-Cerner merger, why his organization is happy to serve as a reference site, and what has helped NY’s HIE remain successful. He also talks about the prioritization challenges facing CIOs (which he handles using a Ouija board), the “Henry Kissinger skills” he picked up as a consultant, and the road that took him to Albany.

Chapter 1

Chapter 2

Playing “the giving back role” as a reference site
Serving on the MedAllies board
SHIN-NY (NY’s HIE)
Connectivity standards — “We’re seeing the march continue”
Pilot for ONC direct standard in 2009
“Heroic effort” required to meet MU
Patient engagement in acute vs ambulatory

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Bold Statements

You want your vendor partners to be successful. Sometimes you drag each other through things kicking and screaming, but in the end it’s about all parties being successful, because if they’re not successful in the longer haul, we’re not going to be.

It’s my hope that within a year, the vendor industry will have caught up and all of the EHRs will be able to do a full direct exchange.

It wasn’t without some heroic effort along the way, including a lot of intense energy between us and our vendor community to assure that certain functions were delivered in a time frame that we could still get to the starting line as of October.

People who are getting toward the end of a hospitalization or even coming in at the beginning of the hospitalization are not necessarily thinking at that time about going home and logging into a portal to look up everything that happened.

Gamble: As far as being a reference site or hosting the site visits, is that something that helps you? What are your thoughts on that?

Hickman: There are different ways to look at the feeling of playing that role. We were asked to play the role for a good time before we said yes. I can give you a couple of examples, actually. One example would be that when we did our development for evidence-based medicine, the medication order sets for pediatrics — which in our case includes kids who are PICU kids or babies that are neonates, and are in some cases, more than unusually, hypersensitive to drug dosing and those sorts of concerns.

There was a tremendous amount of effort and care given to build those order sets. We then built that out well using the Soarian suite and of course have maintained it along that line. We found, because the word got out, that other Soarian customers were talking to us about that and even asking if they could acquire that content from us to help them with their own builds. And so we’ve played that sort of giving back role, which is the other point to be made.

The other example would be the Soarian financials implementation. We had bought Siemens (now Cerner), and I think they still refer to it as the cleanest Soarian financials go-live in their history, cleanest meaning no lift to accounts receivable by the efforts of all the parties involved. It was just a very fine job especially done by our patient financial services folks and others on my IT team, alongside the folks from Cerner. That has caused many other folks who have been going down that path or have chosen to go down that path at some point or are trying to choose to go down the path and decide which path to go on, to reach out to us for counsel about how we were able to do that and not have any ill consequence in the go-live process.

Now, that’s just one metric because a lot of what you do with Soarian financials has to do with a complete changing of your workflows as to patient access, and all the way through the revenue cycle to billing and collection. But because the metrics were so clean, that gets a lot of attention, and therefore people really want to know how we did it and that story’s been told several times now. Again, it really does eventually become about giving back. The time and energy for that is an investment, obviously.

Gamble: Yeah, long-term investment, I guess, right?

Hickman: Yes. In the end, you want your vendor partners to be successful. Sometimes you drag each other through things kicking and screaming, but in the end it’s about all parties being successful, because if they’re not successful in the longer haul, we’re not going to be.

Gamble: Right, absolutely. I want to talk about HIEs and what the picture looks like in your area and some of the successes and challenges you’ve had. Now is Albany part of SHIN-NY?

Hickman: Yes, I think it’d be safe to say every provider that’s participating in some form of HIE in the state of New York therefore has become a part of the statewide health information network of New York, in other words, SHIN-NY, yes.

Gamble: Right. Obviously, the big challenges with HIEs are sustainability, but then also being able to exchange this data back and forth, and it seems like SHIN-NY is one that’s been around and has kind of stood the test. Would you say that’s true, and if so, what do you think has been the key to that?

Hickman: That’s a big question. In terms of the keys to the success of SHIN-NY, I mean, I could certainly talk about vision or leadership and those sort of things, giving some credit and accolades to David Whitlinger. When Dave came to town, he really invested himself in a different sort of way in making the New York eHealth Collaborative a functional organization.

I also would have to credit the work in the communities, because that is where the HIE and the RHIOs in the state of New York have been stood up. And they are the base infrastructure to the state-wide network because without the hubs that are sitting in the regions to connect to one another, there really isn’t the state-wide network. In the case of the capital region, HIXNY, the healthcare information exchange of New York, serves the north country as we refer to it, up in the Adirondacks and along the border, all the way down to south of us, Columbia County, in that area and over through what we might refer to as the Leatherstocking region where Bassett is ensconced.

I started as a board member at the time of its inception, and served on the HIXNY board up until last summer when I was invited to serve on the MedAllies board to the south of us. I felt that for the assurance of no conflict perceptions, that if I chose to serve on MedAllies board, I should step away from the Hixny board and my role there was ably filled by one of them team members here, Bill Duax. Of the HIEs in the state of New York, and by that, I mean looking at transaction volume numbers with people doing patient look ups as providers or the number of health records that are residing in the HIXNY infrastructure as compared to its population as a percentage and so on, that HIE activity has been going very well. The question for all HIEs is always that sustainability question — what other things can an HIE do to make itself valuable? And then there’s also, I think, the open question, is there going to be a time when there is going to be public infrastructure? New York has provided that opportunity, and some of the HIEs are taking advantage of it.

But otherwise, NYCE, the New York eHealth Collaborative, has laid out the standards and they are appropriately complex, both technically in what they had to do, and also in the security elements. But they have laid out the standards that describe how qualified entities — in other words, HIEs — can and will be interconnected for the sake of being able to do an exchange of data across the whole state and not just across an HIE or two. And so that’s all good and so we’re seeing the march continue.

Our organization was an ONC pilot participant as to the direct standard. We started working on the direct standard in 2009 when John Blair at MedAllies called me up and said, ‘This is something I’m really interested in. I know you’re interested in interoperable exchange as well. What do you think?’ We said if we agree to get the right people involved, then yeah, maybe we could show people that direct can really work. ONC stood up a number of pilots across the country, the number might be eight or 10.

This is another one of those fated meetings. There was a day in 2009 when I had John Blair, the CEO of MedAllies, John Glaser, and Glen Tullman (the former CEO of Allscripts) all in my office. And we made a pact that we were going to make this darn thing work so that we could show that there really could be an exchange of EHR data securely through a routing service over the internet with EHRs that are not owned by a single company.

There were a number of other vendors that participated. Epic played a role, as well and others that were ambulatory providers, just so we could do the demonstration. And here we are several years later. We’re still seeing some vendors challenged to meet the direct standard; others have been able to make it work functionally. It’s my hope that within a year, the vendor industry will have caught up and all of the EHRs will be able to do a full direct exchange for the sake of supporting the whole referral management cycle, and especially the closed loop as it relates to patient care by and between a primary care physician and whatever care they’re having in hospital or ED or sub-special setting. I bet you didn’t know that was going on up here in Albany, New York, huh?

Gamble: I did not, no. It’s always interesting what you find out. I know that you’re somebody who’s been involved with the HIEs for a while, but that is really interesting. That deals with one of the biggest challenges that people have, not just within formal HIEs, but everywhere with that interoperability piece.

Hickman: Yes.

Gamble: So now, in terms of Meaningful Use, how are you positioned?

Hickman: We’ve fared well, not without a lot of effort. We attested for stage 2 for the hospital last fall, and we continue to see good results in our metrics as to our performance to the required thresholds. It wasn’t without some heroic effort along the way, including a lot of intense energy between us and our vendor community to assure that certain functions were delivered in a time frame that we could still get to the starting line as of October. And by starting line, I mean to be able to say that this is our period of accounting.

And the same has been true on the practice side. The practices are a little more relaxed because you attest one doctor at a time, and all of the attestations don’t have to be in sync, you can do it over time. So we’ve fared well there as well. Our vendors have had problems with the reporting tools and/or sometimes a functional element that we saw as necessary to a workflow to support getting to a metric, but in the end, the collective team has stuck with it and we’ve been able to get where we wanted to with MU 2 for the hospitals, and for MU 1 then MU 2 along the way as we’re moving forward still with the practices.

We, like others, struggled with the portal. We decided to build our own portal capability with a vendor versus acquiring portal capability from an HIE. We contracted with FollowMyHealth from Jardogs, which, as you know, Jardogs then came in to the Allscripts family. You might know the history with Jim Hewitt and his role; once upon a time at Allscripts he spins out and becomes the CIO, develops a portal, builds a company around it, sells it to Allscripts, then he goes back to be their CTO again. And Jim is staying close to things here too, which is good, but we had to make the investment to valet the portal to our patients on the hospital side.

The practice is not as difficult; if you think about it, there are certain kinds of patients who go to our specialists who want to look in a portal and see what the results are and see them quickly. You can have an endocrinology patient who’s diabetic and after the visit wants to see how they’re doing with all their numbers. Whereas on the hospital side, I think people who are getting toward the end of a hospitalization or even coming in at the beginning of the hospitalization are not necessarily thinking at that time about going home and logging into a portal to look up everything that happened that’s been posted in the record.

And so we’ve done things like, on the last day of stay, actually having some workforce members that round and go to the patient room as we are prepping the patient to leave, and actually help them with their first log-on and walk them through the portal and create an experience for them so that they’ll hopefully want to come back and do it again in terms of accessing the portal for data. So that was tricky, but we wanted our own branding; we wanted our own workflows with that, we wanted to associate the portal with our own landing page and other content, given our academic measurement, so that’s the way we did it and we’ve gotten there.

Chapter 3

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