In 2011, Licking Memorial had an opportunity to go the early adopter route and attest to Meaningful Use stage 1 — which would’ve been a coup for a community hospital. But Sallie Arnett wasn’t confident the software was ready, and decided the risk to patient care wasn’t worth the reward. Four years later, Arnett feels it was “definitely the right move,” and is proud to be with an organization that is willing to wait. In this interview, she talks about the benefits of being a small organization, the three-year strategy to become a fully-integrated Meditech shop, and her team’s strategy to increase patient engagement. Arnett also discusses the myriad benefits of breaking down silos between IS and clinical, the “drive toward best practices” at LMSH, and why she’s stayed there so long.
- IT’s role as facilitator
- Collaborating with clinicians — “We’re not just coming to them and handing them technology.”
- At LMHS since 2001 — “My plan was to stay 3 years.”
- “I don’t think I’ve had two days that are similar.”
- Reflecting on 15 years of change
- Getting through the “dark” times
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As we’re doing CPOE and bringing things on board, we don’t just come out and say, ‘Hey, we have this great idea and we’d like to give you a clinical decision support rule.’ We sit down with them, get their feedback, find out where their challenges are.
It’s fun because it’s something different every day. I don’t think I’ve had two days that are similar, and whatever is on my day planner is never what’s going to happen. So you’ve got constant variety, constant challenge.
Where I really get the greatest pleasure in what we do is when we sit in the room with the clinical staff. You’ll see a clinical coordinator or a department director talk about all they’re doing in clinical imaging, or they’ll talk about the change in the cath lab, and you see them really light up as they talk about the great improvement they’re making in patient care.
We had a lot of late evenings and watched the sunsets more than a few times. That’s been one of those memories that you look back on and think, ‘I don’t know how we got through that,’ but once we got it up and running and it was really running well, it was really satisfying.
When you’re young in your career, sometimes you spend more time butting heads than you do building. I know was that way. And I think being here this long, I’ve had time to really build relationships and understand people’s goals.
Gamble: It sounds like it’s already ingrained into the culture that IT is not about systems, and that’s important when you don’t have to overcome that barrier.
Arnett: Well, I come from a health information background many, many, many years ago and switched over to IT sort of midstream, so I was very familiar with the electronic medical record and medical terminology and all of those things. There’s so much power in the electronic medical record, and as we sit down with our clinical counterparts, I really view our department’s role as being facilitators for all of the clinical people. So if we’re going to make a change and we’re going to help make improvements — and we’re sort of at the hub of a lot of that now, almost every project we have starts with a collaborative meeting of all the team members and looking at what kind of clinical goals can we set, how can we benchmark those, and how can we make improvements.
From an IT standpoint, we’re so ingrained in workflow, and with the clinical folks’ help, we understand our workflows and we’ll sit down and talk through it. For example, we meet twice a month with our hospitalist group. As we’re doing CPOE and bringing things on board, we don’t just come out and say, ‘Hey, we have this great idea and we’d like to give you a clinical decision support rule.’ We sit down with them, get their feedback, find out where their challenges are, and by establishing rapport with them while we’re there, we’re helping them. We’re not just coming to them and handing them technology and saying we have a goal to make money or improve patient care. We’re really working with them to facilitate their workflow, to help them do their jobs more effectively. And in the end, it drives patient care, it helps take care of people in a more effective manner, and it happens to push us along that Most Wired path too, which from an IT perspective is always nice.
Gamble: Sure. Now, you said you’ve been with the organization since 2001?
Arnett: I have. I came in post-Y2K, so it seems like a million years ago, but I’ll be hitting my 15 years in January.
Gamble: That’s great. That’s monumental in this industry right now.
Arnett: I have to say, my plan was to come in and stay three years, like almost every CIO. I got here and I loved it, and have not left.
Gamble: Where you were prior to this?
Arnett: I was with a small health system in Wichita, Kansas, that was probably about half the size of where I am now, probably about a 95-bed hospital and seven or eight physician practices spread throughout the area. It was a lovely little hospital and it got acquired, so I was looking to come back home to Central Ohio and this opportunity came up and seemed just like a perfect fit for me. Sometimes serendipity plays a role and an opening comes up, and it was just a perfect fit.
Gamble: Were you hired in your current position or was it a different role?
Arnett: Ironically, I have been exactly in this role for 15 years almost, which is, as you said, quite unusual in this realm.
Arnett: I’ve had opportunities to do some other things and I just really don’t want to. I like it where I am.
Gamble: Now, it’s interesting to me talking about being in an organization for that long a time because I’m sure that there are challenges — I don’t want to say with motivation, but maybe you’re not getting the fresh perspective that you would get from going somewhere else. But clearly there’s something that’s really making you stay. Is it ever a challenge to kind of stay motivated as a leader?
Arnett: When you love what you do, it’s really not hard to be motivated. I think one of the ways that we’re fortunate here is that we’re well-funded. We have a wonderful commitment from our board and from our CEO. I think we understand organizationally that to thrive and to remain independent, we need to have a great IT infrastructure. I think the board is as equally committed and our CEO is as equally committed to IT as myself and my team, We’re sort of ingrained into the organization, and as we have new projects come along, everybody wants to involve IT in these projects, because the really big improvements are in new PACS and in new vendor neutral archives and in technology.
It’s fun because it’s something different every day. I don’t think I’ve had two days that are similar, and whatever is on my day planner is never what’s going to happen. I can look at my calendar on the way in and none of those things are going to happen. So you’ve got constant variety, constant challenge. Sometimes you think, ‘Hey, I have a little too much challenge,’ but those days are few and far between.
So yeah, there’s definitely never a dull moment. And I have been at a larger health system. I was actually at Ohio State University, that’s where I started out my career, so I’ve done the big medical center and here, it’s like family. It’s nice to be in a place where you know people, we’re all close, and we all have the same goals. It’s a good place to be.
Gamble: I’m sure that time has gone by pretty quickly. Do you ever kind of look back in awe of how different things are at your organization now than they were in 2001?
Arnett: We do. And as we go through things like getting our first Most Wired, and now our second Most Wired, we’ve come so far. We’ve been through so many different iterations of the network and then bringing on wireless. I’ve been here long enough that I’m retiring for the second and third and fourth time equipment that we brought in that when we brought it in, we thought, ‘This is the best thing ever, it’s the best, we can’t wait to have this.’ And then, you’ve retired that two and three times over because the technology has just leapt forward.
I’m so excited to be doing interventional cardiology here. We’re already doing our second iteration of the cath labs. We’re starting to move forward with vendor neutral archive and we’re doing virtual desktops now — we’re going down that path. It just seems like there’s always something new, and I have to say I thrive on the ‘something new’ and the new challenge, so we don’t ever have a dull day.
I think where I really get the greatest pleasure in what we do is when we sit in the room with the clinical staff. You’ll see a clinical coordinator or a department director go through and talk about all what they’re doing in clinical imaging, or they’ll talk about the change in the cath lab, and you see them really light up as they talk about the great improvement that they’re making in patient care. We had the American Heart Association here this morning giving us an award for our interventional cardiology program, and to see that team get up there and know that they’re doing a great job with patient care, that their door-to-doc time is really below national benchmarks, and they’re taking care of their patients more effectively, and the fact that we’re providing 12-lead EKGs to our squads and sending those from the squad in transit to the emergency department before the patient gets here, and that’s helping make a difference for these patients — how ow do you not get excited about that?
Gamble: Absolutely. And with so much change that’s gone on over the years, is there any time period that you recall as being just really challenging that stands out, or has it really been consistent change throughout the time?
Arnett: Change is always constant. We always sort of laugh about two things. When we did our first iteration of bedside medication verification, we had brought in a very new product and we were the first hospital in the country to actually install it house-wide. It had quite a few challenges. I think I’m somewhat renowned in that I actually gave the vendor scrubs and a toothbrush and said, ‘you can go home when this actually works the way that we want it to.’
So that was a challenging time. We had a lot of late evenings and watching the sunsets more than a few times. That’s been, I think, probably one of those memories that you look back on and think, ‘I don’t know how we got through that,’ but once we got it up and running and it was really running well, it was really satisfying. One of the first days of go-live we were rounding about every three or four hours on the floor and we had a nurse come in, one of our really vocal nurses come in, and he said, ‘Look, I just want to tell you people something.’ And I thought, ‘oh Lord.’ I was just terrified because I thought, what have we done? And he said, ‘I just want you to know that you actually saved me from a med error. On this very first day, you saved me from making a mistake.’ That was one of those days were you went from the dark to light and it was really satisfying.
The other is that journey through CPOE for the hospital. It’s taken us a long time to get to where we are. We’re starting to push for the 90 percent boundary for HIMSS EMR stage 7, but it’s taken us a long time, and it’s been a lot of collaboration with a lot of different departments with the physician leadership, with nursing leadership, with pharmacy, with our IT staff. It’s been a journey. And sometimes you just think, ‘How in the world are we going to get past this?’ But we sit down, we think about it, we work through it, we talk to our peers, we think really hard, and we try and try again. And now, we’re to the point where we’re almost to 90 percent of our orders being done electronically, and now we’re starting to look at anesthesia and the more complex areas. So it always goes from the dark to light somehow and it’s always a good journey.
Gamble: I would think one of the advantages to being at an organization for that period of time is to say, ‘We’ve been through the challenges before and we’ve gotten through them,’ and to have that confidence with your team.
Arnett: We have a phenomenal team of people. I think my longest tenured employee has been here since the original Meditech install in 1985. We’ve had quite a few people actually retire out of our team that were on that original install, and then we’ve got new young fresh folks. I just did a management orientation last week; I always talk to them about the medical record. There was a day when the medical record was like the book in the library, it was the only one that you checked out and yet somebody else had your book, and they were all like, ‘What are you talking about?’
I said, ‘Is there anybody in this room that was born after 1996?’ and like half of them held up their hands. They don’t remember a time when there was a single book in the library. They don’t remember a time when they documented on paper. I have folks joining our team that have never known a world other than electronic world. So we’ve got folks that are very seasoned and talented and we’re very fortunately, and we carry that from the IS people and the clinical teams as well. Some days you think some of these challenges are insurmountable, but so far we haven’t really truly found one that is. You just have to figure out a way around it.
Gamble: Yeah, it’s a good way of putting it.
Arnett: Persistence is a good thing.
Gamble: I guess you need that, right?
Arnett: Most people in these roles are ‘type A’ people, and I think when you’re young in your career, sometimes you spend more time butting heads than you do building. I know was that way; I spent more time butting heads than building relationships when I was younger. And I think being here this long, I’ve had time to really build relationships and understand people’s goals. Ultimately, we all have the same goal of taking care of our patients and doing it well. And once you all have a shared goal, it makes a lot of this much easier.
Gamble: Yes, it is interesting too the things you learn over time and how that shapes the leader you end up becoming or striving to become?
Arnett: And some of those are hard won. I know that all of us have said things and done things that we wish we hadn’t done over the years. I think it does carve you and it shapes your career and it shapes your perspective and it shapes how you do your job.
I think the biggest challenge as you grow, I know for me it was learning to trust the people around me. As we work together, you learn to trust people and you understand what each one of us is capable of doing. We all have our own strengths and weaknesses, so we just have to pull our strengths together and move forward as a team. Sometimes that’s easier said than done, but we’ve done some tremendous things and I think we’ll keep doing it because it’s what we love to do.
Gamble: Yeah, it seems like you have a great group there, and you guys are doing some really interesting work, so I really appreciate you taking so much time to share some of those experiences with us.
Arnett: It’s been a pleasure, Kate.
Gamble: Sure, and I’d love to catch up with you again down the road to see how everything’s going because there’s never a shortage of things to talk about.
Arnett: I’m sure. I’d be more than happy to, and I’m sure there’ll be a million more new projects coming down the pike as things go on, so I’ll always have more to talk about.
Gamble: All right, great. Well, thank you so much, and I will be in touch.
Arnett: Wonderful. Thank you so much, Kate.