When it comes to assembling an EHR selection committee, organizations have to think like Goldilocks; not too big, and not too small. Too big of a group means too many opinions to reconcile, and too small gives off the impression that only a few voices count. And so when Firelands Regional put together a group, CIO Mike Canfield opted for somewhere in the middle, a move he believes will pay off come decision time. In this interview, he talks about why the organization is ripping out its EHR system and why it’s critical to have a vendor that will serve as a true partner. Canfield also discusses the major changes he faced after joining Firelands, why having a solid knowledge of project management is a must, and what 20 years in health IT has taught him.
- Creating the right-sized EHR selection team — “We’re not trying to do a backroom deal.”
- Relying on consultants to fill in the gaps
- Vendor management — “It’s a whole different relationship now.”
- Sharing best practices — “I’m a huge fan of stealing shamelessly.”
- 4 years at Firelands
- Dealing with a leadership shake-up
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The risk of involving a bunch of people is that when you pick a system that isn’t their favorite, instead of feeling part of the process, they feel disfranchised and disappointed. We don’t need that going into a system implementation.
The systems are extraordinarily complex, and the demands are so significant that you really need a vendor who can partner with you and help you make sure you get the most possible out of their system.
It’s a great opportunity to talk with both of them about everything from their system selection process to the actual implementation, the consultants they use, the value the vendors have brought to the table, and the challenges they’ve had in their C-suite as they try to make this all happen.
Implementing systems and working out workflows and reporting needs and all the normal IT stuff that you do on a day-to-day basis really does give you a good understanding of how all the different units in a hospital operate, so it really wasn’t as foreign as you might think to make a move to actually start overseeing some of those organizations.
It was a little disconcerting to see them leave and have obviously a new CEO come in the middle of that and have him try to get his bearings with the organization, as well as manage that level of change. It was difficult, but we did well.
Gamble: That’s something I’m sure is an interesting thing to approach. Do you have ideas on how you’re going to do that just as far as getting input on the different systems and doing visits, things like that?
Canfield: It’s been an interesting discussion, so on one end of the spectrum is get everybody in the organization involved and have a really, really large team so that you’ve got good communication upfront and you’ve got everybody understanding what we’re trying to do and people starting to feel a sense of ownership because they’re part of the process. And of course, the other end of the spectrum is have a relatively small group of people sit down, look at the data and information, do a couple of site visits, and make a decision. I think we’re starting to trend toward the smaller-sized team for a lot of decision-making and for offsite demos. We’ll certainly involve as many people as we possibly can for onsite software demos that we do, but the risk of involving a bunch of people is that when you pick a system that isn’t their favorite, instead of feeling part of the process, they feel disfranchised and disappointed. We don’t need that going into a system implementation.
We’re looking at gathering some assistance from outside consulting firms. We’ve talked to a few of them to look at their different styles and practices and how they go about helping organizations work through that decision process. I think we’re going to land on probably 15 or 20 people that are going to be a core group that does the majority of that decision making.
Gamble: Right. I imagine that the more people that are involved, the longer it takes, and I’m sure that that’s something you want to stay away from.
Canfield: It is, it’s true. I have no interest in trying to conduct a meeting or discussion with 40 or 50 people in the room. We will most certainly get sufficient input from all of the functional areas and from the providers. We’re not going to try to do a backroom deal here, but we’re going to get the smallest possible set that provides us the full coverage of functional needs.
Gamble: Right. So now, through your career you’ve worked with different vendors, so you already have maybe some perspective of the different companies going into this?
Canfield: I do. My early career was mostly with SMS and then Siemens products, which are obviously no longer relevant, and I spent seven years with Kaiser Permanente during their Epic implementation, so I’m familiar of how those go. It’s clearly not an option for an organization our size, and we’re not at a point strategically where we would like to partner with a larger organization for access to Epic.
So that whittles it down to continuing with Meditech, working with Cerner, or possibly looking at McKesson. Our opinion I guess is that Paragon just doesn’t have the market penetration that we’d like to see for something that we’re going to commit the organization to, and as they try to collapse their Horizon modules into Paragon, it looks like that’s a little complex. One of the community hospitals around us just did a Paragon implementation. It went well; they’re happy with it and it’s meeting their needs, but the ongoing lack of clarity on the roadmap for the product seems, to me, to be something that we don’t have to deal with. There are other good options out there, so I think we’ll probably move away from that too.
Gamble: It’s interesting; the topic of vendor management and vendor relationships it seems like that’s something that’s kind of ever evolving. Have you noticed, as your career has progressed, that this has changed as far as the way that CIOs and other leaders kind of interact with vendors, especially as things have changed with Meaningful Use?
Canfield: It is. It’s a whole different relationship now. The demands on the systems a decade ago were nowhere near as high as they are now. The complexity of the systems was somewhat less at that point as well, and the people in healthcare IT were, I think, much more IT-driven or IT-trained. We have a lot of people in IT now that come to us from a variety of different backgrounds, which is great — the diversity is hugely helpful. But they don’t necessarily have that strong technical background that we used to traditionally have in IT organizations.
You used to literally buy software from a vendor and pretty much with minimal guidance you were on your own to figure that out, build it, and make it work, and that worked okay for most organizations. Now the systems are extraordinarily complex, and the demands — mostly driven by Meaningful Use — are so significant that you really, really need a vendor who can partner with you and help you make sure you get the most possible out of their system.
Another interesting thing came up in a conversation with some of my peers. We were talking about how the vendor actually can go even beyond that in terms of helping to inform and share information about early adopters with other customers. I believe that discussion centered mostly around Cerner and how they seem to be moving into more advanced capabilities faster than some of the other vendors. The CIO I was speaking with said they can use them actually almost as partners to help to develop strategy, rather than developing strategy and then turning around to their EMR vendor and having to try to get them up to speed with what the capabilities need to be. And I’m sure there are other vendors around that are similarly providing those sorts of leading capabilities.
Gamble: That’s really interesting. It seems like it’s definitely been a game changer, like you said, as the demands have increased, and especially with Meaningful Use and hospitals and health systems having to rely on them to make sure that their products are up-to-speed, that really changes the dynamic too, I would imagine.
Canfield: It really, really does.
Gamble: It sounds like you’re somebody who’s in touch a good deal with your colleagues and peers at different organizations. Is that something you think you will rely on also going forward with the selection and then even the implementation, just to check in with other users of the system?
Canfield: I’m a huge fan of stealing shamelessly. Nobody has enough time and few people are smart enough to figure it all out on their own. We’re in a great position right now with two organizations that we communicate regularly with. Both are very similar to us in terms of size and complexity, and both run Meditech. One of them made a decision to go with Meditech 6.1 and one made a decision to go to Cerner. They’re both probably 18 months ahead of us, so it’s a great opportunity to talk with both of them about everything from their system selection process to the actual implementation, the consultants they use, the value the vendors have brought to the table, and the challenges they’ve had in their C-suite as they try to make this all happen. It is very helpful. There are people out there I’m sure that are trying to do all this alone, and I can’t possibly understand how they’re being successful.
Gamble: Right. If there are others who are in the same shoes or in similar situations, it seems like it really makes sense to try to learn from what they’re doing.
Gamble: You mentioned before you’ve been at Firelands for four years, but first in a different capacity. When you started you were VP of IS, right?
Canfield: Right. When I came to Firelands, I was the first VP/CIO that they had in the organization, and I was focused entirely obviously on the IT area. After I’d been here a little over a year, we had a pretty rapid exodus of some of the senior management team — the CEO, the COO and the CNO all left within a year, and of those, we only replaced the CEO, so there was a whole lot of operational work that needed to be spread around the management team. I picked up quite a few operational areas as well as continuing my role with IT, so I had an increased responsibility and a title change, but still very, very focused on IT as well.
Gamble: I can’t imagine that that’s an easy thing to go through when you haven’t been at an organization too long.
Canfield: It’s really interesting. I’ve been in healthcare for about 18 years now; implementing systems and working out workflows and reporting needs and all of the normal IT stuff that you do on a day-to-day basis really does give you a good understanding of how all the different units in a hospital operate, so it really wasn’t as foreign as you might think to make a move to actually start overseeing some of those organizations. And I’ve got just a fabulous group of directors that are over those specific service lines that I’m accountable for, and that’s obviously a huge help.
Gamble: And as far as having those other leaders leave, was that kind of disconcerting to see?
Canfield: Yeah, it was certainly a unique experience to see them all go so quickly. They worked well as a team, and several of them ended up at the same place. In fact, all of them ended up in the same place for a while once they left here, but it was a little disconcerting to see them leave and have obviously a new CEO come in the middle of that and have him try to get his bearings with the organization, as well as manage that level of change. It was difficult, but we did well.
Gamble: Yeah. I’m sure that when you come away from that, there are always things that you can take from it.
Canfield: Well, it’s been a fabulous learning experience. I really, really enjoyed it.