Don Reichert, VP & CIO, The MetroHealth System, Chapter 1

When Don Reichert came to MetroHealth six years ago, he had three goals: achieve Stage 6, then Stage 7 recognition, and win a HIMSS Davies Award. Not bad for a safety-net hospital that neighbors two very prestigious systems, Cleveland Clinic and University Hospitals. But with the support of the executive team and buy-in from the staff, the dream became a reality. In this interview, Reichert talks about MetroHealth’s multi-year journey from best-of-breed to a core vendor strategy; how he’s been able to lead major change at two different organizations; and how taking analytics to the next level is similar to implementing an EHR. He also shares his thoughts on vendor management — something CIOs aren’t doing as effectively as they can, and the balance leaders walk of taking risks without alienating senior executives.

Chapter 1

• About MetroHealth
• From best-of-breed to core vendor strategy
• Epic EHR, Infor for finance, HR & supply chain
• Change management: “You can be a bulldozer or a collaborator.”
• Building a bridge for newly-acquired docs — “We have a lot going on.”
• Outsourcing & picking “low-hanging fruit.”
• Being a safety-net hospital

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Bold Statements

We have 240 applications approximately and probably close to 80-90 vendors that we deal with, so the level of complexity is there. The thought was that by going with a core vendor strategy, could we reduce some levels of complexity and gain some levels of efficiency? We’re in year three of that, and certainly we’ve been able to take out cost.

It’s getting them involved from day one, and having them feel like they’re a part of the decision process versus having something just handed to them and saying, ‘you just have to make it work,’ which is traditionally the way it’s been in the past — not necessarily at Metro, but industry-wide.

We’re bringing in resources to help with some of these projects, because from an IT standpoint, we just don’t have the bandwidth to deal with all the newness as well as keeping up the maintenance of the existing systems and the day-to-day business.

We’re looking at those low-hanging fruit repetitive positions that we can potentially outsource, but I’m not getting rid of the people that I have. They have very valuable skills, and I’m looking to repurpose them in our organization.

Gamble:  Hi Don, thanks so much for taking some time to speak with us today.

Reichert:  Sure, my pleasure.

Gamble:  Great. To get things started, could you just give an overview of the MetroHealth System in terms of bed size clinics, where you’re located, things like that?

Reichert:  MetroHealth is located in Cleveland, Ohio. We are the safety-net hospital for the region, predominantly focusing on serving the population of Cuyahoga County. We have over 700 licensed beds. We have approximately 25 sites and are adding quickly. We have about 6500 employees in the organization. We’re about a billion dollar corporation. From the ambulatory perspective, we see about 1.1 to 1.2 million patient visits a year. From an inpatient standpoint, we are I believe a little bit north of 25,000 patients a year on the inpatient side of the house.

We are a Level 1 Trauma Center in the Cleveland area. We are affiliated with Case Western Reserve University School of Medicine. All of our physicians are on faculty. We are an academic teaching hospital. We have over 500 physicians, they’re all credentialed as some level of professorship at the college. We have well over 400 residents that we train on a yearly basis. That’s a little bit about our corporation.

Gamble:  What about from an IT standpoint?

Reichert:  As far as our IT shop, we have about 140 people in the IT department. We support around 240 different types of applications in the organization. We have redundancy in our system. We have a secondary data center that supports a lot of our clinical systems and some of our business systems in a failover capacity. It’s about 25 miles away from our main production site.

Our main EHR system is Epic. Our major ERP system is Infor. Some of the other core vendors we have are Cisco, Microsoft, we also have McKesson here and Kronos — those are some of our top systems. We are a Most Wired hospital, two years in a row. We are also a Stage 6 and Stage 7 HIMSS Analytics facility. This past year 2015, we received the HIMSS Davies Award.

Gamble:  I definitely want to get in to that more. You mentioned Epic, is that for a hospital and on the ambulatory side?

Reichert:  Yes it is.

Gamble:  How long has that been in place approximately?

Reichert:  Our journey started back in 1998 with the first introduction of ambulatory. Over the past 16 years, we’ve added the different modules at different times. Inpatient went in, I believe, in 2009. In 2012, we had another big application installed that dealt with MyChart, anesthesia, op time, hospital billing, and registration. Now we’re looking at certainly other applications — hopefully as early as next year, another big bang that would focus on areas such as cardiology, radiology, GI, dental, stork.

Gamble:  You said you’re looking at next year for that?

Reichert:  For a lot of those, yes. Another big bang.

Gamble:  So now at this point, with the organization being veterans on Epic, at least comparatively, is it something where now it’s really just focused on continued optimization and just getting the users to really be able to leverage it for improved outcomes?

Reichert:  Let’s start back in 2012, when we wanted to become an enterprise client of Epic’s. At that moment, we also made a decision as an organization that we wanted to get away from having a best-of-breed strategy and go forward with a core vendor strategy. So we started back then aligning a lot of our core vendors, Epic being a major player in this area, and certainly other ones like Cisco and Microsoft. Recently we signed an agreement with Infor, which was formerly Lawson, to use all three of their modules for finance, HR, and supply chain.

As I mentioned earlier, we have 240 applications approximately and probably close to 80-90 vendors that we deal with, so the level of complexity is there. The thought was that by going with a core vendor strategy, could we reduce some levels of complexity and gain some levels of efficiency in making that decision? We’re in year three of that, and certainly we’ve been able to take out cost. Last year, we took over $1.1 million out in cost in IT, because of either duplication or now there’s a system that in the past was just doing one feature and now is incorporated in one of our core vendors. So we were able to reduce that cost and that footprint within our environment.

Gamble:  Now when that happens, was there a challenge just as far as the users really being used to having those niche systems and having to get used to using the core vendors for more functions?

Reichert:  Sure, it is a challenge. In some cases these systems have been out there for years. Change can be hard for some folks. I think a lot of it deals with how it’s communicated and how one works through that process with the people involved, with the departments that are involved, and how we can ultimately make their lives easier.

It’s getting them involved from day one as well, and having them feel like they’re a part of the decision process versus having something just handed to them and saying, ‘you just have to make it work,’ which is traditionally, I think, the way it’s been in the past — not necessarily at Metro, but industry-wide. IT is the facilitator; the organization says get it done, and you can either be a bulldozer or a collaborator. It just depends on the style of management and the style of communication that one organization has and how successful they want to be.

Gamble:  You mentioned year three, so obviously this is really an involved process when you’re trying to reduce the number of different products and vendors you’re working with. What have been some of the challenges in that?

Reichert:  For us, it’s not just that. It’s also keeping up — our business is growing. Recently we signed over 60 physicians of basically a health plan or a medical practice group. They bring with them close to 50,000 patients, and they’re on a different version of Epic. So we’ve developed a bridge where it gives us time to incorporate them into our culture. We’re using their old Epic system, and later this fall we’re migrating them to our session of Epic.

And as I said, we also have construction going on. We have two towers where we have critical care floors spread out through the organization. We are combining all those floors into two floors, 85 beds total, that will sit on top of our ED. So we’ll have two critical care of floors on top of the ED. We’re a level 1 trauma center, and to the right of that facility is the OR. Just from a workflow standpoint, an efficiency standpoint, things are coming together nicely with that.  That site goes live in June.

While we’re adding all these new practices, we also have a 60,000-plus square foot medical office building, ambulatory surgery center, and either a level 2 or a level 3 ED that we’re bringing live in August of this year. So needless to say, we have a lot going on. We’re also replacing our 25-year-old phone system and doing that throughout the entire organization, and that more than likely will be done by the end of first quarter of 2017.

We’ve put in a new AV system. That has not been rolled out to the entire enterprise, but the main hospital has it and some of the other medical offices have it. But the eventual goal is to run that through every building that we have. Not all the buildings have wireless technology, so we’re in the process of rolling out wireless technology at every one of our sites as well, and really making those things our standard when either we acquire or build a new building.

Gamble:  Right. It’s one of the things we take for granted that a building is going to have wireless, when in reality it’s just not always the case, as you guys are experiencing.

Reichert:  Absolutely. There are many challenges. We are looking at staff augmentation. We’re bringing in resources to help with some of these projects, because from an IT standpoint, we just don’t have the bandwidth to deal with all the newness as well as keeping up the maintenance of the existing systems and the day-to-day business. We’re bringing in extra resources to help. We are looking to expand our FTE count. We’re looking to add about 14 additional staff.

We’re also looking to outsource some of our functions that are a little bit more repetitive in nature. A good example of that is our desktop support people. If I buy a PC today, it comes in and someone has to spend three to four hours provisioning that, then put it out in the field and test it, where for pennies on the dollar, I can have an arrangement with my hardware vendor where I can give them a ghost image. I can have them do it, it shows up, I test it, I put it in, and my cost savings is a lot greater. We’re looking at those low-hanging fruit repetitive positions that we can potentially outsource, but I’m not getting rid of the people that I have. They have very valuable skills, and I’m looking to repurpose them in our organization, whether it be on the infrastructure site or the application side, and I’ll pay hundred percent of their training to give them new opportunities to grow within our corporation.

Gamble:  These are people that you obviously want to hold on to by making sure that they’re in the right positions and they’re being challenged enough. I’m sure that you deal with a good amount of competition when it comes to IT talent.

Reichert:  We do. We have the Cleveland Clinic. We have University Hospital, both very large systems where in some cases we’re competing for the same type of resources.

Gamble:  That’s interesting having really the three major systems in Cleveland, where you have MetroHealth and those two that are pretty large. I’m sure that comes with its challenges.

Reichert:  It does. Our mission is totally different than their mission. Our mission is to really focus on the people of Cleveland. We accept all patients — we don’t turn anyone away, regardless of their ability to pay. We have a lot of outreach programs where we deal with the school system, for example. We handle probably 20 of the schools in the Cleveland public school districts in terms of their nursing functions. We help them link up with a sister site, a sister medical office, so that if something happened during the day while they’re at school, the child and the parent feel comfortable in going to a facility close to where they live. So we’ve done that.

We actually built a mobile van that can see at least two people at a time. They have Epic access. They can see the patient, and if they need to take the patient to a medical office or the hospital, that can be arranged. We also deal with the foster program. One of the things we found out is that foster kids in Cleveland had the worst availability to healthcare, so we’ve worked with the county in making sure that those individuals have access to healthcare.

Chapter 2