Michael Martz, CIO, Ohio Valley Health Services, Chapter 1

“Are you out of your mind?” It was the reaction Mike Martz received when he left Meadville Medical Center, the community hospital that was one of the first in the country to implement Meditech 6.1, only to do it all over again at a two-hospital system with a lean budget. But to Martz, it was a chance to drive positive change; not just by migrating to a new platform, but by forging a new path at an organization that didn’t have a CIO. In this interview, he talks about how he’s applying lessons learned from the previous Meditech migration to the current initiative, why he believes big bang is the only way to go, and his approach to being the new CIO. Martz also shares his thoughts on how to build credibility with senior leaders, and why it’s essential to be recognized first as a executive.

Chapter 1

• About Ohio Valley Health Services
• “Informal” partnerships with area hospitals
• From Meditech Magic to 6.1
• Mandatory training to prepare for go-live
• Physician-led initiative — “They’re making a lot of the decisions.”
• Big bang vs. phased rollout
• “I’m not sure we had much of a choice.”

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Bold Statements

 We can best serve our patients when we have a single unified patient record — the same patient information, no matter what our setting of care is. So wherever Meditech can do the job, we’re going to go with it first. Where it cannot, then we’ll look at other systems, but keep them as tightly integrated as possible.

We provided a lot of options on physician training, including classes that they could go to and at-the-elbow support. We built computer-based training that we gave them on a thumb drive so they can take it home and do it themselves. We tried to give them every possible option, but what we failed to do was mandate the training.

They’re validating a lot of the decisions and they’re making a lot of the decisions. They’re helping review the build and guide us through the build to make sure that we provide them actually meets their needs.

We will also split them into separate groups when we get into individual pieces that only affect ambulatory or only affect acute, and I think we’re getting much better participation here and physician engagement and hopefully better decisions as a result of that structure.

If you don’t go big bang, you then have to integrate modules of the new system with modules of the old system, and you keep shifting those integrations as you bring each module live. It is a very complex, very messy, and very error prone process to try to bring up a system one piece at a time.

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

Martz:  Hi Kate, I’m happy to.

Gamble:  So if you could give us a little bit of information about Ohio Valley Health Services and Education Corporation.

Martz:  Right, starting with the long name. We’re a two hospital system based in Wheeling, West Virginia, with a second hospital right across the river in Martins Ferry, Ohio. Combined, we’re about 340 licensed beds between the two, roughly 1600 staff, and all the normal ambulatory sites, with various specialties such as the Orthopedic Center of Excellence, Oncology practices — a pretty broad range. Wheeling is a small city; we are in an urban area. We do have competitors and friends around us in the marketplace, so we try and be as lean and aggressive as we can, and we work to partner with other smaller hospitals in the region to provide lab services and whatever collaboration they need so that we’re all working effectively for our patients.

Gamble:  And is that pretty informal or is there like a more formal group as far as the smaller hospitals you collaborate with?

Martz:  No, it’s informal. Each of them are separately owned, so these are just partnerships where we team up with each of them to meet whatever their particular needs are. With some of them, we’ll share physicians. We might sure IT capabilities or lab services, it just depends on the needs of each. In many cases they are referring patients to us, so we’re trying make sure we keep a good partnership and collaboration going with them.

Gamble:  And just for reference, Wheeling and East Ohio Regional Hospital — about how far apart are they?

Martz:  The two hospitals, in line of sight, are only about four miles apart. Although they’re in separate states and it’s a pretty wide river to cross, you can drive between them in about 10 minutes.

Gamble:  And you’ve been with the organization how long now?

Martz:  About six months now. I came here from Meadville Medical Center in Meadville, Pennsylvania, which is a similar organization although that was a single hospital in a much, much more rural area and about two-thirds the size of this organization.

Gamble:  So we’ll get into more of that in a little bit, but first as far as the clinical application environment, you were using Meditech currently?

Martz:  Yes. This hospital has had Meditech magic for roughly 20 years, and that includes the acute and ambulatory side. We are in the process right now of replacing that with a new Meditech 6.1, again both in acute and ambulatory. We’ve been lucky to keep them both of the departments running on Meditech here, and we’re definitely continuing that strategy going forward trying to avoid having best of breed systems everywhere that we possibly can. There’s only a couple of departments that have other systems and they use Meditech as well, and use it for everything they possibly can, such as our OB unit—they have the OBIX system for fetal monitoring strips, but they do all the documentation in Meditech so that we have that single patient record.

Gamble:  And is that something you see happening even in the long-term, just utilizing Meditech wherever you can, but then when necessary, still allowing for some other systems to be used?

Martz:  Sure. We definitely want to follow a Meditech-first strategy simply because we can best serve our patients when we have a single unified patient record — the same patient information, no matter what our setting of care is. So wherever Meditech can do the job, we’re going to go with it first. Where it cannot, then we’ll look at other systems, but keep them as tightly integrated as possible and try to avoid having separate islands of information as best as we can. I think most healthcare has to do that these days as we all move to be much more patient centric and much less centered around our little islands of expertise.

Gamble:  Yeah, but that’s not an easy transition, as I’m sure you know.

Martz:  No, it certainly is not.

Gamble:  And as far as going to 6.1, what kind of timeline are you looking at?

Martz:  The hospital began that process a month before I got here, last September. We will be going live with the system on October 1 of this year.  We’ll be going Big Bang with the hospital and all of the ambulatory practices on the same morning. We’re getting ready for that big event now and figuring out how to make sure that it goes as smoothly as we can possibly make it go. One of my blessings is that I did the same thing for my previous hospital up in Meadville, so I do have a pretty good experience to draw on and know what to expect. I know a lot of the mistakes not to repeat. So, hopefully, we’ll make it go well.

Gamble:  And when you did that, are there things that stood out as being particular challenges? Can you give an example maybe of things that you might do differently?

Martz:  Yes, two key things. One is to focus on better testing. A lot of the testing that we had done at Meadville went well, but we found that there were some areas that we needed to test more than we did. Probably the biggest thing is making sure that we’re generating charges appropriately from all of our documentations with the new charges flow as the old ones did.

The other key thing is engaging physicians, and especially training physicians. And that’s one area that we’ve definitely had a stronger focus here I think than we did at Meadville. When we prepared for the Meadville, we provided a lot of options on physician training, including classes that they could go to, and at-the-elbow support. We built computer-based training that we gave them on a thumb drive so they can take it home and do it themselves. We tried to give them every possible option. But what we failed to do was mandate the training.

So a lot of the physicians took some advantage of it but really didn’t take it seriously, and as a result, the first couple weeks of go-live were really a challenge for many of the physicians. Both at Meadville and here at Ohio Valley, go-live day is going to be a bigger event than a lot of people realize, because we’re going to be going pretty much fully paperless. The morning that we go-live, all paper charts are going to disappear from the floors, which is not something most hospitals do. So the doctors are not going to have any charts to go look at. They’re going to have no choice but to sit down at a computer and look up the information of the patients, and that’s a big change for many of them.

We have focused very hard here at having a stronger physician advisory committee for the entire project than we had at Meadville, another lesson learned for me. We have probably 15 physicians engaged in guiding us through the project, and by guiding us, I mean they’re validating a lot of the decisions and they’re making a lot of the decisions. They’re helping review the build and guide us through the build to make sure that we provide them actually meets their needs. They are setting requirements on their peers such as training. They have all agreed that we’re going to require that all physicians have training before they can use this the system on the first day. So we’re now working through the logistics of how do we make that happen — how do we roll out the mandate and how do we enforce it. If we can do those things right and ensure that the physicians have actually had the training before that first day, then hopefully that day will go fairly well.

I think the other main concern here is just because this is a larger organization, having two different sites and also having ambulatory go-live the same day, which Meadville did not, we have an awful lot more offices and sites and departments to provide first day support for, and so it’s going to require a much bigger team to pull that off and be successful.

Gamble:  A lot of good information there. In terms of the physician advisory committee — was that something that was recently put into place?

Martz:  It was. We formed that in January. It’s something we knew we needed to do. Meditech had been advising us for several months to get that organized, and it just took us awhile to do. We actually created a committee in two parts that work in a unified team. We have an acute group that is physicians mostly working in the hospital, working with the main hospital system, an ambulatory group for the physician practices. Many of the decisions that they make are really joint decisions because the system is a single system, and what we build affects both sides of that, but we will also split them into separate groups when we get into individual pieces that only affect ambulatory or only affect acute, and I think we’re getting much better participation here and physician engagement and hopefully better decisions as a result of that structure.

Gamble:  When you talk about things like making training a requirement, I imagine that’s some of the thinking behind having a physician advisory committee because it’s coming from them, and not just from IT leadership.

Martz:  Absolutely. We also have very strong participation and leadership from Meditech’s advisory physicians who have been through these types of go-lives before as well, and they can bring their expertise to bear. But this group has really come to closely understand the issues and challenges that all their peers are going to have, and so they’ve been able to make these decisions with a lot of good thought and I think that’s going to help us, in the end, have a much smoother rollout.

Gamble:  And as far as this is going Big Bang, can you talk about your thinking behind choosing that strategy?

Martz:  Well, I’m not sure we really have that much of a choice. The challenge is if you don’t go big bang, you then have to integrate modules of the new system with modules of the old system, and you keep shifting those integrations as you bring each module live. It is a very complex, very messy, and very error prone process to try to bring up a system one piece at a time and switch one department at a time, and one module at a time from one system to another. You’re frankly likely to create many, many more problems with that kind of piecemeal approach over time than just to get it all out of the way at once. By going big bang, especially with these systems — because they are so tightly integrated that they rely so closely on the entire system to operate — it really doesn’t function well unless all of the system is there operating at once. So they’re not as effective if you only try and bring a part of it.

Big bang is a scary thing to do. Having gone through one at Meadville, so I’ve proven to myself that it can go fairly smoothly. With improvements that we hopefully will make from the last go-live, I think we can make it a pretty good event. After the first couple of weeks, as everybody gets the groove of the new system and gets used to the new workflows and new processes, you actually start to see the benefits of the new system quite quickly and people are much, much more satisfied than if they were having to struggle partly old systems, partly new systems.

Chapter 2