Michael Martz, VP & CIO, Ohio Valley Health Services & Education Corp.
“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 2
- Oct. 1 go-live
- The “paradigm shift” in going from Meditech Magic to 6.1
- Lesson learned: test and test again
- Operational metrics before & after go-live
- New data center platform to “dramatically improve uptime and reliability.”
- Goal of becoming “more patient-centered.”
- Collaborating with other hospitals
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Bold Statements
We’re intentionally changing how a lot of the clinical processes and the administrative processes work, people have a bit of a paradigm shift to go through in some ways. So there’s going to be a lot of handholding until people get comfortable with the new way of everything working.
You can never test enough, and even if you do, you’ll definitely not catch all the problems that a real user on go-live day will discover. So we just have to be prepared to react and respond as quickly as possible when those issues do come up.
That will dramatically improve our uptime and reliability and reduce our operational costs as well, and make it much faster and less expensive for us to bring up new systems when the demands come — and they always do.
We’re still a classic hospital organization from that standpoint, so we have some culture change and some realignment of departments and responsibilities between people that we are working through as we implement this new system. In some ways, the new system is almost an excuse to drive change.
We really look at it as a business and clinical partnership first and then we fold in the IT aspects after that. In some cases, IT winds up being the foot in the door to open up a relationship that we may not have had. But in most cases, it is just supporting relationships that we have in place and making them stronger and tighter.
Gamble: From a perspective of support and making sure there is enough, how are you working to make sure you have enough for the October 1 go-live?
Martz: That is a challenge for us. One of the challenges of this organization is that it is leaner than Meadville was. I think that a lot of hospitals are. I don’t know if there’s a strong rule of thumb, but the majority of hospitals I talk to seem to have a range of about one IT person for every 10 or so patient beds, and that was true at Meadville. Here we have about one IT person for every 17 patient beds. So we’re covering a lot more territory with fewer people, and that does make the support very challenging.
The way we’re dealing with that is to get a lot more engagement with super users and getting them involved in the build. We have a couple of dozen core teams that are helping do the build of this new system, and those core teams are mostly not IT people. They’re mostly departmental people, which means that they’re going to understand the system quite well at go-live because they’ve been so engaged in putting it together. They are going to be very much the frontline of support for each of their departments when we go live. We will have super users in each of the departments that are going to provide that frontline of support for the folks on the first few days, and we’ll be backed up with an IT team. We also have a very good core of consultants here, and we will surge with a great number of additional consultants during probably the two first weeks of go-live just to have the extra hands that can be dispatched to a department or a physician or wherever we need to send them in an emergency to help someone out with a question.
Gamble: Right. And there will be questions I’m sure.
Martz: Oh my gosh, yes. It’s not just a new system, but because we are moving from old systems where our workflows in many ways are still paper-based, and this system is just augmenting that, to a new system where there is no paper, and we’re intentionally really changing how a lot of the clinical processes and the administrative processes work, people have a bit of a paradigm shift to go through in some ways. So there’s going to be a lot of handholding until people get comfortable with the new way of everything working.
Gamble: Yeah. And you talked about having more testing and where that comes into play — I don’t know how much you can test workflow before it actually happens, but I’m sure that there are some ways to try to work through that.
Martz: It’s hard. That is one area that I learned from Meadville — to be a little bit more patient with the testing. We had built several rounds of integrated testing and then parallel testing to the best extent that we could, but we were probably impatient in wanting each of those rounds to finish up in a couple of days. Parts of the processes take longer than two days to do when you go through the work of bringing a patient in, giving them their clinical services, and then departing them, and then letting the accounting processes finish up. That whole process may actually take a full week and we didn’t allow enough time to fully test the full end-to-end cycle at Meadville, so that’s something that we’re definitely going to do differently here. You can never test enough, and even if you do, you’ll definitely not catch all the problems that a real user on go-live day will discover. So we just have to be prepared to react and respond as quickly as possible when those issues do come up.
Gamble: I can imagine the challenge there. You talked about doing all the training and having super users and you do everything you can, but there’s no way to really show someone beforehand this is what it’s going to be like without paper and this is how it’s going to affect everything you do. That, I’m sure, is one of the big challenges.
Martz: Yes, it definitely is. The other angle is that there are some key operational metrics for each department that we need to make sure that they are watching before and after the go-live to make sure that things stay on track. For example, with billing and charges, we are ensuring that each of the departments is closely watching what they are billing and charging before the go-live so that after go-live the can compare the before and after and start to look immediately for any gaps — anything that may be missing so that we can quickly cover them.
By the same token, we’re going to be comparing all the patient’s schedules to make sure that we haven’t suddenly lost the patient somewhere. We’re going to be looking at our patient flow and the volume of patients going through the departments, looking at the processing times from moving patients through the different processes to make sure that the new system is not slowing them down, and hopefully is speeding them up. So there’s a number of metrics that we’re trying to make sure that everyone is paying attention to in advance so that we can do the before and after comparisons.
Gamble: And in the meantime, there are no doubt other things on your plate.
Martz: There is, there is. In addition to Meditech, we have, as everybody does, just a continual flow of security projects that we’re doing to try and keep ourselves as current as we can. We’re working on a new data center platform that we just signed a purchase order for so that we can almost virtualize everything that we have in our data centers. That will dramatically improve our uptime and reliability and reduce our operational costs as well, and make it much faster and less expensive for us to bring up new systems when the demands come — and they always do.
We are working on new reporting systems, and we’re working on improving some of our administrative workflows. We do have a lot of work here that is rather paper-based, and so we’re working to shift as much of that to an electronic process as we can using things like Microsoft SharePoint to make things move more smoothly and on a more automated basis.
As an organization, we, like everybody else, are trying to become more patient-centered and less centered on our different departments and clinical areas of expertise. So we’re looking at how we deal with patients across multiple physicians, multiple settings of care, and becoming smoother in how we move them through their care process. Things like when someone comes into the emergency department and is discharged and needs to be seen by a primary care physician within a week — where possible, we’re actually getting that appointment scheduled for them before they leave the emergency department so that it’s a very smooth, clean process.
We, like everybody else, are shifting very much to an outpatient-centered care organization. We certainly will always have our hospitals, but increasingly, our volumes are outpatient first, and there’s a lot of care coordination between physicians that we need to continue to improve so that everybody is seeing the same information about a patient and there’s no confusion between doctors on which drugs are being prescribed by who, various things like that.
We are trying to figure out how we’re going to deal with population health and the new forms of reimbursement that we’re going to see hit us starting next year—and partly already — where we are much more focused than we used to be in the past on readmission rates and keeping patients healthy and out of the hospital in the first place. We’re still a classic hospital organization from that standpoint, so we have some culture change and some realignment of departments and responsibilities between people that we are working through as we implement this new system. In some ways, the new system is almost an excuse to drive change, but it’s a very effective one for doing that.
I mentioned before about our partnerships with other organizations. Because we’re in a fairly urban area, our patients can go to one of several different hospitals, and so we need to be able to coordinate and communicate well with the other hospitals in the area to make sure that we all are sharing information about the patient and coordinating care well — that it’s only to the patient’s best interest, and will help us with things like keeping the readmission rates down.
Gamble: How has that been working out? I imagine that the organizations are on different platforms or at least versions.
Martz: Yes, absolutely. Honestly, I don’t look at it as a technical question even though I’m a CIO. We really look at it as a business and clinical partnership first and then we fold in the IT aspects after that. In some cases, IT winds up being the foot in the door to open up a relationship that we may not have had. But in most cases, it is just supporting relationships that we have in place and making them stronger and tighter.
So you’re right, it is a mix of other systems. I think there’s only one other hospital around that also uses Meditech, although it’s a different version of Meditech than what we have and what we’re going to, and all the others are different brands. So we very much have to look at how we managed the interfaces. We are putting in a new interface engine to help us manage that.
We also have health information exchanges both for West Virginia and for Ohio that we are in various stages of adopting right now so that we can get communication flow moving back and forth better between the organizations. Both of those health information exchanges are working aggressively, but I wouldn’t call either of them fully mature yet so there’s still some growth and capability yet to be rolled out with them.
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