If you think your organization has a hard time gaining access to data, trying working with the military. For organizations like Fort Drum, it has long been a struggle to provide clinicians with updated health records of military members because of the firewalls that exist. But finally, there’s a light at the end of the tunnel, says Corey Zeigler, whose organization is participating in a pilot that could finally break down those walls. In this interview, he discusses the unique operating model that he believes will position Fort Drum well for the future; the governance challenges that come when hospitals aren’t owned; and how his team is leveraging an HIE to pull together data from multiple EHRs. Zeigler also talks about the organization’s population health journey, his military background, and what it’s like to get outside the four walls of the hospital.
- Providing “actionable data”
- Working with different EHRs — “We have some deep insight on what works.”
- Previous CIO stint at Canton-Potsdam Hospital
- From “little to absolutely no control”
- A more community-based role
- Building trust with CIOs — “What can we do to help?”
- Fort Drum’s forward-thinking model
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Data quality, consistency and completeness is definitely the linchpin of the whole operation. If you don’t get that right, you’re pretty much sunk.
Until you really roll up your sleeves and get your hands dirty with this data and understand it, it’s really hard. And I don’t think that it’s fair to think that through machine learning or other completely automated processes, that if we don’t get eyes on the data, that you can really tell a clinician or a decision-maker that the data is good.
I thought I had little control working in the hospital, and then I came here and I have absolutely no control. It’s definitely much more varied and maybe a little more chaotic in that none of these folks work for us, are owned by us, or are in a defined system with contracts. So it’s really about continuing to communicate that value statement.
If you have that trust there, you can take some chances and you can move forward at a much better rate than if you don’t have that relationship.
As folks move to value-based purchasing, the influence on whether or not you succeed or fail isn’t inside the four walls of the hospital; it’s out in the community. That’s where the patients live, and that’s where they’re receiving the majority of their care.
Gamble: There’s so much that has to go into that and so many areas to consider. It’s pretty amazing.
Zeigler: Yeah. Data quality, consistency and completeness is definitely the linchpin of the whole operation. If you don’t get that right, you’re pretty much sunk.
Gamble: In some ways, I would think that being this type of model does have its challenges when you’re talking about all these different data sources. You have to have data quality, you have to have completeness, and I would think it takes a really good system in place that you have to kind of perfect over the years.
Zeigler: Absolutely. The hard part about being rather small is that we’re really depending on some key resources here. We’ve got some incredibly intelligent and talented folks that have been learning this from the very beginning, and really have deep insight to what works and what doesn’t work. The new solution has a built-in data governance toolset, and so we’re hoping to kind of expand our capability or automate some other typical functions that the folks have been doing by hand. But until you really roll up your sleeves and get your hands dirty with this data and understand it, it’s really hard. And I don’t think that it’s fair to think that through machine learning or other completely automated processes, that if we don’t get eyes on the data, that you can really tell a clinician or a decision-maker that the data is good, and how confident you are in the data.
Many times we get reports from these automated systems — I’ll use claims from the payers as an example — and they’ll be 90-100 pages of things the provider is asked to do and 30 of the patients aren’t alive anymore, 20 had it done somewhere else. So they just find it absolutely useless, and we can’t replicate that same system with the Population Health Management; we’ve really got to weed that stuff out and give them truly actionable data that they’ll find valuable in taking care of their patients.
Gamble: Right. Now, as part of FDRHPO, what kind of staff do you have there that works with you?
Zeigler: We’ve got 37 folks here altogether. That includes our leadership team, and then on the IT side we have 12 folks, including myself, and those are made up of clinical analysts, patient-centered medical home content experts, the PCMH CCEs, and our data analysts.
Gamble: And you said you’ve been there about six years?
Gamble: But before that you were CIO at a smaller hospital?
Zeigler: Correct. At Canton-Potsdam Hospital, here in New York.
Gamble: Can you just talk a little bit about that transition from going from a hospital to this organization, which is really something pretty different.
Zeigler: Yeah. I thought I had little control working in the hospital, and then I came here and I have absolutely no control. It’s definitely much more varied and maybe a little bit more chaotic in that none of these folks work for us, are owned by us, or are in a defined system with contracts. So it’s really about continuing to communicate that value statement for them as providers, them as a business, and of course the betterment of their patients.
So I spend a lot of time out in the community with the providers and some of the different organizations. I feel that my role here is a lot more community-based; I felt like I was a lot more inside the four walls of the hospital before, because the hospitals themselves are just such complex systems, and I hand it to each and every CIO that is trying to take care of hospitals, because it is no easy job. So this one is different. More challenging in some ways, but a lot less challenging in others.
Gamble: Right. So you have CIOs you work with, and if there’s a new person taking over the role, I imagine maybe it’s a strange thing for them to get used to, that that they work with this larger organization, where as you said it’s not an ownership situation. So it’s something different that might take an adjustment.
Zeigler: Yeah, I think it takes a little bit to get their head around it, once we can establish some rapport and trust that there’s no agenda; that their success is the community’s success. I look externally like I look internally with my team about really leveraging service leadership — what can I do to make them successful? What can we do to help? We approach that with every engagement, and it takes a little getting used to. It’s maybe not how they’ve been treated elsewhere or they’ve had some bad experiences, but eventually once you get that trust down, it does a couple things for you. Obviously one, it’s a much better relationship, but the other is that you can move a lot faster. I read the book The Speed of Trust, and that is so true. If you have that trust there, you can take some chances and you can move forward at a much better rate than if you don’t have that relationship.
So it’s a key foundation of being successful, and I think it’s one of the things that have allowed us to be so successful here with this DSRIP — which is a completely new program — is that we’ve had this relationship with all our members here for many, many years. There are 25 of them in New York State that are doing this DSRIP Medicaid redesign, and they don’t know their partners. And so they really have a huge challenge because they’re going out and pretty much saying ‘hi’ for the first time and asking them to significantly change the way that they’re delivering care. Having had that relationship with the folks in our community I think has given us a huge advantage, and we haven’t had a lot of turnover at the CIO level, so that’s good too.
Gamble: Yeah, that definitely helps. And you have you were in the military as well — in the Army, right?
Gamble: That’s something that’s always interesting to me in terms of how that kind of shapes the leadership style you take on. How do you think that your military experience has shaped your leadership role?
Zeigler: Well, I give the military a lot of credit in that they do concentrate on training leaders. In healthcare, I think that you’re so busy just trying to keep the lights on and take good care of patients that a lot of times folks end up in leadership positions just through longevity, like the nurse that’s been there the longest who is the nurse manager now. Sometimes they were a fantastic nurse but they find a lot of challenges in managing.
I came in with what I felt like were some pretty good tools but also there were some challenges. One, coming from the Department of Defense, I wouldn’t say we’re flushed with cash, but coming into a small rural hospital and just having budget discussions, my frame of reference for what was a lot of money was a little different, so that took a little getting used to. I think the military tends to lean a little more toward controlling leadership style, and I really had to adjust to more of a collaborative leadership style — even more so when I took this next position. So you have to find the right approach and change your leadership style for the situation. But I do owe a lot to the years that I spent in the military. I don’t know that any of my education in flying helicopters has helped me much with healthcare, but I do think that the leadership training that I received has helped me a great deal.
Gamble: That’s supposed to help with managing stress, having been in that situation, right?
Gamble: Just slightly different though.
Zeigler: It is nice to say that when things get really bad here, ‘well, nobody is shooting at us.’
Gamble: That’s very true. Well, I think that covers what I wanted to talk about. It’s interesting for me and I think it’s really going to be interesting for the readers too, because although this is a unique organization, it’s really not that different from what a lot of organizations are trying to get to in terms of having this model of shared data. So I think that’s going to be valuable to hear about what you’re doing. I appreciate your time.
Zeigler: Oh, not at all. I think that’s a very intuitive statement, because as folks move to value-based purchasing, the influence on whether or not you succeed or fail isn’t inside the four walls of the hospital; it’s out in the community. That’s where the patients live, and that’s where they’re receiving the majority of their care, and you’re at the end of the chain of that event at the hospital, so your circle of influence needs to be expanded well out into the community if you’re going to be successful.
Gamble: Yeah. I definitely want to touch bases with you again down the road to see how things are going, especially with population health, but thank you so much appreciate it, and I hope to see you soon again in the future.
Zeigler: Yeah, me too. Take care.
Gamble: Alright. Thank you, Corey.