When Brian Tew arrived at Greater Hudson Valley Health System two years ago — as the organization’s third CIO in 3 years — he knew he had his work cut out. But despite the fact that 40 percent of the IT positions were vacant, Tew knew that the core group in place was strong; what they needed was some stability. And so he was deliberate in his approach, building a leadership team from the ground up and improving processes one at a time. Within 20 months, GHVHS had achieved HIMSS Stage 7 recognition, and Tew’s plans don’t stop there. In this interview, he talks about what it took to change the organization’s mentality, the challenge of “keeping the lights on” while developing standards and setting up committees, the biggest priorities he hopes to tackle, and why managing expectations is absolutely critical.
Chapter 3
- Reaching HIMSS Stage 7 — “It completely changed some of the workflows.”
- Leveraging of Epic’s “bells & whistles”
- Upgrading to version 2016
- 8 years at Catholic Medical Center — “I worked my way out of a job.”
- Coming to GHVHS “with my eyes open.”
- Peaks of knowledge & experience
- From geeks to fortune teller
- “Managing expectations is key.”
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Bold Statements
The biggest piece was communicating to the people that are using Epic all the bells and whistles that come with it. You would think that that’s the easy piece of it, but it’s not. It’s constantly being visible, constantly being out there and showing the different tools that actually exist within the EMR.
When this opportunity came along, I knew that this was going to be a lot of work. And so I felt like I came in with my eyes open, but it’s kind of like reading a book about going through childbirth and then actually going through childbirth — you only know what you know until you experience it.
In the very beginning, you had to be a geek. You had to really understand the technology and how it works. But as the job progressed, I had to become an expert in workflow and processes, and really had to see how different service lines can leverage technology to improve the care that we provide to our patients. And now it’s taking the next step to where I have to see in the future.
I’m constantly letting people know the workload that we have and the resources that we have, just so that they can appreciate that IT is hard. It’s hard to implement. It’s expensive to implement, and we have to add value. That constant communication and being able to manage these expectations is just key.
Gamble: You’re talking about getting to stage 7 in a short amount of time, but that doesn’t happen if there aren’t already some really strong pieces in place. Was there anything that stood out as a challenge in obtaining that?
Tew: Again, it’s the resources. As an organization, we staff at the 25th percentile. When you’re leveraging a product like Epic, on the surface you might you need less resources, but once you start peeling the layers, you realize that you’re doing more with the technology and you actually need more resources. So as an organization, we staff at the 25th percentile and that’s just hard. We still had to do breastmilk and blood barcoding. We had to implement those things. We had to get all the papers scanned within the chart in 24 hours, and so that took additional resources, and it took additional equipment and completely changed some of the workflows.
The biggest piece was communicating to the people that are using Epic all the bells and whistles that come with it. You would think that that’s the easy piece of it, but it’s not. It’s constantly being visible, constantly being out there and showing the different tools that actually exist within the EMR.
Gamble: Is that something where in came in handy having some of these committees that weren’t there before?
Tew: It’s certainly paying dividends now, I will say that.
Gamble: At this point, what would you say are some of your biggest priorities? You talked before about EpicCare in the community. Is there anything else that really stands out as a big focus for the near future?
Tew: Community Connect is one. We want to be able to offer that as a service to some of the physician groups. The latest version of Epic comes out in November, and at that time we would be two versions, because we’re currently on 2014. So a big initiative for us is to optimize 2014 at a level that it needs to be, and then upgrade to version 2016. So that’s a fairly large initiative that we have.
And we’re not using Epic to its fullest ability, so some of the other areas of concentration that we’re going to have are mobile applications, which we’re really not leveraging now, and patient engagement with MyChart, which is something we’re doing — we’re just not doing a very good job at it. There are certainly some things that we can do to improve utilization of that tool. Epic has this program called Stars that helps you optimize their product, and so we’re leveraging that initiative as well that help us with the optimization. Diagnostic imaging is another big initiative for us to where now we have images all over the place, and we’re looking at consolidating all of radiology, cardiology, as well as oncology into a single viewer and a single location of storage and being able to push that out within our EMR. So that’s another initiative that we’ll be doing over the next 15 months. And along with all the other hospitals, we’re working on analytics and leveraging all this data that we have.
Gamble: Is there a data warehouse in place right now or is that something that’s in the works?
Tew: Epic has rebranded their data warehouse to Caboodle. So we recently went live with that, as well as a SAP product that helps grab data that’s not Epic. And we’ve created a business intelligent (BI) committee where finance, quality, physicians, nursing, and IT are all big players in that, as well as security. So we really haven’t seen the benefits from that, so we’re still kind of in the early stages. But with the upgrade within Epic, we do plan to also roll out Healthy Planet which is their population health module.
Gamble: So you’ll be a little busy.
Tew: Yeah, there’s plenty to do. There’s no question about that.
Gamble: Now, you said you’ve been there almost two years, and your previous role was at the Catholic Medical Center?
Tew: Correct.
Gamble: As far as coming into this type of role where so much had to be done, did you have was this something where you had any hesitancies about what it was going to entail?
Tew: You mean in making the jump from my last job to this job?
Gamble: Yes.
Tew: At Catholic Medical Center, I had been there eight years and I got to a stage where I kind of worked my way out of a job. Everything was humming right along, and as the organization was in a holding pattern as to whether they were going to stick with the current vendor or go to Epic. When this opportunity came along, I knew that this was going to be a lot of work. And so I felt like I came in with my eyes open, but it’s kind of like reading a book about going through childbirth and then actually going through childbirth — you only know what you know until you experience it.
But having said that, I knew there was a lot of work that needed to get done and that was really what appealed to me: that challenge. We’re still cranking along. Catholic Medical Center was great. There are peaks in your life; these little spurts where you gain a lot of knowledge in a short amount of time. At Catholic Medical Center, we went from completely on paper to becoming completely electronic. And at the same time, they gave me exposure to some operational departments that normally aren’t within the IT umbrella. And so I’m very fortunate for the time that I had to work with them, and as far as making the jump here, I’m glad I did it. The timing was good and I’m going through another one of those little peaks where you gain a lot of knowledge and experience in a short amount of time.
Gamble: You were VP of operations and CIO at the Catholic Medical Center?
Tew: I was. So over the course of time, you get the usual IT departments of IT, communications and clinical engineering, and then medical records. But I also had facilities, plant management and security — not IT security but the physical security. So I had some other departments reporting through me, and that was a great experience as well.
Gamble: In holding the role for several years there and then about two years at your current organization, I’m sure it’s been interesting to see how the role is evolving. Of course, it’s going to be different from one organization to the next, but has it been that interesting to you to see how the CIO role general is going in a different direction?
Tew: Yes. It’s been going at a good, steady pace, so there wasn’t any sudden movements, at least from my experience. But certainly, in the very beginning, you had to be a geek. You had to really understand the technology and how it works. But as the job progressed, I had to become an expert in workflow and processes, and really had to see how different service lines can leverage technology to improve the care that we provide to our patients. And now it’s taking the next step to where I have to see in the future and I have to be able to figure out how to answer questions that the care providers questions they haven’t even asked yet; I have to kind of know how to answer that question even before they ask it.
So even though Greater Hudson Valley is in a bubble where there’s really not pressure to join an ACO, I have to make sure we have the infrastructure in place and that we are able to do value-based population health-type models. So we’re certainly putting the foundation in to be able to do those things, but the role certainly has changed from a technical to an operational role, and now going beyond a strategic partner to really being the tools that the entire organization leverages to continue to be relevant in their communities.
Gamble: It’s interesting. You mentioned early on the idea of managing expectations, and I guess that’s something that really continues to be part of your role.
Tew: That’s really the biggest thing. As a parent, as a spouse, and in areas that I’ve worked, managing expectations is key. I’m constantly letting people know the workload that we have and the resources that we have, just so that they can appreciate that IT is hard. It’s hard to implement. It’s expensive to implement, and we have to add value. That constant communication and being able to manage these expectations is just key.
Gamble: Not an easy task, I’m sure. Well, we’ve definitely touched on a lot. I’d love to speak with you a little bit down the road just to see how things are going. I know you have so much on your plate with the upgrade, and I’d like to touch base and see how the organization is continuing to evolve.
Tew: Absolutely. There’s always things happening. Hopefully a year from now I’ll be smarter than I am right now.
Gamble: That’s a good goal. Thank you so much for your time. I really appreciate it, and I think this will be very useful to our readers. So thank you, and I look forward to speaking with you again.
Tew: Thanks, Kate. I appreciate it.
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