Tom Stafford, CIO, Halifax Health, Chapter 2

We’ve all heard the phrase, ‘if it ain’t broke, don’t fix it.’ What if a product isn’t broken, but could use some improvements, and what if that maker of that product is willing to listen to feedback? If you’re like Tom Stafford, CIO at Halifax Health, you jump at the chance, which is precisely what he did to help Meditech make sure its 6.1 platform included the capabilities that customers wanted. In this interview, we spoke with Stafford about why he’s willing to roll up his sleeves and get involved, whether it’s helping to develop software or leveraging Vocera badges to break down communication barriers. Stafford also talks about his core objectives, why intra-operability should be a higher priority, what his past experience taught him about change management, and what he loves most about his job.

Chapter 2

• Enabling “instant notification” with Vocera badges
• Intraoperability before interoperability
• Leveraging IT to improve care — “That’s what I’m excited about.”
• Change management hurdles
• Background in engineering/manufacturing
• IT’s 4 core objectives
• Customer service strategy: “We don’t talk tech.”

Bold Statements

We’re still missing key connection points between these systems. We need to figure out what they are and what’s the value of them, and actually do those things if we’re going to enhance the clinician’s workflow.

Facilitating intraoperability and focusing on communication is going to enable improvements in technology that will ultimately improve patient care, as well as the efficiency of the clinical and physician workflow. That’s what I’m excited about.

A change that could be done in two weeks may take six months. In healthcare you’ve got to take it slower, and you have to make small, incremental changes and let people get accustomed to them before you make a big change.

The real benefit is when you get physicians to like something and they start telling their friends, who then ask for it. When that happens, you’ve got adoption down pat. That’s our mentality at Halifax Health.

We don’t talk tech. We always talk to our customer’s level of understanding. Half of our customers are focused on providing comfort and care to patients — they don’t speak the language of gigabytes.

Stafford: We also worked with Vocera on secure texting. We wanted a solution that would enable physicians to text each other without potential of a breach or disclosing patient information. We went with Vocera because with their solution, when the nurse gets a text message, it goes to their badge — not just the computer. And that allows for instant notification.

There is an app that can turn the physician’s smartphone into a Vocera badge, which removes multiple steps in the communication process between physicians and nurses. The physician just needs to enter the patient’s room number into their contacts in the Vocera app, and it will locate the nurse and the CNA assigned to that room, and enable them to send a text, which goes right to the nurses’ badge. Or, the physician can initiate a phone call between their smartphone and the nurse’s badge.

In the past, it was much more difficult for a physician to speak with a nurse, because it required calling information and getting transferred to the unit where the nurse is working, where clerk would have to page them. And if a nurse was caring for a patient, they couldn’t leave to answer the call, which meant the physician would hang up, and they’d end up playing phone tag. You can see the potential for breakdowns in that process. With the Vocera app, they can text or initiate a phone conversation with the patient’s nurse or CNA without having to chase anyone down. It’s pretty amazing.

 

Gamble:  Are there any plans to expand that out?

Stafford:  We’re in the process of further rolling that out. We’re going to start sending alerts to the physician’s smartphone via the Vocera app and we’re just trying to figure out how best to do that while juggling so many other priorities.

 

Gamble:  What are some of the biggest priorities on your plate?

Stafford:  It’s interesting because everybody’s talking about interoperability and how important it is that we communicate between healthcare systems. One of my main focuses is actually intraoperability, because in healthcare, all these applications and technologies came up in silos. Even though we are mostly Meditech and we utilize all of their modules, we’re still missing key connection points between these systems. We need to figure out what they are and what’s the value of them, and actually do those things if we’re going to enhance the clinician’s workflow.

So cybersecurity and intraoperability are the top of my list. And actually, I believe I coined that term. I used to call it threading technology together, but you have an Internet and you also have an Intranet, so I’m very focused on intraoperability of all systems. The benefit with Vocera is that I can get important information right to the nurse without having her or him leave the patient, and I can send information to the physician through a smartphone, and all of this is secure. A large percentage of problems are caused by a lack of communication. Facilitating intraoperability and focusing on communication is going to enable improvements in technology that will ultimately improve patient care, as well as the efficiency of the clinical and physician workflow. That’s what I’m excited about.

Gamble:  Right. As far as workflow, is it challenging from your standpoint to determine what changes should be incorporated and at what rate?

Stafford:  Healthcare is interesting. My background is in engineering. I have an undergrad in Aerospace and a Masters in Mechanical Engineering, and I designed medical devices for the first 10 years of my career. In engineering and manufacturing, you change overnight, and have to do it if you want to survive.

Healthcare is highly adverse to change, and for good reason. It’s called the practice of medicine for a reason. They’re always trying to make it better; but when a physician or a clinician figures out a process that produces good outcomes based on a diagnosis, they don’t want to change, because they know it works. That mentality applies in technology too. It’s hard for clinicians and physicians to accept change.

When I went from engineering and manufacturing into healthcare, it really opened my eyes. In my engineering days, as long as I obeyed the laws of the physics and manufacturing, whatever I designed would work and could be reproduced. The company I worked for could make money from it. And so when I went to healthcare, I thought, ‘All I have to do is install software systems. It’ll be a piece of cake.’ But when you install software systems, you have to have adoption. Adoption is based on the laws of culture and behavior, and frankly, there are too many of them. It is infinitely harder to get a physician to use CPOE than design cutting-edge medical devices. That was a real eye-opener for me.

What I learned is that in healthcare — especially on the IT side — you have to be very persistent and never give up, never lose focus. Because a change that we know could be done in two weeks may take six months. In healthcare you’ve got to take it slower, and you have to make small, incremental changes and let people get accustomed to them before you make a big change. It’s baby steps, and that’s what we’re doing.

Gamble:  So as an organization, you’re not afraid to test and incorporate new tools if it means improving outcomes, as long as it’s done right?

Stafford:  Yes. And we always do beta tests no matter what. We never go big bang with anything if we don’t have to, because we want to be able to bring a system up and test it thoroughly. In healthcare there are so many configurations to everything because every patient is different, every diagnosis is different, and every care path is different, and so you have to do beta tests and run it for a bit just to figure those things out. And then you can make changes. Once you’re solid and stable with the beta test, you can go ahead and deploy it to the enterprise. The real benefit is when you get physicians to like something and they start telling their friends, who then ask for it. When that happens, you’ve got adoption down pat. That’s our mentality at Halifax Health.

 

Gamble:  I’m sure it was an adjustment for you in terms of how projects and initiatives needed to be approached in healthcare compared with other industries.

Stafford:  I could see it the first day. I thought, wow. I wasn’t ready for it. But over time I realized that if we just make incremental changes, we can get there quicker. If you think about it, healthcare has been turned upside down in the last five years with the advent of electronic health records — and not in a bad way. You used to have a paper chart. It was easy. A physician would walk into the room, see the chart, flip through the pages, and absorb what they needed to it, and that was the patient story.

Today, it’s all done on a computer. But there are still gaps in the patient’s story, and in order to fill them, physicians need to get answers. By creating an efficient communication network between the physician and the nurse, we can get those questions answered quickly and prevent the workflow breakdowns, and that in turn allows them to provide better patient care.

Gamble:  In addition to all of that, what are some of the other big priorities on your plate?

Stafford:  As I mentioned, intraoperability is very important because we have to get the hospital systems communicating correctly and get the right data flowing internally before we start talking to anyone else. And of course cybersecurity is a big focus, along with meeting MIPS and MACRA requirements.

In our IT department, we have four objectives, with the first being customer service. And it’s more than just being respectful to people; we don’t talk tech. We always talk to our customer’s level of understanding. Half of our customers are focused on providing comfort and care to patients — they don’t speak the language of gigabytes. They don’t get gigahertz. If we talk tech to them, they tend to get embarrassed and shut down, and so we focus on listening to them and figuring out what the problem is. We also don’t say ‘no’ in IT. There are a thousand ways to solve every IT issue. So even if we can’t give customers exactly what they want, we can give them options.

The next objective is to maintain operational stability. With the advent of EHRs, that means we have to be up all the time. The third objective is to enhance strategic and operational initiatives, which is really intraoperability, and then the final objective is to safeguard ePHI. Those are our main objectives, and as long as we’re working on those, we’re providing value to the organization.

 

Gamble:  And you’ve been in your current role for about three years, but with the organization longer?

Stafford:  I’ve been with the organization for 10 years this month. When I came into Halifax Health, I was the manager of the Project Office, and I had a similar role in engineering. So even though the work was different, the processes around it were very similar to me. And then I became Director of Information Services and had security, applications, and the Project Office. After about three years, I was fortunate enough to be able to take on the CIO role, and it’s been great.

Gamble:  How did you make the leap from engineering to IT?

Stafford:  It was interesting. My neighbor two doors down started working as an analyst for Halifax Health around the same time I started in engineering. Our careers had similar trajectories in terms of management, and then she asked me to run the Project Office at Halifax Health, and I did. My thinking was, ‘today I have to worry about the laws of physics and manufacturing — it’ll be really easy to work in healthcare.’ It wasn’t; it’s actually a lot harder, but it’s very rewarding. Knowing we’re able to put the technology in that can help save lives is a good way to go home at night.

 

Gamble:  As far as transitioning to the CIO role, what was the adjustment period like? Was there anyone you reached out to for advice?

Stafford:  I had a very good mentor, and I listened a lot and applied the engineering principles I learned in college. That’s when I came up with those four objectives and we started focusing on what was really important. All the work we do is value-add; that’s core to our strategy.

And we’ve been able to cultivate great teams over the last few years. We were named the 10th Best Place to Work in IT for a midsized organization by Computerworld in 2015, and we were second place last year. My teams are very engaged; the attrition rate in the IT department is six percent, which is amazing.

We’re doing a lot of good things, and as much as I’d like to freeze time, I won’t do that because I’m looking forward to the future and all the things we can do in the hospital with better connected systems.

 

Gamble:  Well, your organization is doing great work, and it’s been really interesting to hear about it. I appreciate your time, and I’d definitely like to catch up again down the road.

Stafford:  Sure. I’m pretty passionate about this. I know we can do things in IT that can definitely help our clinical workforce care for patients, and I’m looking forward to it.