Susan Marino, CNIO, Hartford HealthCare, Chapter 1

It was five years ago that Hartford HealthCare began its journey to become an integrated system, and five years ago that the organization named Susan Marino as its first CNIO. The timing is no coincidence; in fact, it was a deliberate move by leadership to appoint someone with a deep knowledge of both nursing and informatics to help establish governance, guide the training process, and most importantly, ensure that the front-line staff was able to work as efficiently as possible. In this interview, Marino discusses the “never-ending” Epic rollout that’s becoming a game-changer at Hartford, how hear team is working to optimize the system without placing too much burden on physicians and nurses, and their biggest priorities for the coming year.

She also talks about her own journey, reflecting on the hurdles she faced early on and the “one win at a time” approach she took to bring nursing to the decision-making table, and emphasizes the importance of leveraging technology to increase satisfaction among nurses.

Chapter 1

• About Hartford Health
• 5 years into a “total transformation”
• The “broad perspective” CNIOs bring to the table
• Hospitals live on Epic: “Now we begin optimizing.”
• Prioritization challenges
• Leveraging MyChart to engage with patients
• Key goal for 2018: “How do we make documentation so there are less clicks?”

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Bold Statements

It’s having significant leadership responsibility looking across all of our clinical and non-clinical systems at how to optimize clinical practice, quality of patient care, and collaboration across not only nursing leadership, but all of our disciplines, truly ensuring a focus on our workforce as well ensuring that they are competent with the technologies that we are bringing forth at such a rapid rate.

Yes, our rollout for the main hospitals and clinics and provider offices is complete, but never complete. Now we begin optimizing, getting those proficiencies for our clinicians, and really looking at how do we create efficiencies.

The most difficult thing coming is, how do we whittle away at what are the most important priorities for our organization? How do we look at the key priorities across all of our spaces and what is the value add that informatics bring to those critical initiatives?

How do we make the documentation such that you have less clicks, and you have more information that is pushed to the nurses to help them understand trends of their patients or itemize what things they need to do throughout the day to be sure that they are successfully helping our patients.

Gamble:  Thank you, Susan, for taking some time to speak with us today.

Marino:  Thank you, Kate. This is a wonderful opportunity. I’m very glad to be joining you.

Gamble:  We’ve been seeing progress as far as the number of organizations with CNIOs across the country, but the numbers are still low. And so I think it’s important to get that perspective for our CIO audience and really get into your role and the importance that nursing leaders bring to an organization. I think the best way to start is by getting an overview of Hartford Health — what you have in terms of the number of hospitals, what you have in the way of ambulatory care, and where you’re located.

Marino:  Sure. I’d like to first say that it has been an extraordinary opportunity for me to have come down this pathway. It was never something that I dreamed about coming out of nursing school. I really respect and admire the individuals that I worked with who had the vision to develop this over 20 years now since I began in informatics. Most if not all of it has been within Hartford Healthcare, starting at Hartford Hospital.

Right now, Hartford Healthcare is inclusive of five acute care hospitals throughout the state, from the central Hartford area where Hartford Hospital is located, to the eastern area where Backus and Windham Hospitals are, as well as New Britain Hospital of Central Connecticut and MidState Medical Center. We have a behavioral health network that includes two inpatient hospitals and many outpatient programs, and practices embedded now in some of our primary care practices. We also have a medical group throughout the state, as well as our newer patient population integrated care partners, which includes 1,800 members, and almost 400 primary care providers across our space here in Connecticut area.

Gamble:  Okay. And we’re going to get into some of the changes that the organization has gone through in a little bit, but first can you outline what you consider to be your key responsibilities as CNIO?

Marino:  Sure, and this certainly that has developed over time. At this point, we are about five years into what has been a total transformation within our health system, which is the implementation of our new EMR, Epic. And so at that point, when our executive team made a decision that we were headed in that journey, I was moved from Director of Informatics to CNIO. Since then, I have been responsible for really a broad system perspective for our transformation and really looking at workflows with our team. So there’s a pretty significant strategic piece to my role in thinking through — along with our executive leadership — where are we headed with our technologies, and what are our responsibilities for our programs. It’s having significant leadership responsibility looking across all of our clinical and non-clinical systems at how to optimize clinical practice, quality of patient care, and collaboration across not only nursing leadership, but all of our disciplines, truly ensuring a focus on our workforce as well ensuring that they are competent with the technologies that we are bringing forth at such a rapid rate.

And of course, viewing quality and safety as a pinnacle. We have HIM regulatory groups. We have continuous improvement, constantly looking at our data to be sure that we’re delivering the utmost in information to our clinicians for decision support. We’re looking at policies and procedures to ensure safety for our patients, we’re looking at regulatory responsibilities, and we’re working with the joint commission and our local State Department of Public Health. We’re also building teams — not only our own clinical informatics team and the staff that we have, but also individuals across our organizations who have an interest and expertise to support our technologies and informatics and engaging them to support their professional development and support the organization. And we’re certainly working with vendors and working with academic partners to provide new programs, looking at how our students are educated, how do we integrate informatics and analytics into the curriculum, and how do we engage them in their clinical rotations. So a lot of different areas of support and guidance for our system and in partnership with our information technology system.

Gamble:  And as far as Epic, it is implemented across all of the hospitals?

Marino:  We just came off of our final acute care hospital rollout to Backus Hospital in October. All of our ambulatory practices are done, and our behavioral network is done although we’re going to be doing an upgrade there soon. We are now moving into our post-acute space. We just went live with Healthy Planet for our integrated care partners and care management, looking at data for our populations that we serve. Our home health groups will be going live sometime later in 2018, so we’re getting ready to kick off that program.

Case management is a huge component of the next step. While our case managers are currently in Epic, there is a brand new module from Epic that is going to help with their needs as clinicians and give them new tools to really make them much more efficient, especially across transitions of care.

So there is no end to it, in answer to your question. Yes, our rollout for the main hospitals and clinics and provider offices is complete, but never complete. Now we begin optimizing, getting those proficiencies for our clinicians, and really looking at how do we create efficiencies. You hear a lot of chatter in our publications and on the news about the impact of a new electronic medical record to our clinicians and the time and the inefficiencies that can come along with that. There is absolutely some of that and more, and we are really on a journey to say, now that we put the system in, how do we optimize it so that it really helps our clinicians transform their practice, better those efficiencies and really advance the care of our patients?

Gamble:  Obviously there’s no shortage of priorities for your team and the work that the clinical informatics team is doing to support the organization. So it’s really shifting now to the next phase of optimization and looking more at population health.

Marino:  Absolutely. And you’re right, the most difficult thing coming is, how do we whittle away at what are the most important priorities for our organization? How do we look at the key priorities across all of our spaces and what is the value add that informatics bring to those critical initiatives?

Our organization has a balance scorecard that is not only for the next fiscal year but for multiple years out, so there are several things on there that we know will come for the next few years. Every single one of those key 10 priorities for our organization have embedded specific goals that we as a team will need to help our organization meet.

Certainly our PeopleSoft and Epic programs will continue over the next few years. So as you can imagine, things such as the patient experience and how we can help with that. There are elements of Epic such as MyChart that look at how can get the patient into their own portal and allow them to see the documentation. We’re looking at how can we get them to see the education that’s available through the MyChart portal so that they can have a better understanding of their own health and monitor their health over time along with us. That’s an absolutely significant priority for us this year.

Because we’re coming off of these rollouts, we’re also looking at efficiencies, particularly with how our nursing staff is functioning. How do we make the documentation such that you have less clicks, and you have more information that is pushed to the nurses to help them understand trends of their patients or itemize what things they need to do throughout the day to be sure that they are successfully helping our patients with their length-of-stay targets or their work effort for the day.

And then we’re certainly looking at growth for the organization. One of our other key initiatives to support the organization has been the development of a virtual health program, looking at different services and different areas across our organization. Right now we are working with our headache group to help them develop a virtual health opportunity in addition to their regular office visits, looking at how can that help their patients feel more comfortable and provide them more convenience more direct interaction when needed with their provider.

We also have an employee health benefit for urgent care where we’re bringing that virtual care opportunity to all of our employees and their families so that they can have the convenience at home of connecting with the provider and saving them time and cost for their individual care as well.

There are so many different areas of opportunity for us this year, and I think especially because we’re coming off of that Epic rollout, one of the most significant things for us and for me and my partner, CMIO Spencer Erman, is to really understand more about how much time our individual departments are spending, and how do we measure the work we do so that we can be sure we’re providing the return on investment and the value add for our organization.

Chapter 2