If an organization wants to ensure a successful EHR rollout, there are many components that are important, but one that is absolutely essential. The people who will use the technology must be “intimately involved in developing the strategy and testing the workflows.”
It may sound simple, but in reality, “It’s very easy not to do that,” said Stephanie Lahr, MD, CIO and CMIO at Regional Health. As a physician, she knows firsthand how difficult it can be to dedicate the time needed to sit down with everyone from OR surgeons to the front-desk staff and utilize their input in creating a roadmap. But it absolutely has to happen.
Recently, healthsystemCIO spoke with Lahr about her organization’s transformation – including why they chose to do a big bang, what it took to lay the foundation, and why they contracted with a third party. She also discusses the importance of having a “physician-driven governing body with a technology focus,” her team’s vision for the future, and how she is able to balance dual leadership roles.
- Combined CIO/CMIO role – “I’m able to do it because of the team here.”
- Finding the right balance as a leader
- Mentors & sounding boards through CHIME Boot Camp
- Physician advisory committees – “That’s where we hash out the questions.”
- The next phase of data
- AI & machine learning as more than “cool new technologies”
- Standardizing communication – “We have more tools than we know what to do with.”
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That probably is the hardest part about the combined role — finding that balance between leading and managing a large division, while also having time to use the informatics knowledge I’ve gained over time to figure out where there are process improvement opportunities.
Whether they realize it or not, they all have some informatics and technology expertise that a lot of their physician colleagues don’t have, and they’re able to represent that back to the areas in which they work, and bring forward those concerns.
I absolutely think they’re going to have relevance in healthcare. It’s just trying to figure out where they will fit best, and how to use them to really improve things, as opposed to using them because they’re new, cool technologies.
We have to be able to bring it together and figure out what’s the right way, at the right time, for one person to communicate with another and have an overarching approach that weaves things together in the same way we’ve done with the EHR. It all has to be connected so that we’re not so disjointed.
Gamble: I would imagine it’s a challenge to manage both roles. In certain scenarios there’s overlap, but in other areas, I’m sure it’s a tough, and it makes it critical to have a good team.
Lahr: Absolutely. I would say the only reason I’m able to do the combined role of CIO and CMIO is because of the fabulous team of leaders, as well as the other caregivers on my team. The IT division is a wonderful group of people, and the directors that I have working for me do an amazing job and really are experts in each of those areas. We’re able to problem-solve and manage things together.
When I arrived here, I started a process of cultivating additional physicians to work in informatics and IT. I now have an associate medical information officer who spends two-thirds of her time with us, soon to be three-quarters. She’s an urgent care provider, and so she has a more ambulatory focus, which allows her to spend time thinking about improvements, workflows, efficiencies, and problem-solving in the ambulatory environment.
My background is as a hospitalist, and so, I still hold on to a lot of the informatics and problem-solving on the inpatient clinical side of things. But that probably is the hardest part about the combined role — finding that balance between leading and managing a large division with just over 200 employees, while also having time to use the informatics knowledge I’ve gained over time to figure out where there are process improvement opportunities in the hospital or across the system, and what’s the best way to use technology to do that. And so, it’s an ongoing assessment of the balance — do I have it right or not, and if I’m off-balance, how I can try to get it back.
Gamble: Right. I’m sure there was a learning curve going into the CIO role. How were you able to navigate that?
Lahr: One thing I did was to attend CHIME’s CIO Boot Camp. I actually did that a few months before I became CIO, but after the announcement had been made. That was a really fantastic experience, for two reasons. First, the content of the course is quite phenomenal and gave me some exposure to thinking about things in a different way. It also introduced me to a number of great CIO colleagues across the country who have allowed me to continue to utilize them as mentors and sounding boards as I’ve been growing and developing in this role.
I also have other mentors, including the former Regional Health CIO [Richard Latuchie] who is now retired, so I try not to bother him very often, and Steve Garske, who I worked for prior to coming here. Steve is a good friend of mine; he’s the CIO at Children’s Hospital Los Angeles. He has a ton of experience, and comes at this from very much a computer science technology background. And so we’re able to have great conversations with different expertise coming into that leadership role.
Gamble: Sure. Now, when it comes to developing and maintaining strong relationships with physician leaders, what have you found to be some best practices? As someone with experience both in clinical and IT leadership, what’s the key to forming strong relationships?
Lahr: I think having a physician-driven governing body that has a technology focus is really important. We have a group of physicians that are part of the leadership team and help govern where the organization is going. And so, from the technology side, we try to participate and listen and learn where want to go and how we can support those initiatives. But that group often gets too busy with operational decisions to devote enough time to technology and EHR-focused decisions.
So we created another group. There is some overlap with other leadership groups, but it’s physicians from across the system who participate in an IT advisory committee that meets every month. That’s where we hash through questions about things like our communication strategy. In fact, probably one of our biggest, most overarching opportunities is communication — how are we going to make sure it meets everyone’s needs? And then there are small things, like how can we improve order sets? Where are we with more forward-thinking ideas like leveraging voice technology in different ways? What things do we need our EHR companies, as well as our other vendors, to do to help us become better and more efficient?
Having that physician group with that focus and that knowledge is huge. Most of the group I have now has been in place since I came here about three years ago, which means that, whether they realize it or not, they all have some informatics and technology expertise that a lot of their physician colleagues don’t have, and they’re able to represent that back to the areas in which they work, and bring forward those concerns. I think that’s key — not just engaging with physician leaders, but creating a group of physician leaders with a specific interest and focus around technology.
Gamble: That makes sense. Looking at 2019, what would you say is the biggest priority your team is focused on?
Lahr: It would be impossible to pick one thing. Given our evolving maturity and where we are in our EHR journey, we’re at a point where we’re starting to get data. We have data in one EHR; now we need to start leveraging the data that’s there.
And so, now that everyone is comfortable with Epic and we’re starting to accumulate data, what are the next things we need to do to make that data work for us, whether it’s by improving processes or improving patient care, either on a broad scale or individually. Leveraging the data, I think, is going to be one of the major challenges and opportunities over the next couple of years.
Keeping up with advancing technologies and figuring out when, where, and how they’re going to be relevant to healthcare is another challenge. A lot of people are talking about AI, machine learning, and blockchain; I absolutely think they’re going to have relevance in healthcare. It’s just trying to figure out where they will fit best, and how to use them to really improve things, as opposed to using them because they’re new, cool technologies.
Security is absolutely going to be at the forefront. The more dependent we are on these systems, the more we risk when these systems aren’t available or have been breached. And so we’re working across the organization with our legal and compliance teams, as well as educating all of our caregivers and providers that maintaining the security of our systems is the job of everyone. We can go out and buy tools to do certain things, but a lot of it is how we interact with the system. And as we look at tools that can help provide security, we need to make sure we’re not making ourselves secure to the point where it’s a major disadvantage to clinical workflow. We still have to be able to provide care and do it in an efficient way without introducing things from a security standpoint that can get in the way of that.
The final thing is around communication. Right now, we have more communication tools than we know what to do with. The day of the pager is almost behind us, but to be honest, it really isn’t the case in healthcare. While we have a lot of cool emerging technologies, the pager still fits into a workspace that it’s been difficult to fill with other technologies. There’s secure messaging. There’s secure email. There’s messaging within your EHR. There are alert systems. All of those are happening, but we have to be able to bring it together and figure out what’s the right way, at the right time, for one person to communicate with another and have an overarching approach that weaves things together in the same way we’ve done with the EHR. It all has to be connected so that we’re not so disjointed in our communication.
Gamble: A lot of great stuff there. I’m sure it’s really exciting to think about getting to the next phase with EHRs and data — the ‘fun part,’ as you said.
Lahr: It’s the reason why we’ve set up systems in the way that we have. Data capture is just data capture. There are great advantages to have one patient at a time be able to, for example, share information through Care Everywhere. But we can really start to impact patients on a more global scale and start to see the benefits in our patients’ health and wellness by leveraging data and finding relationship or opportunities where we didn’t see them before. The human mind isn’t going to figure them out — that’s where AI and machine learning come in. Are relationships out there that can advance the field of medicine? We need a lot of data — and we need to crunch that data — in order to figure out what some of those relationships are. It’s very exciting.
Gamble: Right. Well, that about covers it. Thank you so much for your time and your perspective.
Lahr: Absolutely, I appreciate the opportunity to be able to participate.