Q&A with CIO Christopher Timbers, Part 2: “Technology Isn’t the Challenge.”

“People will find a way to use technology, whether we sanction it or not.”

It’s a harsh reality health IT leaders face on a daily basis. But it’s also an opportunity, particularly if you’re CIO at an independent health system residing in a sea of large IDNs. At least, that’s how Christopher Timbers chooses to view it. If NorthBay wants to remain competitive, it’s not enough to merely offer the latest tools and technologies — it must be done in a way that “truly enhances” both the clinician and patient’s experiences.

Recently, healthsystemCIO had a chance to speak with Timbers about how his team is working toward its goal of making NorthBay “an easy place to practice medicine,” which means communicating effectively with users and responding quickly to issues that arise. He also talks about the pros and cons of being a longtime Cerner shop, what he learned from his mentors Dr. Michael McCoy and Stephanie Reel, and why he relocated across the country (again) to come to NorthBay.

Chapter 1

Chapter 2

• Creating a “mature & well-established governance process for IT.”
• GetWellNetwork’s Interactive Patient Care System
• Improving mobility for nurses – “We’re looking to completely redesign our workflows and processes around these tools.”
• Video visits
• Beta partnership with Cerner
• Mobile devices in the clinical setting: “Screen real estate becomes an issue.”
• Balancing usability with data security
• “People will find a way to use the technology whether we sanction it or not.”

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Bold Statements

We have nursing leadership that’s looking to completely redesign the process around these technologies. And so, rather than just say ‘this is the way we’ve done it in the past in the surgical unit,’ they’re thinking ahead and looking to implement new technologies.

We discovered that the technology component of it is pretty easy. Of course, we had a few hiccups in the beginning, but for the most part it works really well. Embedding it into day-to-day operations, however, has been a challenge.

We see what other places are doing well, and so we feel a big push for us to figure out how to do that, as well as a lot of other things that are more patient-facing than what we’ve traditionally done in healthcare IT.

People will find a way to use the technology whether we sanction it or not. It’s on us to make sure that we’re getting out technology that’s really designed for the clinical setting and meets all the compliance requirements of HIPAA as well as other security needs of the organization.

Gamble:  I’m sure there are different committees in place that work as the go-between to make sure users are getting what they need, but not to the point where it’s breaking IT’s back.

Timbers:  We’re very fortunate in that we have a pretty mature and well-established governance process for IT. We look to that group to help guide where we make our future Investments and how we prioritize some of the short-term changes and modifications we need to make. I think it helps stay us aligned with the overall strategy of the organization, as well as the day-to-day business and clinical operations. That has been one of the things I would point to as having been very successful.

 

Gamble:  What are some of the other priorities on your plate right now?

Timbers:  The really big thing for us is happening next summer. We’re going to be opening a new wing with 22 new inpatient beds and 8 operating rooms. We’re moving all of our diagnostic imaging services into the new building. It’s a big endeavor.

As part of it, we also have an initiative called the patient room of the future. We’re bringing in a patient interactive system from GetWellNetwork that allows the patients to interact with their care team through their TV, which is a different and more modern way.

We’re also going to be rolling out Cerner’s CareAware, which is a connectivity solution. We’re really excited about this because nursing will be able to do a lot of functions on a mobile phone rather than having to go to a PC. It will allow them to do their barcoding for meds and specimen collection, and it’ll allow them to get alerts when new orders come in. It also has a secure texting function that will work with the care team and the physicians involved. So we’re very excited about it.

What I’m particularly excited about is with the brand new unit, we have nursing leadership that’s looking to completely redesign the process around these technologies. And so, rather than just say ‘this is the way we’ve done it in the past in the surgical unit,’ they’re thinking ahead and looking to implement new technologies. They’re going to completely design workflows and process around these electronic communication tools that will be in place.

I think one of the biggest challenges with any IT project is having a really engaged project sponsor who has a vision for how to use the technology. That’s what I think we have with this project. We’re looking forward to it. We’re hoping it will be successful in being able to replicate that in some of the existing nursing inpatient units.

 

Gamble:  I would imagine it’s helpful to have an incubator where you can track what’s successful and what needs to be tweaked. 

Timbers:  Absolutely. Another thing we’re working on is a beta partnership with Cerner for their video visit technology. It’s little different than the partnership they have with American Well — this is actually embedded in the Millennium product. As a patient you would access it by going through the patient portal, and as a physician you would access it through their ambulatory organizer. And so, rather than the next appointment showing up as being in a clinic in one of the exam rooms, it would show up online through a video visit. It’s been interesting rolling it out, because we discovered that the technology component of it is pretty easy. Of course, we had a few hiccups in the beginning, but for the most part it works really well. Embedding it into day-to-day operations, however, has been a challenge.

Our focus with video visits has been a little bit different. Some organizations use it as a proxy, or a way to do something similar to urgent care. Oftentimes you have a group of physicians who are handling the video visits on that particular day; if you’re doing a video visit, you get whichever physician is available. Our strategy has been to have patients do video visits with their existing providers. And so we’re trying to set it up in certain areas where instead of having to come into the office, you can do a video visit with your provider for follow-up care. For example, if a patient undergoes shoulder surgery, a lot of times they’ll have to come to the orthopedic surgeon’s office just to see them for a few minutes so they can assess the range of motion. This can be done very effectively with a video visit.

We have a lot of providers who have great vision on how to use this; where we see challenges is in how it feeds into the day-to-day practice. Some physicians are fine going from exam room visit to an exam room visit, then seeing a patient through a video visit, and going back to the exam room. Other providers want to do their video visits in one big block of time, but sometimes that doesn’t work so great for the patient. If you tell the patient the only time available is on Tuesday afternoon, that might now work.

It’s a really neat technology, and it’s been interesting to see that the challenge isn’t with the technology itself or with the desire of the patient or the physician to do it. Where it gets muddied up is in the logistics of making it happen the way we want to do it at NorthBay.

 

Gamble:  With these initiatives, it’s apparent that there’s so much focus on the patient experience, and using technology to improve it. I think that’s going to become more and more important in the next few years.

Timbers:  I absolutely agree. One of the reasons we wanted to be a beta testing partner is because we felt that to stay competitive, we needed to be able to offer something in this space, or else potentially risk losing those patients. I think more and more patients, at least at lower acuity levels, are going to be looking more at convenience. We see what other places are doing well, and so we feel a big push for us to figure out how to do that, as well as a lot of other things that are more patient-facing than what we’ve traditionally done in healthcare IT.

 

Gamble:  Right. Ideas like the patient room of the future have a lot of potential, but of course there’s a lot that needs to be done to get there. 

Timbers:  Absolutely. Again, if that is how the patient expects to communicate and interact with you, you’ve got to be prepared. A lot of times that means rethinking your workflows, rethinking your communication channels, and rethinking expectations for when you check certain systems. That, I think, is a big part of making it a successful and positive experience for the patient, because if it becomes something where they put information in but nobody responds to them, it’s just a new version of the same aggravation they get when they push nurse call and don’t get a response. Now they’re putting something into the computer and not getting a response. And so the onus is on us to not only use the technology, but use it in a way that truly enhances the patient experience and makes them feel that we’re being responsive to their needs.

 

Gamble:  In terms of the mobile solution, it seems we’re seeing more of a desire to use one device and necessarily have to switch back and forth. That seems to be an evolution.

Timbers:  I’ve historically had mixed success with mobile devices in the clinical setting, because at some point in time, screen real estate becomes an issue. Everybody loves the concept of a tablet, but in some clinical settings where you have really complex flowsheets and you need to be able to see the entire flowsheet all together, it doesn’t work. You’ve got to have that 27-inch monitor or another larger solution. What we’re hoping isn’t necessarily to avoid a trip to the computer, but to eliminate three or five trips to the computer by having the information available on a mobile phone.

 

Gamble:  Right. So I guess it’s an ongoing effort to try to present nurses and physicians with data the way they want it.

Timbers:  The other thing we see is they’re doing it on their own. Our nurses communicate with physicians via text pretty frequently. Occasionally they will take and send pictures. All of it is appropriate, but it’s not secure. And so, a few years ago, we were quick to roll out a secure texting solution, because we knew it was an effective means of communication for them. We weren’t going to stop it by just saying, ‘no, you can’t do this because of HIPAA.’ We had to put a solution out there that’s HIPAA compliant and would allow them to continue to do it.

We really see this as kind of the next step in that evolution. We’re taking it, but we’re building in some slack-like functionality where there is a more structured way for care teams to communicate through this device, as well as adding some of the functionality that traditionally would have been PC-based.

People will find a way to use the technology whether we sanction it or not. It’s on us to make sure that we’re getting out technology that’s really designed for the clinical setting and meets all the compliance requirements of HIPAA as well as other security needs of the organization.

Chapter 3

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