Q&A with CIO Linda Stevenson, Part 1: “There’s Always a Fear of Change.”

If an individual excels at programming or writing code, does it necessarily mean he or she is ready for a management title? Like many issues facing healthcare IT leaders, there is no simple answer, says Linda Stevenson, who recently became CIO at Fisher-Titus Medical Center. She believes the ability to determine whether an IT rock star has what it takes to climb the ladder is just of many soft skills leaders need to advance their organizations.

Recently, healthsystemCIO spoke with Stevenson about the work her team is doing at Fisher-Titus, particularly around patient engagement, and the strategy she employed as the new CIO to assess readiness for change. She also talked about the need to market to consumers, how her organization remains independent while also partnering with large organizations, the unique opportunity for those in IT, and how she uses yoga to keep her grounded.

Chapter 1

• About Fisher-Titus: small hospital, large slate of offerings
• “At-the-elbow support” for monthly go-lives
• Creating physician champions
• Marketing to consumers
• Remaining independent while working w/ partners – “We have the freedom to have the best of the best.”
• Her approach as new CIO – “From a technical standpoint, I was ready.”
• Communicating through change
• Finding the “big rocks”

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Bold Statements

We have a lot of projects on our list, but we need to make sure we’re doing the right projects in the right order to bring the biggest benefit to the organization.

When we take on these IT initiatives, they cost a lot of money and they take a lot of time. As a result, we want to make sure everybody receives the benefits, not just on the internal side.

When someone new comes to a leadership role, there’s always fear of change, so I had to get them to understand that I’m not here to rip the rug out from underneath them – what I’m here to do is help.

It was really important for me, even though I didn’t have the relationships yet, to get with all the leaders and have that discussion: ‘Tell me what’s on your roadmap, and then let’s go through it together and figure out what’s the biggest bang for our buck.’

Gamble:  Hi Linda, thanks so much for taking time to speak with us. Let’s start with an overview of Fisher-Titus Health System — what you have in terms of hospitals and other care offerings, and where you’re located.

Stevenson:  Sure. Fisher-Titus is located in Norwalk, Ohio, about an hour west of Cleveland. We’re a 100-bed hospital, but we have a lot of other services as part of our offerings. We have home health. We have hospice. We have assisted living. We have senior care. We also have a group of 75 employed physicians. And so while we may be small hospital-wise, we have a lot for our patients across the continuum of care.

 

Gamble:  We’re starting to see that where the emphasis isn’t on having a big hospital or having a certain number of beds, but focusing on the care continuum.

Stevenson:  I think it’s so important with the changes in the way we’re delivering care in the future, with less emphasis being on patients in-house. Of course, we want to be able to care for the patients in all stages of their clinical needs; this is a way to do that and make sure we have some control.

 

Gamble:  Right. In terms of the clinical application environment, what type of EHR systems do you have in place right now?

Stevenson:  We primarily use Cerner. Fisher-Titus has been on Cerner since long before I arrived. It’s been at least 10 years. Right now we’re in the process of implementing Cerner in the ambulatory setting. The nice thing is we actually have Cerner from registration all the way through billing, and ambulatory will take on a similar approach. We’ll be getting that one-chart look at patients no matter where they go, which is so helpful for continuity of care. Although there are a few exceptions; we have best-of-breed systems in home health, hospice, and cardiology.

 

Gamble:  What phase is the project in now?

Stevenson:  The hospital is fully functional and has been for many years. We continue to improve that, of course, but the focus right now is ambulatory. We’ve recently started a major go-live in May, and we’ll go live with another set of offices each month for the next four months.

 

Gamble:  In terms of doing a staggered rollout, what do you feel are the advantages in doing in that way?

Stevenson:  There were a few. Because we’re a community hospital, our IT resource pool is not as large. We have about 30 people in IT, and we have to be able to support the hospital at the same time we go live with ambulatory. We have to have people at the elbow in the ambulatory offices, as well as back here in the command center. Because of that, there are only so many things we can handle at one time, and so we’re limiting it to offices where we have really strong physician champions. Plus, when we’re only live at a few places, we can work through and resolve any issues and make any improvements before we go live at the next three offices.

 

Gamble:  That make sense. Can you talk about the process you’re using to get input from users and work it into the strategy for the next rollout?

Stevenson:  We actually have a CMIO; he’s one of our employed physicians. He is part-time CMIO and part-time in his office, and it’s been such a blessing to have him as a physician champion. He works very closely with the physicians from each of those offices to prepare them for go-live, making sure they provide input into the decisions. He also makes sure they have enough exposure to the system before their department goes live so that they can become champions for their own teams. That’s one of the really positive things we’ve been able to do.

 

Gamble:  It’s not something we see a lot in terms of smaller organizations having a CMIO. I’m sure that comes in handy.

Stevenson:  It does. We’re very blessed.

 

Gamble:  So obviously that’s a big initiative. What are some of your other key priorities right now?

Stevenson:  My first priority at Fisher-Titus has been to look at the roadmap. We have a lot of projects on our list, but we need to make sure we’re doing the right projects in the right order to bring the biggest benefit to the organization. Two things I know we’re working on in the short term is to get a new set of IV pumps and then do the infusion interoperability with those pumps so that nurses don’t have to manually enter the medications into the pumps and document all the medications that have been infused. That interoperability will kick off later this year.

We’re also working on quite a number of additional items as far as revenue cycle so that we can work with patients on their ability to pay and validate addresses, and work with them on financial arrangements with the Experian product.

 

Gamble:  It sounds like there’s a lot of focus on workflow and enabling people to do their jobs in a more efficient way.

Stevenson:  Absolutely. The other thing we’re going to focus on is patient engagement. Being a smaller organization, we really want to make sure patients want to come here, so we’ll be putting together initiatives around telehealth and additional patient functionality through the portal. One of the pieces we’ve looked at is Apple Health. We don’t have a lot of use with it yet, but I think that’s part of what we need to do here; we need to market the fact that we’re doing these things to try to get them excited about engaging in their care.

 

Gamble:  Are you talking about creating awareness of how patients can use these tools?

Stevenson:  Yes, but it’s not just awareness how to use it — it’s awareness that we have these tools and are doing this for them, whether it’s the Apple Health portal, or smart rooms, which we also do here. We actually have myStation at the bedside, which allows patients to view videos and do different things on the computer while they’re here, so that even while they’re in-house they can be more engaged in their care. I think a lot of it is marketing to the patient.

 

Gamble:  You talked about Apple Health; it’s interesting because at first we were hearing about organizations like Johns Hopkins doing things like that — not necessarily smaller organizations.

Stevenson:  Right. And the thing is, patients don’t know how they can take advantage of it. So we’re starting to partner more with marketing to get them involved, because when we take on these IT initiatives, they cost a lot of money and they take a lot of time. As a result, we want to make sure everybody receives the benefits, not just on the internal side.

 

Gamble:  Sure. And is Apple Health live, or is it in a pilot phase?

Stevenson:  Apple Health is live. We were one of the first groups to go live. We don’t have a lot of people using it, because again, we haven’t marketed it.

 

Gamble:  You also mentioned smart rooms. Can you talk about that initiative as well?

Stevenson:  Yes. I’m really excited about that. I joined Fisher-Titus recently, and so I wasn’t involved in the implementation. But I know it’s been live for about 5 to 10 years now in our ICU. It’s pretty unique for a community hospital to have that type of functionality. It’s exciting.

Another thing I’m working on is, how can we bring even more to the patient through the myStation tools like meal selection that we aren’t doing right now.

 

Gamble:  Really interesting. When you talk about patient engagement, it’s such a big umbrella; there are so many ways that can be done. And it’s not just in the hospital; you’re focused on engaging with patients at home as well.

Stevenson:  Absolutely. That’s where telehealth and the patient portal come in.

 

Gamble:  Right. Now, in terms of the organization itself, is Fisher-Titus independent?

Stevenson:  We are independent. We have affiliations for some of our services; for example, we partner with Cleveland Clinic for oncology, but we are an independent hospital. We have the freedom to have the best of the best — we can work with one hospital for their oncology program and another one for stroke if want to. We also have some groups where hospitals get together and say, ‘How can we do things like group purchasing?’ Even discussions about working together to solve the Windows 10 problems. The idea is, let’s work together and see if there’s any group benefit.’

 

Gamble:  That’s great to hear. I think it’s easy to fall into the thinking where it’s an all-or-nothing proposition — you’re either independent or part of a large system, and there’s no in between. It’s nice to see that there are other ways to go about things.

Stevenson:  Right. We don’t all have to compete with each other. When it’s done right, there’s enough business to go around. Even now, the CIOs meet on a regular basis to share stories, learn from each other, and find best practices so that we can all provide better services to our hospitals.

 

Gamble:  And you’re pretty new to this role, just a few months in. What was your approach to being the new CIO and getting to know the team and the organization?

Stevenson:  I was very blessed that my last role, even though it wasn’t a CIO title, allowed me to do a lot of the things that I do in this role. From a technical standpoint, I was ready. What I needed to focus on when I got here were one-on-one meetings with all the employees on my team. I think it was really important to get to know them and understand their concerns.

Of course, when someone new comes to a leadership role, there’s always fear of change, so I had to get them to understand that I’m not here to rip the rug out from underneath them — what I’m here to do is help. It’s that servant leadership approach. It was really beneficial to meet one-on-one with every employee in IT, as well as key leadership members, to make sure I could understand their needs and figure out how to best partner with them.

 

Gamble:  Sure. You don’t want to come in on your first day and say, ‘Here’s what needs to change.’ I imagine it’s a delicate approach.

Stevenson:  It is. Because there wasn’t a roadmap when I first got here, my concern was that we weren’t doing the right things at the right time. It was more like, ‘whoever screams the loudest, that’s what we do.’ And so it was really important for me, even though I didn’t have the relationships yet, to get with all the leaders and have that discussion: ‘Tell me what’s on your roadmap, and then let’s go through it together and figure out what’s the biggest bang for our buck.’ And then it’s deciding which things need to come first, second, and third, and actually putting a number on them so that when I pull everyone together, I can say, ‘These are the big rocks. These are the things that are going to bring the most benefit. We’re doing those first, and the other things will have to take a backseat until we have resources available.’ My goal is to never say ‘no,’ but, ‘let’s figure out when and how.’

 

Gamble:  What was your mindset going in to this role knowing how much work had to be done to establish a roadmap? Did you welcome the opportunity?

Stevenson:  I did. I think that’s one of my strengths. My background is in project management, and so I automatically think big picture, and I think about how the pieces and parts need to come together. That’s what I do best — get people together to see the bigger benefit, and determine how we need to plan together. I was fine with it, even though it was going to be difficult.

 

Gamble:  I’ve had conversations with a CIOs about project management. Those who have that experience and training speak so highly about how beneficial it is. Is it a skill you have found to be particularly useful?

Stevenson:  It’s been critical. As a matter of fact, I think being in project management forces you to see all the disparate parts that need to come together to act as one in order to achieve a goal — that’s the nature of it. I’ve been doing it for so many years, and so pulling people together to have conversations has been part of my daily job. When there’s confusion on how we’re going to approach the purchase of, for example, a new medication station, let’s get everybody together, talk it through, and give everybody their assignments. Everything becomes a little mini project.

 

Gamble:  So it’s also about dealing with things in chunks as opposed to trying to tackle the whole thing.

Stevenson:  Right. I think that’s very true because there’s only so much you can bite off at one time, and it becomes a question of, how do you break it down? You break it down into pieces so you can understand those pieces. Then you go to the next level — it’s like doing a work breakdown structure where you get more details as you know more.

Chapter 2

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