Q&A with CMIO Mark Weisman, Part 1: "What can we optimize to make life easier?"

Mark Weisman, MD, CMIO, Peninsula Regional Medical Center

During the past few weeks, so much has changed because of the COVID-19 outbreak. One thing that hasn’t changed — one thing that can’t change — is the CMIO’s core objective: to make life easier for providers, according to Mark Weisman, MD. For his team at Peninsula Regional Medical Center, that means removing hard stops and eliminating alerts that don’t provide value. “We still have the same priorities in terms of making this tool easier, even in the middle of a healthcare crisis.”

Recently, Dr. Weisman spoke with healthsystemCIO about how the organization is working to accommodate more patients during the pandemic while also maintaining quality care, whether that means ramping up telemedicine efforts or setting up makeshift clinics. He also discussed PRMC’s multifaceted strategy to address and reduce clinician burnout, the evolution of the CMIO from “buffer” to true leader, how he hopes the role will continue to grow, and the advice he offers for CIOs who want to develop stronger relationships with clinicians.

Chapter 1

About Peninsula Regional (3-hospital system based in Maryland)
PRMC’s COVID-19 strategy
“My job is to make sure we’ve got the tools in place that providers are going to need.”
Pushing telehealth along
Learning from leading organizations – “No one’s worrying about competition right now.”
3-pronged plan to reduce clinical burnout
Arch Collaborative findings – “Our providers were not thrilled”
CMIO’s advice for CIOs: measure and form partnerships
Maryland’s capitated model: ““To do it right requires a strong investment in healthcare IT.”

LISTEN HERE USING THE PLAYER BELOW OR SUBSCRIBE THROUGH YOUR FAVORITE PODCASTING SERVICE.

Podcast: Play in new window | Download (Duration: 17:03 — 15.6MB)

Bold Statements

That’s our biggest hurdle right now: lack of access to tests — not being able to understand who is carrying it and who is not right now, and trying to protect the public.

I’m seeing little pockets of it. I see people dip their toes in it. This is really forcing the issue, because we don’t want to see patients face to face who are potentially infected if we can avoid it, particularly in the ambulatory world.

What can we optimize here to make life easier? It’s about removing the hard stops. Removing alerts that aren’t providing value, really questioning the value of the clinical decision support that’s been put in place, and moving toward a mindset of ‘prove to me that it’s working.’

I don’t think CIOs can really be effective if they’re ignoring the clinical part of the organization and just focusing on infrastructure or security. They have to be heavily invested in the clinical part, and do that in partnership with the Chief Nursing Informatics Officer and CMIO.

I saw an opportunity to be able to come in and make a difference, and that’s what I wanted to do. I want to make a difference in the healthcare system that I’m working for. I want to be effective. I want to be partners with other leaders in the C-suite who are interested in doing the same thing: advancing quality and reducing variation in care.

Gamble: Hi Mark, thank you so much for taking time to speak with us. We really appreciate it, especially with everything going on. Why don’t you start by giving a high-level overview of Peninsula Regional Medical Center?

Weisman: Sure. Thanks for having me. Peninsula Regional is a three-hospital system based on the Eastern Shore of Maryland. We have another hospital we just acquired in the lower part of Delaware. One is on Epic and the other is on Cerner, so we’re going through all of that now. We’re just under 400 beds total, with about 3,500 employees and about $750 million in revenue. That’s a rough idea of who we are as a health system.

Gamble: There’s probably no better place to start than with what’s going on right now, because I’m sure this would come up as we talk about your core objectives. What is your organization doing with regard to the coronavirus outbreak?

Weisman: As the CMIO, my job is to make sure we’ve got the tools in place that the providers are going to need. The organization is doing all types of things, like getting a tent set up out front to handle the mass volume, figuring out how to staff all the phone calls, and working on testing.

That’s our biggest hurdle right now: lack of access to tests — not being able to understand who is carrying it and who is not right now, and trying to protect the public. When someone comes into the hospital, how do we keep visitors who are sick out? Those are the tasks the hospital is taking on.

My role is really looking at the tools. In case we need to do more telehealth, how can we do that? How can we make sure we have the smart tools we need in place to help providers document coronavirus-specific issues, like self-quarantine? That’s not something we’ve put into our system before. And so, it’s having a standardized form or tool that our emergency department can use to input instructions so that our patients know how to self-quarantine.

Gamble: When you talk about telehealth, a lot has to be in place, obviously, to make that happen, or to ramp that up. What’s the approach there?

Weisman: It’s a great question. The financial incentives for telehealth have not been there for the entire country to really wrap their arms around it and be excited about telehealth. I’m seeing little pockets of it. I see people dip their toes in it. This is really forcing the issue, because we don’t want to see patients face to face who are potentially infected if we can avoid it, particularly in the ambulatory world. Think about a doctor’s office that has someone with potential coronavirus; they have to disinfect that room and all the surfaces. When you’re trying to see patients every 10 to 15 minutes, that’s really going to put a cramp in your style. But if this could be done via telehealth, that’s a different beast.

Most of us are not completely prepared for an integrated telehealth experience. We’re an Epic shop, and so we would want to use MyChart to enable the patient to get a provider on the phone with a single click or two. Many health systems have that; we don’t. We’re using a more clunky workflow using Webex where we get the patient’s email and send them a link to connect. It’s not as smooth and sophisticated, but it certainly gets the job done. We can hold a WebEx meeting between a provider and a patient. But the telephone works too for basic things like checking up on people. We’re still doing that, but sometimes it’s nice to lay eyes on people if you’re wondering how sick they are, and whether they should stay home or come in. In the meantime, we’ll do a mixture of things to make it work.

Gamble: Right. I’m sure what we’re seeing right now is amplifying the need to push for telehealth out of those pockets and create a more integrated experience.

Weisman: I’m hearing some interest from the federal government in covering telehealth. We need all the payers to get involved and say, ‘yes, we’re going to cover it,’ and not have requirements that you have to be in a rural area, or you have to be at the facility, and all those rules Medicare has. They need to waive all of that and let us do our work here and get some of the regulatory stuff out of the way. I haven’t seen that. I’ve seen some indication that the federal government is interested, but there’s still the 1135 Form that a doctor has to fill out and request permission from Medicare for waivers. It’s not easy; not yet. This crisis may very well push us there. We have the ways to make it a seamless experience for patients and providers.

Gamble: You mentioned documentation process — when you’re dealing with something like this, which is a unique situation, are there steps you have to take to make sure the right codes are there?

Weisman: Absolutely. There are providers on the West Coast who are already going through this; specifically those at the University of Washington and Providence St. Joseph’s. They’ve been wonderful about putting out information. ‘Here are the practical things you need to be doing right now, and we’re just kind of following their lead. It’s a great community; all the competitive pressures are gone. People have too many patients — no one’s worrying about competition right now. We’re worrying about taking care of patients and make sure our providers are well supported.

There are certainly things we’ve had to do. For example, we have coronavirus codes, but they’re not specific to this new coronavirus, COVID-19. When are those codes coming? How do we get them? We use IMO and we have to do an import of that data or manually enter in the codes. We’re getting there. We don’t currently have any cases [as of March 16], so we haven’t had to worry about it yet, but we know they’re coming.

Gamble: One of other concerns is the burden on physicians and nurses. This situation can add to the burden, which is scary. I’d like to talk about how you’re looking to address this, particularly in light of COVID-19.

Weisman: Before coronavirus moved in and took over our lives, my core objective as a CMIO was to make the lives of providers and nurses better. There are a few ways in which we’re doing this. One is to look at our EMR and ask, what can we optimize here to make life easier? It’s about removing the hard stops. Removing alerts that aren’t providing value, really questioning the value of the clinical decision support that’s been put in place, and moving toward a mindset of ‘prove to me that it’s working.’ What may have worked three years ago and was left in place may not be working as well today, because providers have developed the muscle memory to know exactly where to click to get past whatever support you’re trying to make useful to them. That’s something we’ve been working on.

The second part is optimizing. Our system, for whatever reason, was never optimized. That’s one of the things that attracted me to Peninsula Regional; they never did optimization, so there was a huge opportunity to sit down with providers one on one and teach them skills — things they didn’t even know the system could do. They’re amazed; they’ll say, ‘why have I been struggling with this for so long,’ not knowing the tool has tremendous capabilities. They’re so excited about the tool once they get a little bit of attention and learn how to optimize it. Now, with the coronavirus that’s still the case; they still need to know how to use those tools, and so the opportunity continues.

The final part is really building up the governance and the informatics skill set — the infrastructure, and having physician builders or provider informaticists who understand the value of this work and can work with others. When I came here, there was only one other provider who had deep knowledge of the EMR. The two of us couldn’t sit next to each other in case a bus came along and hit us, because there’d be no one left in the system who knew the EMR from that standpoint.

And so my goal has been to train up some physician builders. We’ve got a good number now, and I think we’re getting to a critical mass where we can have these individuals on governance committees, and have providers can have a voice in how the EMR is configured. It’s making a huge difference in the lives of the providers.

Gamble: I’m sure you don’t want to see these efforts fall to the wayside. It’s like triage; you have to take care of what’s urgent, but it’s so important to not lose sight of these objectives.

Weisman: Right. We did a provider satisfaction survey through KLAS, and we learned that our providers were not thrilled with the EMR. We scored fairly low, so we had a lot of work to do. And so, although we have new priorities clinically, we still have the same priorities in terms of making this tool easier to use, even in the middle of a healthcare crisis. We need to make these tools easier; get the junk out of the way so our providers can do the work they need to do.

Gamble: As a CMIO, you have experience in dealing with burnout. Do you have any advice for CIOs on how they can make sure they’re effectively addressing the issue, and why it’s important to have that baseline?

Weisman: It’s so important for the surveys to take place. If a system hasn’t done it, KLAS offers the survey, and it’s relatively inexpensive. Of course, there are other surveys out there too. You have to ask: how do your people think the EMR is performing? Be prepared for some comments that might hurt a little bit, because for the analysts, who have been putting in years of work to make this better, and when providers come back and say, ‘this thing’s not great,’ it hurts their feelings. But we have to get past that. We have to say, ‘Okay, how do we make it better by working with what we’ve got?’ Things like artificial intelligence tools and ambient AI that will to listen to our voice and take down notes — that will be wonderful. It’s starting to happen, but in terms of mass distribution, it’s going to be a while.

And so my advice for CIOs is to 1) measure, and 2) form a partnership with the CMIO. In the past, the CMIO role was more about building relationships with providers; I think it’s because CIOs weren’t as comfortable doing it. We have to move past that and get to more of a partnership.

Gamble: That’s great advice. And you’ve been in your current role for about a year or two at this point?

Weisman: Yes, that’s right.

Gamble: What made you interested in coming to this organization and pursuing the CMIO role?

Weisman: I saw an opportunity here, which really intrigued me. Part of it was the fact that they had never done any optimization. I loved doing optimization at my previous organization. I love making life better for doctors and nurses, so they can go home at the end of the day and feel like, ‘Yes, I’m ready to do this again,’ and not just be wiped out and exhausted. So that was a lot of fun.

I also saw that they really didn’t have a strong governance process in place on the provider side. I saw an opportunity to be able to come in and make a difference, and that’s what I wanted to do. I want to make a difference in the healthcare system that I’m working for. I want to be effective. I want to be partners with other leaders in the C-suite who are interested in doing the same thing: advancing quality and reducing variation in care, and all of those opportunities existed here.

The other thing I liked is that Maryland has a unique payment system. It’s more of a capitated model. We don’t paid for heads in beds, where the more clicks of the MRI machine you get, the better off you are. That’s not the case in Maryland.

It’s an interesting challenge in how to reduce the cost of delivering care, because you really are financially incentivized the right way in this state. I don’t want people to come into the hospital if they don’t need to, because it’s expensive for us, and it’s not good for them.

Gamble: It’s really interesting. I’ve heard about Maryland’s model in past interviews, and it really would be nice to see that become a trend. But these things don’t seem to move as quickly as we’d like.

Weisman: I agree. I think financial incentive in our healthcare system is one of those things that really holds us back from moving successfully into value-based care and into population health. There are many things that I think interfere with our ability to do that, one of which is the investment in healthcare IT. To do it right requires a strong investment in some tools. But the financial incentives aren’t there, and so the ROI isn’t there. The CFO is thinking, ‘I’m really not terribly interested in the analytics platform you want us to buy, because the return on investment isn’t there. All we really need to do is get people to come into our hospital, so I need to be spending that money on marketing dollars.’

It really changes the dynamic being in Maryland where you need to do population health. It’s important. It’s a different environment. I really enjoyed being part of it. I think we’ll see more of that as health systems and payers start to align a little bit more. I’m not convinced this shared savings model is going to work, because it’s just not enough to incentive providers to be interested.

But that dynamic is changing. There’s a particular system I know of where the payer bought the health system, and now has an invested in a partnership to make sure patients stay healthy, because they’re a health plan. I think they’re going to do great things, and I’m excited to watch.

Part 2

Interview Sponsored by:

Related Posts:

Share Your Thoughts Cancel reply