Rick Lang is a firm believer that no CIO can provide all the leadership needed throughout an IT organization. During his decades of experience — including 16 years with Doylestown Health — he has learned that delegating and empowering individuals to “act as direct representatives” is absolutely critical to the success of an organization. If leaders can do that, while providing support and removing roadblocks, they can “get through any crisis.”
His theory was certainly put to the test in 2020 when Doylestown — an independent health system based outside of Philadelphia — was hit not only with the Covid-19 pandemic, but also a tornado. Fortunately, Lang’s team rose to the challenge, working around the clock to provide the support clinicians need to care for patients, and creating a new partnership to keep that data safe.
It hasn’t been easy, by any stretch. But thanks to the solid foundation Doylestown’s IT has created, and the culture that has been cultivated over the years, it was possible. Recently, Kate Gamble, Managing Editor of healthsystemCIO, spoke with Lang about how his team has faced the challenges of the past two years; how they ensure physicians are heavily involved in decision-making; the dramatic shifts the CIO role has seen, and what it takes to lead through difficult times.
- Creating a structure in which the CIO reports to the CMO – especially one who “championed CPOE and electronic health records” – helped build buy-in and move the implementation process forward.
- For Doylestown, the benefits of being a beta site for Meditech 6.0 C/S “outweighed the trials and tribulations,” particularly because it meant having onsite support to resolve issues quickly.
- Rather than relying on a standard help desk, Lang’s team implemented a “CPOE helpline” that has been a huge satisfier. “This way, they don’t have to wait for help.”
- One component that can’t be neglected is the importance of effective change management. “Nobody’s going to be totally happy with every system you have, but we work hard to make it the best we can for the docs.”
Q&A with Doylestown Health CIO Rick Lang, Part 1
Gamble: You started with Doylestown in 2006. Can you talk about what was happening in terms of IT adoption?
Lang: To give you some background, when I first came here, I was reporting to the chief medical officer — I had never had that type of relationship before. That was part of what enticed me to come here.
In my previous leadership positions, I had been trying to push CPOE to the front, but I could never get anybody to take it on because there’s a big ownership piece with the medical staff. And so, I thought having an opportunity to report to the CMO — who, in this case, was enamored with technology — could be a great thing, and it was. Our CMO, Scott Levy, MD, championed CPOE and electronic health records, and we were able to move things along really quickly.
Gamble: That’s an unusual reporting structure.
Lang: It is, but it was needed. When we talk about CPOE and electronic health records, this isn’t more geek food for the pocket-protector set — doctors need to buy into this. We’ve all heard stories of implementations gone wrong, where doctors walked off or went on strike because the organization tried to bring up a system too fast and they didn’t consider workflow issues.
And so, we did it in phases. We started with our hospitalists, then we brought on our cardiologists, and a year later, the emergency department. Once we got the ED up it really took off.
Gamble: How soon did the selection process start after you arrived?
Lang: Day one. When I got here, we started talking about the EMR right away. We had been using Meditech Magic, and after looking at all the products available to us at that time, we decided on the Meditech 6.0 Client/Server product. It was a brand-new product for them — only one other hospital had it.
We felt it took us to the next level of value in terms of price point, but it was tough. It was a true beta site for us. We took a big risk, but it ended up being very successful because we were able to bring up CPOE and electronic medication administration within 18 months of going live with Meditech 6.0. It was a very trying time, but the benefits outweighed the trials and tribulations.
Being a beta site
Gamble: It was, as you said, a big risk to select a new product. What was the mindset there? Was it difficult to sell others on that concept?
Lang: There were a few things. Meditech was already in place for years before I got here, and so the data conversion was a lot smoother. We also had great support from Meditech. Because they were trying to roll this out to their client base, we knew we were going to have a big team onsite, and we did, which is one of the biggest reasons we were successful.
We expected there would be unbaked code — that’s the risk you take. But the development was smooth, and it didn’t take long because Meditech had so many resources here; all of the bugs and issues were dealt with right away. That’s what happens when you’re a beta site.
Most importantly, the physicians liked it — they still do. And in fact, we’re getting ready to move to Meditech Expanse. We’re not first this time around; there are about 600 installs. But it’s an improvement, and our doctors are really excited about the new features and the slick web-based interface.
Gamble: What about user satisfaction — what have you done to address that?
Lang: Our chief medical officer, Dr. Levy, is heavily involved with IT decisions, and we have a group of physicians that sits on every one of our IT committees, and so we constantly get feedback from that. We’re in tune with that. Our people are on the floors all the time with the docs, so they have a lot of input.
Our physician informaticist — Mary Ellen Pelletier, MD — is an active hospitalist. She has used the system day in and day out and can tell us what she does and doesn’t like. Dr. Pelletier gathers the teams together, gets their input, and filters it back to us.
“There’s no vacuum here.”
But we also get input on our own. There’s no vacuum here; we’re listening all the time. We have a special CPOE line that physicians and ordering clinicians can call so that they don’t have to go through the standard help desk. They call the CPOE line when there’s an issue and our team is able to respond 24/7. Even if we’re at home, we can access their screen remotely and assist them. This way, they don’t have to wait for help. We’ve always felt that good service, flexibility, customization, and doing everything we can do to help physicians and make it easier for them will be a winner every time. And it has been.
Gamble: How did the idea for the helpline come about?
Lang: When I first got here, the helpdesk was mostly used for calls for lab or radiology results, but everything else was on paper. When we brought up CPOE, we knew that would fail without real-time support. If a physician called the service desk and was put in a holding queue, that wouldn’t work. We had hired several RNs on our Meditech development team and our clinical teams, and we knew we had to respond immediately to them, or they wouldn’t support what we were trying to do.
“We want to respond immediately”
When we first launch any initiative, we’re on the floor. When a new physician or member of the medical staff comes on board, they go through a whole extensive training and onboarding process. And so, when they have an issue, we want to respond to them immediately. When they call that number — which we have to change, from time to time — someone answers. It doesn’t matter if it’s dinner time or 10 p.m. or 2 a.m., they get an answer.
Making it “the best we can”
Lang: Right. Nobody’s going to be totally happy with every system you have, but we work hard to make it the best we can for the docs. We had some resistors at first, but they’ve been won over. When we go to the next version of Expanse they’ll probably say, ‘I like it the way it is,’ even though it will be better. Change is not easy for a lot of the docs; we understand that.
Not getting caught up in buzzwords
Gamble: Sure. Let’s talk about digital transformation. I read a piece where you said something along the lines of, ‘isn’t this what we’ve been doing for the past 50 years?’ and I thought that was interesting.
Lang: It’s funny. Those of us who’ve been doing this awhile get a laugh when a marketing person comes up with new terminology to remarket and repurpose an existing process. One example I like to use is Agile. We’ll say, isn’t that just project management?’ I don’t want to oversimplify it because I know there’s more to it than that, but to me, it’s about processes getting better and more refined. And so when I first heard the term digital transformation I thought, ‘that’s what we’ve been doing.’
I always go back to Moore’s law and Metcalfe’s law. I teach a graduate health informatics course at Delaware Valley University; it’s mostly clinical people with no IT background. I tell them Moore’s law has run its course because we just cannot double the speed of a CPU every 18 months anymore, but Metcalfe’s law has taken off because for every node you add to the network, the value increases exponentially – and the miniaturization of components has taken Metcalfe to a new level.
Think back to when fax machines were first invented. No one wanted to buy one at first — what good would it do? You have to be able to fax to somebody else. But then the deli down the street got one, and I could fax in my lunch order. And then the lawyer’s office got one, and the doctor’s office. Pretty soon everyone had one and you couldn’t exist without it. That’s what’s happening today with technology.