El Camino Hospital, a not-for-profit organization in Mountain View, Calif., is located on a 41-acre campus in Silicon Valley. Operating statistics show the hospital has almost 400 licensed beds, more than 2,200 employees and a medical staff of 830 physicians. The organization is also one of the first in the country to go live with computerized physician order entry. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with CIO Greg Walton about the current state of affairs at El Camino.
AG: You said something very interesting and, I think, very perceptive about that next mountain chain. One of the things we’ve observed is that the more advanced CIOs are moving beyond implementation into deeper usage. Is that what you would see as that second mountain chain?
GW: I would say that’s the first mountain on the second mountain chain. But to take the analogy further, I think Gartner has done a good job of describing the five stages of the electronic medical record. And to get to mentorship and those higher levels really requires a culture, because just because you have the transactions in place, doesn’t mean anything. And to get that culture, I believe there are certain components that you need.
First of all, you need strong physician leadership relative to IT. And if the CIO isn’t a doc, then he or she needs to have a doc ally, whether it’s reporting to them or as a colleague. That’s a requirement.
Secondly, you’ve got to have the reporting capability to generate the information necessary to give physicians and caregiver’s feedback about quality and performance. That’s not going to happen on many transaction systems that people are implementing today and so, when they get to the CPOE hill, they’re going to realize they don’t have the information to really affect behavior. What happens is when you’re in CPOE for a long time, you realize the absolutely startling complexity of automated care delivery. It is phenomenally complex and to get data that reflects how an individual’s team is doing, a service line is doing, a disease management team is handling something, that’s complex multi-dimensional reporting.
The transaction systems, I think, are going to be the weak link and I also think organizations have no experience with them, so that’s the whole next mountain chain to climb. I get the data, do I have a culture, do I have a program, do I have a leader, do I have the desire, all those things are the next wave that we’re going to experience, I’m going to guess, in the next two to 10 years.
AG: How can a CIO know the culture of their organization and the appetite for risk-taking projects like vendor co-development?
GW: How you know is over time. You spend a lot of time listening, you spend a lot of time walking around asking questions and listening and watching people in meetings and just paying attention, so you learn a culture, really, through attention. But then I think there’s also sub-sets of culture that you have to pay attention to; there is the board leadership CEO culture; there is a medical staff caregiver culture, and then there’s the IT culture. All of those have sub-sets and domains that are interlocking but also independent; and so getting that figured out is real important.
Then, as relates to innovation, I think that innovation and development are probably going to be achieved for survival in the next era of healthcare IT. I frankly think that a lot of organizations have gone out and bought the same system in the same market and I wonder what’s going to happen if they really have to compete over this next decade. Now, if there is a lot of government control, who cares? But if we have to survive on our wits, and deal with attracting customers and patients and keeping them, and building relationships with our partners and using technology, I would rather be the black sheep in a market than have the same tool that everybody else has.
Having said that, if I had the same tool that everybody else had, I’d sure want to be doing more things innovatively and doing things that only my organization can do, not just the guy down the street. I’ve always found it peculiar that the way some people think you survive in healthcare is to buy the same thing that everybody else bought. There are some early movers, but then there’s the dull middle and there’s a lot of people that are dull middle right now. I think they are going to wake up in a few year and, if we’re in a competitive market, find themselves in very interesting circumstances.
Now, on the other hand, if the government regulates all this, who cares? If you can solve the VA system, that will be the end of it. But we’ll see.
I’m inclined to think, in the IT business, it’s always back to the future. When I started in this business, there were a few people doing self development and there were a lot of people doing nothing. Then commercial off-the-shelf software started hitting the market with the likes of IBM, McDonald Douglas, Shared Medical Systems and, back then, HDOC. Well, a lot of technology’s changed, there’s a lot of bright people out there and I suspect that you’re going to see some places say, “Maybe us doing some things with the tools that we can buy in a market and marrying them with commercial software might make us more competitive,” and we’ll see what happens.
AG: Do you think the CIO has a duty to shape the culture of not only the IT department, but also the clinical department in terms of its attitude towards information systems?
GW: I think absolutely that’s one of the roles of a CIO — to objectively, in a balanced fashion, educate the organization about information technology. That’s where I think people bring agendas, I’d worry about that. I view myself as the senior technical advisor and leader to the board, my executive colleagues and the entire organization. What I want us to do is understand that there are no magic bullets but also understand that this technology is a powerful lever. Used properly, it can effectively improve patient care and quality and business outcomes. So I do think it’s an obligation and a key role, I think it’s a lot about education and openness and transparency, whether it’s sharing budgets, sharing reports, whatever it is, to help the organization grow. That’s why I said, no matter how good you are, no matter how advanced you are, the great news about healthcare IT is you can always get better, because I believe we will not see the end of the evolution of IT in healthcare in my lifetime. Somebody might see it, but I won’t.
