KG: Memorial University is a stage six hospital, correct?

PL: Yes. We achieved Stage Six of the EMR Staging Model in 2007.

KG: Would you characterize Memorial University as a fairly cutting edge organization?

PL: I would, yes. We have a lot of work to do as far as house-wide deployment, but we are cutting edge. Our leadership has been very supportive. We still have the challenges of adoption and other hurdles like everyone else, but if I can get a pilot group willing to test new technology, I can usually get the support of leadership to do that.

KG: That's extremely important, I'm sure. When you talk about leadership, are you referring primarily to the other C-suite level executives, or physician or IT leaders?

PL: I would say the C-suite and clinician leaders. And I have to tell you, the clinician leaders are the easiest ones. They're usually ready to try anything that will help them deliver better patient care. It helps quite a bit having that kind of environment.

KG: As far as your information systems, are you involved in any major projects or upgrades right now?

KG: What was the impetus for moving the critical systems to remote hosting?

PL: The initial reason for even investigating that was just capital funding avoidance. The organization has been in a significant financial turnaround for the last two years. At the beginning of our financial decline, we had intended to build a new data center; we had actually spent a year designing it, and then we hit the financial crisis, we had to look for other alternatives. So that's what drove us to look at it. But I have to tell you, as we started investigating other alternatives and we decided to partner with McKesson on remote hosting, it's really become a long-term strategy. I don't know if, in the long run, it will reduce our costs, but at this point, it certainly is cost neutral, or close to that. It assures us a level of system availability and reliability that we probably would not have funded ourselves. And if I look at just the situation that we're in today, we don't yet have the level of system availability and reliability that we will have under this agreement. And it will be maintained for us, and that's the challenge we've always had. The initial capital investment is usually pretty easy to sell - it's those major upgrades and uplifts to the environment that are more difficult to get through a capital process. So we no longer have to fight that battle.

KG: That's really interesting. We've been talking to quite a few organizations about how the current economic downturn is impacting the moves they make, and a few CIOs have stressed the importance of focusing on long-term results, and not finding a quick fix.

PL: You bring up a good point with the economy. As we talk about our budgets for the year, we're looking at how to plan if the economy continues to go south. We've got a plan and a budget for 2009, but we really haven't incorporated a significant shift in our payer mix; for example, if there is a significant rise in the unemployment rate, which we anticipate there will be. And so, what is our contingency plan, how are we going to reduce our expenses to be able to respond to that. Well, in an environment where you're highly automated like hospitals are, the first thing to go will be hardware upgrades and infrastructure for the data center. Those are the first things that get cut off the list; I no longer have to be concerned about that.

So I'm maintaining, still, a state-of-the-art environment in California at McKesson's data center. It's funny, the decision really came as a desperate move, but it's becoming more strategic as we work through it. We think that's going to be very good for us. I think that really has become a way to work in this financially stressed environment.

KG: Have you had a positive response from the patients as far as using personal records?

PL: We have; our patients have been very receptive to it. We've all been kind of surprised at the number of patients that are setting up personal health records. We have participated in employer health fairs and been able to sign up employees on site. They love it.

KG: It seems that with personal health records, the key is how the information is shared by various caregivers and systems.

PL: Right, and in this particular case, the product that we use connects them to their physicians' practice, so when they set up a personal health record, not only can they populate their health information that we can see, but they can also interact with the practice. Prescription information that is available in RxHub will populate automatically. We are not sending any clinical data to the PHR yet. They can request appointments, ask billing questions, do a follow-up on a test result question, etc. I don't think we have any physicians responding at this time, but the nurses are. One of our employed physicians is my PCP, and when I send a message to the practice, I'm actually talking directly with her nurse.

It's really nice and convenient. I'll usually send a message at night when I'm at home, so when I get home from work the next day, I have a response. Obviously you wouldn't handle any high-priority issues that way, but just for routine communication, it's a lot easier than me spending an hour during the day trying to get through on the phone. For me, I'll always think to call the doctor at lunch time, but they're closed at lunch. This way, when I think of it, I can just send an e-mail.

We've been very happy with the product we're using from Relay Health. It's an easy implementation.

KG: That's the same provider you're using for e-prescribing.

PL: It is. And that's really a temporary measure until we get our EMR deployed enterprise-wide on the ambulatory side.

KG: And the EMR is McKesson as well?

PL: Yes. We're pretty much a McKesson shop. The majority of our applications are McKesson. Each time we buy a new system, we look at the market place, but we also consider integration as a highly-weighted feature of the system. But we do look compare McKesson to the market in most cases. We did this for our EMR and determined that McKesson was the best fit for our environment, which really has to do with our in-patient environment and the integration we want to achieve.

KG: I want to switch gears a bit and talk about professional development. You're involved with several societies such as HIMSS and CHIME. In what ways has this benefitted you?

PL: I think that for one thing, it helps me stay educated and current on HIT issues. That is one of the greatest challenges of my job. There is so much information - so much reading material, so many conferences, it's almost overwhelming. I have a basket stacked with magazines, including Healthcare Informatics, and they're magazines I really would like to read and would benefit from reading, but it's a big stack. Being out there, I get exposed to other organizations, so I get real experience, and there are educational opportunities. I feel like it just keeps me in the mix; I can get so isolated in my hospital, in my town and just really not be learning.

The other thing is the interaction with the leadership and the board - it adds credibility when you can tell them what other organizations are doing. I think that when I have a sense of who else is doing what I am proposing, I can give them a general idea and then if they want more information, I now have the contacts through these organizations to go get it. Understanding what like health systems strategies are builds credibility into the strategic decision making process and it helps them to make decisions with me. I think that in some cases, it helps to drive my strategic plan when I can tell leadership what others are doing. It also increases my credibility.

KG: That's an interesting perspective. I can understand that if you're referring to similar organizations that are adopting technologies and having success on that front, it can really help your case.

PL: It does. And they really like to hear that; they want to know who's doing what. I'm also very involved in Georgia's healthcare IT initiatives. I serve as the Board Chair for the Georgia Health Information Technology and Transparency Advisory Board. For me, having that commitment helps to keep the meetings on my schedule and ensure that my attendance is a priority on my schedule. I'm the kind of person that if I want to know about something, I just get involved.

KG: Last summer I spoke with Rich Correll, the president of CHIME, and he couldn't stress enough how valuable it is for CIOs to stay educated on legislative matters. As the new administration takes over, I think it will be even more important to be aware of what's going on.

PL: Absolutely. I think we need to stay out front and prepare as best we can. There's obviously a lot of things that we just don't know about, but even that information - of what we don't know about - can be helpful in planning as we can build in contingencies in the areas that are unknown. We had a discussion here recently about whether we delay our EMR, and part of that discussion had to do with legislative matters and reimbursement potential for physician practices using EMR and how that impacts us financially and can we afford to be behind in that. Those are all the discussions that we have to keep in mind when we're planning; we can't just isolate our decision-making to our organization anymore.