Dublin Methodist Hospital is a part of OhioHealth, a not-for-profit, charitable healthcare organization consisting of 15 hospitals and 20 health and surgery centers throughout a 46-county area. The new 94-bed hospital, which opened in January, can expand to 300 rooms if demand increases in its northwest corner of central Ohio. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to chat with CIO Michael Krouse.
AG: When did you start and what organization did you come from?
MK: I came from the Washington state neighborhood. There's a little system out there called Northwest Hospital and Medical Center. Prior to that, I ran the western half of the United States for First Consulting Group. I’m also the founder of a company called KH Consulting which I started before I came out here and took on this role. That company specialized in strategic planning and executive input services in terms of placement, not recruiting, but interim support for senior executive roles.
AG: Tell me a little bit about the size of Northwest Hospital where you came from?
MK: It’s a single hospital, 220-bed facility. When I joined, we were in active discussions with Swedish Health Services in Seattle, which is much bigger. I'm trying to remember how many beds Swedish is because they purchased Providence. When I joined, we were in this discussion about pulling all of these systems together. When I came onboard, I was the senior VP over administrative services. I had human resources, IT, medical records, position development and several other components, so not what you would term a traditional CIO role. My 12-plus years at First Consulting Group, I was working with all the major, large healthcare systems in the western half of the U.S. — the Catholic Health Initiatives, the CHWs, Adventis Health, the Stanfords, the UCLAs etc. That's where, in my role, I was leading them from an IT perspective, relative to what kind of investments should they be making and how to deploy them.
AG: As an outside consultant, were you able to see solutions that internal people couldn’t grasp because they were wrapped up in the day to day?
MK: I've been here since June of last year, and I guess to answer your question directly, it's always easier to see from the outside with a fresh set of eyes, so that you're not immediately imbedded in the cultural aspects of why certain things happen. You always have a fresh eye and a freshened ability to ask the question why do you do it this way. Additionally, I think one of the reasons the organization was interested in getting me onboard here is because I've got so much additional experience into other health systems across the country relative to the way that they do things. So to take Ohio Health to the next level, was to bring all of that experience to the table and challenge the status quo where it makes sense and run with it where it doesn't. That's the beauty of being the new set of eyes.
The difference is that once you're here, you've got to see it through. You're no longer playing the role of the consultant that says from on high, ‘These are the things you should do, and once you get these people to do that, I'll check back with you in six months.’ Now I'm also the resource that has to make that happen. Operationally speaking, I've been on both sides of that coin. I've been a consultant for many years, and I've been an operational person for many years. There are pros and cons to coming at it from different angles.
AG: Dublin is brand new. Were you involved from the blueprint stage?
MK: It’s a multiyear project. Any time you're bringing something up like Dublin from the ground up, it's probably been, certainly from an IT perspective, nearly a two year planning exercise. I would say that they were in the throes of building some of the core applications that we utilize in our other facilities.
At my arrival, what we were really interested in doing was aggressively introducing some of the newer components of technology. Those newer components included the bar code scanning technology in terms of the way we were going to deploy the single sign-on fingerprint scanning technology. It was state board of pharmacy approved. The idea was to push the electronic medical record in the right way so you've got a completely wireless communication infrastructure. Those are the pieces that I really jumped into in my arrival to ensure that the way in which we were kind of going about those pieces — all those new things, because they're brand spanking new to Ohio Health — were really critically well done. There was a fair amount of foundation work that had already been done. And in terms of inheriting the caretaker aspects, all the core applications and things like that had been built, that's absolutely all I did.
AG: Was there someone in the CIO role who had put those things into place? Who had done that work?
MK: There was an individual by the name of Bill Winnenberg who had been in this role prior to my arrival in Ohio Health for quite a number of years. When I came onboard, I made the decision to make Bill a part of my permanent team and to continue with an active role in overseeing the Dublin project effort. He had started the ball rolling, along with Cheryl Herbert, who is the CEO of Dublin, and together they were already getting teams moving on building the core infrastructure necessary to make this happen.
AG: That gentleman then became part of your staff?
MK: Correct.
AG: Can you tell me about how you came about the position; were you recruited?
MK: I was recruited.
AG: So it was just the right time, the right challenge for you?
MK: Yes. There were several things that weighed for me. (1) Any time you've got an organization that is putting money into brick and mortar, it represents a great opportunity to introduce technology at the front end of the curve, rather than trying to retrofit existing processes. That’s very appealing to me. (2) Relative to the maturity of Ohio Health as a system, it's still relatively young. (3) Financially, it was very strong, doing very well, receiving all types of accolades as one of the best place to work. The three of those things, and the cultural readiness to take their next step into the next realm of the provision of patient care, were really the things that drew me into the organization.
AG: It sounds like a CIO’s dream job — to start at the very beginning. Would you describe it that way?
MK: I would absolutely describe it that way. That was clearly one of the very attractive qualities of the role and the opportunity that presented itself, in addition to the other things that I mentioned. In essence, it gives you a proof think tank and an opportunity to test out everything that you say that you want to do in building a truly paperless environment; not a pseudo paperless environment, not an environment where people claim that they are paperless and yet you can still find medical charts floating around, not an environment that talks about physician mobility and yet you see desktops all over the place. The opportunity to get in and say, ‘We're really using notebooks, we really are relying upon the wireless backbone, we really are introducing communication vehicles that allow, at the push of a button, people to talk to each other regardless of where they are; to locate the person in the physical plant.’ We are introducing ICU units with mobility on wheels.
We are involved with the introduction of mobile interpretive services. The fact that we’re building a hospital in an area that has a large Japanese population is a good example. Dublin is located close to where Honda has its corporate headquarters, the fact that we can get immediate access to an interpreter, rather than calling for one and having them show up an hour later, is a big deal.
These are all great opportunities to really deploy IT. Also to get on in the front end of the curve as it relates to some of the regulatory requirements that are coming down the pike. The State Board of Pharmacy is a classic among them. This idea of positive identification for meds administration is something that other states will have to address.
We happen to be one of four in the country, from a state perspective, that are requiring specific aspects of positive ID for those that administer medication, order and administer. We got over that hump with the technology of our single sign-on or biometrics scanner, but we had to do it in a way that would work along with the State Board of Pharmacy to meet their stringent requirements for positive ID, because there are all kinds of biometric readers out there. Some of it reads the surface of the skin, others read other things, and we had to pick one and work with one that actually functioned and met those requirements. Not only were we successful at doing it, but we deployed it.
That was one of those things that I said right from day one that I wanted to deploy when I came onboard. That wasn't originally part of the plan. But by doing that, what we were able to do is get over two hurdles. (1) To avoid a multiple password environment that most people operate within healthcare, and (2) to aggressively meet the State Board of Pharmacy positive identification requirements that allows me then to go out and do provider order entry from a number of different locations; whether that's there at the hospital, whether they're at home and they're accessing the mobile ICU unit and saying I want to place an order, I can support that environment now from a process flow on the part of the physicians, without introducing overly complex solutions, without trying to do workarounds, or jury rigs relative to the way that the physician practices. Absolutely attractive, I mean very, very much a key reason to wanting to come here.
AG: You mentioned being paperless. I've heard some prominent CIOs on occasion talk about how they want to get rid of paper where it makes sense, and they were reluctant to make being paperless the goal. What are your thoughts there?
MK: Well I think there is always going to be some aspect of paper, at least probably for the near term. By that, I mean patients are going to be presenting with paper. They're going to come to us with some record of some sort. Many of them in today's environment still need to have a document, something they can hang onto for discharge instructions because their home environment may not be as electronic as we would like it to be. I think, at least in the near term, I think there is going to be room for paper simply because the private practice arena is still very slow to adopt kind of the electronic medical records.
Depending upon the numbers you see, anywhere from 15-20 percent adoption in the ambulatory EMR. That's 80 percent that aren't quite there yet, meaning they're generating a fair amount of paper, and when the patient then presents to us as a hospital facility, they're bringing that paper with them. Now for us, we scan that into the document, and the reason that we do that, to make it digital, is so that we can move it around. What we don't want to rely upon is key private practice information being a part of the medical chart, and not being able to get that to the hands of the providers within the hospital environment, but rather relying upon somebody picking it up and dropping it off somewhere. For us, it's really important to provide better patient care by automating that information because by digitizing it, you can move it. And you can move it readily and you can have multiple people gain access to it simultaneously.
On the discharge side, I think we're probably going to continue to generate some discharge instructions, but you will not see at Dublin anything even remotely resembling a chart. They simply don't exist any longer. They're all electronic.
AG: The Pebble Project, do you want to touch on that at all?
MK: It really centers around the idea of aesthetics and patient family and environment and light and all of the concepts that have been written about over the years to elevate, not only the patient experience, but the speed in which they recover. So the hospital itself was designed around this pebble concept that if you were to move into the hospital, you wouldn't see harsh corners, everything is kind of rounded. Water is a theme that is kind of woven throughout the physical facility. Sunlight — every room has natural sunlight in terms of the patient care rooms. The facility is designed for the ease of family to move in and out of the facility. It's a very quiet facility, and we have adopted things like Vocera, they provide little badges that hang around people's necks and that's the way that they communicate with each other. There are no big overhead pages and codes and things going off that can disrupt the patient’s experience or be more harsh to them as an environment. That really is in the essence of the Pebble Project. All of those design aspects; certainly were taken into account from day one.
AG: Any other IT-related elements that were part of that overall attempt to make it a comfortable environment?
MK: Certainly the mobility is key and cornerstone to being able to support the Pebble environment. And when I say that, I’m saying everything has got to run off a wireless environment. You've got to have the ability to put into the hands of the clinician a mobile device that can be utilized to chart care, can be utilized to administer meds, can be done in a way that's not necessarily intrusive into the experience of the patient. In the middle of the night — prior to Dublin — we used to have devices that were handheld devices, but one would do a mobile phlebotomy or blood test, one would do vitals, and another one would do I/Os (inputs and outputs). We were able to combine that into a single device so that one individual could go in and take a blood test, do a vital, possibly scan or deliver a med without having to pop in and out of the room with various devices, which is intrusive, particularly in the middle of the night when a patient is trying to get some sleep.
AG: Did you work with a vendor to create that device?
MK: We worked with McKesson to consolidate all of those applications onto a single device.
AG: And is that commercially available, or is that just for you?
MK: We were the first in the country, at least according to McKesson, to combine all three applications onto a single device.
AG: Do you know what it's called?
MK: It's just a little handheld reader. Symbol handheld is the name. One of the endpoints, in terms of the environment, that Pebble played directly into is the idea that we've got easy online access for things. For example, the ICU is stressful to our patient population when they've got to sit and wait for something to happen. It's also stressful to our patient population when they've got to repeat themselves, whether that be registration information, whether it be health plan coverage, whatever it may be, it makes no difference. Part of the Pebble experience is to make it as easy on the patient and their families in receiving the care that they require. Again, part of the reason you want to be paperless, part of the reason you want to be wireless, part of the reason you want to be able to move that information into the hands of any caregiver is to show the patient that everybody in the hospital knew everything they needed to know about them.
This is a classic example. We don’t have a registration area at Dublin. You physically walk into the building, you are greeted by a Wal-Mart-esque kind of greeter who takes you up to a kiosk and checks you in and routes you where you need to go from that point. All of those aspects were built into the Pebble project.
AG: Would you say you were a partner in developing the three-in-one handheld you mentioned?
