Part I
AG: What exactly are you using Eclipsys for right now? You said you are working on a CPOE project, so you're not using Eclipsys for that currently?
KM: We’re using their order entry at a department level. We use them for results review, department order entry. We are testing a handful of forms for nursing documentation, and we will do full-blown nursing documentation in the fall. It’s actually an extension of the project from last year. We’re calling it a Phase 1B. We will go paperless with nursing documentation probably in September.
We’re also doing emergency room electronic forward tracking, and we’ll do medical device interfaces in the ICU, as well.
As far as CPOE goes, we’re a community-based hospital. We don’t employ any physicians. Right now, we really are doing more of the groundwork, and we’re gaining value from lessons learned by other organizations, and we’re trying to work on getting physician buy-in to technology just to begin with. To get there, we’re using the portal as a stepping stone, making sure that we can even get them to use the computer, and then move to standardization efforts. Some of those ground-building things before we launch into CPOE will increase our chances of success.
AG: Do you have any plans to take advantage of the Stark relaxations?
KM: We’re just having discussions about it, but we haven’t made any decision. We have two large IPOs that work with us, and they already have investments into ambulatory care products. The rest of the physician population is made up of small physician offices, and we’re discussing it. We hope to do something, but we really don’t know.
AG: Do you think that hospitals will inevitably have to integrate electronically with their local physician offices?
KM: I think if you look at care holistically, you almost have to. You have to have the vision that to truly treat a patient, we have to be able to share data across the care continuum. This includes long-term care and into the patient’s home. I don’t know when it’s going happen, but I think that if we want it to work, that has to be the endpoint.
I’m pleased to see that the government is supporting removing the financial burden from the physicians, and I think it’s a starting point. I think that there are also other ways that you can achieve some communication. We have outbound interfaces today from our transcription system into our major physician practices, with the big ones out here in California with 200 docs. We’re already sending outbound discharge summaries and populating their records, and that we didn’t need any Stark help on. I think there are other ways of achieving, making little steps towards it too.
AG: What is your annual IT budget?
KM: I can tell you that it’s 3 percent of the total hospital budget — 3-3.5 in line with the industry standard.
AG: Do you feel that’s enough for you to accomplish your goals?
KM: I can get done the projects that I have on my plan. Projects get added. I think if we take projects off of budget and out of planning, it will become difficult. I don’t have extra staff — we don’t have a lot of wiggle room.
AG: What’s the process of getting monies budgeted beyond that 3 percent if you have some specific, large-scale initiative you want to do?
KM: I make sure that all IT incentives are linked to the hospital strategic plan in some fashion. In that way, they sell themselves. If the hospital’s mission statement is providing high quality healing services for the patient as a whole person, and I want money for a disaster recovery project, some type of security, then we can get it. My latest thing is I’m really reevaluating all our HIPAA policies, but it all ties back to the patient. They will support it within reason. Obviously, I’m not going to ask for 10 projects and $10 million, but everything is strategically driven. I think then that speaks for itself.
AG: What is your staff size in IT?
KM: We have about 32 right now. We’re pretty lean actually. I tell people that and they're surprised because we are a 450-bed facility.
AG: If you had it your way, what would that number change to? What do you think is the perfect number?
KM: That’s an interesting question. I would prefer to have more staff that has a cross coverage. I think one of my risk areas is always knowledge. Who has the knowledge, and the danger if you lose that resource. So I would like to have additional resources so that I have more cross coverage on applications in case something did happen and you lose a staff member. That being said, if I wanted to cross cover more applications, I think I would need at least another five to seven people.
AG: Speaking of staffing, what about governance? Are you structured for success?
KM: The governing structure here is that all major IT decisions are approved by an IT steering committee, which is a cross section of executives and some department directors. That committee does report up to the board as appropriate. The IT department itself organizationally reports through finance. I report to the CFO. For me, that works very well. The reason being is initially when I came into the organization within the last two years, I really needed to understand the funding. So to be aligned that way it made the most sense and it’s worked out really well.
AG: In a perfect world, would CIOs report to the CFO or CEO?
KM: My answer is going to be that it depends on the organization. When I worked with consulting organizations, I found that every organization is different. The people who fill those positions in every organization are different. You can get a CFO that’s extremely strategic. Just because there is a traditional model for a CFO having fiscal responsibility, it does not mean that they aren’t IT savvy or understand the strategic objectives of the organization. So I say that a CIO should align themselves with whomever in the organization will support the IT mission the best for them.
At this point in time, because the CFO here is so strategic and incredibly IT savvy, and because of her fiscal responsibilities, it’s really helped our department a lot. The executive team here too is always all very approachable, so I don’t need to report to the CEO to have strategic initiatives, because the way our organization works, it’s very open and communicative. But I would think maybe in another environment, like academics or something, that it’s totally a different model. We’re a faith-based community hospital, and that’s what works here.
AG: What is the most difficult part of your job? What's the hardest part of managing this particular job?
KM: I would say on a day-to-day basis, my biggest challenge is recruitment and retention of qualified staff. It’s a very competitive market in California, and I’m considered LA county. The cost of living out here is very high, and for me to even recruit from other states, it’s just hard when people come and they interview and they see what it costs to live here. The amount of people, the resources I’m able to pull from are limited, and the investment that it takes to have people learn the applications that you have is quite significant.
I find it hard to find staff who know the applications that I have in my hospital — someone who knows Quadramed and Eclipsys. We have a strong belief here in education and training. We invest in it heavily, and then I retain that staff. We spend a lot of time on employee successes and satisfaction and job fulfillment and advancement, and then we try to use that too as a recruitment tool, just because it takes so long to get someone up to speed. Things are always changing and people want to experience different things, so always keeping people challenged and fulfilled, it takes a lot of work. That’s the personnel piece.
AG: What is it you think about your style, your approach that makes you able to retain staff?
KM: I really think that a lot of my clinical training allows me to have good communication skills to help people feel like I understand their needs. I personally have always believed in education and advancement. I fund that. I think that they believe I truly have the staff’s interest at heart and the hospital’s, because most of the time when people come in and they will have a question about what to do or a project, or how should I handle this, I always try to say what’s the best thing for the hospital; we’re really all here for the hospital. I think that they appreciate that approach — I always bring it back to why are we here.
