CentraState Healthcare System is a private, not-for-profit health organization headquartered in Freehold, N.J. The system consists of the CentraState Medical Center, an acute-care medical center licensed for 271 beds; the Star and Barry Tobias Ambulatory Campus, a 171,000-square-foot outpatient center opened in late 2007; and t hree senior living communities. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to chat with CIO Neal Ganguly (also head of HIMSS New Jersey Chapter) about his accomplishments, challenges and goals.
AG: Tell me about your thoughts of HIMSS this year, any impression you had. Obviously, you mentioned you were just there for a couple of days.
NG: Overnight actually. I flew in very early Monday. So I was just down there for the night and spent the day, did some presentations at the Siemens booth on Monday, had some other meetings. And then Tuesday, I attended a bunch of CHIME focus groups in the morning and the lunch in the afternoon, and then I flew out. So I really didn’t get to enjoy even the show floor, which is typically what I like to do. I’m not big on the sessions. There is a lot of value in them, don’t get me wrong, but I send a lot of my people to those. I like to walk the show floor and kind of see where the trends are, what some of the vendors are starting to push to see if there are things that I think might be of value to our organization.
AG: I’ve spoken to some CIOs who say they hide their badges so they don’t get attacked. Do you do that?
NG: It depends. If there is a vendor I’d really like to talk then, of course, you kind of show the badge to get a little attention. But if you're just kind of surveying, it’s usually better — especially in the smaller booths, because they're just hungry. And you can get caught up in there for a good half hour sometimes if you don’t want to be rude. The floor has just gotten so large. I don’t know the exact number of vendors that are exhibiting now, but I’ve been going for the better part of the last eight or nine years, I guess, and it’s just gotten bigger and bigger and more difficult to navigate. You used to be able to do it in a day and now you need two days to do it.
AG: I’ve spoken to a number of CIOs who say the show is a bit too big for them now to really do quality networking, that they prefer the smaller CHIME events. Do you feel the same way?
NG: I do. I think the CHIME event is a much better networking event, particularly for CIOs. I think HIMSS still has great value for the rank and file. I think CIOs need to be kind of tied to HIMSS, and I’m glad that CHIME always has the spring forum just preceding HIMSS, so it gives you that opportunity to just kind of tag on a day to see some of your key business contacts. From a show perspective, in terms of the exhibit floor, CHIME doesn’t attract that kind of a presentation. It’s more networking.
AG: You just did a couple of days, and you think that’s pretty sufficient for your needs down there?
NG: No, this year really wasn’t. I needed to spend another day down there.
AG: So next time, you might do a little more time?
NG: Yeah, I think I will. I’ll probably try to spend two nights/three days and do a little bit better survey of the environment.
AG: Let’s talk about you a little bit and CentraState. Tell me when you took the job as CIO over there.
NG: August of 1999.
AG: Were you promoted internally, or did you come from another institution?
NG: I came from another place. It was a hospital slightly further north in New Jersey called Elizabeth General, which no longer exists. It’s now merged with a Catholic institution and became what's called Trinitas Health. So I left during that merger.
AG: How can you describe the work you’ve done, the things you’ve put into place? Tell me what you found when you arrived at Centra and where you've taken it today.
NG: CentraState is a very robust community hospital. My predecessor here had done a very nice job in putting an infrastructure of technology in place. So I found a comfortable operation that ran well. But what I also found was there were a lot of challenges in terms of meeting user expectations. The systems worked that were left in place; however, the users had a lot of issues with usability, efficiency of the system in terms of duplicate data entry, things of that nature, and also consistency. You could enter data in certain areas, and it would present where you wanted to see it, however, if you entered it somewhere else, it wouldn’t present. So there was sort of this concern on the clinical side, ‘Well how do I have confidence in that data?’ So those are the kind of things that really hit me as I first got here.
Our first step was to put together a little strategic plan looking out — and I tend not to look out much beyond three years. We call it the five year plan, but really years four and five are placeholders. Some of the things you think are going to be hot, you’ve got to put them on your radar, but you don’t develop a whole lot of need around them. The plan really kind of took us going through a gap analysis and saying hey, what are we missing here? And we looked at a bunch of the applications that we didn’t have in place and tried to understand what the value is that they would bring to the organization, but we also looked at the existing applications and said are we getting value from these? One of the things we kind of saw early on is that our clinical system, while functional, wasn’t really meeting our needs and certainly, as we aligned with the organizational strategic plan, we saw that it was unlikely to meet our needs for growth into the future. So we kind of started working with that vendor (Meditech) first as the incumbent vendor to say, ‘Look, these are our needs, can you help us address them?’ Meditech is still a vendor of ours for some things, but they had covered our full clinical environment, and we were looking more at the nursing and pharmacy level — what we call core clinicals, interaction between nursing and pharmacy for order entry and also the interface out to some of the ancillary systems, and then our medical records system.
As we worked with Meditech, we found that their corporate vision kind of wasn’t in line with ours. They're a good company, they’ve got a product that works well, but they have certain expectations of how it’s going to work, and if you're not really aligned with that, you're kind of out of luck. So we decided at that point to see what else is in the marketplace. And we went with an RFP for clinical systems and, in the end, selected Siemens with their Soarian product. That was kind of an interesting move for us as an organization and for me as a CIO, because we knew we were getting into very new territory here, and it was a product that was evolving. As any sales cycle goes, we didn’t realize how much evolution still needed to occur when we really signed the deal, but we’ve been lucky enough to ride that wave of evolution to the point today where we have a product that really is working well here and meeting our needs.
A couple of key things we kind of clued in on was this whole value proposition of workflow. Our CEO and our board were focused on two things in terms of the IT strategic plan; we called it the Ps (patient safety and productivity). So that was a mandate of ours that while we had to try to show value in whatever we were doing, those two key themes were paramount. Workflow, really as a concept, appealed to us tremendously. I don’t think we really understood how much complexity it entailed.
AG: When you use the word ‘workflow,’ what exactly are you talking about?
NG: It’s interesting because I’ve heard it from other vendors as well, and then when Siemens showed us what they meant by workflow, I think it’s different. To some people, workflow is: I’ve got a rules engine and when an if-then rule is triggered and I get an alert, that’s workflow, and then I have to do something about it. The real workflow engine has to take that further. It has to combine messaging services. It has to make sure you can escalate issues. It has to make sure that the system is bringing that alert to closure somehow. And I wasn’t seeing that from other vendors. With other systems, you're getting an alert, and now it’s your responsibility to do something about it and somebody can monitor whether you did or you didn’t, but that was kind of it.
What we found with Siemens was they had embedded a commercial workflow engine by a company called Tibco in their product. I had been involved in an association called AIIM. AIIM is heavily involved in the banking and insurance industries — the financial sector — and they have document management. That was my first exposure to workflow engines. It was very interesting to see this Tibco product embedded in there because you could actually build an entire process flow and model it and see how it worked and then measure the outcome. That was another thing that was a big problem for us as we began to look at what some of our needs were — how do we show the value? We don’t have the tools often to measure this stuff. So this workflow engine seemed to give us a good vehicle for this.
I distinguish workflow from process flow. To me, process flow is the actual physical process. What we had to do as an organization is sit down and look at our physical process first and understand where the points of variance are. And we found that even nursing unit to nursing unit, there was great variation in terms of how certain things were handled. And as we began to look at that as part of this implementation around building this process into the workflow engine, it helped to standardize process a lot. That brought inherently some value to the organization in terms of efficiency.
AG: When you use the term ‘process flow,’ you're thinking of the way someone does their job. Workflow, you associate with the rules built into an application?
NG: Workflow I associate with the rules and also — I’ll use the word ‘accountability.’ The system forces accountability and ensures that the rule and the alert that was generated from that rule are acted upon. So it brings it to closure as opposed to just saying, ‘Well hey, watch out, look for this. If you don’t look for this, I’m going to let somebody else know you didn’t look for this and then if that doesn’t still do it, then I’m going to do the following, and I’m going to keep watching.’ This goes for things like lab results that are to come in – to see if there is a positive impact to you acting on this.
