Dana Moore is the SVP & CIO at Centura Health. Frank Myeroff, President of Direct Consulting Associates, recently had the opportunity to sit down and speak with this leading industry executive. During the interview, Mr. Moore discussed Centura’s recent switch from Meditech to Epic, overcoming EMR implementation challenges, and his perspective on the current state of the healthcare IT industry.
Please tell us a little bit about yourself.
I have an accounting degree and spent most of my career in the financial and revenue cycle areas of healthcare. I joined Centura as an interim CIO in 2004 and became an employee in 2005. I am married with two college age children. Centura is a JOA with two sponsors. Catholic Health Initiatives and Adventist Health System formed the JOA in 1996. We now have 15 hospitals, several hundred employed physicians, home health and senior living facilities. We are a $2.8 billion ministry.
What is the biggest challenge on your plate currently with switching from Meditech to Epic?
Straddling two worlds. We are in the process of attesting for MU2, adding a new hospital to our MEDITECH platform and planning for Epic. Like everyone, we are also tasked with being good stewards of our resources so that adds another challenge to the mix. We also have affiliated hospitals and physicians asking for IT support and that adds to our workload.
What are the biggest pitfalls organizations fall into regarding their EMR implementations?
Lack of adequate resources and lack of testing. We have been fortunate to build a great IT team and a great base of informatics, physicians and other users to help design the software build, workflow, clinical content, and decision support. Everyone understands their role and supports each other. We also test, test, and then retest. You cannot afford to make a mistake on the clinical side or the revenue cycle side. All of us have read about the recent implementations that have had challenges. There is a common theme that users did not have ownership in the process and testing was rushed.
In your recent interview with HIStalk, you spoke about where you think the Meaningful Use program will end up. To that end, what policies/regulations need to be put in place, if any, to make the program successful?
The fact that only a handful of hospitals have successfully attested for stage 2 shows the challenges the program is facing. For us, when we started, there were 4 physicians in Colorado with a Direct address. We have been working with CORHIO and using our own staff to get physicians signed up. Of course, since the timelines for physicians and hospitals are not in sync, most physicians had no idea what a Direct address was and why they needed it. Then we had issues with CORHIO and MEDITECH getting the technology to work. While I applaud challenging goals, the program will fail if the goal is not achievable and everyone throws their hands in the air and drops out.
Thus far in your career, what do you feel is your greatest accomplishment?
Finding great people and getting out of the way. There is no accomplishment I can legitimately point to and say I did that. Everything that is accomplished here is a team effort. I might have an idea but it takes all of us to move it from idea to inception.
What are the most important characteristics an HIT leader needs to be successful?
1) A sense of humor; 2) A strong sense of self; 3) Amnesia – the person you are calling an idiot today will be the champion you need tomorrow; 4) Ability to inspire others; 5) A strong understanding of the organization’s finances; 6) A zealot for the patient.
You have taken an unconventional path to becoming a CIO. What steps in your career helped shape the leader you’ve become today the most?
Watching good leaders and trying to model their behavior and watching bad leaders and trying to remove any common characteristics. I am blessed with a pretty good memory and the ability to read very fast. Therefore, I can read a lot of material and retain it. I also have been blessed to spend a lot of time at different health systems (from my consulting years) and have seen a lot of what works and what does not work.
Scott Leddy, MD is the Chief Medical Information Officer at Wake Forest Baptist Medical Center in North Carolina. Dr. Leddy was kind enough to answer questions about himself and the direction of healthcare for John Yurkschatt, Recruitment Manager of Direct Consulting Associates.
Scott, Please tell us a little bit about yourself.
I’m someone who has always held a fascination with technology and biology. I think at its core it’s an obsession with complex systems. When I was a kid I easily grew bored at family dinners and would sneak away into an office that had an Apple II computer. I wanted desperately to play games on it and taught myself to program, hoping I could build my own. Later in life I discovered nature’s programming language embedded in our DNA, which culminated in my eventually practicing medicine. I maintained my passion for technology however, so when EHR’s hit the scene, this serendipity led me to the role of CMIO.
How did you decide to move from being a practicing Physician into technology?
The hospital system I was working in as an emergency room physician back in 2001 began its journey to adopt Epic, and I started off simply attending a few advisory meetings to help steer the project. I was deeply critical of what was first offered, and so my administration wisely redirected my energy into deriving solutions to the problems I saw. As my efforts in this vein became successful, I found myself spending less and less time in my clinical practice and more time refining our EHR platform. Part time became half time, and within a few years I wound up being the organization’s first CMIO.
What fascinating projects are you currently working on?
I try and cultivate a few sideline projects at all times that aim to push the envelope of what we can accomplish by applying technology to healthcare — the very fun part of the work. A longstanding interest has been the application of Real Time Location Sensing (RTLS) in a care environment. I’m fascinated by what you can determine simply by knowing that a given piece of equipment is next to a given patient or caregiver in a certain location, and the opportunities for process improvement and automation that result.
We’re working on a host of RTLS applications presently at Wake Forest Baptist Health, from simple things like biomedical equipment management to far more complex ones like optimized patient flow. I see it as a great investment for our organization. Once the sensing infrastructure is in place it’s simply a matter of adding inexpensive tags and thoughtful logic to produce creative solutions to everything from hand hygiene monitoring to staff and patient safety.
I’m also passionate about how we create and improve EHR governance and demand management models. I’m always looking for better ways to empower end users with a sense of control over the technology they use daily at a personal level while balancing the strategic objectives of the organization. It’s an example of what I love about working in healthcare technology. It really is still in its infancy, with so much ground yet to be covered and mastered. After more than a decade in the field I’m still learning new things every day, appreciating new approaches and strategies. It’s challenging – it keeps you on your toes.
As the CMIO, how are you moving Wake Forest Baptist Medical Center toward Meaningful Use and ICD-10?
While the adoption of both ICD-10 and Meaningful Use are huge initiatives for any organization, I don’t believe their implementation varies significantly from the core strategies needed for any other aspect of successful EHR adoption. Our team strives to understand the technology we have to address the challenge, its strengths and weaknesses. We tailor the EHR build accordingly and then test to ensure that the paradigms and tools we’ve constructed match the needs of our users as closely as possible. Once we’re confident that we’ve done a good job with the technology at hand, it’s then a matter of ensuring we effectively train our users for the changes about to impact their world, from the concepts inherent to these initiatives to the details of how they will impact their day-to-day work. My team and I also strive to give our users a voice in the process, a sense of control, so they feel involved instead of imposed upon. Like any significant change we deal with, it’s not really about technology, it’s about people. It’s about good change management.
What are the biggest pitfalls organizations fall into regarding their Epic implementations?
I believe Epic offers a host of strengths as an EHR platform – it’s extremely comprehensive and connected, and offers a surprising array of possible customization from the enterprise level right down to the end user. These strengths can act as a double-edged sword, however, as they also mean that Epic is extremely complex. I think it can be tempting for organizations new to the platform to overextend the scope of their initial implementation. This can create a system that presents challenges for users to learn and adopt quickly. It can also create a build that could have benefitted from a little more experience on the part of both their implementation team and users, resulting in a need for significant optimization.
The other pitfall I’ve seen as a recurring theme in any EHR implementation, not only Epic, is succumbing to the inclination that this is an IT project. While technology certainly plays a central role in an Epic rollout, as I mentioned this is really all about people and how they work from day to day. Leadership has to be fully involved and working hard to ensure that people from every corner of the organization have a level of involvement and ownership in the effort. Failing to do so too often results in the EHR feeling like something that was imposed on everyone by IT, instead of a great new set of tools that, once learned, will provide a better way of getting things done. A good implementation creates the latter.
What is the biggest obstacle to broader clinical adoption?
There are a host of factors that challenge broad clinical adoption of EHR’s. One of the most challenging is the very complexity of healthcare delivery itself; the enormous amount of science and ever-changing knowledge needed to deliver good care; the vast amount of data we collect on every patient we treat; the dizzying array of methodologies and varied processes that are used to deliver care. These add up to produce a huge challenge for creating and adopting technology that helps providers make sense of all the information and variability they’re forced to deal with, especially in a way that remains affordable for even the smallest organizations.
The other extremely significant challenge I see is the ever-rising tide of regulatory and payer-induced expectations for adherence to prescribed process and data collection. I think for many providers this creates a sense that they’re being distracted from delivering care to meet the needs of coders, researchers and lawmakers. And since these expectations so often manifest in the EHR as a need to enter this extra bit of data here, make a few extra clicks there, it’s easy for them to start to resent the technology as simply a tool for advancing the agendas of those once removed from front line care delivery. Right now I think it’s a path of least resistance to place these expectations squarely on physicians and nurses, who are already stretched very thin to have the time it takes to deliver quality care.
You’ve worked in a variety of segments across healthcare; how has this affected your perspective on healthcare and the industry?
It’s given me a great appreciation for the enormous complexity of delivering quality care. There are so many competing perspectives and needs that have to be balanced and satisfied that it can overwhelm you at times. I’ve learned that to drive progress you have to be methodical, deliberate and patient. You have to strive for the incremental successes and let them add up. For so many of the challenges healthcare faces, in particular healthcare IT, there simply aren’t easy answers.
In some ways I see healthcare as the victim of its own success. We’ve really done amazing things in the past century to reduce human suffering and extend lifespan. But the cost, both in dollars and effort, has been enormous and only continues to grow. As an industry we need to learn how to turn these accomplishments into being readily reproducible and affordable. More than ever I believe technology is vital to our success in this endeavor.
What is the biggest challenge on your plate currently?
Demand management. Wake Forest has come a long way in a relatively short time in this regard. Still, finding the appropriate thresholds and balance for responding to patient safety concerns, optimization requests and strategic initiatives remains a delicate dance between corporate culture, organizational goals, user engagement and capacity. It remains the most artful aspect of the business.
Thus far in your career, what do you feel is your greatest accomplishment?
There have been a host of quality projects for which I’ve been able to help leverage the Epic platform in a pivotal way. I particularly remember working with one group on improving door to lytic times for stroke patients, which resulted in dramatic improvements in a very short time. We were able to pilot it in a single institution and then quickly replicate the process across the entire organization, to the benefit of hundreds of patients and their families still to this day. It was this work that really made me a believer in the benefits of an integrated EHR. It’s where it became patently clear that this technology could be enormously impactful to the outcomes of our patients.
Do you have a mentor or mentors that helped contribute to your success?
There have been so many great, bright people I’ve had the privilege to work with over the years, too many to mention here. A few that particularly stand out include Andrew Mellon and Ferdinand Velasco, two great informaticists who I was lucky to learn from. Elliot Trotter is another – an ER colleague from Texas who has been a real pioneer in the use of scribes with an EHR. I owe a debt of gratitude to them all.
Richard Paula, MD, Chief Medical Informatics Officer and Vice President at Tampa General Hospital is interviewed by Andrew Tipton, Project Manager, Direct Consulting Associates.
Tell me about yourself:
I began my career in informatics while practicing emergency medicine. The ED is a fast moving place; with so many moving parts, emergency medicine was one of the first specialties to recognize the need for accurate data. While I was the Associate Medical Director we implemented an ED specific EMR, which allowed us to change our way of thinking. We suddenly had access to a treasure of data, which allowed us to address obvious areas we needed to improve. I quickly developed interest and talent for using data to improve our metrics. When the CMIO position was created as part of our decision to implement Epic hospital-wide, it was a matter of being in the right place at the right time.
What has made you personally successful in your healthcare career?
Keeping a well fed sense of humor. Healthcare is full of brilliant individuals working long hours at difficult, often life-saving tasks. Throw on the everyday burden of compliance with ubiquitous regulatory issues, and it obviously becomes extremely stressful. My colleagues, who have suffered professionally, often lacked effective methods to defuse the deleterious effects of that stress. I spent my formative years in medicine working at large, urban emergency departments in the South; there was more than enough suffering and death than I care to remember. I always strived to maintain my sense of humor, to laugh, to try to keep my spirit up, as well as that of my patients. This has helped me immensely in my transition to healthcare IT. Our big-bang go live was the largest, most engrossing project ever experienced by most of my colleagues inside IT, and without laughter and humor it would have been much more rough.
What is the biggest challenge you had in recruiting talent?
The healthcare IT labor market has certainly been difficult to navigate. We suffer from recruiting from within a relatively small pool of talent, as well as competing with large scale projects, which are well-funded and attract skilled individuals from all over the country. We experienced significant attrition immediately after our implementation for our Epic trained staff. Salaries offered by industry firms were impossible to match. When you are offered life changing money, I can agree the decision to leave is attractive.
According to Healthcare IT News, there’s a healthcare IT talent shortage looming. Are you forecasting a growing shortage in 2013? If so, what measures are you taking to remedy this?
This may be the case, but we have actually experienced an increase in applications for many of our posted positions. The large bolus of EMR implementations subsequent to the HI-TECH act has subsided, and many individuals are gravitating back toward more stable full-time positions. The one area where we do predict a shortage is in data analytics and business intelligence. The surge of data streaming from connected systems, both clinical and non-clinical has created the need for individuals who understand how to manipulate and present data to help healthcare enterprises improve operations.
What is your philosophy and/or methods with regards to retaining top talent?
As an organization we have invested in a talent screening tool, which has been used successfully across the country at other hospital systems. There have been excellent results screening potential employees to demonstrate when there isn’t a good fit, prior to making the decision to hire someone. After someone is hired, we realize the need to create a sense of team; we have cookouts, bowling nights, etc. We have also created an ITAG (IT advocacy group) who discuss everything from parking, to which paintings to hang in the hallways.
Individually, I like to let my employees know we share high expectations. We set goals and give individuals the freedom to use their drive and creativity to meet them. Micromanaging kills professional relationships. I always try to value personal relationships; make a point to know personal details about your team, their hopes, goals, children and mean it.
What technical skills do you see as “hot” or in-demand in the marketplace right now?
Anyone who knows how to fetch, manipulate, organize, and present data. Business intelligence is coming to healthcare, we have volumes of data coming at fire hydrant speed from our EMRs, our PACs systems, and we are just figuring out how to use it to our advantage.
What is the most important characteristic an HIT leader needs to have to be successful?
I gave a talk at a graduation a few years ago and was asked a similar question. Leadership traits are not specific to industry or career.
Enthusiasm – Wake up and be determined to get things done. Steven Pressfield wrote a book called “Do The Work” which I highly recommend. Set goals and work toward them with energy and determination.
Resolve – Do not let minor setbacks and defeats become obstacles. It is easy to allow yourself to become emotionally tied to what has gone wrong and prevent yourself from moving forward.
Humor – As I mentioned earlier, most situations can be viewed from different perspectives. I tend to find a perspective which makes me smile or laugh. After a bad day, find something to make you laugh and it will help you get back on track.
What are the biggest pitfalls organizations fall into regarding their EMR implementations?
Wow, this answer could take 500 pages. I will give you my top three: First, understand the financial implications of turning on a new billing system. Every day there is another story about a hospital system finding themselves facing large a financial deficit due to an EMR implementation. CIOs get fired, employees are laid off, and this can be disastrous. Second, do not underestimate the amount of work it will take to create a robust data reporting structure. From governance to the physical creation of valid reports will take thousands of hours. Reporting capability is often oversold by vendors, and it’s not until you try to turn them on do you discover the problem. Third, provider engagement, physicians, nurses, therapists, everyone taking care of patients need to be involved during the implementation.
How do you built a client’s trust?
Trust is built around results. Set realistic goals, explain the rationale behind the decision making in setting those goals and be transparent when there is difficulty. Trust isn’t lost by mistakes, or missing goals, it is lost by hiding mistakes and disguising the real reasons for projects gone wrong.
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To contact Andrew Tipton:
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