Alleviating a patient’s pain is central to the mission of healthcare. Yet, while a wide range of remedies exist to counteract physical pain, there is no simple prescription to address the many “pain points” experienced by healthcare systems’ CIOs. Amid a rapidly changing healthcare environment, these leaders are charged with developing and executing IT strategies that enhance the effectiveness and efficiency of their organizations while staying within tight budgetary constraints.
By Scott Westcott, Contributing Writer
From outdated technology to changing culture, three healthcare CIOs share their thoughts on the daily struggles they are facing and how they are overcoming them.
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Alleviating a patient’s pain is central to the mission of healthcare. Yet, while a wide range of remedies exist to counteract physical pain, there is no simple prescription to address the many “pain points” experienced by healthcare systems’ CIOs. Amid a rapidly changing healthcare environment, these leaders are charged with developing and executing IT strategies that enhance the effectiveness and efficiency of their organizations while staying within tight budgetary constraints.
Ever-increasing complexities in the healthcare industry have made diagnosing and addressing CIOs’ challenges all the more difficult. The ACA has created fundamental changes to providers’ reimbursement structure, and Meaningful Use and HIPAA requirements create growing resource and financial demands on IT. Those factors, along with cybersecurity concerns and fast-changing economic dynamics, have made the CIO’s job more challenging and more critical to the success of a healthcare organization.
As a result, effective CIOs need to balance their technical expertise with strategic and leadership skills to drive change and innovation.
“The biggest challenge is juggling so many different projects that are underway at the same time throughout a healthcare organization,” says Gary Barnes, CIO of Medical Center Hospital in Odessa, TX. “Many organizations tend to still be so siloed, but our role as CIOs is to look across the organization as a whole to make sure we are not duplicating efforts and are leveraging efficiencies in the best ways possible.”
Barnes, along with Money S. Atwal, CFO/CIO at Hawaii Health Systems Corporation (HHSC) — East HI Region in Hilo, HI and Keith Robison, CIO at WCA Hospital in Jamestown, NY, shared some of the issues that keep them up at night — and the solutions and approaches they are implementing to address these challenges.
Struggling To Survive In An Often Hostile Environment
Connecting IT Investments To Patient Care — Ultimately, healthcare providers are all about administering optimal care to patients. Yet many of the back-office investments and operations can seem far removed from the front lines where doctors and nurses are caring for patients. CIOs advocating investments in technology face the challenge of effectively making that key connection as a means to get buy-in and support from C-suite decisions-makers and staff alike.
“Being both CFO and CIO for an organization forces the CIO to be aware of the financial challenges for our region,” says Atwal, who carries both titles at Hawaii Health Systems. “Obviously, being financially challenged further requires the CIO to justify a return on technology investments. Thus, one of the biggest pain points we have is correlating certain technology improvements to direct patient care. Many vendors have a difficult time doing that, and the burden falls on the CIO to communicate and sell that to the c-suite executives.”
Culture Change — It’s one thing to propose and implement new systems and technology and an entirely different challenge to get staff, physicians, and others to embrace those changes. “We have to alter the culture to a point where change is accepted quicker and those affected understand the need and benefits of it,” Barnes says. “It comes down to constant communication to make sure everyone understands why we need to do things differently.”
Medical Center Hospital has established “e2 Empowering Excellence,” an initiative designed to help navigate change. As part of that effort, the hospital enlisted the help of the Studer Group, a firm that helps healthcare organizations with the change management process to “create an aligned culture that is accountable to achieving outcomes together.” Meanwhile, the hospital has also contracted the Virginia Mason Institute to advise on a lean initiative aimed at creating greater efficiencies and better process alignment.
“Studer is focused on the cultural side, and Virginia Mason is about improving processes and streamlining the organization,” Barnes says. “Together it makes for a powerful approach that allows us to implement the needed changes in the most effective ways possible.”
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Doing More With Less — The phrase “doing more with less” is common among CIOs. In healthcare, this concept is put into action in any number of ways, including managing dwindling reimbursements that strain revenue streams and decrease profitability.
For Robison, the reimbursement challenge is compounded by the unique financial pressures a community hospital faces. “The situation with reimbursements makes it more difficult for hospitals to make investments in technology and infrastructure and makes things more challenging for IT,” Robison says. “Purchasing a new IT system is a huge investment for a small hospital these days. There just isn’t the cash on hand needed to make a significant purchase of new technology.”
Operating in a rural healthcare region, Hawaii Health Systems is also challenged by the reimbursements associated with its payer mix.
“The payer mix for our region is approximately 75 percent Medicare, Medicaid, and Managed Care, resulting in those patients’ costs not being fully reimbursed,” Atwal says. “Furthermore, being a safety-net hospital, we are required to take every patient regardless of their ability to pay. Due to those economic circumstances, our region is required to do more with less.”
Atwal says the hospital is continuously looking to optimize and leverage technology for increased efficiencies without negatively impacting patient care. They are also proactive in pushing for change to the reimbursement formula for rural areas and an equitable payer mix.
“We continue to lobby the Hawaii legislature to re-balance reimbursement formulas to account for the 75 percent Medicare/Medicaid population,” Atwal says.
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Robison agrees legislation is a key part of any solution addressing what he views as an unfair burden on smaller, rural hospitals when it comes to reimbursements. “It seems when the formulas are established they are looking at larger organizations that have significant resources and capabilities,” Robison says. “Smaller community hospitals and the challenges they face are not as visible to them.”
Upgrading Outdated Technology — Despite reimbursement challenges, there remains a clear and pressing need to update and enhance technology. Each of the CIOs interviewed is currently involved in overseeing significant system upgrades with projects in varying stages of development.
At WCA, Robison is focused on phasing out a DOS-based ERP system purchased and installed in the 1980s. The system is severely limiting and impacts cost and operational efficiency. For instance, the materials management team is not capable of electronic transactions and has to rely on paper processes. Meanwhile, human resources is working with a dated system “that lacks the bells and whistles of a newer HR system that could benefit the recruiting process.”
While the hospital has gotten by with upgrades and customized fixes to address issues, the system is now at the point where it needs to be replaced. WCA is in the vendor selection process for a new integrated ERP system it hopes will offer considerable capabilities and efficiencies; however, cost and financing remain a major consideration.
“We are working to come up with innovative ways to make the financing work,” Robison says. “Specifically, we are looking at a subscription-based approach. Having the capital up front to purchase a system is not a viable option, so we are alerting vendors that we need a subscription model implementation.”
The focus at Medical Center Hospital is on replacing the enterprise EMR accounting system. “We are a McKesson shop, and we’re losing support on the product we are using, so we need an integrated system for inpatient and outpatient,” Barnes says.
Barnes went on to say different departments throughout the organization have, through necessity, taken a “best of breed” approach — customizing and upgrading technology as needed at the expense of enterprise-wide consistency and integration. “The bottom line is we need a system that is integrated across the entire organization to create better efficiencies and benefit productivity,” Barnes says.
Like most other hospitals, Hawaii Health Systems is dealing with the many challenges presented by October’s ICD-10 transition. Consistent with the goal of preparing for the transition, the IT focus is on upgrading its current MEDITECH EHR to the next generation platform, as well as administrating other tech enhancement projects.
The hospital is also integrating its existing KRONOS Timekeeper with KRONOS Scheduler to leverage realtime acuity with nurse scheduling. Another key initiative is working with BridgeHead Software, a health data management company, and MEDITECH to install a view-only EMR tool which will allow staff, clinicians, and physicians to view the patient’s information during a downtime or upgrade.
Doing What Is Needed To Overcome
The pains expressed by these three are echoed by many in the healthcare industry. So what is being done to address them? Our panel of CIOs pointed to process change as an essential way to help drive the IT enhancements that are necessary.
Working Together For Solutions — At Hawaii Health Systems, internal resources have been developed and subject matter experts have been asked to assist in implementing new technologies with immediate ROI. Supporting that effort is a weekly review meeting called iORF (Interoperability Review Forum), which consists of key business managers and EHR analysts working together to identify new opportunities while discussing challenges.
All areas of the healthcare system are represented, including nursing, pharmacy, radiology, ancillary, and revenue cycle departments. Optimization of workflows as well as EMRsystem optimization is a primary focus.
“We also use iORF, in conjunction with our Medical Informatics Committee and executive staff approvals, to help prioritize any new project requests,” Atwal says.
At Medical Center Hospital, Barnes says they have focused on developing a more strategic and integrated approach to identify and address pain points. “We wanted to make sure we have a governance model that looks across the organization as a whole to make sure we’re not duplicating efforts,” Barnes says.
From a logistical standpoint, that meant blending the capital equipment committee with the IT steering committee. The combined group now meets regularly and reviews ongoing and planned projects and focuses on developing and executing an integrated technology strategy.
Initially, the approach proved frustrating as the group faced tough decisions regarding prioritization of projects. However, over time, it has allowed for a more consistent and efficient focus.
“When you get all the right people looking at the right things for the right reason it makes a significant difference,” Barnes says. “It supports our organizational goal not to duplicate or overlap services and make sure technology is well-integrated.”
Case in point — a 3D mammography machine that did not go through the steering committee ended up consuming an inordinate amount of system disk space. “Those are the types of issues we now have a better chance of identifying up front and heading off before they become problems,” says Barnes.
Creating Consistency — For Robison, solutions at WCS have focused on technology workarounds that help prolong the life expectancy of current systems while they work toward implementing new technology. “We try to utilize a single vendor approach as much as we can which can lead to more integrated and efficient purchasing,” Robison says. “From a technology standpoint, we roll out new EHR apps consistently across the organization. For example, the pharmacy group and the clinical group are experiencing the changes in concert.”
Relying On Data — Pain point solutions are easier to identify — and garner greater visibility and buy-in — when they are supported by solid data. Atwal emphasizes that analytical reporting has become essential to sustain daily operations in healthcare and to make the case for improvements.
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“Analytics helps management compare historical data with real-time data to make key business decisions,” Atwal says. “But having key IT resources dedicated to analytical reporting remains challenging due to constantly changing healthcare requirements and limited availability of resources.”
Playing Through The Pain
The old saying goes, “No pain, no gain.” Clearly, combining healthcare’s increasing complexity with rapidly advancing technology, CIOs everywhere will continue to have to deal with major challenges and a wide range of pain points. Yet, as these three CIOs emphasize, challenges can be overcome by refining processes, creating new efficiencies, and remaining focused on better collaboration and communication. As Atwal points out, planning and preparation pay off when it comes to running an efficient and effective healthcare organization.
“We believe and have proven that spending a significant portion of the project management cycle on planning a project yields major benefits,” Atwal says. “My understanding from speaking with other CIOs is that successful implementations remain a major challenge in their organizations. We believe the key to a successful implementation is having a strong understanding of your business processes and challenges, as well as aligning the organization with the right business partners.”
Doing More With Less — The phrase “doing more with less” is common among CIOs. In healthcare, this concept is put into action in any number of ways, including managing dwindling reimbursements that strain revenue streams and decrease profitability.
Robison agrees legislation is a key part of any solution addressing what he views as an unfair burden on smaller, rural hospitals when it comes to reimbursements. “It seems when the formulas are established they are looking at larger organizations that have significant resources and capabilities,” Robison says. “Smaller community hospitals and the challenges they face are not as visible to them.”
“Analytics helps management compare historical data with real-time data to make key business decisions,” Atwal says. “But having key IT resources dedicated to analytical reporting remains challenging due to constantly changing healthcare requirements and limited availability of resources.”
