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One-on-One With New Hanover Regional Medical Center SVP & CIO Avery Cloud, Part II

October 19, 2009
by Anthony Guerra
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In this part of our interview, Cloud says without a sound infrastructure, collapse is a matter of time.

Southeastern North Carolina-based New Hanover Regional Medical Center is the ninth largest healthcare system in the state with a dedicated team of 4,400 employees, 565 physicians and 800 active volunteers. Recently HCI Editor-in-Chief Anthony Guerra had a chance to chat with CIO Avery Cloud about just how HITECH is effecting his plans.

(Part I)

GUERRA: Most CIOs probably understand they have to check all a vendor’s products by going “under the hood,” not relying on the assumption that everything is integrated; but do you think IT directors at small hospitals are aware of that need also?

CLOUD: Yes, I think it’s largely driven by background. The CIO has a hard job because you have to be a business person, and then you have to be a technologist at the same time and, as you know, those two things don’t exist well in the same body quite often. I would say, probably the majority of CIOs know that, understand what you’re talking about, but unfortunately there are a lot that don’t. And especially in smaller shops, the temptation is to take the vendor’s word for everything because it’s simply less trouble, especially if you’re short-staffed and you don’t have professionals on your team to guide you in this regard. CIOs have to recruit well because they can’t know it all, and if they don’t have trusted advisors on their team who understand software and understand the vendor’s business, who understand development and all of that stuff, they can certainly get caught flatfooted and accept a lie.

GUERRA: It sounds like it can be critical to bring in some consultants who can help you make these decisions.

CLOUD: You got it. You either have to have consultants or some talented employees.

GUERRA: Otherwise, you could make a big mistake.

CLOUD: You could make a huge mistake. And I’ve certainly seen it during my 30-some years in this business.

GUERRA: Tell me about what you’re doing with Compuware.

CLOUD: To me, the story isn’t necessarily about Compuware; it’s in the problem, because I suspect it’s being faced largely by CIOs across the country.

Anyway, I took this post and quickly discovered that the appetite for automation was insatiable and a lot had been achieved. So we were essentially victims of our own success. I’m very, very pleased to be part of an organization that understands the value of information-based automation to improve the quality of healthcare and the efficiency of our operations. I don’t have to provide that level of education here, but I’ve had to do that in the past.

But that boon also had a bane, and the bane was our ability to keep up with demand. We were moving quickly toward full EMR automation, CPOE progress notes, electronically controlled meds administration – all of that required an IT infrastructure that was as solid as a rock. And ours was not. It required service levels that were high and ours were not. So to put it bluntly, I felt that this IT organization was going to be crushed under the weight of future demand.

So, what we had to do was figure out how to prepare this organization for what I saw coming. So I collaborated with my CEO. He understood the challenge, and we basically called a moratorium on new implementations. That doesn’t mean we didn’t do any, but rather that we did very few for a year. Our agreement was we would spend a year fixing IT and so, as we explored what methodologies we could employ, we knew that implementation of a strong service-management model was important.

But I am one that does not believe in talking industry jargon and wooing and wowing people with acronyms; I knew I had to make the whole service-management concept mean something. We translated it to our organization by saying that for one year, we are going to concentrate on four S’s: Stabilizing, Systems, Services, and their Satisfaction. We coined this term “Project S.”

What we did was determined what automation tools might be required to stabilize all of those things I talked about. I believe in integration for IT systems just like I believe in integration for clinical systems. We sought to determine how we could automate the workflow of IT, with as few tools as possible, for information to flow seamlessly from one mode to the next.

I’ll give you an example of that. I coined this term called the “Metamorphosis of IT Management Information.” A call comes in and is recorded on a call-tracking system. Data is moved to a ticketing system. The ticketing system data is moved to a project. The project produces the need to track time, to track status. So then you have a status reporting system: the project management system, a change control system.

And so what we were looking for was something where the data moves within the same system and it changes states without requiring a change of systems. That’s what led us to the (Compuware) Changepoint/Vantage combination.

The other thing we needed was something to monitor the environment so we could have a predictive environment. What was killing me was that the way we found out things were broken or underperforming was through a call from a customer. That’s not the way to find out. And so, that’s where Vantage came in. So Changepoint really dealt with the internal operations of IS. It allowed us to automate our workflows, and Vantage gave us a strong monitoring environment that integrated with Changepoint, The data could flow between the two.