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One-on-One With Norwalk Hospital CIO Jamie Mooney, Part I

December 7, 2008
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In this part of our interview, Mooney talks about how the “go/no go” decision on projects has a new tone.

Founded in 1892, Norwalk Hospital is a 328-bed not-for-profit community hospital located in Fairfield County Conn. The organization serves a population of more than 250,000 residents with approximately 2,000 employees, 500 affiliated physicians and 600 dedicated volunteers. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with CIO Jamie Mooney about her efforts to empower clinicians with information management tools.

AG: When I saw you at the CHIME conference, you asked a question about dealing with the economic crisis. Why don’t you start out by telling me how the economic crisis is impacting you and what you're hearing from the CEO and Board?

JM: First of all, where we are in Fairfield County (Conn.), which is suburban New York City, we actually have a double hit. I think I said this to you when we were out at CHIME, but Wall Street IS our Main Street. So not only do we have the macroeconomic issues around not having access to capital and everything else that’s going on in the large market, a lot of our customers (our patients) are Wall Street people who have lost their jobs, are losing healthcare. So we’re impacted in two different ways. And that’s just something to think about.

What we have been told is basically if it’s not started, we’re not doing it. We reformulated our capital committee to have more broad representation from the vice presidents across the hospitals, because we are really making go/no go decisions on fairly important things. And we've shrunk our capital budget by about 80 percent. Things are being approved either because there is a patient care issue, potentially, or because something is broken and must be fixed, or there is a high risk of short-term failure. Those are the types of things we’re looking at right now.

So all the things that we were hoping to do, nice to do, Phase II of something — those we’re being asked to wait. You can do the math, but I walked into a meeting with a $4 million request and I got $250,000 approved. And I was asked, “Jamie, what do you need to keep yourself in compliance or things from breaking?” So that’s basically where we are.

Now I’ve already had a couple of contingency things approved, but it’s been a very rigorous process. We have to come forward with business plans. It’s not like they were throwing capital at us before this, mind you, but there is certainly a lot more rigor in terms of the process. And we’re all looking at what's best for the patient, everything is focused on the patient, what's the most important for the patient right now.

AG: You must be making some very difficult choices.

JM: I’ll just give you a great example. We are a very electronic hospital. We have an EMR, we have computerized physician order entry, we have bar-coded medication administration, we have SmartPumps … we have a lot of great technology that we’re using around patient care. But one piece that’s missing, for instance, is nursing documentation. We’re kind of the inverse of most hospitals which will start with something like nursing clinical documentation and then go to these other more advanced technologies. The way things have happened here, we've got a lot of the advanced technologies, but we need nursing documentation.

We have taken the stance that we’re going to put that off for 6-8 months, whatever it takes, because although it’s very important in terms of patient care, we think our patients are very safe with all these other systems we've put in, and this is an additional measure, but it’s not impacting the patient care at the moment. Would it enhance patient care? Would it make our clinicians more efficient? Absolutely. But that we’re going to put off.

Yesterday, we got approved to upgrade our hardware behind our telemonitoring equipment, because the servers are old, the technology is old, so now if one server goes down, it takes half of our telemonitoring monitors down. That’s much more of a patient care issue. Not to mention we want to move telemonitoring from being in the middle of the nursing station to being in a room where the nurses can sit uninterrupted, almost like a control room, which is really the standard of care at the moment.

But just in terms of how we evaluate things, there is more of an immediate patient safety need with the risk of telemonitoring going down than there is with not having online or nursing documentation fully rolled it out. That’s the kind of thought process that’s going on at the moment.

AG: Do you find that you’ve had to be the face of negative news to clinicians in terms of, “I know you wanted that, I wanted to get you that, but it’s not going to happen.” Have you had to have those tough discussions with some of your top clinicians and how has that gone?