Greenwich Hospital is a 174-bed community hospital serving residents in Fairfield County, Connecticut, and West Chester County, New York. A member of the Yale New Haven Health System, Greenwich is a teaching hospital that is affiliated with the Yale University School of Medicine. In 2009, the hospital was awarded Stage 6 EMR designation by HIMSS Analytics. Recently, HCI Associate Managing Editor Kate Gamble spoke with CIO Jimmy Weeks about the importance of establishing solid relationships with other C-suite executives, the benefits of rolling out wireless in newer buildings, and the value of social media.

KG: What is the relationship between you and Mark Anderson, CIO at Yale New Haven? Are you in contact fairly often?

JW: Mark and I have been talking even before the affiliation was inked (in 1998). My thought was, if we're going to be going down this road, I'd rather know who my peer is up there and talk about where we think things are going, sooner rather than later. So Mark and I actually reached out to each other and had lunch about 10 years ago. And we meet pretty often. Some days we'll talk on the phone two or three times. I have a solid line to the CFO and the CEO, and I have a dotted line to him. Whatever he needs, I provide him with, and vice versa. He's very supportive.

KG: So establishing that relationship right off the bat has definitely had its benefits?

JW: I think so. There are always opportunities to find out what worked for one person and what didn't, and what challenges we can both learn from. So we have formal meetings every two weeks, and that's not including any specific project meetings.

Not a day goes by where we don't talk or e-mail, and that's because there's so much going on. For a while, the focus at Greenwich was on making sure we have our EMR up and running, and on expanding our network. We've been on a tear for the last 10 years - we built an entire new facility. But now the focus, especially with the changes brought on by HITECH, is on things like health information exchanges. Who are we going to collaborate with? Are we going to go in with eHealth Connecticut or are we going to do our own thing, and which physician offices are we going to speak to first? There are just huge challenges right now. And it's for the betterment of the patient, but still, these are technical and resource challenges.

And the most value resource of all is the staff. You can buy the best system out there, you can buy the best infrastructure and you can have the funding, but if you don't have people that are seasoned professionals who know healthcare and IT and can put the two together, you're just going to flounder. Because the vendors, at least the ones we've worked with, are also lean right now and don't have much depth.

KG: How much has Greenwich been impacted by the economy? Have you had to put plans on the backburner?

JW: The hospital has gone through some downsizing, but it's been mostly through attrition, and mostly in areas other than IT. But we did recently lose all three LIS people (to organizations located closer to their homes). We've found that recruiting and retaining people is really tough, especially in an area like Greenwich. Even though the real estate market took a beating, this town is still hugely expensive to live in, so most of the staff commutes from further out.

And it's hard because the hours are long. Even when you go home, the nature of this facility is that people have dinner and logging in from home. We recently came on board with CPOE, so we have two or three of the nurses going online to see if the orders are okay, if the clinicians are having any issues, and if they are in fact logging on and using it. And they all do it in their off-time. I don't have expectations that they do it; they're just an amazing team.

KG: The building you're now in is fairly new. How much of an advantage has that been in terms of being able to roll out wireless technologies?

JW: The old building had issues with energy efficiency and brickwork that needed help and constant maintenance. With the new building, my team was lucky enough to be brought to the table with the architects and the electrical engineers to design a brand new infrastructure. We put in Category 6E and 10-Gigabit fiber solutions and decent-sized IDF (Intermediate Distribution Frame) closets, brand new Cisco switches, and a brand new wireless network (from Cisco). We had the opportunity that many of my peers didn't have.

We have about 300 wireless devices, and that includes everything from wireless computers on wheels and laptops to SpectraLink wireless phones and Vocera badges. We'll be adding between 250 and 280 wireless IV pumps shortly. The idea is, first we'll get them up on wireless so they can be managed by biomed and pharmacy, and then our goal is to integrate the IV pumps with the Meditech system so that the start and stop times flow over and the orders are verified. Our goal - and the vendor warns us that we'll be an early adopter - will be to integrate that so the nurse or the IV technician doesn't have to document everything manually.

KG: Is that typical of your organization, to be an early adopter?

JW: It is. When we started this back in the late '80s and early '90s, we actually partnered with a company called JRS that was using our nurses to build a clinical documentation system. So we had bedside computers in our south wing back then. And then when our current CEO came on board, he saw that it was all best-of-breed. Pharmacy had its system, lab had its system. He was actually in a meeting where the vendors were arguing with each other and blaming each other for the fact that the interfaces weren't working. So he excused them, kept us in the room - at that time I was director of telecomm - and just said, ‘I'm done. We're a small, community hospital; we're not Columbia Presbyterian or Yale New Haven where we have huge needs. Go out and find something that does 80 percent of what we need. Find one system that has install-base in Connecticut, that has a good track record, and I'm done with this. All of these guys can go away.’

And in 1993, we signed a deal with Meditech. First, we implemented the financials and got off the mainframe - we were on iBacks at the time - and we then began to implement clinicals. So we began the trek down the road to clinical documentation online, and we migrated from JRS over to Meditech. It's been a good ride to where we are now, and now we're actually looking at whether we should upgrade to 6.0.

KG: So all in all, you've had a positive experience with Meditech?

JW: We have. The cost savings alone is big. I don't pay near what others are paying for their HIS systems. They're not exactly the greatest marketers, but we're getting a deliverable, affordable and integrated product. I've had many conversations with my peers at HIMSS about the horror shows they've gone through, and I don't have that.

KG: How has your involvement with HIMSS and CHIME benefited you as a CIO?

JW: It's a huge learning experience. I take advantage of the focus groups (at HIMSS) to hear stories of what people did that worked, what didn't work, how they recruit, things like that. Everything that you do in your daily job, you learn from those folks. Everything from what wire management did they use in their IDF closets to what are they doing for business continuity. I find that HIMSS could be a month long and it wouldn't be enough for me. The same goes for CHIME; they have great speakers sitting at the table with peers during lunch or the networking sessions. I always come away learning something.

KG: And I know you're big on social media, especially Twitter. How has that impacted your role?

JW: Well it's funny, but I wouldn't have gotten into Twitter if it wasn't for the little booth they had at HIMSS where they were showing people how to use it. And I only started that recently. That's pretty embarrassing; an early adopter of everything else and it took me that long to do social networking.

But what's amazing to me is the power it has. People are so passionate about bringing this forward for the betterment of safe and quality care, and not for the betterment of just buying more technology. It's exciting. Sometimes it's too consuming, because if you try to look at every single Tweet and follow the links, you'll be there forever. But it's just one more example of being able to share stories of what works and what doesn't. I think that's very powerful if people take advantage of it; they'll make fewer mistakes and just cut to the quick and do it the way that's most successful instead of trying things they're own way.

KG: I think at first, a lot of people dismissed it as another flash in the pan, but now we're seeing that it really has some legs.

JW: It does. And we've all had memberships on user lists, where people put out things like, ‘I'm looking for a new bar code printer for arm bands.’ You got responses on occasion, and that still will have a place, but with Twitter, it's just a broader audience where you can throw out anything from restaurant recommendations in Chicago to the best way to implement disaster recovery in a certain situation. If you put something out there, you'll get responses from peers, who'll say, ‘We did this and I'd never do it again,’ or ‘We did this and it worked out great.’ It's just one more resource. And with people having it on their iPhone and Blackberry, it's very timely and live. You don't have to wait a few days for an answer.

It's like the Internet. It's not all that long ago that we were invited by the Connecticut Hospital Association to be one of the first six hospitals in the state to connect to the Internet. And I remember thinking, ‘Wow, this is cooler than the bulletin board I used to run.’ But it was still so non-graphical, so character-based, and you didn't know where it was going to go. And now, it's just amazing the information you can get out there and the resources that are available to you.