It's often said that necessity is the mother of invention. For Donna Staton, a first time CIO, that necessity was JCAHO. Staton had just come on board as CIO of Fauquier Health System, an 86-bed acute care community hospital, when JCAHO introduced the new medication reconciliation standard of January 2006.
With the new standard as her first challenge, Staton, who had never worked in a hospital setting before, brought a fresh pair of eyes and an innovative approach to a problem that had eluded many other long-time CIOs. It was the proving ground for Staton. Her novel approach, coupled with keen analytic skills led her to partner with a vendor in pursuit of a new IT product for medication reconciliation.
Staton came from a software development background, and feels that experience gave her a head start. “I came in with a brand new perspective,” she says. “I knew that just because our system doesn't do this now, doesn't mean it can't do it if we approach it in the right way.”
How to get from here to there? “For me, it was getting the right people talking to each other.”
Staton may have been new to a hospital setting, but she knew enough to listen to her physicians. “In January, everyone was trying to wrap their arms around how do we do this,” says Staton, referring to the JCAHO standard. “It was a daunting task for clinicians because when clinicians think about treating a patient, they don't necessarily think about ways that the technology can work for them.”
Some of her doctors had been using an e-prescribing solution in their private practices in the outpatient setting, then printing the prescriptions in the hospital. “Change is very hard.” Staton says she looked at what her doctors were doing in their offices, looked at the new standard and said, “Wow, if we could marry these two things together, this would be an amazing capability that would really streamline the way clinicians operate and also address a need.”
Brand new to the role, Staton wasn't afraid of admitting gaps in her knowledge base. When she met with the vendor of an ambulatory e-prescribing solution (Rockville, Md.-based DrFirst) used by many of the organization's affiliated doctors, all she had in mind was getting a better understanding of what her doctors were using in their practices, and learning a little more about e-prescribing. But her inquisitive mind saw an opportunity. The vendor was beginning work on a complementary product for the acute side, all self-contained within the third-party ASP system. Staton's analytical skills grasped the inherent problem with that approach right away.
“I looked at them and said, nobody's going to buy that. That is of absolutely no value because clinicians want to operate in the environment that they're in. And then I said, ‘Let me tell you what would really work.'”
DrFirst listened to her idea. The company initiated a concept phase with Fauquier and the product evolved. The system Staton helped develop at Fauquier is a Web-based application that integrates with different prescription databases like RxHub and the pharmacy benefit management system. It allows order writing, report printing, and it brings in the medication information from different practitioners and care venues.
The application lets the clinician write the discharge medications using the Rcopia system from DrFirst. The final data set reflects the current medications. It flows the information back into the Meditech (Westwood, Mass.) CIS system in the hospital, using Iatrics Systems (Boxford, Mass.) for the third-party interface to Meditech. “We want our CIS to be the system of record,” Staton says.
Staton's ability to think outside the box also served her well as she faced her clinical limitations, as she didn't automatically assume the physicians were necessarily the only place to start looking for answers. She says she went to the nursing leadership for guidance because “in medication reconciliation, when you look at who's actually doing the heavy lifting, it's the nurses.” Meanwhile, Staton says she was also meeting weekly with her physician group. “I used that as a launching point for me to get an understanding of the pain points of our physician community.”
How did Staton, in her fist CIO role, respond to the unique needs of her clinical staff so quickly? Prior to taking the helm at Fauquier, she was the clinical informatics program manager for the National Institute on Drug Abuse.
Staton believes working in software development forced her to develop critical thinking and communication skills. She feels it contributed most to her ability to attack a problem creatively because, as she says, “The problem could be anything.” She believes in taking a step back, putting herself in the other person's shoes, and thinking about the value proposition. Staton says her actions are dictated by the WIIFM (What's In It for Me?) factor. “If you don't have a demonstrable benefit from that standpoint you need to go back and think about why you're doing it.”
Staton has settled in to her role as CIO. “It's been a really steep learning curve, but it's also been so refreshing to feel like I can make a difference at a patient level,” she says. Her latest project is an e-health strategic plan. “You can't be afraid to take chances, and you can't be afraid to stick your neck out there. From my perspective, when I started, I didn't have anything to lose.”