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At the Intersection of the EHR and Clinical Transformation: One Expert’s Perspective

May 10, 2014
by Mark Hagland
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Mary Ford discusses how her work as a CIO and now consultant has informed her perspectives on the Triple Aim and clinical transformation

In a panel titled “Achieving the Triple Aim: The Future of Healthcare,” as part of the Atlanta Health IT Summit April 15-16, sponsored by the Institute for Health Technology Transformation (iHT2), a group of panelists discussed the challenges and opportunities involved in achieving the Triple Aim—the idea of improved quality, enhanced patient engagement and satisfaction, and improved cost-effectiveness in healthcare, as promoted by the Cambridge, Mass.-based Institute for Healthcare Improvement (IHI).

Among the panelists was Mary Ford, who spent nine-and-a-half years as senior vice president and CIO at Lakeland (Fla.) Health before joining the Smart Solutions Health Care Group, a consulting firm now part of the New York City-based WeiserMazars tax and audit firm. During the panel discussion on April 15, Ford said of the CIO role in clinical transformation work around Triple Aim-based principles,  “The biggest critical success factor is to learn to trust one another. So if I’m the CIO, there’s a great deal of trust when I go to the chief quality officer and say, let me help you. Because what he really thinks is, you’re going to make me use this system, and then it’s not going to work, and then you’ll send me to some low-level lackey, and then I’ll be hanging out there in front of all my colleagues.”

Mary Ford

In addition, when asked about collaboration, Ford, referencing her Lakeland Regional experience, told the assembled audience, “Lakeland Regional sits in the middle of Polk County all by ourselves. When I arrived in Lakeland in 2005, we had no electronic systems at all other than ADT and billing. And we were sort of the country bumpkins. So we were trying to build our system in our little vacuum, and we had a lot of questions and concerns. And I made a call to the CIO at BayCare, and said, can we come and see what you’ve done? Well, that first 30-minute drive—to walk through their hospital, to see what they were doing and listen, began a long-term relationship that we started to build with them.”

In addition, Ford told the Atlanta Audience, “What we started to see was that we had many issues in common, and in fact we were ahead of them in certain cases. And so we had the opportunity o share. And we joined with All Children’s and Tampa General; and we started meeting with the CMOs and CIOs regularly, and we really started to find commonality and what we’re really working towards, which is in fact the patient. So we were in fact extremely successful. And I’ll be forever grateful that BayCare, which was so much larger than ourselves, was so giving. And it was great that they identified things we were doing right, too. But we were very pleased and were very successful in that whole Tampa Bay area.”

Shortly after the panel discussion, Ford sat down with HCI Editor-in-Chief Mark Hagland, and  amplified her comments, which were informed by her work not only as a CIO at Lakeland, but also as the senior executive over quality improvement there. Below are a few excerpts from that interview.

What do you see as some of the biggest issues of the last couple of years for you and for all healthcare IT leaders?

One of the biggest issues has got to be the speed at which we’re making these changes—making sure that the level of change has been acceptable for nurses, doctors, pharmacists, etc., is key. Every time you make a change, you need to make it more intuitive. Obviously, if something is easier and more intuitive, people jump on it more quickly. In the consumer world, if the kids grab a game and it doesn’t working or isn’t user-friendly, it’s gone. So we have to start thinking about that it has to work, it has to work the first time, and it has to make a difference in their ability to do their job. The technology is a tool and it has to be a byproduct of taking care of the patient.

Are we at an inflection point in terms of physician willingness to adopt technology?

We mandated CPOE [computerized physician order entry] at Lakeland; we didn’t come live until June 2012. Our president and chief medical officer mailed a letter to every physician. Initially, that felt dictatorial. But we’ve had tremendous support for our physicians, we just flooded the floors with people to assist. Physician rounding can’t stand and wait five minutes. And then we had documentation that was available but not mandated; you could still hand-write and have it scanned in. But we reached a tipping point, where physicians who are now electronically documenting, were reading scanned-in documentation that’s all scribbled; and the doctors came to me six months after the CPOE go-live and said, we want you to set a date certain for mandatory physician documentation.

And as CIO, you have to be deeply involved with the physicians; and you have to speak knowledgeably about things like sterile environments and infections and everything. And you have to be able to work with the vendors.  You also have to find a really good partner relationship with your EHR [electronic health record] and other vendors. And in our case, we were a Cerner [EHR] client. And where they didn’t have every answer, we would bring in another vendor. And I had to be honest with them and say, this isn’t working. And as CIO, I had to manage all the relationships among the vendors.

Clearly, being able to create collaborative relationships with physicians and with vendors is important. To what extent will CIOs need to understand certain clinical concepts and processes at something of a deep level, when it comes to clinical transformation?

Well, I’ll tell l you, I was put in charge of quality at Lakeland. And when a surgeon comes in and says to me, we’ve got bio-debris on an instrument that came into the hospital, guess what? I have to then understand that technically. And just because I’m not going to do surgery doesn’t mean I can’t understand what’s going on with infections. So for instance, with central line infections, I don’t have to read very long to realize a central line is always put in above the waist. And I can learn to understand things, and you can gin fact go back and question things, and say, here’s the data. So you in fact can start to drive processes. But you have to understand your role. And I worked very closely with our chief quality officer, and he is a physician. And I wouldn’t overstep my bounds. But I would say, let’s take to our chief quality officer only the data around bad outcomes. We had a chief medical quality officer to distinguish that the CQO is a physician. The chief quality officer reported jointly to me and to the CMO. We would meet once a week. But you’ve got to have that marriage. The tools had better change the quality; that is so important to all this.






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