Eisenhower Medical Center is a not-for-profit healthcare institution consisting of the 289-bed Eisenhower Hospital, the Betty Ford Center at Eisenhower, the Barbara Sinatra Children’s Center at Eisenhower, and the Annenberg Center for Health Sciences at Eisenhower. Situated on 130 acres in Rancho Mirage, Calif., the medical center has provided a full range of medical and educational services for more than 30 years for residents and visitors to the greater Coachella Valley. Recently HCI Editor-in-Chief Anthony Guerra had a chance to talk with CIO David Perez about his work.
AG: You responded to our offer about the Virtual Hospital Tour. Just out of curiosity, what are you interested in highlighting with the photographs?
DP: I think we really want to emphasize the doctors and the nurses using the technology. A few years ago we went live with bar coding at the bedside, and we will soon be up on a new system. We’re going to switch it. The patients even think that it’s cool, and they feel that there is some safety mechanism in that they are triple-checking before they're given the medication. I want to show clinicians in front of devices to make the point that they can take care of patients, even though we have moved them to the technical world.
AG: So definitely having the people in the pictures using the technology.
DP: Right. We’re fortunate that we have a PC in every room, but we also have the computers on wheels; for example, our rehab services, all our physical therapists and even in the outpatient area, where those therapists will have their own PC devices. We don’t know if we’re going to give them laptops or we’re going to give them handheld or if they're going to use carts. We have a fairly good sized physical therapy room with all the equipment, the weights and the bedding and all that, and those clinicians too will be documenting.
AG: When did you take the job as CIO over there?
DP: Six years ago.
AG: And where did you come from? Were you a CIO somewhere else?
DP: I was working for a consulting company for 14 years (Superior Consultant Company).
AG: What was it about this position that drew you? Were you looking to become a CIO at a hospital?
DP: When I arrived here, I was not looking for any permanent position. I came in actually as a consultant. I was brought in to basically turn the department around. I had the directive that I would probably be here 18-24 months. When I initially arrived, I had no intention of staying permanently or taking on a job with Eisenhower. Shortly after my arrival, I saw that things were definitely different here. In my healthcare career, I’ve had the opportunity to work at over 44 different hospitals in United States. I’ve worked at places that range from a 33-bed hospital to 550-bed hospital. There was a uniqueness here at Eisenhower that caught my attention. And so when the CEO asked if I would stay on permanently, I accepted that opportunity.
AG: And what was the difference? Was it their openness to implementing new technologies?
DP: Exactly. We have a CEO that is a proponent of information technology. He wants us to do a lot when it comes to information systems and technology. He has gained the board’s approval to spend the capital that we have spent thus far since I have been here. My current project is an $18 million project, as far as the systems we’re currently replacing and/or that are new. When I first arrived, we were on a $12 million project and we have completed that project, and now in six years, I’m on my second major project, and this one is $18 million.
AG: Having worked at all those hospitals, you must have been at places where you saw CEOs that did not have that attitude. How difficult is it for a CIO to function in an environment where the CEO doesn’t see the value or doesn’t see the need to fund IT the way the CIO may feel it should be funded?
DP: It’s extremely difficult or it doesn’t function at all. I have been in those cases where the CIO or the IS director never really even had face-to-face time with the CEO. So it is extremely difficult to move beyond your normal day-to-day systems that you have, and some departments are just barely making it where there is no budget for IT growth or IT education. And as I said, there was a difference here completely in that our CEO honestly believes in it.
AG: I spoke to another CIO recently at a hospital in California who was also a consultant who wound up getting hired as a fulltime CIO. Do you think this is a common occurrence, and do you think this is perhaps a tactic for hospitals looking to bring on a CIO, to bring in a consultant and see if they work out, as a test run?
DP: It could be. I also believe that back in the ‘90s, there was money being put into IT because we were nearing the year 2000. There was this push to get your systems up to par/up to speed, and there was money being put into IT back in the ’90s. Back in the ’90s, the hospitals really didn’t have a whole lot of resources or knowledgeable resources to help implement systems. They called upon a lot of consulting companies to come in and help them with full projects. And then in the early 2000s, there wasn’t a whole lot of money being devoted to technology.
In 2000, a whole lot didn’t happen like they anticipated. Money got tight in the early 2000s, so hospitals began to push back on needing those resources and spending the money. Now within the last two or three years what's happened is that — because our government has been pushing electronic documentation and electronic help — there is a huge movement across all the hospitals to implement electronic systems and electronic medical records, a lot more money is being put into IT. Therefore, they need strong CIOs to lead the endeavors, or lead the initiative to implement all the clinical systems now. So where they're getting them from is either from the consulting world and/or ones that have been out there and now they're able to have the capital that they need.
AG: What do you think are the most important qualities in to be a successful CIO today?
DP: To be able to sit at the executive table and know the business needs of the hospitals. So it’s important to know what is going on in the clinical world, being part of that executive team and knowing the business challenges and business needs of healthcare today.
AG: Tell me little bit about the big projects you're working on, either anything you’ve just completed, or something coming up over the next six months to a year.
DP: Since November (going back three months), in the last three months, we have implemented a new emergency room documentation system. We replaced our emergency tracking board. We've gone up in periop charting, which is clinical documentation in the ORs and the invasive areas. We've implemented a corporate master patient index. We replaced our radiology system.
We’re replacing our laboratory system, and in three months we’ll be replacing our med administration at the bedside. We will be replacing our pharmacy system, and we will be bringing up documentation for our clinical areas, which is nursing, rehab and respiratory. We will also be implementing a pharmacy robot. So we will have a robotic dispensing machine in our pharmacy.
AG: What are the biggest challenges in these projects?
DP: Probably the main challenge would be the process reengineering/redesign that the clinicians are having to go through. So there is a paradigm shift in their day-to-day process of taking care of the patients. This probably is the number one challenge in making that shift. Number two would be the pressures on the IT staff in taking on this many implementations in this period of time. I do have outside help, different consultants in on different project areas, as well as my own staff. So I have been able to bring in outside help for these projects.
AG: Regarding the first issue you mentioned, of the workflow redesign and getting the clinicians to embrace that, any best practices you can share?
DP: Early on when we kicked off this major project of all of these implementations, we had a reengineering team put together that involved all areas of the hospital. So it involved every department that would be affected by these implementations and even departments that their systems may not have been changing. One example is the admitting area and the registration area. We weren’t changing their system, but they would be affected because their registration data would be feeding the new systems. So we put together a reengineering team and a process reengineering design was developed. We completely went through and flow-charted out our current processes, and we flow-charted out how the new process would be implemented and what the changes would be.
We started with our emergency room department, our OR department, our clinicals on different areas on the floor, our case management, nursing, rehab services, respiratory services — everyone was involved in the process reengineering. That was a four-month endeavor. We went through that process pulling everyone together. It was painful because there were some weeks they literally were working eight-hour shifts five days a week in a room going through that. It helped very much because it brought departments together in one room that typically may not have to work through processes and don’t realize that what they do on the front end effects the clinicians on the back end. So it definitely was very positive in that it brought those teams together.
AG: Are you saying eight-hours a day, five days a week, in addition to the regular job?
DP: No, we pulled them off their regular job during this period.
AG: How did that get handled in their regular department with them being missing?
DP: They backfilled them with other resources, either overtime or outside resources.
AG: So you definitely need a lot of support at the CEO level to get anything like that accomplished.
DP: That’s correct. The CEO, CFO, COO and the CNO have all been extremely supportive and at the table with me, as the CIO, going through these projects.
AG: Tell me if I’m wrong, but the CIO cannot be the one driving these. It has to be coming from the CEO level or the clinicians, and you have to be facilitating and supporting, because if you're driving this bus, it’s not going to work. Is that true?
DP: Absolutely. I am not the executive sponsor on any of these projects. So when it comes to our clinical documentation, our CNO, she is the executive sponsor. She is the one that is updated every week by the project team. On the ancillary side, it’s our COO who is the executive sponsor. But you're absolutely correct that I am not driving this project. This is a hospital wide initiative. As a matter of fact, each year we choose one main initiative, or one main mantra, if you will, and this fiscal year it is our clinical informatics implementation. This is our hospital-wide initiative for this year.
AG: Having been at so many hospitals in the past, I wonder if people are still making the mistake of putting the CIO as the lead person on these projects. Do you think that’s still going on? Could that be the reason we see failed implementations?