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, 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: Do you think CIOs are still, mistakenly, being asked to 'own’ the implementation, rather than the clinicians that are going to use the technology?
DP: I don’t think it is set out to be that way in a lot of places. I think we all have the idea that we know it can't be labeled as an IT project. We set out that way. But I know the challenges going through this, even though we’re all doing what I describe; there are still those challenges once in a while, people might slip and call it our IT project. It’s the old way of thinking that if it’s information systems, therefore it’s the information systems department driving this. So I think what happens is, they start off with saying 'okay this is going to be driven by the clinicians or driven by radiology or laboratory,' and then we fall back because the IT people are the ones who have the knowledge on how to bring in a system.
Every day I need to remind myself and remind my staff that we are the engineers behind the scene supporting the front-end people. We are the builders behind the scene. We’re the plumbers, we’re the electricians, but we are not the ones driving this. We bring them their options, they need to make the decisions. We constantly have to remind ourselves to keep doing that. And it works, because you realize this after we’ve been doing this now for a year actually since we kicked off originally, that it takes a while to sink in on the other side — the clinical side — the clinicians or the end users, that this is their system; they need to make the decisions and so forth.
AG: And if they don’t want it, then it’s not your problem to make them use it.
DP: Right. We won’t do it. They’ve heard me say that. ‘If you don’t want to move forward, let me know,’ and I said I can pick up the phone and call the vendor and we won’t be going forward. And they are like 'oh no, no, no'.
AG: What percentage of the physicians at your hospital just have admitting privileges; they're not employed by the hospital? Is it all of them?
DP: They're not actually employed. We do have a hospitalist group but again, they're not employed by the hospital. It’s a management contract.
AG: How many hospitalists?
DP: Eight, I think.
AG: How many physicians have admitting privileges but are independent?
DP: We probably have a staff of 390.
AG: Those 390 physicians are the ones that you really need to embrace the CPOE solutions.
DP: Correct. CPOE is scheduled to be implemented in the summer of 2009.
AG: It’s such an interesting dynamic in healthcare where the physicians are not on staff; some of them can be very well known, renowned, respected, have admitting privileges at multiple hospitals in the area, your competition. So you have to be very politically savvy and gentle and ginger, is that correct?
DP: You just described my world.
AG: Tell me a little bit about some advice you could give to your colleagues, anything you’ve picked up on how to successfully work with physicians from the CIO role.
DP: Bring them into the fold. Bring them early on into the idea and thought process of where you're headed. When we chose McKesson, our vendor, we traveled the country with anywhere from four to eight physicians each time. We made them part of the team of knowing what is going on, where we want to go. Right now, the post-discharge medical record is electronic. So currently right now, on the floors, they're still manually paper charting. But once the patient is discharged, everything is either a code-fed or scanned, so the physicians post-discharge need to look up their patients records electronically, and they have to sign off on their deficiencies electronically.
During that process, we brought them in early on during the design, during the training. We know physicians don’t come to the classes to be trained. We have to go out and find and reach physicians individually. We had people going to the physicians’ offices. We had people set up in the physician lounge and medical records to always be there, explain to them, showing them where we’re headed, what we’re doing and that we’re there to help them. So I guess bring them into the fold early on and make them part of the team.
AG: In terms of your staff, are you able to recruit the talent you need at the money you are able to pay? What are your thoughts on maintaining the proper talent level in your staff?
DP: It is challenging. We’re out in the Palm Springs area — the Coachella valley. It’s a resort community. The population is growing immensely with families that are moving in. The population is younger than it was several years ago. We’re in a desert community, desert resort town. What happens is when the kids graduate from high school or want to go to college, they leave the area. It’s hard to get them back into the area until they are about 65 years old. But that is changing. We've got two universities now that have opened up satellite campuses out here; that is helping. We can tell. It’s challenging having the right IT resources. Technology is changing so quickly that the current staff has to be willing and able to change with that technology, learn the new applications or learn the new utility tools, or learn what's changing and keep up with it.
AG: Do you have continuing education for your staff in your budget?
DP: I do.
AG: And you think most CIOs do as well?
DP: I think it is generally being done. I don’t see how they would be keeping up if they didn’t invest that money in training courses or certifications courses. I’m sending my director and a manger off to a half-day seminar on data center moves and data center setups because we’re going to be moving our data center. That’s a huge initiative, so we’ve got to be willing to take the time to send them off to these classes or courses.
AG: Speaking of the data center, I hear a lot of buzz about server virtualization. Are you doing anything in that area?
DP: We are doing server virtualization. We have begun that initiative. We’ve taken on a smaller project to roll it out. We’re doing it with our print servers. This is about as far as I can give you right now. I don’t have all the technical knowledge as my manager would.
AG: Is that not a CIO-level story? Should I not pursue that?
DP: There are a lot of CIOs that will probably know it inside and out; I just have not caught up with it myself personally.
AG: Anything else come to mind that you would want to read a story on? Anything you're curious about, something where you would love to see what other people are doing in a particular area?
DP: I would love to see how other areas and hospitals are reaching out to the patients in the community. We will soon be rolling out an ability for the physicians to offer to their patients a Web site where their patients will be able to go on and can access a PHR (personal health record). So if you go to your physician and he wants to sign up with the hospital, we will send the physician their patients’ results, the radiology transcription results, their laboratory results. The physician then will be able to electronically communicate to their patients and send the patients the result if they choose to, and they can also do e-mail back and forth between their patient, as some insurance companies are now paying for E-visits (electronic visits).
So that would be very interesting to see if we’re behind the curve, ahead of the curve, in the middle of the pack. That seems to be a big thing, especially in our patient population. We’re a resort town, so during the summer months, our patients go back to their homes, and during the winter months, we have snowbirds that come in here. We've got a lot of patients that live two places.
AG: What vendor or what appreciation are you using to push out that service to the physicians so that they can then communicate with their patients?
DP: RelayHealth (owned by McKesson).
AG: It’s an application that sits in the hospital?
DP: No, RelayHealth hosts it, and we send them the files.
AG: So is that integrated with your McKesson hospital information system?
DP: RelayHealth is not. We are offering the McKesson HAC (Horizon Ambulatory Care) system. We are offering to our physicians that application also that we will host here at the hospital. And that one is integrated with our hospital information system.
AG: Where does RelayHealth come in?
DP: It’s for those physicians who may not be able to afford an ambulatory care system in their office, or they're not ready to move into that area yet.
AG: So if they have the money, they get the McKesson HAC solution?
AG: Let’s say they chose that, so they have the ambulatory solution, they're integrated with the hospital, could they then still use the McKesson product to interact with the patients, or do they use Relay?
DP: If they want to interact with the patient, they’ll have to use RelayHealth. I want to get to the point where if they're on ambulatory care, we have some way of them communicating to their patients also. McKesson doesn’t offer that just yet. So that’s why we chose to go ahead and even though we have purchased HAC, we wanted to get a jumpstart on being able to offer this to the patient, so we went ahead and entered into the agreement with RelayHealth.
AG: If the practice doesn’t have the money for the McKesson HAC, they can just use RelayHealth to communicate with the patients.
AG: But then they are not integrated with hospital, you would have to email them or send them files some other way?
DP: Correct. We’ll send them a file every night of their patients’ results.
AG: If you have the money, you get the McKesson product, and you're really fully integrated with the hospital, you still have Relay, because McKesson doesn’t have the product yet to integrate between the office and the patient, so you bring Relay in for that piece.
DP: Correct. McKesson owns RelayHealth.
AG: But Relay is not fully integrated with McKesson product yet.
AG: Do they plan on it, do you know?
DP: I don’t know that. I think they're still trying to work through that themselves.