El Camino Hospital, a not-for-profit organization in Mountain View, Calif., is located on a 41-acre campus in Silicon Valley. Operating statistics show the hospital has almost 400 licensed beds, more than 2,200 employees and a medical staff of 830 physicians. The organization was also one of the first in the country to go live with computerized physician order entry. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with CIO Greg Walton about the current state of affairs at El Camino.
AG: Has the economy impacted you or the projects you’re working?
GW: Our financial situation is strong. We’re very blessed to have a very strong balance sheet and good cash flow. Our days in AR are under about 45 and our profitability is high. That said, we are noticing a significant drop off in elective procedures, and we’re also noticing a real nervousness at all levels, whether it’s physicians, patients, business partners, strategic partners, about the economy. So while it hasn’t hit us, and typically healthcare lags anyway, and we expect it will and we expect it to be severe.
AG: How do you think that might play out? Would you be asked to make a 5 percent, 10 percent cut in your budget?
GW: Well, we have a strategic plan and a multiyear capital plan, and that plan has certain economic assumptions that are pretty conservative, so I’m not sure at this instant that we will have to have a downgrade of that plan. On the other hand, I think our general concern about the economy will cause us to be conservative and not perhaps do everything as aggressively as we might. That’s primarily because we’ll be watching patient flow of elective procedures and, generally, also we’ll be watching what government might do about the economy as it relates to healthcare. There’s a lot of unknowns; more unknowns now than there were six months ago.
AG: I’ve always heard of your hospital as being a first mover with electronic medical records, is that an accurate description and, based on that history, does it put you in a better position than a lot of places today?
GW: I think that any organization that has accumulated an IT legacy such as this is probably in better shape than those who haven’t. I’ve been working this industry my entire career and I’m convinced that people that started early to understand IT and to apply it; they are ahead of those that didn’t. It’s hard to catch up when projects take so long and cost so much money. That said, El Camino was the first hospital to deploy CPOE, so we have physicians walking around here that have done CPOE for 40 years. As a result, I think the culture is very advanced and very receptive to all kinds of innovation. And yes, we like to think of ourselves — and that’s one of the reason I came here — as an innovative culture. We are doing some things that we think are fairly leading edge.
AG: Can you go into some of those main projects that you have on your plate now?
GW: For one thing, we’re building a replacement hospital. Our goal around that hospital is to make it as advanced as possible. So it will have every type of technology that we think is reasonable today, and a few things that we’ll be experimenting with. For instance, one of the things we did is deployed a complete distributed antenna system, so given the fact that we had a greenfield opportunity, I wanted to go with an advanced networking technology. That will give us a full spectrum of complete saturation of signal throughout the entire building for cellular coverage, Wi-fi coverage, emergency coverage, paging, medical telemetry, etc. That, in itself, will give us extreme mobility, and we are moving towards more and more mobility as time goes on. We also, because of the nature of who we are, will be deploying some robots, we’ll deploy some tele-presence, we’ll deploy some digital sign-ins and advanced way-finding, and probably one of the slickest things we expect to deploy is digital art.
AG: Digital art? The images will change?
GW: It changes based on different criteria, and we’re still deciding what those criteria will be.
AG: Do you think that the ROI equation will change as we move forward? You mentioned a number of projects, how hard have CIOs been held to offering up a concrete ROI on a project, and do you anticipate that to get a little stricter?
GW: I think it varies by institution. One of the things I’ve learned in my career is there are times when strict ROI applies and there are times when you throw it out the window, and that’s a judgment call. And that’s one of the hard things and maybe that’s why CIOs are in the positions they’re in, is to make those hard judgments. Certainly some of the things we’re doing here don’t have an immediate, direct ROI. On the other hand, because we are the hospital of Silicon Valley, we feel like we need to be in a leadership position and demonstrate some new technologies, not only to our citizens but to the industry overall. So there will be times when we will throw the rulebook out.
On the other side, we are constantly looking at different technologies for ROI, so I don’t think it’s a black and white scenario. I think a good CIO is going to be the one who knows when to apply the rule and when to say the rule doesn’t apply, and ultimately have the support of the management team in that philosophy.
AG: But the CIO really has to make that case in a convincing way to the board, to the CEO, correct?
GW: I would push back a little bit and say that the CIO needs to find partners in the clinical business community to make the ROI work. I don’t think a CIO can impose a project just because he or she alleges an ROI. I think what you do is you find business opportunities or challenges and then, with your partners, you go out and build a case for technology; whether it’s a whiz bang system, like the one we’re going to deploy with handheld devices and on-demand meals, etc, or something that’s much harder to quantify, like an enterprise master patient index. So I think it’s more strategic when it comes to ROI, to partner effectively with the leaders in the business.
AG: You mentioned the replacement hospital as a situation where you were able to do some interesting things. Can you go into that a little more and talk about how going into a new facility lets you be a mad scientist or frees you from an existing physical structure?