LF: Technology is just the tools. If you’re a landscaper and you tell them about a wonderful rake, it doesn’t work. It’s not about the rake, it’s about the garden you’re going to be creating and the value of that garden.
BB: Technology has changed to more of a commodity. Before, IT was that black box, you had your solution, it was proprietary. Now it’s a commodity, so it depends on what you do with it … what you actually do with that technology.
LF: People understand, 20 years ago, before the advent of the personal computer and Windows and everything, we had the mystique. IT people could say anything, but now many of the people around here are much more knowledgeable than I am, and they’re working in the department. My kids are more knowledgeable. It is different.
AG: Let’s talk a little bit about interacting with the clinicians. You mentioned that the easy wins were workflow and process engineering. To me, that’s the hardest part, getting clinicians to embrace a new workflow, a new process. Clinicians want to practice care, they want to give care. Good luck if you try and get a physician into a training session for a new application. How are you dealing with that, how do you bring them on board and get them to embrace these new tools?
LF: We went through this with CPOE, it’s very difficult. You now have this going around the country. (CPOE) is almost impossible in an environment like this where we have really community-based physicians. We don’t have a large population of residents. You go to Montefiore Hospital in New York, I think they’re 100 percent CPOE, but they’re all residents. You come here, you’ve got a handful of residents and you have 1,500-1,600 community docs who go to a number of hospitals. If you get to mandate CPOE, it’s really, really difficult.
What we did about five or six years ago, we brought in what is today called a CMIO. We picked somebody, he is no longer with us, he left us recently, really a brilliant doctor with very strong credibility, very good business sense, a lot of charisma. He really worked with the physician community. He was the evangelist. Because of his credibility, he was able to move them. And we moved to maybe 40 percent CPOE, which is not bad in an environment like this with an old system that really is not geared toward physicians.
AG: How important has the CMIO role become? We recently wrote about the “CIO’s New Team.”
LF: I attribute much of our success to the fact that we had a very strong CMIO for a number of years. Now he’s moved on and we have somebody else who has equally stepped into the role, and she’s doing a fabulous job. But we have that model here. We have the CTO, the CMIO, reporting to the CIO. We also have the director of clinical systems who is a clinician (a nurse), with a whole group of clinical informatics people, as part of the CIO organization, as well as the technical people. I think you need that. If you have that decentralized, it becomes somewhat more difficult. The CMIO role is really critical.
AG: Let’s talk a little bit about Stark and what you’re doing on that front. Do you have a strategy for that or are you going to wait maybe until you get Epic in place and then extend out the Epic ambulatory product?
LF: The intention is to host the Epic ambulatory product. What we’re going to do as part of the first phase of the implementation is to do a pilot with one or two community physicians with Epic to introduce it. Then we want to offer it on a subscription basis within the confines of Stark — whatever we can finance, we will. But our vision is to be able to offer this to as many of the community physicians as want to have it. Right now, we’re not underwriting anybody.
AG: When do you envision that — and I know you have the whole Epic thing to take care of. What’s your vision for when this might happen?
LF: The pilot for physician practice we plan to be implementing next year, and in early 2010 to have it operational in the private physician’s office. From that point we would do a slow roll out. We have to determine how we’re going to do this in terms of Stark or what kind of subscription fees we would pay, what we could afford to underwrite ourselves, and then we would offer it and roll it out in 2010-2012.
AG: Do you have a goal for completing the Epic rollout?
LF: Which piece of Epic, because we’re doing it in steps? Our first phase will be to replace the inpatient system, including the hospital along with the ambulatory centers, the ER, radiology, and critical care. That big critical core piece of it, we’re looking to go live in the second quarter of 2010. It’s about 18 months, but it’s going to take us a while to do it, and we haven't signed a contract yet with Epic. We’re pretty close, but we’re hoping to start the implementation in September. That would give us about 18 months. That would be the first phase. And part of that first phase would be a pilot for community physician offices.