Playing it safe doesn’t seem to be the most important concern for Hackensack University Medical Center’s CIO Lex Ferrauiola and CTO Ben Bordonaro. If that was the case, they’d almost certainly leave well enough alone, and Siemens and GE in place. But the duo has other plans — turning HUMC from a medical center held together with interfaces to a truly integrated organization, promoting data transfer across the continuum of care, from inpatient services to ambulatory physician practices. To make that dream a reality, the organization has settled on Epic. And while its vendor of choice comes with a high price tag, Ferrauiola and Bordonaro say you get what you pay for.
AG: So they can see into the hospital system?
BB: Absolutely. So I visit (the practices), and more often than not it’s the subspecialties that usually have the EMRs. They’re the more lucrative practices and things like cardiology specialties and things like that. But we have a lot of family practice docs. So if someone had opted for ASP models to date, the ones that have asked for our help have gone ASP just because they’re not going to have IT people in their shops. They have a five or 10 doc practice. They’re not going hire an IT person for that. So between that and the cost of it, it’s tough for a practice, to be honest. So that 4 percent (adoption) number, I wasn’t surprised when I saw that.
AG: When I think of the practices and why they might be reluctant, three main things come to mind. We talked about cost. The second would be the fear that their productivity is going to take a big dip, which almost everyone says it will. And number three, I’ve seen doctors who are concerned about the hospital being able to see their financial data.
LF: We had that right up front. They would like to buy into essential hosted systems. The big concern is that the hospital or some other physicians would be able to see. That’s something that has to be addressed.
AG: Are hospitals concerned about polluting their data pools with data that came from outside, from a practice? I can’t imagine a world where clinicians would take action off data that was generated somewhere else and actually give medical care based off it. Have you thought about that?
LF: Taking from the physician office?
AG: Allowing any sort of outside data. If you have PHRs, people are going to be …
BB: I was going to say, welcome to the world of PHRs.
AG: Right. People are going to be coming in with PHRs, are you going to take that into your ED system and upload it?
BB: Microsoft will run the world (laughing).
AG: Right. So you have PHR data, you have insurer data, which is coming from claims, and then you have ambulatory-generated data. Are you ever going to let outside data into your systems?
LF: I think that’s going to be a big liability issue. It would be to the extent of somebody walking into the hospital with a pad of paper with everything written on it. It might be useful to take a look at it, but are you going to do a treatment plan based on it? Are you going to risk liability? I think eventually we’re going to have to move towards that. There’ll have to be faith and trust in the technology and the security and the integrations of the technology before that’s going to happen. I think it’s going to take a long time.
AG: You have to know where each particular piece of data came from.
LF: And is it right. Did the person who entered it, did they make a mistake? When they were prescribing, did they miss a decimal point? Well, just because they entered something into a computer, doesn’t mean they didn’t make a mistake there too.
BB: That happens today on a small level. But today, a patient brings in their meds, and they are still typing into a system. Forget about the typing part, but the patient can be bringing in a med and the doctor doesn’t even know if they're actually taking their med or not. They’re still making those decisions today. It’s going to obviously be more technology driven in terms of doing a data feed. But we have some of those same issues today.
I’ve been attending a lot of things for PHRs lately, and obviously, you’ve got both sides of the coin. One side will say, I would love to have that information, and the other side says don't pollute me with that information. But, in essence, that’s a real struggle and that was even for our CMIO here that just left, because what’s better? Is it better to have nothing and to make your own clinical decisions, or is it better to have some data and make your clinical decisions based on it? Because if you fed the data from a PHR, isn’t something better than nothing? There are definitely arguments on both sides of it right now. They're heated discussions that happen every day right now.
AG: Let’s talk a little bit about staffing and recruiting IT talent. You mentioned that you have 100 people here on your team. We saw a study that came out recently that said Congress was going to get people into educational programs for healthcare IT because there’s going to be a shortage. Are you seeing difficulty staffing for what you need? How do you go about staffing? What are some of the techniques you use to make sure you’re getting the right talent?
LF: I think it’s a lot easier to take a clinical person that understands the operation and teach them the level of technology that they need than it is to take a technology person and try to teach them clinical workflows. The applications people really have to understand the business. It’s probably not only true in healthcare, it’s probably true every place you go, that the people that work in IT that are working on the applications really need to understand the business and the processes, in this case, clinicians. So a lot of our people come from the clinical side, and then they learn the technology piece that they need. In Ben’s case, he’ll need a DBA. They, on the other hand, really have to be specialized technologists.
BB: There really are two sides of the house. There are the analysts and then there’s the high tech. The analysts are what Lex covered, and I would take a clinician any day to work on IT. You want to build up that knowledge in your workforce today.
On the high tech side, I am struggling with recruits, not retention, we do extremely well with retention here. We have a lot of people that are highly talented that have been here. Our turnover is extremely low, much lower than the rest of the house, such as nursing and others. The hospital itself has a very low turnover rate. On the high tech front, because we’re putting in high tech systems, I compete against the financial houses and everything else, and I lose more times than I win on getting a candidate. It’s been a little struggle to get the high tech people.
In terms of healthcare IT workers, I work with programs with colleges. So I’m working with the Stevens (Institute of Technology, New Jersey) and everybody else, to build their healthcare IT programs because I believe that’s so important for the future of the workers. So I attack it from a couple of different fronts. I think the clinicians are extremely important. I work on programs with the colleges, both with bachelors and masters programs. And we work on retention of our current staff that we have.
AG: Can you give me a couple examples of the high tech skills that you need?
BB: Storage, infrastructure, we’re no different than any financial house, ones that are very versed in storage, technology, disaster recovery, high availability. This hospital runs 24/7, so I need to maintain all those systems 24/7. So these are high tech people that run big systems, run redundancy, know networking inside out, very high tech stuff.
AG: So with someone like that, if you get your dream person that, you could care less if that person wants to go near the hospital.
BB: The purely high tech?
AG: If you get someone who just knows it cold, but can’t even look another person in the eye?
BB: It’s a loaded question because you want them to understand the business. They need to understand what they’re implementing. My DBAs appreciate that they’re maintaining a system for surgery, that a doctor is doing a surgery on a patient, rather than just that they’re editing tables of data. They actually appreciate that. I think part of that helps them with their care of the system. And they know that they’re not just deleting rows in a table, but they may be deleting a patient record in that system. They actually have a hand in the care of that patient.
LF: That’s the key part. It’s not just a job, it’s not running a system to produce financial reports. At the end of the line, it’s really part of the healthcare team. It is involved with the treatment of the patient. A mistake could end up costing the patient’s life, just as a good system could facilitate the healing process. So it makes it really special.
I don't think that the DBA, for example, has to be like totally understand all the clinical workflows, but they have to be cognizant that they're a piece of this healthcare team. Whereas the other people, the analyst people, they really don't have to understand the technology. They just take it for granted.
AG: Let’s shift gears. A lot of CIOs I’ve spoken with have said that it is very important for them to walk the hospital floor, to be among the clinicians and patients. First off, it builds credibility, it builds exposure, they see you're out there, and you see a lot of things, such as workarounds, that you would never have seen. Tell me about how much you are able to get over to the hospital (across the street from your offices) and how important that is for someone in your positions.
LF: I think it’s very important at the executive levels. All of us are required to do patient rounding. It’s part of our customer satisfaction initiatives. It’s a good thing because we’ll go to a certain floor to which we’re assigned and we’ll go to the nursing station and ask for a couple of names of patients. We’ll go and introduce ourselves and explain what we do and ask if there’s anything we can do for them. I think that’s just good practice just as a human being.
I think it again goes to the understanding as Ben was saying. I can’t imagine doing my job here in a vacuum where I didn’t do that. I understand what the doctors do, more than that, a patient. I say this sometimes because I do the executive welcome at general orientation every couple of months. I’ll tell the new people coming in that when you’re laying on the stretcher and they're wheeling you down the hall, and you’re looking up at the same tiles on the ceiling that you see every day when you’re on your way to a meeting, it really puts things in perspective. But it’s a good thought, it’s a good perspective. I’ve been on all ends of this thing, as a patient, as a worker, and as a colleague with the doctors and the other different departments we work with. It’s critical. It makes healthcare different. I never had that feeling when I worked in brokerage and finance. It was never really that. It was like, well that’s over there and we’re around the computers. It’s really different here.
BB: On my side, two things, I do JCAHO rounds. So I’m involved in the box surveys. I interview nurses for how they’re doing with their joint commission standards. That’s entirely non-technical, but puts me on the floor and on the clinician’s side. I sit on administrative operations also. So I sit there with the operations of the hospital. I’m not only the propeller-head that sits in the office and architects the next greatest thing in terms of wireless or something else. I also sit on operations of the hospital, so both the business and the patient-care side. You need to have that dual role to be effective.
LF: Ben got a very distinct honor this year that he may not classify as a distinct honor (laughing). He’s now part of the rotation for director on call at the hospital. He’s always on call for technology, but this is for the hospital. For example: the emergency room is filled and we have to go on bypass, what do we do? So he’ll be right on the hot seat for that. So he really understands the whole big picture.
BB: I just finished my MBA. I was trying to make a decision on business versus high tech. Business won in that decision hands down.
AG: On what would be more useful to your career?
BB: Absolutely. Eventually I see IT dissolving into business. The role is going to be much different in the future.
LF: I agree with that.
AG: It would seem that CIOs would make good leaders for the overall organization. Do you think more CIOs will start moving into the CEO role?
LF: I think you’re right. There’s been a transformation across the board. When you look at the CFO role, we have a new CFO who’s been here for a year, he’s brilliant, he is a renaissance person. He understands everything. He could be a CEO, he has that. The CFOs of the past, like the CIOs of the past, were really boxed in. We’ve had three or four generations of CFOs here. And they were CFOs, they were numbers people.
The guy we have now is much broader than that. It’s good for us because he really sees and supports the vision. The transformation that you see happening with the CIOs and CFOs it really is happening with the whole “C” suite. C’s should be able to be interchangeable, I think. I think one strategy for a CEO might be to take a “C” team and somehow cross rotate them. There are issues with that, but it could be exciting and stimulating.
AG: Based on some of the things you’ve gone through in the last six months, and with the Epic process, do you have any advice for your colleagues?
BB: Technology is just changing so fast. Sometimes I guess I am in the habit of overanalyzing too much. Sometimes you have to architect and go with it. You’re not going to make a blind decision, you have to go with it and fit it into your strategy. If you always wait for the next best thing you’re never going to fulfill any part of your strategic plan.
AG: Do you think technologists by their nature want certainty? I’ve read that Colin Powell said this on leadership, “I want about 40 percent of the available information and then I’m going to make a decision” because otherwise you wait too long and try and be too certain. I think that’s what you’re trying to say.
BB: Yes, I think if I’m waiting to see an exact statistic based on a my RFP that I put out for technology, sometimes I’ll get all the information back, sometimes I might not. You need to make the best educated decision and move forward with it, or else you’re going to get left behind either way on the decision.
LF: I think one of the most important things is really succession planning. Ben and I talk about this a lot. Ben is brilliant. My hope is that Ben goes into my job, I think he will. I’ve been very fortunate that I’ve had a number of really good people in this role. Part of it is to give them the freedom to have the high profile in the organization so that they can develop. And sometimes they move on.
One of Ben’s predecessors, a great CTO, went on to be the CIO at Moffit down in Florida. The CMIO we had here went on to MedStar. I’m hoping selfishly that Ben will stay in this role while I'm here and when I'm ready to go that he can move into it. You have to select people and really want to nurture them. I think that’s our responsibility as leaders and managers and executives to really nurture people, whether it’s in the place that you’re in or from the next step of what their career’s going to be. It’s not just to have people in the roles to do the job.