Newark Beth Israel Medical Center, a 673-bed regional care teaching hospital established in 1901, is a major referral and treatment center for patients throughout the northern New Jersey metropolitan area. Newark Beth Israel is home to a robotic surgery center, the state's first accredited sleep disorder center, The Saint Barnabas Heart Center, and the Children's Hospital of New Jersey. Healthcare Informatics Associate Editor Kate Huvane Gamble spoke with Tomas Gregorio, vice president and CIO at NBIMC, about his organization's efforts to drive innovation - both inside and outside of the hospital - and to grow tomorrow's IT leaders.
KG: How long have you been CIO at Newark Beth Israel?
TG: For three years.
KG: Where were you before that?
TG: I was at St. Joseph's Regional Medical Center in Patterson, N.J. I was an IS director there for three years, and I was with PricewaterhouseCoopers for seven years before that.
KG: Newark Beth Israel is an affiliate of Saint Barnabas Health Care System. How does this work in terms of the leadership structure? Who do you report to?
TG: For the system, I report to Joe Sullivan, who is the senior vice president and corporate CIO for all six hospitals, as well as the CFO here locally.
KG: You've previously referred to Newark Beth Israel's IT and support department as a “technology incubator” for Saint Barnabas. What exactly is meant by that?
TG: We have a relationship with the New Jersey Institute of Technology, where I got my master's, and we rotate students through the hospital in order to come up with innovative ways to deal with many of the day-to-day operational issues that happen in the medical center. It's a low-cost, effective way of not only building the next healthcare IT people of the future, but also alleviating some of that pressure on my current staff, and not moving them away from the clinical or billing responsibilities that they have with the systems we have in house.
For example, we worked on a project with NJIT on voice recognition. We had a physician who had some issues with his handwriting, as many of them do, and it was resulting in some liabilities for us in terms of being able to understand what he was trying to communicate. So I got a group of students together and they analyzed the doctor's patterns in terms of how he did business in the hospital, when he came in, and how he wrote his notes, and we came up with an application set of templates where the doctor could document his progress notes using his voice, clean them up, print it out, and put it in the chart. It was extremely successful, so much so that we have over 60 doctors using the same technology now. We try to do innovative things to try to solve our clinical and business issues here at the medical center.
KG: Very interesting, sounds like a win for both physicians and the IT staff.
TG: That's right. It's actually been very good for the IT staff. The hospital IT staff tends to be around for a long time; there's low turnover in most cases. So it was a mentoring type of relationship that we built with the university and the students, and it's been great for my people to be able to mentor younger staff. The other thing is that they come with no baggage. A lot of the people who have been here forever are kind of set in their ways. Well, these folks are like sponges - they're able to assimilate anything and do anything we ask them to do.
In today's world, it's really easy to do anything with technology as long as you have one of three factors: time, money or people. We've been successful at doing that, and also mentoring these students. I teach a health IT course (at NJIT) in the fall, and we stand to get at least another 25 students into our system to help continue the building of that next generation IT staff.
KG: We're starting to see a lot more health IT classes pop up around the country, where students can obtain valuable information and experience that they otherwise might not have gotten.
TG: And it's real-world experience, it's not classroom training. So my hope is to have that balance between the course I teach and some internship work here at the hospital.
KG: So in terms of your strategy at NBIMC, does clinician input as far as what technologies are implemented weigh heavily?
TG: Of course. I'm in an urban, inner city setting. My job is to make the physicians' experience as friendly as possible; so that they want to come here, and so that they want their patients to come here. And not only to be clinically taken care of, but so it's easy for them to practice here. If you go on YouTube and look up “tomhealthtech,” you'll see the physician expo that we had last year. At that expo, we presented all the technologies that we had developed in-house, and we had a show for the physicians where they could sign up for voice recognition, remote signature, putting consoles in over our hospital information system.
We even have a concierge service where they walk up to the counter and we hand them a tablet PC and tell them to go do their work and bring it back later. So being innovative with the doctors definitely makes them happier practicing medicine here.
KG: Is the expo something you plan to have on a regular basis?
TG: Yeah. As a matter of fact, we had a small one (in March) in our lobby. It was doctor's day, and we presented them with a much smaller scope in terms of the things that they can do here at Newark Beth Israel. Absolutely.
KG: It sounds like a great opportunity for them to see how the technologies work, especially ones that they might not be that familiar with.
TG: That's right.
KG: Now you recently implemented kiosks at Newark Beth Israel, correct?
TG: We were an early adopter - it was before the company that we use was bought by NCR. So before I got here, there were only two departments using it. Now we have over 20, in addition to the emergency department, which was just the second place in the country to do it (Parkland Memorial Hospital in Dallas was the first).
KG: Which two departments were using it?
TG: I believe it was two of the same-day surgeries areas.
KG: The primary driver, I imagine, was to move patients into triage more quickly, especially in such a populated city like Newark.
TG: Absolutely. We see 100,000 patients in an ER built for 45,000. Patients used to come in and handwrite their name on a form and sit down. Now they walk over to the kiosk, check themselves in, and say what they're there for, and the system knows how to prioritize them in the queue to make sure that the sickest patients get seen first.
KG: And the kiosks can also help direct patients more efficiently? What types of interface is required for that?
TG: We have a real-time interface to our hospital information system from Siemens. So the patient checks himself in and, if he's been here before, the information comes up. Otherwise, once he checks himself in, he creates an account on Invision. Whereas before, even though he checked himself in electronically, there was no connectivity between the two. And it was sort of that electronic piece of paper, and the patient still had to go back to the counter. Now, the patient sits down, the account is ready there to be seen, he gets called up to get triage, they check him in, and now the account is up-written and the process works.
KG: Are there interfaces set up with scheduling and billing systems as well?
TG: Yes, there is. In the outpatient areas, we use http://scheduling.com, so when patients have an appointment and they arrive, they come in to the ambulatory or outpatient area and they check themselves in. When they check themselves in, it's pulling that info from http://scheduling.com, checking them in, updating http://scheduling.com and then creating the account like I explained in the ED. Plus they sign their consent electronically, all the HIPAA consents and everything are done on a handheld tablet.
KG: With all of this, did you need to expand the infrastructure?
TG: The whole hospital is wireless, so initially, we had the areas that were using the kiosks - like the waiting rooms - wireless to be able to do that. But now, anywhere in the building you can use the tablets to go over to a patient who might not be able to get to a kiosk. We have the freestanding and the handhelds, so you go up to a freestanding line and you check yourself in, and if you can't, we give you a handheld one. The handheld one is also used for signatures. The kiosk that's free-standing is pretty much like a terminal or a PC.
KG: And the staff was on board with implementing and expanding kiosks?
TG: Yes, absolutely; so much so that they're now thinking of other ways of being able to do this. Since we are in an overcrowded ED, how can we leverage that technology to speed up the discharge of the patient. We have to work on some regulations in this space in terms of when the doctor has to see the patient before discharge, because we really like to use the technology to get the patients out faster since we're able to help them get in faster.
We also have a few other things on the docket. I'm hoping to work with the government stimulus money to expand into the community - churches, schools, federally qualified health centers; get those folks integrated so they can also see what services are offered here at the Beth, be able to check themselves in before they get into the ED or one of their visits here at the hospital. We're also looking to send out cards, almost like membership cards, to patients at Newark Beth Israel. So when they come in, it's like an express check-in where they just swipe themselves in.
I can see putting this kiosk in a community church, having that church membership be able to get information about their diabetes, heart disease, etc., as well as be able to see what appointments are available at Beth and get themselves registered, so that the patient experience, when they come back, is easier for them here.
KG: So that helps further establish your hospital in the community and get more patients in the door. I know that you were looking into setting up text message services for patients. Is that still in the works?
TG: Well that's also part of that long-term strategy; unfortunately, financial times have made it difficult for us to be able to capitalize on a lot of that. I'm hoping some of that stimulus infusion can help do a lot of that - the messaging and community initiatives that I mentioned before.
KG: It's tough right now. A lot of the New Jersey hospitals have been particularly hit hard with the recession. Have you had other plans that have been put on the back burner because of the downturn?
TG: All capital projects are on hold right now.
KG: It's a waiting game, for sure. You're a member of the NJ HIMSS chapter - how long have you been involved with the organization?
TG: About a year now; I joined last year.
KG: How has that involvement helped to enrich your role as CIO?
TG: Well, since it is a board of CIOs, we get to bounce ideas off of each other and host events to help promote healthcare IT. We've also expanded the membership recently to make sure that folks on my staff can also participate and get educated on further advancing their understanding of health IT. The clinical staff also gets education on many things.
We also have a big advocacy group. We went to Trenton in March - we had more than 112 participants from all over the state go to our state capital here in New Jersey to try to advocate on behalf of healthcare IT. We don't want our legislators to forget that this money's coming from the government, and it needs to work its way down to the hospitals.
KG: I think it's so important that people get that face time with legislators and make the case for health IT.
TG: It is, it's very important. We were able to get through to at least 12 of the representatives, and then everyone had their own assignments.