Somerset Medical Center is a nationally accredited, 355-bed regional medical center, providing a variety of emergency, medical/surgical and rehabilitative services to Central New Jersey residents. The organization’s 650-member medical and dental staff represents all major medical and surgical specialties. To learn more about the novel governance structure at the hospital, HCI Editor-in-Chief Anthony Guerra recently spoke with CIO & Director of Strategic Planning Dave Dyer.
GUERRA: When I noticed you were “director of strategic planning,” in addition to CIO, it caught my eye. Did you always have that title and, if not, why was it added?
DYER: Back in March of 2008, our CEO came to me and said, “Would you like to expand your role?” And I said, “Well, what do you have in mind?”
This was all based upon some innovative things we’ve been able to do from an IT perspective, such as running a data-driven organization and basing decisions on that data. So he suggested we put together a planning and physician support department under me, and then expand my role to assist him in working with the board to put together strategic plans for the organization.
So with that, we also hired a director of planning underneath me who knows the specifics of New Jersey certificates of need, and we went on a search and hired a director of planning that reports to me and a decision support manager and a decision support analyst, they report to her. So I’m supporting the planning team on one side and doing the traditional IT components on the other, which include biomed and communications.
GUERRA: Has the arrangement prevented you from missing some opportunities?
DYER: In terms of things we might have missed, I really can’t think of anything. I mean, traditionally, the planning department VP reports directly to the CEO or the COO. I think what our arrangement has been able to do is allow us to craft a process for the organization where we can create sound objectives and goals. Obviously the benefit to that, from the IT side, is IT is completely aligned with the strategic planning process within the organization.
We’re a fairly wired institution. We have CPOE up and running and we have an EMR connecting us to physician practices, but when you look at some of the disruptive innovations that are out there – such as accountable care organizations or medical home models – a lot of that is also driven off of IT, but with decision support. We’re in the process of implementing a new decision support tool as well, which will give us the ability to do a product line analysis.
So this has also been very helpful in terms of looking at health information exchange initiatives within the state. We have a full understanding of our demographics here in Somerset County. Also, I’ve worked very closely with lobbying firms in Washington, D.C., and we’ve been able to obtain about $1.5 million in federal grant funding, particularly for electronic medical record implementation, through lobbying our senator.
So it’s been a nice mix having the two together, albeit, it’s quite different than what you typically see in a hospital.
GUERRA: Would you call what you’ve done, structurally speaking, a best practice?
DYER: Yes. We’ve just kicked off a new process with the board in which we established an ad hoc strategic planning committee. We’ve been working closely with that board committee and the chair of that committee to develop a process for Somerset Medical Center. It’s a fairly traditional strategic planning process. We’ve got the process and the timeline together. We are in the midst of doing the environmental assessment right now and we’ll then be reviewing our vision, mission, goals and values and developing the goals and strategies that map back to that. So we’ve gotten much more closely engaged with the board of directors on this as well.
This is a different model, and we’ll have to see how it turns out over the next nine months.
GUERRA: Should CIOs view governance as something that can be changed if it’s broken?
DYER: The important thing is that the CEO is engaged and understands the importance of it. For one, having the CIO report to the CEO is extremely valuable. I was fortunate in that our CEO used to be the CFO, and when I first got here, it was a traditional CIO reporting to the CFO level. Our CFO was then promoted to CEO and that relationship stayed.
Governance is a fairly complex structure that you must have in place and, at least from the IT side, if you can have a board committee with CEO involvement and executive team involvement, it makes life much easier to move forward. Then you focus on getting your high level strategic plan approved which is aligned with the organizational plans. It just makes life a lot easier to move forward and there’s less friction associated with it, and less questioning of why things are going on.
On the IT side, it’s a very complex structure because you must have change management committees, you have to have oversight committees, you have to have project implementation committees, and then also informatics committees. They cross multiple lines. So it’s a fairly complicated structure to implement, particularly around clinical technologies. Having an understanding of governance, and how the board operates and what the board likes and doesn’t like, helps make that process a lot easier.
GUERRA: While titles are important, the person is as well. You could report to an IT-friendly CFO or a numbers-cruncher CFO who sees you as a big cost center.
DYER: Well, it’s all about value in terms of how you can define value, and if you can show value. You also have to balance goals with physical realities or the ability of your organization to move forward. There’s actually a very interesting Web site called www.Hospitalvalueindex.com that I recently saw, and they attempt to define what hospital value is, and they look at quality, cost and revenue and then satisfaction with services. So when you’re putting together your plan and costing out your plan and meeting with the CFO or the executive team, you have to have it in a context of how it’s going to deliver value, and it’s not necessarily always an ROI or cost savings, it’s either a quality improvement or a revenue-generation activity that you need to staff up for.
For example, if you’re going to be opening a new service, there’s a lot of IT implications associated with a new service offering. Another example is we have a physician alignment strategy in which we’re assisting our docs with implementing EHRs through the Stark relaxation program, and that was a hard sell for the CFO, but we got an understanding that that will be important moving forward. So, to me, it’s about being able to articulate value and where it is on the value curve.
GUERRA: For the CEO, CFO, COO types, you can’t end your pitch with “and we’ll give better care.” I mean, you do have to bring it back around to, “… and so we’ll have more revenue, we’ll be more profitable, we’ll be a healthier organization,” is that correct?
DYER: Yes, and again, it depends on the specifics of the initiative because, really, the devil lives in the details. So there are certain things like barcode medication administration (that’s one of the things we have not completed here yet) which ties in with patient safety, reduction of errors, and being able to prove that the reduction in errors relates to a reduction in overall cost of treatment and potential litigation. It potentially impacts your insurance ratings as well. So your argument must be very specific to initiatives in question.
GUERRA: I wonder if CIOs realize how important it is they become salespeople when trying to get approval for these projects.
DYER: That’s absolutely a challenge, there is no question. The KISS method is always preferred in terms of trying to keep it simple, but you must have sufficient detail and enough understanding of how it fits within the value chain or the value curve of what you’re trying to achieve and where it maps to that.
So you’re absolutely right, you do need to sell the position and sell IT. It’s a constant process that you need to do all the time. So selling it to the clinical analyst on your IT team is a different discussion versus the directors who are under you or managers who are under you versus the executive team versus the board.
GUERRA: A different conversation with the CMO than the CFO.
DYER: Right, absolutely. There’s no question. I mean, what’s in it for me is always a question that you have to answer, along with the value piece of it. So typically, you’re right about the CMO. Ideally, again, you’re looking at quality, either revenue generation or cost reduction, and service satisfaction. For example, CPOE is a very difficult sell unless you have some champions within the organization, particularly the chief medical officer, understanding the need to do it. We’re in a gain sharing program here in the state of New Jersey for a CMS demonstration project. Our CMO leads that effort in which we can share cost savings with our doctors based upon a third-party analysis of data proving that we’re reducing length of stay, reducing readmission rates, etc. There are measures that are required for this and there are three facility-specific measures, and CPOE percentage was one of them. Our CMO absolutely wanted to make sure it was part of that whole process because he understands the safety and the improvement curve associated with CPOE, although it’s not necessarily a satisfier to the doctors, depending upon who you are.
GUERRA: Right. Is the CMO your major point of entry to the clinical world?
DYER: It’s both the CMO and the chief nurse because anything that you look at – from an IT perspective – impacts the workflow of clinicians, nursing, pharmacy and the docs. So you have to have a triumvirate between the CIO, CMO and CNO if you want to be successful in any clinical initiative.
GUERRA: Do you have a CMIO or CNIO?
DYER: We have a director of medical informatics who is a physician, so it’s the same role as a CMIO, and he actually reports to me.
GUERRA: We’ve heard that the CMIO role is becoming critical.
DYER: Most definitely. I mean, I view him as a colleague, not necessarily as someone who reports to me. The only thing I do is make sure that his paycheck gets processed and that his evaluation gets done but, other than that, I view us on equal footing. He works very closely with our CMO as well, and he’s probably the major conduit to our CMO and has more contact than I do with him on a day-to-day basis. The CMIO position is absolutely critical if you want to engage physicians in the use of technology, although it can create interesting situations for nursing and for other groups, but we’ve established a multidisciplinary committee to address that – the Healthcare Informatics Committee – and we’re budgeting that for next year. We went through a little bit of an economic downturn, so we eliminated the nursing informatics position, but we are going to shoot to reestablish that with the budget process this year.