healthsystemCIO – Strategies for Hospital IT Leaders

David Bensema, MD, CIO, Baptist Health

As an internal medicine physician, one of the most important lessons David Bensema learned was that if he was going truly engage with a patient, he first needed to establish trust. As CIO, he employs that same strategy to engage with physicians — something that doesn’t always come easy, even for an MD. In this interview, Bensema talks about what has surprised him most during his first year as CIO; the tough part when it comes to creating a task force of the “best and brightest”; and the strategy his team is using to roll out Epic across 7 hospitals. He also discusses why he doesn’t like the word ‘optimization,’ how he keeps the end user’s needs as top priority, and the one thing that needs to change when it comes to CIOs and project planning.

Chapter 1

Chapter 2

* Leading EHR selection process as CMIO

* Heavy physician representation

* “Lean” 175-person Epic team

* Frustration with poaching — “It’s keeping that vision in front of myself and helping others see it.”

* Epic rollout: “Operationally led, IT supported”

* Challenges with clinical summaries

* Broadband Internet — “We are struggling as a state.”

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Bold Statements

We needed to get on a unified system. We needed to get away from the incredible disparity that we had in our system, and we needed a partner that was going to be able to grow with us.

We took a lot of highly experienced people from within our system. We had tremendous support from our leadership — that doesn’t mean we didn’t cause pain and we didn’t cause angst.

I know there’s something great coming. It’s keeping that vision in front of myself and helping others see that vision.

They were brought on because of their personal technical expertise, and also because they had been identified as somebody within the system who could get their head up and function as a CEO and take that broader view.

The 50 percent mark is a tough one to keep up. Getting everyone to focus for three months was one thing; getting everyone to do it as every patient, every time is still a lift.

Gamble:  In terms of the selection process, this was a few months after took on the CMIO role, so I wanted to talk about what that process was like. First of all, the way things happened, was it outlined that this was going to happen right away and it was going to be a significant part of your role?

Bensema:  No. I live the true IT life. Most things come by surprise. When I took on the CMIO role I was being brought on because obviously Meaningful Use was becoming an increasingly heavy lift. I was asked to help with physician engagement and with development of additional order sets and I-forms within our existing EHR to help our hospitals achieve Meaningful Use targets, and so I came in with that in mind. One month later, our CIO left the position and we had an interim appointed. A month after that we’d had a review from an outside consulting group and they pointed out what was obvious, which was that we needed to get on a unified system. We needed to get away from the incredible disparity that we had in our system, and we needed a partner that was going to be able to grow with us.

And so we started a search process in early October of 2013, and I was privileged to have the opportunity to help put that group together. I was also privileged that I was given a lot of leeway. Mr. [Stephen] Hanson, our CEO, the board and the leadership of Baptist Health all allowed me a lot of opportunity to put together a task force in a way that reflected my heart as a physician. I was also a nursing assistant in 1980-1981,

Ed Grogan, VP & CIO, Calvert Health System

In the current health system landscape, where organizations just keep growing, Calvert Health System is considered to be quite small. But it’s a “mouse that roars,” according to CIO Ed Grogan, who has spent the past 12 years leading Calvert’s transformation from a small hospital to a dynamic health system. In this interview, he talks about the Maryland eCare initiative and partnerships that have expanded Calvert’s reach and helped improve care for patients across the state. He also discusses the organization’s comprehensive EHR-selection process — and why they ultimately chose Meditech; their work with CRISP, including plans to implement a “Magic button” for physicians; the importance of team chemistry; and his “passion for technology integration.”

Chapter 1

Chapter 2

Chapter 3

* Best-of-breed affiliation strategy

* Staff retention — “Success energizes people.”

* Learning “team chemistry” from Coach K

* Participative meetings

* 21 years with Inova — “I wore a number of hats there.”

* A passion for technology integration

* Riding The mHealth wave

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Bold Statements

That clinical collaboration helps improve our care protocols and helps improve the quality of care we can deliver at the local level.

Our philosophy is we want to provide care for those working in the organization so they can care for our patients better.

Having talent is important and retaining the talent is important; it’s vital. But just as important is having good team chemistry, and I think we have that here.

It’s very much a participative approach, and that helps generate esprit de corps, gets folks engaged, generates understanding regarding projects and things, and makes us successful.

I’ve leveraged my education and experience to focus on technology integration, which is one of the passions that I have, and to try to leverage that to help things moving forward.

Gamble:  I would think something like that is a great win, especially looking at smaller, independent organizations and the things you can do to ensure your survival and really make an impact. Because I can imagine the challenges with how the industry is right now of being an independent organization. Something like this is a game changer, I would think.

Grogan:  Yes. We pay for the service, and how we offset the expense is because we have more diligent care 24/7, we have shorter length of stay. Because we have shorter length of stay, we have fewer lab tests and everything else, so that helps offset the cost. And of course we’re paying for quality, too. But it does basically give the smaller community hospital the ability to not only have the technology, but also to have the clinical collaboration with those at a higher level of care — at the tertiary care center. That clinical collaboration helps improve our care protocols and helps improve the quality of care we can deliver at the local level.

Obviously there are times when we have to transfer out of the ICU or transfer from the ER to a larger, to a higher level of care. But it does help us provide excellent quality at the local level for the things that we do, and it helps maintain our independence, as you were saying. We have sort of a best-of-breed affiliation strategy here at Calvert, where we have the best of breed for ICU telemedicine, critical care affiliation with the University of Maryland. We have some best of breed affiliations for basic cardiology,

David Bensema, MD, CIO, Baptist Health

As an internal medicine physician, one of the most important lessons David Bensema learned was that if he was going truly engage with a patient, he first needed to establish trust. As CIO, he employs that same strategy to engage with physicians — something that doesn’t always come easy, even for an MD. In this interview, Bensema talks about what has surprised him most during his first year as CIO; the tough part when it comes to creating a task force of the “best and brightest”; and the strategy his team is using to roll out Epic across 7 hospitals. He also discusses why he doesn’t like the word ‘optimization,’ how he keeps the end user’s needs as top priority, and the one thing that needs to change when it comes to CIOs and project planning.

Chapter 1

* About Baptist Health

* 15-month Epic rollout by region

* “We’ll be troubleshooting and making adjustments that are required immediately.”

* Creating & populating Epic record in physician practices

* Staffing for go-live — “We need them present.”

* “I don’t know that we can ever optimize, but we can always improve.”

* Personalization labs

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Bold Statements

The team’s been doing a great job, but we know that there are glitches, and so we want to be able to find that with a very supportive environment and a smaller cadre of patients and staff before we initiate the rest of the rollout.

Being a physician myself, I love seeing when physicians are able to continue in independent practices, and so as we do our Epic implementation, we’re very aware of that and how we support those independent physicians and involve those physicians in the inpatient build.

We need them not only for staffing, because obviously we don’t want to have any impairment of patient care; we want to make sure that the quality and the safety of our patients’ experience is paramount. But we also need them to learn how to use Epic in their clinical settings or in their everyday roles.

‘Optimization’ is not my favorite term because I don’t know that we can ever optimize, but we can always continuously improve. So we’ll apply continuous improvement principles and go live with the next hospitals with the improvements identified in place.

Gamble:  Hi David, thank you so much for taking some time to speak with us today.

Bensema:  My pleasure, Kate. Thank you.

Gamble:  Sure. To give our readers and listeners some information, can you just talk a little bit about Baptist Health — what you have in terms of hospitals, ambulatory care, things like that?

Bensema:  Sure. Baptist Health is a seven hospital system in Kentucky. We cover the breadth of Kentucky, from Paducah in the far west to Corbin in the far southeast. Our hospitals range in size from 100 to 450 beds, with a total of approximately 2,100 acute care beds in the system. We have currently one up-and-running transitional care unit, LTAC, and we have two long-term acute care facilities in Madisonville and Paducah that are going to be going online shortly. We also have a psychiatric unit in our Corbin hospital, and we have approximately 180 ambulatory sites of care, which includes imaging centers, ambulatory surgery centers, physical therapy offices, and also primary and specialty physician offices.

We employ 450 physicians — probably plus 10 by now because it moves so fast — and an additional 250 to 280 non-physician providers, APRNs and PAs. We have 17 currently retail sites in the Wal-Mart supercenters staffed by APRNs; they’re limited service clinics. We also have approximately six urgent care centers in the Louisville, Kentuckiana region and two additional in the Lexington/Richmond area and one in Paducah.

NextGen’s community HIE

Attesting to MU 2 (acute in 2014, ambulatory in 2015)

Push & pull methods of data exchange

CRISP’s magic button to give docs “a broader scale of information.”

Patient-centered medical homes: “It’s not just high tech; it’s high touch.”

Maryland eCare

“We’re the mouse that roars”

Easing staff burden with consultants & interns

Work-life balance

Getting personal with staff — “It’s importance to me to know what’s going on with them.”

“Dynamic” HIT industry

Cutting edge, not “bleeding edge”

Evolution of physician engagement

About Calvert

Allscripts ED, NextGen in ambulatory

9-month EHR selection process: deep dives of “the big 3”

Meditech’s population health roadmap

Using consultants

17 focus groups — “We wanted to engage all the major stakeholders in the organization.”

Physician advisory council