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Peter Strombom, the retiring vice president and CIO of Meriter Hospital
, still remembers the day, 16 years ago, when a physician stopped him in the hallway to register a complaint.
Meriter had just finished installing its existing phone system when the doctor cut Strombom to the quick. Why are your physicians not consulted in the selection of a telephone system? he asked.
The question shaped a key process improvement for many information technology installations to come. From then on, hospital technical staff would work closely with user groups - including physicians, nurses, and administrators - in the selection of new technologies.
User involvement - indeed ownership - at the earliest stages of IT projects is one of the reasons Strombom doesn't equate successful technology implementations to scaling Mount Everest. It's an element often missing on IT projects, and it's one that does not preclude the involvement of IT staff to ensure that project elements meet enterprise standards.
The users must own the decision - they must be very involved in making that decision and they must own it, Strombom explained. If they don't own it, then it's going to be very difficult to get it accepted during implementation.
Strombom finds it difficult to believe return-on-investment calculations, and he jokes that he knows the IT department is providing business value to Meriter because he is still employed. However, he does try to measure IT value in certain terms, as he did when he strapped pedometers on Meriter nurses to determine whether an Epic Systems
implementation would result in nurses walking 20 percent less, freeing more time for patient interaction. (They actually walked 40 percent less).
In his 19 years at Meriter, a 448-bed teaching hospital, Strombom has been in lock step with the Tight-Loose-Tight model for IT implementation. The label refers to having very tight expectations for different projects, and communicating them to the staff; being loose enough to let staffers, within established standards, use their own initiative to get the job done; and then tight again to make sure expectations are met.
That model will be applied on each of Meriter's 250-plus IT projects in 2007, especially the three big ones: the ongoing Epic Systems electronic health record installation, a journey that began in 2003; a Lawson
enterprise resource management system; and a new Internet phone system that, yes, will be aided and abetted by user input.
Given the early involvement of users, Strombom said Meriter does not suffer from physician resistance to electronic health record adoption. Unlike other locales, Strombom said there is no physician resistance at Meriter.
Meriter, a 2006 winner of the Governor's Wisconsin Forward Award of Excellence
, first worked with its nurses on clinical information technology. However, physicians also have embraced it, in part because instead of having to ruffle through endless paper files, patient information is just a couple of clicks away. That could pay dividends this year when the hospital conducts a pilot project for computerized physician order entry
There has been a great acceptance on the nurses' part, Strombom said. We are not focusing on the physicians at this time, but most of the physicians actually use the [computer] tablets and get their clinical information from the network. Sleepless nights
Strombom doesn't lose much sleep over Meriter's IT issues, but as someone who will stay active in retirement through international consulting and service on boards, he has tossed and turned because of the overall state of technology. He openly wonders what's being done to prevent electronic terrorist attacks, especially given how Internet-reliant the world has become, and what's being done to prevent the export of intellectual capital from the United States to global competitors.
As he looks to the future, he sees more hospitals and healthcare providers making significant capital investments in IT, and he doesn't believe they recognize all the implications of these investments. He predicts there will be a global cost to support and upgrade capital investments in a range of technologies, including expanded storage needs for picture archiving and communications systems, data warehousing, and the ever-changing infrastructure backbone required to support them.
The move to electronic medical records will be accompanied by requirements for disaster recovery capabilities, either by individual hospitals or a consortium of area hospitals acting in a communal fashion. The federal HIPAA
mandate to protect against the loss of patient data will require additional security investments for laptops and hand-held devices.
In three to five years, all this will be felt on the bottom lines of healthcare providers worldwide. At the same time that we are continuing to make capital investments, I hope there is a cost [reducing] impact here, Strombom said.Clinical outcome
Strombom touts a low 3 percent turnover rate on Meriter's IT staff. He believes in keeping IT staff involved and challenged for retention purposes, but he looks for two non-technical skills in evaluating the merits of prospective IT staffers. When I hire people, the first thing I look at is the personality of the individual, he explained. I try to gauge that personality in the interview and, secondly, I listen to their communication skills. If they pass test one and test two, then I'll have a look at their technical abilities to do the job.
If they don't have the personality, and they don't have the communication skills, they are not going to be a fit in the department.
Strombom believes the essence of CIO leadership centers on developing a vision beyond day-to-day IT operations. CIOs need to look into the future, he said, and be able to predict which emerging technologies can be deployed in the organization, and more importantly, how technology can leverage healthcare innovation to improve care and contain costs.
I think the role of the CIO is to be looking ahead to try and answer those questions, and then to be able to turn that around and recommend operational decisions which will allow that to happen.