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La Crosse, Wis.
- There are several reasons why Deb Rislow believes she has risen to her current position - CIO and director of information systems for Gundersen Lutheran
- at the perfect time.
First, health information technology has never been a hotter topic as the federal government tries to drive faster deployment, and as hospitals and clinics apply it to reduce medical errors, control costs, and improve care.
Second, she's been around long enough to have learned plenty of lessons from past technology implementations - successful and otherwise.
Third, she has earned a place in the boardroom, and she serves an integrated health system where upper management sets the tone for IT projects, not the squeaky wheels.
By squeaky wheels, she means the people who are vocal about needing a particular technology, with or without due diligence. While Rislow doesn't have to grease these wheels, there was a time when their needs came before sensible, executive-reviewed implementations.
With corporate objectives now woven into IT, Rislow believes she has the executive backing to properly execute implementations.
I've been here 15 years, and there were many years where the squeaky wheels got what they wanted, whether it was from IS or any other service department, she said. That doesn't happen today. If there is not true alignment with [corporate] strategy, it won't happen.Convergence
On large IT implementations, Rislow makes use of project- and change-management methodologies, but she also is concerned with IT-business alignment, making sure lines of communication remain open and active, guarding against scope creep, and recognizing project teams. The latter helps Rislow avoid becoming too distant from project details.
That's coming in handy as IS juggles several crucial projects, including the convergence of communication devices. Ten years ago, physicians had a pager and that was about it. Today, a doctor might have a pager, a cell phone, a personal digital assistant, and a computer with an IP phone. As a result, Gunderson is investing in converging these devices with IP telephony to allow for data sharing, e-mail, dictation, and paging on a single device.
A physician technically should be able to integrate their pager and their cell phone and really end up with a single device that's allowing them to dictate, take phone calls, and receive pages, Rislow said.
In the first two years year of the project, Gundersen spent $300,000 annually on infrastructure to support the convergence, but as convergence advances toward completion in three to five years, the annual spend is about half that.
A wide area network for patient data exchange is another project on Rislow's plate. She is responsible for a network connecting more than 45 regional clinics in three states, but since some patients have to travel one or two hours to reach the main hospital and clinic in La Crosse, many will opt for a regional clinic in one of Gundersen's rural coverage areas. Gunderson is committed to connectivity to regional clinics to ensure data exchange, and is installing the necessary infrastructure in clinics and affiliated regional hospitals.
The project brings a $350,000 annual commitment. Gunderson has obtained grants to assist with the work, and since Rislow serves on the governor's eHealth Patient Safety Board
, she is familiar with the development of statewide standards. It really does fall in line with the RHIO
concept, she said, so we're very heavily invested in that.The groundwork
Without the electronic medical records groundwork, which was established eight years ago, these transformations would not be possible.
Gunderson, which has tried to lower costs faster than competitors, was among the earliest adopters of EMRs, and the desktop PCs to view them in exam and hospital rooms.
Paper charts had a lot to do with the transition to EMRs. In a perfect world, when a patient was to be seen, the chart was to be pulled from a central storage room and brought to the doctor the day before. In the real world, the chart could be with a physician who saw the patient two days before, or it could be in the emergency room or a radiology lab.
In some cases, physicians had to care for patients without the proper documentation. In those situations, they were dependent on the patient repeating information for them, a time-consuming process that could be eliminated by simply implementing an EMR.
The pros of implementing an EMR are that patient information is available immediately, and in full, when a doctor sees the patient, Rislow explained. They would be able to pull the chart up, see lab results, radiology films, and notes from past visits, and have it in aggregate form as well.
Previous systems were complicated and not designed with clinicians in mind, and physicians and nurses wouldn't use them, according to Dr. Tom Lathrop. He said some physicans were worried that EMRs might interfere with the doctor-patient relationship, but he vouched for the speedier information retrieval made possible by electronic records and for Rislow's approach to change management. "She came in with the idea that she wanted to understand what we would use," he said.
In conjunction with the EMR, Gunderson installed computers with wireless cards in every exam room on campus and out in its service region.
The organization invested $150,000 in a Unix-Oracle
system, which it thought was a large amount of money. We thought we were breaking the bank, Rislow recalled, but it paid for itself hand over fist with the utilization that came with it.
Since implementing the EMR, Gunderson has begun its migration to a wireless system, which is near completion. It started wireless service with Computers on Wheels in the nursing units, where workers tend to remain in their departments, but when it migrated to physicians, who often move from floor to floor with their PDAs, Gundersen's first wireless lessons were learned.
With doctors on the move, it was getting wireless bleed through from floor to floor. Physicians were leaving their previous connection as they moved to other floors, which Rislow called a huge dissatisfier.
The solution was to increase the number of wireless access points, and lower their radio frequencies. A lot of times, you have to increase the frequency, she noted, but we had them up high and they were bleeding through the floor. The PDA devices were confused from one unit to the other in terms of which hub they were accessing.
PDAs are used for dictation, to synchronize e-mail, and to upload healthcare reference materials, and physicians are allowed to take them out of the hospitals and clinics. To ensure patient data safety, which is largely dictated by the Health Insurance Portability and Accountability Act
, the devices are secured through a login process, they have a rapid timeout based on lack of utilization, and the data is securely encrypted.
In addition, once the dictation is uploaded through the wireless system and onto the patient's EMR, it is no longer stored on the PDA.A place at the table
Rislow majored in computer science, started her career as a registered nurse, and has almost completed her MBA - all of which have helped her get to this point.
Earlier in her career, she witnessed CIOs as they were largely out of sight and out of mind, but a necessary transition has taken place. When Gundersen launched its EMR implementation, the title of CIO didn't exist, but that project helped convince the organization that its chief technologist should have a seat at the table.
In today's world, the CIO really can't be the technical person sitting in the back room, she said, but for the most part, for many years, that's what the CIO was.
What they lacked was the business acumen and the leadership acumen to really be able to communicate and sit at executive tables and gain the credibility and the respect of their peers.