Reproduction permitted for personal use only. For reprints and reprint permission, contact firstname.lastname@example.org.
- As the information services director of an organization that has traveled a long road with Epic Systems
software, Galen Metz is in an enviable position.
Metz, who joined Group Health Cooperative of South Central Wisconsin
in late 2006, serves a health maintenance organization that has adopted virtually all the core Epic ambulatory and insurance modules - from the core electronic medical record to
the member portal.
GHC-SCW, which was the first Madison health organization to deploy an EMR, is so far ahead of the adoption curve that now it can focus more on the business intelligence advantages of EMRs.
Area hospitals implementing the Epic EMR find themselves immersed in the task of implementation and soon afterward will transition into the phase Epic refers to as optimization.
But business intelligence?
They are not even thinking about business intelligence because implementation is a big, daunting task, Metz said. They can't look too far ahead and take their eyes off the implementation ball, but the technology does serve as the foundation for what comes next.
Now that GHC-SCW can focus on incremental Epic upgrades, the next step is to capture the information generated from those modules to improve business decision-making and business performance.
Metz, who essentially serves as the organization's CIO, looks forward to leveraging data captured in the EMR to optimize workflows, enhance quality, and provide information to stakeholders. In terms of having data, it enables us to discover and identify those patients in our database that should have tests and that should have immunizations, and to proactively identify where we have some preventive care opportunities, he said.
Having long established its Epic suite, business intelligence is still a bit down the road for the cooperative, but it has taken concrete steps to accommodate it. Metz plans to take full advantage of the reporting mechanisms of both Epic and McKesson
software - Epic for
operational data and reporting and McKesson for overall analytics - but his first job was building a data warehouse using the McKesson clinical-management product. As a staff-model HMO, Group Health Cooperative is comprised of insurance and clinic pieces, and it has both insurance claims data and clinical medical data in its data warehouse.
It gives us a unique perspective on the data and the patients that we serve, Metz said. I don't think that was the intent of installing Epic, but it is an important by-product. It enables us to find information more easily than sorting through stacks and stacks of paper.
If you want to identify diabetics in your membership, it's a daunting task looking through paper records.
There is also a personalized care aspect to data capture. GHC-SCW has an outreach quality management service in which it tries to identify individuals in its member population. In accordance with National Committee for Quality Assurance
standards associated with patient populations, best practices would dictate that certain people in a certain age range should have various immunizations. The cooperative uses alerts in its system to contact those populations and encourage them to come in for scheduled tests and immunizations.
That can take on added dimensions as data mining reaches its full potential.Project momentum
Metz, who came to GHC-SCW from PacificCare
, said the best lesson he's learned from a large IT implementation is from the post-implementation phase. One of the most difficult things to accomplish is simply sustaining project momentum, which is possible over a long period of time even though it's natural for the initial enthusiasm to wane.
During the implementation, Metz said it's important to be persistent in dealing with obstacles that block the path to the desired result. Major IT projects require a lot of care and feeding along the way, and any sizeable project is going to spring some surprises.
You will have to anticipate spending some time dealing with the unexpected, and you have to anticipate that, he said.
The organization's next Epic implementation is not a major project, but it is expected to bring business benefits. The cooperative will install more registration kiosks, which Metz compared to having a self-service line at a gas station. Kiosks not only have helped the organization with patient check-in, they provide an option for tech savvy patients for a number of scheduling and other tasks that receptionists normally would do.
With the kiosks, we have 45 percent utilization, Metz noted. It frees up receptionists to deliver more personal care, and they have a wide range of responsibilities. It enables them to do a better job of dealing with the walk-up patients.No provider left behind
Metz, who is analytical by nature, has studied past supervisors very closely, learning as much from competent bosses as he has from substandard ones. He's also a bit of a paradox in that during quiet times, he devours books on management and technology, but other times he enjoys the amped-up rock of Stevie Ray Vaughan and ZZ Top. Believe it or not, listening to the latter group once helped him get through a dental procedure (filling), which is quite a departure from the elevator music that normally is heard in that care setting.
He's also a big Stephen Covey fan who frequently finds himself referring to the book The Seven Habits of Highly Effective People, both consciously and subconsciously. He's also gotten a lot of mileage out of The New CIO Leader by Marianne Broadbent and Ellen Kitzis of Gartner
, and he has gained from Jim Collins' Good to Great, which emphasizes getting the right IT people on the bus. (Metz goes a step further, stressing the importance of getting them in the right seats on the bus.)
But it was Covey who provided one his favorite inspirational quotes, which is printed on a poster in his office: Seek first to understand. The poster was given to Metz by a co-worker, and it meant a lot to him that an associate knew how important Covey was to his professional standards.
One emerging standard is the desire to spend more time on business strategy. Metz spends about 20 to 25 percent of his time on strategic matters, which he thinks is high compared to other CIOs, but he'd like to devote even more time to looking at the strategic forest rather than just the project trees.
Metz is involved in GHC-SCW's strategic planning, which he described as a rigorous process, but the first step was building relationships with various department heads. In those conversations, he's constantly trying to understand their needs and pain points, and determine if there is a way to leverage technology to help.
Mapping their needs to technology solutions has led to ideas and projects that otherwise may not have surfaced. One year ago, the cooperative was planning its 15th Epic upgrade in seven years, but it first wanted to know if doctors were using all the functionality in its existing business systems. That led to a physician survey in which doctors identified areas, including chart notes that required a sort of shorthand for doctors, where they did not feel as comfortable using the software.
That, in turn, resulted in a series of workshops amusingly titled, No provider left behind.
I think we forget that physicians are people, and there is an absorption factor, Metz said. We ended up deferring the Epic upgrade to enable this catch-up training.Sharing patient data
As an organization with five clinics and 60,000 members, GHC-SCW is grappling with several of the universal issues facing healthcare organizations: maintaining quality of care, containing costs, and the move to interoperability between organizations.
Metz believes Madison, whose health facilities are pursuing electronic patient data exchange, is on the forefront of interoperability. With plans to use Epic Systems' Care Everywhere
product for interconnectivity, Madison hospitals and health plans are working toward a go-live date for the exchange of patient data, and state government helped recently by removing some statutory barriers to the sharing of patient information.
Metz is impressed with the commitment that made the removal of those barriers happen faster than some thought possible, and he believes GHC can effectively exchange information with other Madison facilities. The new go-live date has yet to be determined, but a timetable should soon be set.
My read is all Madison healthcare organizations want to do this, Metz said. All are supportive of it, and I think we are uniquely positioned to do this. We are all collaborative in nature, we all have Epic technology, and we have the support of executives in each of these organizations.Managing people
To Metz, the best part about being a CIO is the opportunity to build relationships. During his career, he has been forced into relationship repair work due to acquisitions and the cultural and integration work that occurs when rules and relationships change. With GHC-SCW, which has 790 employees and reports $190 million in annual revenue, he would prefer to help younger IT workers climb the career ladder in a stable environment.
I've fostered that and have a sense of stewardship about that, he said. People are in my care.