Nilofer Merchant is an expert on collaborative leadership and author of, "The New How," and "11 Rules for Creating Value in the Social Era."
The Enterprisers Project (TEP): You completed a total refresh of Green Clinic's technology as one of your first undertakings as CIO. What were some of the challenges of that project?
THOMAS: Green Clinic is a complex organization. Our medical professionals treat approximately 1,000 patients per day across 25 specialties. It's a regional organization with a lot of complexity and technical and compliance issues that further complicate how IT operates.
Our physician-owned organization, founded in 1948, is comprised today of 50 doctors and about 450 employees. The biggest challenge is that everybody is priority number one. Whenever a system goes down or someone has trouble getting something to work correctly, IT hears about it immediately. And because we are a healthcare organization, we do not have the luxury of tolerating downtime.
TEP: Sounds like a demanding environment! Did you have to make special efforts to sell the doctors and other stakeholders on the benefits of modernizing your technology?
THOMAS: There was some resistance to the expense of refreshing the IT environment, but Green Clinic had long had a physician-led plan to move to a fully electronic record system and part of my role was to facilitate that plan. Having our physicians already on board meant that the issue of expense came down to gaining consensus on what the final product would need, and then negotiating around those requirements.
We built an internal committee of department stakeholders and then sat down and identified which systems needed to be updated, which needed to be integrated, and which needed to be updated in order to be integrated. We also established a pilot site for our initial medical record system installation and ran it in a live environment for 18 months in order to determine the strengths and weaknesses of the system and the suitability for our environment. That pilot run also helped us to prioritize the order of systems to be integrated into the production medical record platform, based on how often the pilot physicians had to go outside of the test system for additional information.
Communication was key. With 50 physicians and 25 specialties all working from the same medical record platform, a one-size-fits-all approach did not work. Users don't want to feel forced into a system they don't like or that doesn't work the way that they need. We spent almost six months prior to our production go-live sitting down with physicians and departments and implementing their workflows electronically, then working to streamline them. By doing this we were able to show the value of the system to the physicians and staff before it went into production, as well as calm any fears about how it would run once we went live. By automating workflows and preparing everyone ahead of time, we were able to keep the emphasis on our patients during our systems and infrastructure upgrades and not let the technology steal our focus.
TEP: What were some of the benefits you saw from the new deployment?
THOMAS: We realized numerous benefits from our electronic medical records (EMR) system but the biggest were flexibility and availability. Our charting prior to the EMR was primarily on paper, which meant that there was one patient record and it needed to travel to wherever the patient was being seen, prior to the patient's visit. If a physician or department did not return the chart to the medical records department after a visit, it might not be available the next time the patient needed to be seen and staff would have to go locate it. Considering that we have 25 specialties, it is not uncommon for patients to come in for a visit with their primary care provider and then be referred to a specialist in another department during that same visit. The EMR broke the hold of those paper charts and allowed us to more efficiently treat patients, and well as enabling our physicians to securely access charts from wherever they happen to be working.
The side effect of that change though is that if a chart can be accessed from more devices and locations, we have to be able to support more devices and locations in a manner that is quick and efficient. We knew this from the start though and designed our infrastructure to be flexible enough to support the various workflows of our staff.
TEP: You also changed how you handle remote support. Can you tell us why?
THOMAS: In addition to a primary office facility and a hospital in Ruston, we operate six satellite facilities, two in Ruston and four in the surrounding 80-mile rural area. So, obviously our resources are spread over a wide area and IT issues have to have the capability to be resolved remotely.
If a nurse is tied up at her desk trying to get the system to work, or a doctor who is a tablet user can't connect to the system, the patients may not be seen on time. Electronic medical records are clearly an important component in the ability to see patients, provide care and determine a course of action. If the doctor can't work because of technical problems, then care falls behind and we've got people sitting in the waiting rooms longer than necessary. There is a true cascading effect when IT cannot keep up with the demand for problem solving from users.
Prior to using our current appliance-based remote support tool, The Green Clinic's IT department used brand-name cloud-based remote access software to provide remote support to users. While the IT support team found these tools adequate for performing unilateral tasks, such as deploying a software update, they did not support sharing a technician's screens capability that enables support reps to remotely teach users how to perform tasks through impromptu classes during support calls.
When we got a call from one of our remote locations, we often had to send out a support rep to make sure the problem didn't disrupt their work. It was a time-consuming and expensive structure. Most of our data, including EMRs and lab data, is in a digital format, so we couldn't continue along that path. It wasn't sustainable with the data profile growing over time. We had to take a more proactive and efficient approach. In addition to that, once we had clinic personnel relying more heavily on smartphones and tablets to perform their work, our department saw the need for a remote support solution that could support those devices as well.
TEP: What about security?
THOMAS: Security is another reason the clinic switched. We have to be HIPAA compliant. Security underlies every single thing we do. We can't afford to have patient information lost or breached. Our remote support sessions are hosted within our firewall, not out in the cloud like the remote support tools we used previously.
Vendor access has also been in a lot of headlines lately, and not in a good way. Companies are waking up to the fact that access from vendors and other outside entities must be controlled. We can now securely control and monitor vendor access to the clinic's network and define privileges for each vendor that needs access to the Green Clinic's network, limiting the systems they can access. The remote access tool we have in place now logs every action a vendor takes while on the network for added security.
TEP: What benefits have you seen since changing how you handle remote support?
THOMAS: Our problem resolution speed is much more advanced now. We also use the system to remotely set up and configure new machines. Putting aside things like general maintenance or configurations that require a few hours of our time, our average IT support session time is down to about 3 minutes from the time we get a trouble call and we're in the machine to the problem being fixed and IT resolving the issue.
As far as reducing IT's trips to physical locations, calls from remote sites averaged about one or two per site per week that used to require an onsite visit, either for support or training needs. I estimate that 90 percent of those can be handled remotely now, saving my organization the cost of mileage for a tech, lost time due to travel and lost hours that would be allocated to other more pressing IT projects. Depending on the remote site being visited, travel time averaged between 1 and 3 hours round trip, previously costing my organization 5-10 hours a week in time lost due to travel.†If you factor in the time of the staff who can't work while they're waiting on IT to arrive, it would cost the organization even more in lost productivity.
Now some sites have not had the need for IT onsite in at least three months. Being able to remotely support, troubleshoot, and fix a problem and then go back to what we were working on without leaving the office makes us considerably more productive. It also gives us time back to be able to go out and proactively address needs that add value to the organization.†
TEP: Any advice you'd pass along to other CIOs undertaking transformative projects such as these?
THOMAS: The world where IT was just another business department is coming to an end, and the world of IT as a business enabler is well established. First and foremost, identify your stakeholders in any project, large or small, and open a line of communication with them. Be a partner. Seek to understand how they are trying to improve the business with technology and take it a step further. It is hard to transform an organization when you offer the same solution to every problem. Sometimes you have to step out of your comfort zone and spend time in someone elseís to gain a real understanding of how to deliver value.
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