Rex Healthcare in Raleigh, N.C. — a part of UNC Healthcare — is a completely paperless organization. It installed its electronic medical record system in 2007 and has since reached Stage 1 of Meaningful Use and achieved 80 percent adoption of computerized physician order entry. Leading the system's HIT advancement and implementation are Rex President David Strong and Vice President of Information Technology and CIO Novlet Bradshaw, who keep technological advancements at the forefront of the hospital's strategy. In fiscal year 2012, for example, HIT's capital allocation was second only to bricks and mortar investments at Rex.
Here, Mr. Strong and Ms. Bradshaw describe their current initiatives and drive towards meaningful use, describe the most stressful components of HIT and note how the role of the hospital CIO is expanding in today's healthcare environment.
Q: Ms. Bradshaw, CIOs possess an astounding combination of business and technology knowledge. Do you find one skill set emphasized in your role more than the other?
Ms. Bradshaw: No, they are both critical skill sets that have to be successfully leveraged and intertwined daily as the situation or audience dictates.
IT has [evolved] to become a critical success factor in the healthcare industry, especially driven by key initiatives over the past few years. IT involves the delivery of great service, not just technology, and we have to be able to differentiate our hospital business by delivering valued IT services and solutions. We are no longer technologists who sit in the basement, crank out code, take calls from the help desk or orders to fix somebody's computer, or reset a password. Because we are now helping to transform business, we also need to transform ourselves into being key business leaders, like a CFO or a COO.
The chief technologist can't speak a language no one understands, so everyone leaves us alone to keep the lights green in the datacenter. It is equally important that I stay abreast of the technology trends and changes in the industry, and remain proficient so I can lead the team and work with our IT partners to deliver the most reliable, easy to use and secure IT solutions to the business. That way, I am able to collaborate with our business and clinical partners to realize the Rex vision to deliver compassionate care enabled by technology
Q: Mr. Strong, how has your knowledge of HIT evolved in recent years? Do you find yourself possessing a more sophisticated understanding of HIT? If so, who or what has helped you get here?
Mr. Strong: Information technology is a key component of the healthcare business, and healthcare leaders can't sit on the sideline, abdicate that responsibility, and defer their understanding of technology. [As] much as a CEO has to understand and lead in areas such as strategy, finance and operations, the same is now required with HIT understanding.
The role of the CIO is a key seat to fill. This person has to have the right set of technical, business and interpersonal skills that will collaborate with the executive team to deliver IT leadership, education and governance.
Q: Ms. Bradshaw, is there a certain aspect of HIT and healthcare reform that has caused you the most frustration, stress or uncertainty?
Ms. Bradshaw: It's actually both exciting and overwhelming right now. This is a great time to be an IT leader, but it is not for the timid and unmotivated. What is most challenging and rewarding for me right now is to meet the entire project and resulting resource demands driven the healthcare mandates related to meeting meaningful use, performance based reimbursements and ICD-10 by mandated timeframes all occurring over the next couple of years. These are all happening at the same time that the healthcare business is changing and we have to form alliances with our providers and better integrate our clinical, business, decision support, administrative and IT infrastructure systems across our various entities in the UNC Health Care System.
Our IT users are getting more sophisticated. They're demanding we meet leading edge automation requirements that enable them to use the latest and greatest leading edge mobile computing devices (just like at home) that are not necessarily ready to support enterprise computing natively, securely or safely.
Q: Can you discuss meaningful use a bit more? How is Rex coming along in that area?
Ms. Bradshaw: We have fulfilled all the requirements and are currently attesting for Stage 1 meaningful use for the hospital per federal requirements. Meeting these criteria set by the government will allow Rex to receive an incentive, and more importantly avoid millions of dollars in penalties for missing quality- and performance-based measures that could start as early as 2013.
The key to successfully implementing this project was cross organization collaboration among clinicians, administration and IT. Working together for the last 12 month as an organization was a priority. We expect to receive our incentive payment any time after Jan. 2012. We are also executing the activities necessary for our ambulatory physicians, who are eligible providers, to qualify later in 2012.
Q: Mr. Strong, with the advancements made by Rex and the industry as a whole, can you imagine going back to paper records and the days before such sophisticated HIT? Can you share a few thoughts on how things have changed?
Mr. Strong: The journey to full implementation and adaption of electronic medical records and automated medical systems is a long and tedious road. The complexity of automating and making the systems easy to use and intuitive — and to get all the physicians comfortable using CPOE — has been a five-year journey for Rex. All of our nursing co-workers use the EMR, and without mandating full CPOE adoption, we now have more than 80 percent of our orders being done via CPOE, and our more than 1,000 physicians are trained in our hospital EMR system.
We are 100 percent electronic as all paper-based documents are digitized and uploaded into the EMR post discharge so clinicians have access to the entire patient records electronically. Up until about a year ago, when we struggled with a hybrid environment, some physicians contemplated if it would be more beneficial to move back to paper records. The transition had its challenges, but today, I don't think that would be voiced by the most ardent resistors of the EMR. Most of the limitations are now with the system capabilities, not physician adoption.
Q: HIT privacy and data breaches have been a significant concern for hospital administrators and lawmakers. 2011 brought a few major institutions into the limelight for privacy problems. How does Rex try to prevent problems related to privacy, compliance and HIPAA?
Ms. Bradshaw: Our process of keeping our data and infrastructure secure is multi-faceted and is always a top priority, given the strict HIPAA requirements to keep protected health information secure. We have a dedicated team of IT employees whose responsibilities are to make sure we safely manage and prevent unauthorized access to our data. We continuously perform risk assessment, and we have implemented solutions so we have the right controls and audit processes in place to manage access and data loss prevention.
Based on the same risk assessment, we also developed a robust disaster recovery, business continuity and security, and compliance program intended to address all the identified gaps. For example, we are making plans to have a redundant data site for all our critical applications, so they are always available. We also replaced our security software. And we hired independent consultants to periodically and proactively identify any vulnerability so we can address the gaps as soon as they are found.
Q: Mr. Strong, what are some of Rex's goals for HIT in the year ahead?
Mr. Strong: Rex, like other healthcare organizations across the country, has to implement and update our HIT systems and solutions to meet the various healthcare regulatory mandates and initiatives such as meaningful use and ICD-10. We must become prepared to proactively get in front of changing reimbursements and increased recovery audits from the federal government.
HIT goals must address these needs and minimize our risks while continuously improving our physicians and clinicians' capabilities in proving safe and efficient patient care. Rex is a member of the UNC Health Care System, which is simultaneously responding to these same mandates while we increase our integration — especially in HIT interoperability. We also have a goal to be in the top 10 percent of healthcare systems across the country and HIT will help us achieve that goal.
Ahead of the Meaningful Use Curve: Q&A With CEO Chuck Sted and CIO Steve Robertson of Hawaii Pacific Health
Blazing New Trails: 7 Successful Leadership Practices of Today's Top Hospital CIOs
Here, Mr. Strong and Ms. Bradshaw describe their current initiatives and drive towards meaningful use, describe the most stressful components of HIT and note how the role of the hospital CIO is expanding in today's healthcare environment.
Q: Ms. Bradshaw, CIOs possess an astounding combination of business and technology knowledge. Do you find one skill set emphasized in your role more than the other?
Ms. Bradshaw: No, they are both critical skill sets that have to be successfully leveraged and intertwined daily as the situation or audience dictates.
IT has [evolved] to become a critical success factor in the healthcare industry, especially driven by key initiatives over the past few years. IT involves the delivery of great service, not just technology, and we have to be able to differentiate our hospital business by delivering valued IT services and solutions. We are no longer technologists who sit in the basement, crank out code, take calls from the help desk or orders to fix somebody's computer, or reset a password. Because we are now helping to transform business, we also need to transform ourselves into being key business leaders, like a CFO or a COO.
The chief technologist can't speak a language no one understands, so everyone leaves us alone to keep the lights green in the datacenter. It is equally important that I stay abreast of the technology trends and changes in the industry, and remain proficient so I can lead the team and work with our IT partners to deliver the most reliable, easy to use and secure IT solutions to the business. That way, I am able to collaborate with our business and clinical partners to realize the Rex vision to deliver compassionate care enabled by technologyQ: Mr. Strong, how has your knowledge of HIT evolved in recent years? Do you find yourself possessing a more sophisticated understanding of HIT? If so, who or what has helped you get here?
Mr. Strong: Information technology is a key component of the healthcare business, and healthcare leaders can't sit on the sideline, abdicate that responsibility, and defer their understanding of technology. [As] much as a CEO has to understand and lead in areas such as strategy, finance and operations, the same is now required with HIT understanding.
The role of the CIO is a key seat to fill. This person has to have the right set of technical, business and interpersonal skills that will collaborate with the executive team to deliver IT leadership, education and governance.
Q: Ms. Bradshaw, is there a certain aspect of HIT and healthcare reform that has caused you the most frustration, stress or uncertainty?
Ms. Bradshaw: It's actually both exciting and overwhelming right now. This is a great time to be an IT leader, but it is not for the timid and unmotivated. What is most challenging and rewarding for me right now is to meet the entire project and resulting resource demands driven the healthcare mandates related to meeting meaningful use, performance based reimbursements and ICD-10 by mandated timeframes all occurring over the next couple of years. These are all happening at the same time that the healthcare business is changing and we have to form alliances with our providers and better integrate our clinical, business, decision support, administrative and IT infrastructure systems across our various entities in the UNC Health Care System.
Our IT users are getting more sophisticated. They're demanding we meet leading edge automation requirements that enable them to use the latest and greatest leading edge mobile computing devices (just like at home) that are not necessarily ready to support enterprise computing natively, securely or safely.
Q: Can you discuss meaningful use a bit more? How is Rex coming along in that area?
Ms. Bradshaw: We have fulfilled all the requirements and are currently attesting for Stage 1 meaningful use for the hospital per federal requirements. Meeting these criteria set by the government will allow Rex to receive an incentive, and more importantly avoid millions of dollars in penalties for missing quality- and performance-based measures that could start as early as 2013.
The key to successfully implementing this project was cross organization collaboration among clinicians, administration and IT. Working together for the last 12 month as an organization was a priority. We expect to receive our incentive payment any time after Jan. 2012. We are also executing the activities necessary for our ambulatory physicians, who are eligible providers, to qualify later in 2012.
Q: Mr. Strong, with the advancements made by Rex and the industry as a whole, can you imagine going back to paper records and the days before such sophisticated HIT? Can you share a few thoughts on how things have changed?
Mr. Strong: The journey to full implementation and adaption of electronic medical records and automated medical systems is a long and tedious road. The complexity of automating and making the systems easy to use and intuitive — and to get all the physicians comfortable using CPOE — has been a five-year journey for Rex. All of our nursing co-workers use the EMR, and without mandating full CPOE adoption, we now have more than 80 percent of our orders being done via CPOE, and our more than 1,000 physicians are trained in our hospital EMR system.
We are 100 percent electronic as all paper-based documents are digitized and uploaded into the EMR post discharge so clinicians have access to the entire patient records electronically. Up until about a year ago, when we struggled with a hybrid environment, some physicians contemplated if it would be more beneficial to move back to paper records. The transition had its challenges, but today, I don't think that would be voiced by the most ardent resistors of the EMR. Most of the limitations are now with the system capabilities, not physician adoption.
Q: HIT privacy and data breaches have been a significant concern for hospital administrators and lawmakers. 2011 brought a few major institutions into the limelight for privacy problems. How does Rex try to prevent problems related to privacy, compliance and HIPAA?
Ms. Bradshaw: Our process of keeping our data and infrastructure secure is multi-faceted and is always a top priority, given the strict HIPAA requirements to keep protected health information secure. We have a dedicated team of IT employees whose responsibilities are to make sure we safely manage and prevent unauthorized access to our data. We continuously perform risk assessment, and we have implemented solutions so we have the right controls and audit processes in place to manage access and data loss prevention.
Based on the same risk assessment, we also developed a robust disaster recovery, business continuity and security, and compliance program intended to address all the identified gaps. For example, we are making plans to have a redundant data site for all our critical applications, so they are always available. We also replaced our security software. And we hired independent consultants to periodically and proactively identify any vulnerability so we can address the gaps as soon as they are found.
Q: Mr. Strong, what are some of Rex's goals for HIT in the year ahead?
Mr. Strong: Rex, like other healthcare organizations across the country, has to implement and update our HIT systems and solutions to meet the various healthcare regulatory mandates and initiatives such as meaningful use and ICD-10. We must become prepared to proactively get in front of changing reimbursements and increased recovery audits from the federal government.
HIT goals must address these needs and minimize our risks while continuously improving our physicians and clinicians' capabilities in proving safe and efficient patient care. Rex is a member of the UNC Health Care System, which is simultaneously responding to these same mandates while we increase our integration — especially in HIT interoperability. We also have a goal to be in the top 10 percent of healthcare systems across the country and HIT will help us achieve that goal.
Related Articles on HIT and Leadership:
Spurring Innovation in Healthcare Delivery: 5 Best Practices of Health System LeadersAhead of the Meaningful Use Curve: Q&A With CEO Chuck Sted and CIO Steve Robertson of Hawaii Pacific Health
Blazing New Trails: 7 Successful Leadership Practices of Today's Top Hospital CIOs