Yearly Archives: 2014

Ebola and the role of an EHR

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“EHR Flaw at Core of US Ebola Case”.  No CIO could ignore this October 3rd headline. As a CIO, one of our nightmares is that a problem in the systems we implement could cause a major medical error. One of our core missions in health care information technology is to prevent medical errors.

The statement blaming “EHR flaw” was retracted within 24 hours as the facts became clear. But as hospitals prepare to safely care for patients with Ebola, the role of the Electronic Health Record becomes more clear.

The EHR is a critical tool for handling any kind of infectious disease.  It is the means by which the appropriate information is captured at patient intake and is clearly accessible and visible to all caregivers. Close coordination between clinicians, operations and IT are extraordinarily critical in designing and implementing clinical systems. Continue reading →

Plan for the future, manage for today

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How often have you heard an IT leader say they want a position that’s “more strategic” and “less operational?”

The reality is that there is always a balance of both, depending on the level you work at in your organization. Sometimes, it’s not the balance you’d like to see.

Me too.

As the CIO, my typical day is back to back meetings. Plus, I squeeze in email and phone calls on a range of additional issues. I read and answer email well into the evening after I get home.

In the past week, I’ve reviewed presentations and read articles on health care in the future and how technology enables innovation: reflective thinking and planning.  Continue reading →

Listen and learn — why I host staff breakfasts

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Last November, I started the practice of hosting monthly breakfasts for up to 20 of my department staff at a time. We skipped two months around the time of our major inpatient go live in June. That means I’ve spent time with at least 160 staff getting to know them, listening to their concerns and answering questions in a small, informal setting. There’s a small group of “frequent flyers” who have come to more than one so far. I tease them that it must be the food but I know it’s them wanting to have a voice which I’m happy to listen to.  “Make your voice heard” is a theme I’ve been encouraging all year.

At the most recent breakfast, there was a lull in the conversation.  I called upon one of my frequent flyers whom I have come to know is willing to tell it like it is.  Continue reading →

User group meetings — learning from others (part 2)

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Last week, I wrote about the value of site visits as a way to learn from others. Fresh off the annual Epic User Group Meeting (UGM), I’ll call it a site visit on steroids. There are over 10,000 attendees, 100’s of educational sessions presented by users, direct access to Epic staff, and plenty of networking time; you see what I mean?

This was the first year it made sense to invite my executive colleagues from UMHS to attend. Our core Electronic Health Record is now in place, our executives need to look to the future: what else is possible with the product we already have, what new functionality is planned for future upgrades, and what other Epic users are doing.

Three UMHS executives answered my call and they were glad they did: the Hospitals and Health Centers CEO, and the executive directors of the children and women’s hospital and the adult hospital.  We will debrief as a group soon about what they saw and heard, and to explore what functionality we should prioritize next. Continue reading →

Site visits — learning from others

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What do NHS Trusts (hospitals in the UK), the Department of Defense Military Health System (MHS) and Brigham and Women’s Health Care (BWHC) have in common? They all think they can learn from our experience implementing an integrated electronic health record (EHR) at UMHS. We hosted a group from the UK in early July and hosted military leaders from MHS this week. And we are planning to host a team from BWHC in late October. The UK and MHS are in the planning and vendor selection phase while BWHC is less than a year away from their big bang implementation of a new integrated EHR.

One of the great things about the health care industry is that we are always willing to learn from one another. Continue reading →

Leader as conductor

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Many leaders use a musical analogy to describe leadership: the leader is like a conductor. I wonder how many of them have actually been part of an orchestra or a choir member? I have been in HIT management for 30 years and I have sung in church choirs for over 20 years.

When I walk into our weekly choir rehearsal, I am just one of about 50 voices ready to take direction from our leader – an extraordinary young man, Glen Thomas Rideout, who just completed his PhD in Musical Arts in Conducting. Regardless of the job we hold or the day we had, we are there to take direction from him, to listen to one another and to make music. Continue reading →

Beyond the core Electronic Health Record

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Hospitals have been either implementing or replacing their core electronic health record (EHR) in recent years. The work has included the entire suite of applications that make up the revenue cycle, patient access, and advanced clinicals in both inpatient and outpatient settings. But as we look beyond the core EHR, there is much more potential for technology.

This week at UMHS, clinicians and staff did a two day “deep dive” into the next group of applications as we move forward with our EHR. Teams from transplant, anesthesiology, radiology, cardiology, and home care reviewed Epic’s capabilities so we can decide what will be included in our next phase of work – what we call MiChart Stage 4. These important assessments require an in-depth review of current capabilities, and an understanding of the product roadmap. Continue reading →

Importance of rounding or going to the “gemba”

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In lean speak, you have to go to the “gemba”, that place where the work is done. GembaTo go to the “gemba,” I rounded with some of my colleagues in the early days of our inpatient Epic go live. They included our Chief Medical Informatics Officer (CMIO), the executive director of our children and women’s hospital, and our Chief Nursing Officer (CNO).  We visited many different inpatient units – to listen to staff tell us how it was going and describe issues. It reminded me that I need to once again make time to regularly round with our users. Continue reading →

MiChart – the beat goes on

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Walking down the hall at our University Hospital last week, I ran into a UMHS senior leader I hadn’t seen in weeks. He asked me how MiChart was going – that’s the program name for our new integrated electronic health record. I said “very well.” I joked there are no picket lines outside my office and I’m not getting nastygram emails. I’m actually getting to focus on a lot of other things now, compared to those first few weeks after our MiChart Stage 3 inpatient go live two months ago. Our clinicians and other staff are adapting pretty well and, overall, things are going smoothly.

With this stage of our Epic implementation completed, we now have an integrated system across ambulatory, inpatient, hospital outpatient departments, and revenue cycle. Continue reading →

On the lean journey

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I recently heard Amir Dan Rubin, president and CEO of Stanford Hospital & Clinics, describe the three plus year lean journey of his organization. While those in the audience were impressed and even BilliPullQuotesalivating over what they have accomplished, Amir was the first to say they have much more to do. A true journey it is. Even leaders from some of the organizations we want to emulate say they have many miles ahead on the lean journey.

What is lean? According to the Lean Enterprise Institute, “the core idea is to maximize customer value while minimizing waste. Simply, lean means creating more value for customers with fewer resources.”

Amir Rubin and John Shook, the CEO of the Lean Enterprise Institute – both national thought leaders in lean thinking – were the keynote speakers during the Healthcare Value Network (HCVN) site visit that the University of Michigan Health System hosted last month.

The network is a learning collaborative of health care organizations committed to lean transformation. UMHS is a founding member of the network. Attendees at this session included leaders from Stanford Health and Stanford’s Lucile Packard Children’s Hospital, Lehigh Valley, Cleveland Clinic, the BJC System, UMass and NY Health and Hospitals Corporation.

Our Michigan Quality System (MQS) actively participates in the network and organized the 2 ½  day site visit. MQS combines the strength and success of our longstanding commitment to scientific problem solving with tools and a unified philosophy to provide a robust approach to quality improvement. MQS adapts lean thinking as a consistent approach to quality and process improvement.

Led by Dr. Jack Billi, MQS has been helping UMHS make steady progress on our own lean journey for 8 years. Jack says he wants to develop 25,000 problem solvers – every UMHS employee. Our lean journey is evident throughout UMHS:

“Managing to Learn” courses focus on teaching A3 thinking by tackling a real problem with support of a mentor

  • People work with a lean coach
  • People develop a value stream for a functional area
  • Groups implement daily huddles and visual boards

MQS staff and others showcased some of our more advanced areas of lean work at UMHS during this site visit.

Colleagues from other network member organizations also had the opportunity to visit a few outstanding companies in the Ann Arbor area to learn from them:

  • Con-way Freight is a trucking company that is an exemplar in using their Visual Strategy room to manage their business
  • Menlo Innovations is a software development company that has intentionally chosen to found its culture on the Business Value of JoyTM 
  • Last, but not least, Zingerman’s is known for its fabulous deli food and its unique culture – they offer training programs to other companies

Managing to Learn was one of the first training programs I attended at UMHS. I took on a project that turned out to be too big for a first A3 but, with the CEO as my mentor, I learned. Many of my management team and staff have attended lean training. We use standard forms for projects and capital requests that follow the A3 format – background, current state, problem, analysis, goals, and countermeasures. We still have room for improvement in true A3 thinking and problem solving. We track various metrics but don’t have a visual room or board where we regularly post such information to review it as a group.

HCVN group Gemba visit to University Hospital OR huddle board. What went wrong today?

HCVN group Gemba visit to University Hospital OR huddle board. What went wrong today?

Gemba is a Japanese word which means “actual place”. In the process improvement context, “going to the gemba” means observing the process in action. Going to the “gemba” in my department is difficult; the majority of staff work in cubicles on computers. What exactly is the team’s process to observe and understand on a “gemba” walk?

I’ve been honest about the challenges in my own department, and I’m committed to applying lean methodology to our work. I look forward to the upcoming Lean Management On the Job Development (OJD) Program for senior leaders. One lesson I learned from Amir’s talk is this: senior leadership setting common expectations throughout the organization is critical to success. As we continue to roll out lean in IT, I expect everyone to participate.  It needs to be embedded in everything we do. Lean will become the way we work.

Stay tuned for what I hope to be some of our own lean success stories.

 

See the Michigan Quality System website to learn about our health system’s lean journey: http://www.med.umich.edu/mqs/

See the UMHS Quality Improvement website for more information on UMHS efforts: http://www.med.umich.edu/i/quality/index.html

See the Virtual Lean Resource Center to learn more about lean: www.med.umich.edu/i/quality/tools/lean_assist.html