"Staffing, operations, project management — there was nothing there anyone could point to and call good. It was almost like you had an IT shop from the mid-1990s that somehow wandered into 2010."
So says current Akron (Ohio) Children's Hospital CIO Thomas Ogg of the state of the hospital's IT department when he took the helm four years ago. He was the fifth CIO the organization had had in five years, coming into a department an external consultant had called "DOA."
"No one in the organization took IT seriously, everyone said it was broke," says Mr. Ogg. "But it wasn't even a matter of it being broke — it was never really there in the first place."
To add to Mr. Ogg's challenge, Akron Children's was embarking on an organizationwide Epic implementation. The hospital had more than doubled its IT staff in the year prior to his arrival in preparation for this project and was in the process of doubling it again, without additional leadership or having a cohesive vision for the department.
So one of the first things Mr. Ogg focused on was creating a workable leadership structure. "I had to focus on leadership first since we had only a dozen or so people in leadership roles, and none were working at manager or director levels because the department hadn't grown its own leadership," he says.
When he arrived, the upper-level IT leaders had to be very hands-on in each project, unable to delegate much. He started pulling employees with leadership potential into leadership roles and began a crash leadership development program. "With no project management office and no project managers we began building a PMO from scratch. Now the managers and directors are able to be managers and directors… and I now can go be a vice president because I have a team underneath me that can take goals and go," he says.
Using his background as a healthcare consultant, Mr. Ogg led reviews of the entire department to assess its current state. He took stock of all the department's systems and resources — "We didn't even know what apps we had in place," he says — and worked to identify gaps or inefficiencies in the department's processes. He also convened the department's revised steering committee, now including board members, providers, the CMIO and other hospital executives, and led the committee in the development of what Mr. Ogg calls a "bridge strategic plan — something to take us from where we were to where we needed to be."
While he was reshaping the IT department, Mr. Ogg was also pushing forward with the Epic implementation. Under previous CIOs, IT implementations had been what he calls "very conservative" — lengthy processes with heavy initial customizations that resulted in a system that was exactly what the physicians or other end-users wanted. But with about 18 months to install Epic, he realized the hospital's usual approach was not going to work, given the time constraints and all of the existing IT infrastructure that had to be replaced before the Epic install could go live. "The organization’s leadership discussed this and decided to move to the other side of spectrum — we decided we were going to get it installed quickly using more model solutions and then go back and optimize," he says. "It was an excellent test of our new governance process and the organization stood behind its decision."
While there were some issues with the Epic system when it went live in June 2012, Mr. Ogg reports little pushback from the hospital's physicians and nurses, mostly because it was the hospital's first major electronic health record system. "They figured out that we were addressing the real and larger needs but trying to move fast. It wouldn't be exactly what they wanted right away but they saw the value in it," he says. “From right after go-live, computerized physician order entry utilization was near 90 percent. Bedside medication administration verification started a little slower but picked up very quickly. It is consistently above 95 percent, and CPOE is well above 90 percent now and increasing."
The organization decided that the implementation on the ambulatory care side was to be more conservative with more customization prior to install because these physicians, coming from Allscripts, are used to a high-functioning EHR. But the more aggressive pace, especially on the hospital side, was "a very effective way of installing in this environment," he says.
Mr. Ogg's approach has been validated with several recent awards and achievements. Four months after it went live on Epic, the hospital was able to attest to meaningful use. In January 2013, the hospital that had been at HIMSS Analytics Stage 1 when he took over as CIO was recognized with the organization's Stage 6 Award. Six months after that, Akron Children's was named a "Most Wired" hospital by the American Hospital Association and the College of Healthcare Information Management Executives. Mr. Ogg expects Akron Children's to be ready to apply for HIMSS Analytics Stage 7 designation around mid-year.
Today, Mr. Ogg's department is still working at an aggressive pace to keep the hospital moving forward. "We're at the point now where we have a good foundation installed with our Epic system, and we're working on installing mid-tier apps like upgrading our infection control app or adding a helicopter transport app," he says.
The hospital is also working to improve business analytics capabilities, prepare for meaningful use stage 2 and connect to Ohio's statewide health information exchange, along with over 90 other projects this year. Now that the department has repaired its leadership, staffing, operations and infrastructure issues, the key, he says, is prioritization. "Before, whoever screamed the loudest or who had the most political muscle got their project worked on, and no one liked that," he says. Now, Mr. Ogg works with the hospital's other vice presidents to cooperatively determine which projects are at the top of the department's to-do list, and which are not a priority.
The project prioritization is part of Mr. Ogg's effort to proactively engage with the hospital's other departments about ongoing projects and emerging needs, and keep IT on the other executives' minds. "That's how to develop a real IT culture where people are thinking about using IT as a strategic asset," he says.
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