The role of the Healthcare Chief Information Officer is changing. Shane Pilcher, CIO at Siskin Rehab, knows it’s important to be on the front lines and understand how every aspect of the organization operates. As Siskin’s first CIO, he paved the way for IT to have a place at the executive table, and now he’s finding new ways to make sure all technology is optimized to fully meet physician needs. In this interview, Pilcher discusses reassessing workflows when implementing new technology, why Siskin needs more than an acute-care-based EMR, and how telemedicine is affecting rehab. He also touches on the CHIME CIO code and the true importance of peer-to-peer connections.
It has been a wonderful combination for the organization, as we’ve witnessed significant growth over the past couple years that I’ve been here. IT has helped enable a lot of that growth, as well as invested significant effort eliminating legacy systems and to update and optimize existing systems.
The longer you spend with any EMR, the more invested you get, and the harder it is to make a change. But, while you get invested with customized content, optimized processes, and those types of things, when you decide to make a change, it’s important to not get caught up in trying to take your old system and fit it into the new system.
We need to spend time looking at how we do our business, optimizing those things, and then wrapping technology around that to enable it.
Not only is that information really important, but the peer-to-peer relationships that you create are critical. You cannot put a dollar value on that, it’s priceless.
I’ll also say, a good resource to have a provider that’s totally against the system as well. Through the process of engaging them, getting them involved, and making them a part of the building process, if you turn them into a supporter, you have a huge resource that will then help the other physician population come on board as well.
In some cases, I would even suggest that the CIO is very close to having to have the same level of vision that a CEO has in an organization because you cannot focus directly on IT, you must understand the organization as a whole with all of its nuances so that you can help lead them and their technology strategy.
Campbell: Coming from a consulting background, and now working on the healthcare delivery end, you bring a unique perspective to the CIO role. Tell me a little more about Siskin, how you came to be an organization and what your role is today.
Pilcher: We are one of the few remaining, independent, inpatient, acute care, rehab hospitals in the country. We’re just under 200 beds and have been established in Chattanooga, Tennessee for 25 years now. We’re one of the primary sources for rehabilitation care in the area. I came to Siskin in July of 2015. At that point, they had never had a Chief Information Officer, and certainly IT was never part of the Senior Leadership team. It was a fantastic opportunity to take them down a new direction and finally have IT at the table where decisions were being made and strategy was being developed. It has been a wonderful combination for the organization, as we’ve witnessed significant growth over the past couple years that I’ve been here. IT has helped enable a lot of that growth, as well as invested significant effort eliminating legacy systems and to update and optimize existing systems.
Campbell: Very good. If you’ll allow me to inquire, what are the primary clinical systems that you use today within the organization for EMR and potentially care coordination?
Pilcher: We are a McKesson Paragon shop. We’ve had Paragon in place for a little over ten years now. We are actively pursuing a different EMR, and we’ve narrowed it down to a couple of vendors. We expect a significant EMR implementation in our future within the next calendar year, so its exciting times. Paragon covers most of our areas, especially inpatient care coordination, but we also use an outpatient ambulatory EMR called TheraOffice, it’s one of the few out there that is heavily focused on therapy and rehabilitation care.
Campbell: Thank you for providing background and insight into your pending EMR replacement project. You bring a unique perspective, given that you’re a registered respiratory therapist and served in the United States Navy. Given this, tell me a little bit about how that clinical expertise has benefited you in your career and moving into healthcare information technology.
Pilcher: Absolutely. I have definitely had a varied career path. I do things unusually, in most cases, and my career path is evidence of that. I became a respiratory therapist in the Navy. I spent eight years on active duty and thirteen years in the reserves. After coming off of active duty, I joined Erlanger’s Children’s Hospital in Chattanooga and spent a few years there working as a therapist in the pediatric ICU, the neonatal ICU, the ER, and other areas. They had an opening in the IT department. They were just looking for someone with clinical experience that had an interest in Electronic Medical Records and they were willing and open to train that clinical person to build and optimize the system. So, I found my first opportunity in healthcare IT and spent a few years doing that. I then started consulting, and spent about fifteen years doing that. I was doing all sort of projects from, initially, EMR implementations, optimizations, through strategic planning and interim leadership.
Campbell: That reminds me of the career of Dr. Dale Sanders from Health Catalyst. I attended the Healthcare Analytics Summit a few years back and he talked about applying his diverse career, including command posts at the US Air Force, and how that military background can serve some purpose in offering structure to, what can be, a very overwhelming healthcare IT space, so thank you for that.
Can you tell me a little about any IP you have invested in Paragon today? I imagine having it in place for ten years there may be some technical debt in that system in terms of, perhaps, clinical rules, or documentation. If you could elaborate on the challenges of cataloging those different types of IP in systems as you plan on moving. A lot of healthcare delivery organizations today are moving from a system that is more comprehensive to an Epic or a Cerner, and I assume that is part of your decision making process.
Pilcher: Certainly. The longer you spend with any EMR, the more invested you get, and the harder it is to make a change. But, while you get invested with customized content, optimized processes, and those types of things, when you decide to make a change, it’s important to not get caught up in trying to take your old system fit it into the new system. It’s a beneficial opportunity to be able to reassess what you’ve been using for that period of time and determine if that’s really what you want to bring forward. It also allows for evaluation of established clinical workflows that you’re wrapping technology around. One of the key mistakes that organizations have made for the projects that I’ve been a part of, and even here if we’re not careful, is we try to take a current process and wrap technology around it. If the process and workflow is flawed, or inefficient, we’re just going to exacerbate that and make it worse. We need to spend time looking at how we do our business, optimizing those things, and then wrapping technology around that to enable it.
With Paragon, we have a lot of customized content in it, a lot of our assessments are there. However, because of our unique situation, we are McKesson’s only rehab client, at least up until the last year—I think they got a smaller rehab client that they’ve implemented Paragon with. So, while we have required functionality that Paragon provides us, based on CMS’s Data Regulatory Requirement feature, additional functionality really hasn’t materialized in the last ten years. We’ve had to do a lot of manual processes outside of the system to be able to overcome those gaps. While we have a lot invested in the system, it’s going to be easier for us to make that move than other hospitals only because we’ve had to do so many things outside of the system or used bolt-on third party applications to try and overcome some of the limitations within the system. Now we’re looking for systems with predefined rehab content. We don’t anticipate getting into a situation where we’re the only rehab client that the vendor has, where they don’t have specific functionalities for rehab. That’s due to the fact that while we’re an acute care hospital, we’re also rehab, and we don’t do everything like an acute care hospital does; we need something more than just an acute-care focused EMR.
Campbell: Thank you for elaborating on that. Switching gears, a little bit, can you tell me about your payer base in your market blend, and how that may be unique?
Pilcher: We’re very heavy with Medicare/Medicaid, quite a few of our patients fall into that bucket. We have a variety of other insurance providers, partnerships with organizations as well, for their workman’s comp and other injuries.
Campbell: Is there a good mix of value-based payment occurring, specifically with Medicare Advantage? If so, I imagine there might be a focus for you on HCC – hierarchical condition categories.
Pilcher: I see there being more opportunity. We partner with a few of our referral sources and their value-based programs, but as far as specifically, that’s about the only impact that has with us. Due to our payer process we get daily stipends, if you will, a certain amount of reimbursement per day from our commercial insurance partners and from Medicare. A lot of the value-based purchasing efforts in the acute care hospitals aren’t directly impacting us except as we partner with them to provide care to fit into their value-based purchasing programs.
Campbell: Tying into that, you have a state of the art facility that provides treatment for brain injury and stroke. Do you have any initiatives in place for shifting some of that rehab to home rehab, or incorporating telemedicine, or perhaps patient centered medical home? If so, can you elaborate on that?
Pilcher: The type of patients and the overall population that are presenting to inpatient acute rehab as well as our subacute rehab, is drastically changing. The typical orthopedic patients are being shifted to home health and outpatient therapies, and we’re there to help with that. Inpatient wise, we’re seeing patients with higher and higher acuity levels; they’re sicker than they’ve ever been and require a lot more care. While a lot of the orthopedic and nonmedically significant care is being shifted to home health, our focus has been to ramp up our brain injury, stroke, and neuro programs, as we’re seeing a significant increase in demand for that. Also, we have patients coming in directly from the ICU requiring rehab, so we’re seeing sicker patients, and many of those that are not being shifted towards the home health and outpatient environment.
Campbell: Thanks for elaborating on that. That’s a very compelling point, you are acute care so obviously you’re going to deal with those who have an inpatient stay. With that said, is it mainly limited to the surrounding areas or do you get out-of-state patients who seek you out because you’re a center of excellence?
Pilcher: We do have patients who come from across the country. The majority of our patients are locally and regionally based. We get referrals from as far as Nashville and Birmingham, but most of our patient population is more local than that.
Campbell: Shifting gears again, what pop health initiatives are in place today? Do you have any care coordination that’s occurring between the acute care setting and home health, easing those transitions of care? Are there initiatives in terms of referrals and/or handing off your portion of the patient record, perhaps through an HIE or any other means?
Pilcher: All of that is in transition at the moment. We have some coordination with our two largest referral sources, the two largest hospitals in the area. They have some specific population health initiatives that we factor in with some of their patients. For some of the orthopedic patients that are not candidates to be discharged, we have programs with organizations to bring them into our organization. As far as very formal sharing of information, that’s not happening much in this area yet, but our two largest referral sources are in the process. One just went live with a new EMR that would give them that ability, and another one is planning on doing it shortly and would change out their system to a system that would support sharing of data. Then, of course, with ours, that’s a key component to whatever system we put into place, to greatly enhance the sharing of data in our area. As far as a formal HIE, that’s not present.
Campbell: Great. I want to touch on your experience at CHIME as well, and gather some of your impressions from it. I know I personally valued the new clinical informatics track this year, which focused on the topic of physician efficiency and engagement. If you could elaborate on your goals with going to CHIME and how you may approach EMR replacement based upon things you may have learned at CHIME, specifically getting clinicians to use a new system and learning the nuances of that.
Pilcher: I think CHIME is an invaluable resource to CIOs in our market space. I was actually part of the planning committee for the fall forum this year, so I’m very pleased to hear that you liked what you saw. We spent a lot of time trying to make sure that the educational content contained value and I certainly think it did. Not only is that information really important, but the peer-to-peer relationships that you create are critical. You cannot put a dollar value on that, it’s priceless. It’s those individuals that are willing to take your call at a moment’s notice so you can bounce an idea off them, and determine how they handled things. When I was transitioning from the consulting side to the CIO role, there were numerous CHIME members that I had developed relationships with over the years, and they were readily available for me to call at any time—and believe me I did—to be able to get advice from. That’s something that, while we get hundreds of calls a day, and can’t take them all, if a CHIME member calls another CHIME member, that call is usually taken. I really value that with our fellow CHIME members.
Being able to get information on how they engaged their clinicians is key because, as we know, that’s not an easy population to have completely adopt an EMR platform, and having them engaged is critical. My advice is that engaging clinicians from the beginning, early on, and frequently throughout the process is a key piece to that adoption. They have to understand that the EMR doesn’t always bring efficiencies, like it was once touted. In some cases there are some, but it usually takes physicians longer to do what they need to do versus when they did it on paper. Understanding why we’re doing it, the safety implications that come from it, and then making sure that they’re part of the process of designing the system that they’re going to use is key. Finding a physician who is leaning towards being able to use the system well is a good resource to have. I’ll also say, a good resource to have is a provider that’s totally against the system as well. Through the process of engaging them, getting them involved, and making them a part of the building process, if you turn them into a supporter, you have a huge resource that will then help the other physician population come on board as well.
Campbell: That’s a great point, to focus on those outliers and not necessarily the low hanging fruit. I agree with your sentiment around CHIME, and kudos to a job well done coordinating that event. Like I mentioned, I witnessed CIOs who are always so gracious with their time. There’s just a deep amount of trust built up among peers and that’s invaluable especially when you’re in a tough position. As you mentioned, the healthcare CIO position today has morphed, as they are the quarterback and the glue within the organization to tie information technology to administration to. I’ll also mention too that the session Bryan Bliven and Dr. Tom Silva from Missouri Health presented was profound. They shared key insights with the way they engaged physicians, making sure that there’s rounding occurring, ensuring there’s -training that is occurring right across from the break room. Those pragmatic and novel approaches were well received.
Pilcher: I completely agree with you on the rounding part. As a CIO, you cannot stay hidden. You have to spend your time out there and that’s where you are able to develop a lot of trust with your end users and not just your senior leadership team. It can be kind of scary and dangerous to get out there because you’re going to hear what doesn’t work, but if you’re committed to getting it fixed, rounding is huge. Just to follow-up on what you were saying, as far as the transitioning of the CIO role, I know a lot of those educational tracks dealt with the transitioning of the CIO and the role we play. In my opinion we are one of the few leaders on the senior leadership team that truly has to understand every business sector of our organization, every business line – understand what they do, how they do it, why they do it, where their pain points are – so that we can then help them put technology around that. In some cases, I would even suggest that the CIO is very close to having to have the same level of vision that a CEO has in an organization because you cannot focus directly on IT, you must understand the organization as a whole with all of its nuances so that you can help lead them and their technology strategy.
Campbell: Absolutely. It must be multidisciplinary, and you must be able to fortify partnerships with your clinician peers. Thank you for sharing these cogent insights and for providing sage advice.
About Shane Pilcher
Shane has more than 25 years of healthcare and healthcare IT experience. He brings to Siskin Hospital his strong healthcare, military and corporate experience in leading teams to align IS strategy with corporate strategic plans.
Shane became a Registered Respiratory Therapist in 1995 while in the United States Navy where he served as a Respiratory Therapist, Navy Corpsman and EMT. In 2003, he converted to an Intelligence Specialist where he served time in Iraq and was the leading Chief over the Naval Intelligence Reserve Region Southeast’s Reserve Intelligence Training program. Shane retired as a Chief from the United States Navy with more than 20 years of active and reserve service. He has also received his Fellowship designation from Healthcare Information and Management Systems Society and holds a BS in Business Administration.