Meeting with Richard Rogers of HealthFirst and Lexmark innovative solutions

CMIO Magazine: Tell me a little bit about your background and about HealthFirst


Richard: I’ve been with HealthFirst for about 14 years and currently I serve as the SVP of support services, responsible for IT, medical equipment, and clinical engineering.  I also set the strategic planning and vision for each business unit.  HealthFirst is a $1 billion corporation comprising of 3 hospitals, with the 4th hospital under construction.  We have about 6500 EFTs, one of the largest employers in Brevard  and Palm Bay Florida. Other services include outpatient centers, the county’s only trauma center, home care, specialized programs for cancer, diabetes, heart, stroke, and rehabilitative services, central Brevard’s largest medical group, three fitness centers, Medicare Advantage, commercial POS, and commercial HMO health plans.


CMIO Magazine:  What key clinical projects are you working on?


Richard: The top three clinical projects would have to be Physician Order Management, the implementation of a new Pharmacy system along with the implementation of electronic medication administration record (eMAR) roll-out.


CMIO Magazine:  What Lexmark products or services should hospitals and other providers know about but probably don’t?


Richard:  As part of our electronic medical record (EMR) implementation some time ago, output management became an issue.  We were dealing with multiple types of equipment such as printers and fax devices in our units and this model put a great deal of support demands on our technical and implementation staff.  We didn’t have a good system for handling printer cartridges, a nurse would overstock to minimize downtime so we had inventory and storage issues.  We also faced challenges with our leased copier and fax machines.  We support physicians outside of our network in the community so not having good control over our processes can be inefficient and costly.   Thus, we began the process of looking to standardize, consider consolidation and add new functionality where appropriate.  We went through a vendor selection and decided to contract with Lexmark.  We ended up reducing costs and introduced additional functionality such as scanning using a single device that can also print and fax.   We ended up outsourcing the equipment services to Lexmark in over 80 locations that we support.


CMIO Magazine:  How has Lexmark solutions made a difference in patient experience?


Rich:  The patient experience has improved by allowing our physicians, nursing staff and the support team to spend more time focusing on patient care rather than dealing with malfunctioning device issues.  Also, given the staff’s ability to scan documents right in the clinical areas rather than sending them to medical records for processing, we’re more efficient and effective in handling paper which gives our patients a sense or trust that their documents are protected and secured.  We’re also able to handle patient instructions in a more effect and personal manner.  With Lexmark solutions, we’re able to print patients instructions with a patient’s name and any specific directions personalized for each patient.  We’re also able to handle our remote locations as some of them have 1-2 physicians with little support for administrative work. 


CMIO Magazine: Bad economic conditions are sure to hit healthcare providers hard with more uncompensated care and tougher lending markets. When IT costs come under the microscope, how can technology, including that provided by Lexmark, prove that it’s paying its way?


Richard:  We also reduced the number of carriers who transported medical records, lab results or similar types of documents from one location to another by centralizing Lexmark’s data scanning and retrieval solution.   By providing standard processes and devices, we can train nursing and support staff faster and utilize their services across the system which has helped us reduce the need to hire outside nursing support via different agencies. 

 CMIO Magazine: Any closing remarks?

By standardizing the equipment and the output [printing, faxing and scanning] of our workflows, we have a more efficient organization.  We have a much better handle on expenses. This project looked very overwhelming at first and getting everybody to agree and make decisions around devices, processes and policies is a huge cultural challenge and can be a barrier.  The organization needs to assign the right leader to be responsible for developing the vision and strategy and being empowered to execute it.

What is a Chief Clinical Informatics Officer (CCIO)? A meeting with Jerry Osheroff, MD of Thomson Reuters

CMIO Magazine: How has the CCIO role evolved for you?

Jerry: I studied Electrical Engineering to pursue my passion for systems design and improvement, and then Internal Medicine for the healing interpersonal connections it provides.  An informatics fellowship brought these elements together, and started me on the course of helping to address pressing performance challenges in our healthcare system through better clinical information management.  Initially this played out through independent consulting, then working with the American College of Physicians, and then with a  start-up that was subsequently acquired by Micromedex (a clinical decision support company known to many of your readers) in 2002. 

In 2003, I was appointed to the newly-created CCIO position to help accelerate the evolution of Micromedex from a vendor of clinical knowledge bases to a provider of clinical performance improvement solutions.  Over the next several years, several businesses within Thomson Corporation (now Thomson Reuters) came together to round out the performance improvement portfolio.  For example, with analytic, benchmarking and reporting solutions from Medstat and Solucient, and workflow solutions from MercuryMD. So, during the last 6 years the role has grown with the organization, i.e. guiding the development and dissemination of a broad array of services and tools to help our customers realize measurable performance improvement.  There may be something of a parallel here with some CMIOs in provider organizations, whose roles have grown along with their institutions.


CMIO Magazine:  How would you categorize your roles and responsibilities as CCIO?

Jerry:  I’d say it starts with our customers and the tremendous performance challenges they face, and works backwards from there.  At a high level, my role is to help ensure that we fully leverage our assets and capabilities in helping care delivery organizations provide care that is safe, high quality and cost effective.  That includes helping to enhance, communicate and deliver on our value proposition, which involves working closely with our strategy, product management, marketing, sales and services functions, among others.    My personal expertise is focused on clinical decision support, so I work particularly close with that part of our organization.  For example, making sure we get the right information to the right person in the care delivery team (including the patient), in the right format, through the right channel, at the right point in workflow – to support better decisions and outcomes.  So I help enhance and disseminate our current CDS solution portfolio which includes applications for clinical surveillance, order set management, alerting, reference information and workflow support, and many others.  I also work closely with the part of our business that provides performance benchmarking, analytic and reporting solutions, which are important to measurable performance improvement. There’s interplay with these issues and the Payer side of our business, and I work closely with those teams as well.

Complementing this customer-facing work is fairly deep engagement at the national level on efforts to ensure that CDS is fully leveraged to drive widespread performance improvement. This includes helping develop roadmaps for national action on CDS, publishing guidebooks to support successful CDS deployment and the like.  Of course there are great synergies between these customer-facing and national efforts – each supports the other. I collaborate with many provider-based CMIOs in this national work who similarly realize synergies with their ‘day jobs,’ again reinforcing the parallels between the CCIO /CMIO roles in vendor and provider organizations.

CMIO Magazine:  Who do you report to?

Jerry:  Currently I report to the Executive Vice President who oversees our CDS business unit, and he reports to the CEO of our Healthcare and Science business.  However, as I noted earlier, success in my role as CCIO for a vendor (as with CMIOs in provider organizations), is largely defined by the ability to coordinate, guide, and support many diverse functions across the business.

CMIO Magazine:  If the CIO is clinical, is there a need for a CMIO?

Jerry:  I think the functions are different.  My sense is that the most effective CMIOs take a more cross-functional approach to leveraging technology to measurably improve key organizational outcomes. CIOs are typically more directly responsible for the care and feeding of the technology itself – though clearly they too need to be sharply focused on the organizational value.  I would imagine that a typical CIO would not have the bandwidth or focus to pay full attention to the details of HIT-enabled quality improvement (and evaluation of these efforts) as a CMIO should.

CMIO Magazine: from CPOE and EMR perspective, do you see a value behind it?

Jerry:  in short I would say “Absolutely yes”.  There is a huge upside for CPOE and EMRs.  That being said, it can also backfire if not implemented correctly, since the modifications it causes in workflow are substantial and complex.  We’ve written about keys to success – focusing on the CDS components of these systems – in the implementer’s guidebooks I mentioned earlier.  These success factors include working with the users of these tools to jointly addressed shared goals, rather than doing the implementations to them. This is a lofty goal, but the most successful implementations come closest, while the most problematic are often the farthest. The technology is a means to an end, not an end in itself, so the ends need to be explicit and shared, and guide implementation at each step.  We need to ask, ‘what are the stakeholders’ goals, and how do we best leverage the technology to achieve them?” For example in many cases, implementers focus excessively on intrusive alerting – instead of leveraging the full complement of CDS interventions – which results in end-user frustration, overrides, and failure to accomplish the desired objective (such as reducing ADEs).  Effective CMIOs ask the right questions, drive toward shared answers, and support technology execution that delivers results.

 CMIO Magazine: Any closing remarks?

A little more about my title – we decided to use ‘clinical’ and not ‘medical’ to emphasize that the role’s scope extends beyond matters pertinent to just physicians; my role addresses the needs of all care delivery stakeholders.  Similarly, the term ‘informatics’ is used to emphasize the critical importance of people, process and technology in supporting the improved outcomes the CCIO role helps drive.  

I’d conclude with the assertion, echoed in your other writings, that at its core, the CCIO/CMIO role is about driving meaningful and measureable improvements in key organizational and patient outcomes.  Our success really is a matter of life and death; for our organizations, the patients they serve, and ultimately for the broader healthcare system.

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