Memorial Healthcare's Frank Fear: Federal initiatives strain our workforce

For emergency room doctors at Lansing, Mich.-based Memorial Healthcare, the implementation of virtual desktops helped to dramatically improve workflow, according to CIO Frank Fear.

"What really drove our push to implement [for virtual desktops] was a need for quick access to patient data," Fear (pictured) told FierceHealthIT in an interview at HIMSS14 in Orlando, Fla. "We trialed a lot of different technologies like laptops and tablets, but the doctors soon found out that the idea of carrying around a tablet with them just wasn't really effective workflow-wise for them."

In addition to talking about his physician's workflow issues, Fear also discussed challenges with the virtual desktop rollout, which included personnel needing to focus on federal initiatives like Meaningful Use Stage 2 and ICD-10.

FierceHealthIT: You chose to meet the workflow needs of your physicians, rather than having them adjust to technology choices made from above. Why did you do that, and why do you think your physicians preferred the virtual desktop to tablets?

Fear: Better productivity, which means better outcomes. They found that they liked sitting at their physician device areas, reviewing the patient's chart, going to the patient's room and being able to tap in and tap out of a patient's record without all the hassle of continuously logging in.

For casual access, a tablet can help you to pull up information on a patient quickly; it's great for consumption. They're not so great for data entry, though. In an environment where you're working your shift and moving from patient to patient, it's not really good for intensive order entry or documentation. Tablets definitely have a role in clinical workflow, but not necessarily in a fast-paced ER environment.

FierceHealthIT: What challenges did you experience rolling out the virtual desktop?

Fear: It pulls away a lot of the management from your help desk folks and moves it onto your senior level infrastructure folks. When someone calls in and they have an issue with their desktop, before, a help desk person could get on there and configure the desktop and work it; with virtual desktops, a lot of the time, you have to go back to that virtual desktop image and make a change, and our help desk can't do that. That's really put a lot of added pressure on our senior level people, and those are the folks I need to be working on a lot of different projects.

FierceHealthIT: By other projects, can I assume you're referring to federal initiatives like Meaningful Use Stage 2 and ICD-10?

Fear: Exactly. When I started in IT in healthcare 11 years ago, you'd have one, maybe two major projects. Now, a lot of my folks have five or six major projects on their dockets; it's putting a lot of stress on them.

The other piece that is so challenging is, our board and executive team have a whole other set of strategic initiatives that we need to work on that don't necessarily align with Meaningful Use Stage 2 or ICD-10. For example, home health; there's a big initiative to try to drive that business. There's an aging population and we need to do more there to keep patients in our health system. That has very little to do with Meaningful Use Stage 2. With ICD-10, there's an alignment there, but kind of loosely from a billing standpoint.

So not only do we have to make sure we're addressing these regulatory requirements, but we also have to make sure we drive strategic initiatives outside of those to grow the hospital in an environment where our reimbursement continues to get cut and the payer model is changing with value-based purchasing and accountable care organizations.

My staff has been running at 100 percent for a long time now, and it's wearing on them. It's exciting that we're all being called to the table--we're all passionate about IT and its impact--but it's tough to see them getting worn down.

FierceHealthIT: How far along are you with Meaningful Use Stage 2 and ICD-10?

Fear: We're at the point now where all of our IT systems are at the level that they need to be to address ICD-10. All of our staff have gone through the appropriate training, both basic and specific, and we start our parallel testing in May, where we'll have folks code both ICD-9 and ICD-10. I feel really optimistic about where things are going to land in the end, even though it's still a really big change.

As for Meaningful Use, [the Centers for Medicare & Medicaid Services] calls that a voluntary program and I laugh. I don't know how that's really voluntary. When you're talking about the potential for penalties, that can be a tremendous hit to a hospital's bottom line. That's a high priority, as well.

You look at schedule, people and money to try to address those, but with schedule, there isn't really much wiggle room there, and with people, our cut in reimbursements makes it very challenging to add staff.

Editor's Note: This interview has been condensed for clarity and content.