At the Health IT Summit in Minneapolis, sponsored by Healthcare Informatics, Cris Ross, CIO of the Rochester, Minnesota-based Mayo Clinic organization, shared his perspectives on CIO leadership and his organization’s IT journey, on Wednesday morning, at the Marriott Minneapolis City Center.
Complexity is built into the landscape at Mayo Clinic, Ross noted, with its 23 hospitals, 3,715 beds, 112 clinics, 1.3 million outpatient visits per year, 4,500 physicians, 2,400 residents and fellows, 57,1000 allied health staff, 67,000 employees overall, and $10 billion in annual revenues, spread out across several states. Furthermore, with its illustrious history of clinical and operational innovation, it is imperative that the healthcare IT leaders in the organization create and optimize systems worthy of the organization, Ross said.
Ross began his keynote address by providing his audience with some background on the history of Mayo Clinic, including on the innovative culture that emerged at the very beginning of the organization’s existence, 153 years ago, when the English-born William Worrall Mayo, who had served as an examining surgeon for the military draft board during the American Civil War, set up a medical practice in Rochester, Minnesota, with his sons William James Mayo and Charles Horace Mayo. After a devastating tornado struck Rochester in 1883, the Mayos collaborated with the Sisters of Saint Francis in establishing a hospital there, and from there, the Mayo story evolved forward.
Among other innovations very early on were the creation of one of the very first true medical group practices, in the early 1890s, and the creation of the first shareable patient medical record, by Henry Plummer, M.D., one of the original group members at Mayo Clinic. “They hired Henry Plummer, an endocrinologist, who was also an engineer,” Ross noted. “He also invented the modern medical record. He and his colleague Maude Mellish [Wilson] came up with the concept of how to consolidate all the data about a patient in one place, which was an innovation, as data was scattered everywhere. The other was how to share a record, as the fuel to the operations of an integrated group practice. That was also a huge innovation. The last piece was, Maude’s insight was, if we could systematize the way data was collected, we could use it for research purposes, and derive insights from data. Quite an insight during the period 1908-1910. The work behind creating a single record was a huge element in creating a unified clinic at Mayo. And even the idea of outpatient consultations was more or less pioneered at Mayo Clinic.”
It is in that context that he sees his responsibility as CIO, Ross told his audience. “This is a world-class institution that needs world-class IT,” he said. And that constant awareness sits at the core of his strategic planning as CIO, he noted.
Thus, his “lesson number one” among several: “know your place”—meaning that he feels it incumbent on himself and his team to provide the Mayo organization with a level of IT foundation and capabilities worthy of its culture of innovation.
And while the Mayo Clinic’s IT organization “consumer-centric, responsive, individualized, and best-of-breed”-focused several years ago, Ross, said, the best-of-breed focus had created a level of IT foundational weakness that was not sustainable. “To this day,” he said, “we have 2,000 named applications. The bad part was that our technology was siloed, proprietary, diversified, and imperfect. Here we were, arguably, the world’s best group practice, but our IT was far from perfect. So we created themes. For example, we had three EHRs [electronic health records]—one in Rochester, one shared between Arizona and Florida, one used in our community health systems in the Midwest. We were on a sustainability death march. We had multiple systems kluged together, we just couldn’t get there. So, sustainability was a theme” for the corporate IT team, moving forward into the future. “Innovation was another theme. Capability and execution were the third and fourth themes.”
Given some of the operational imperatives involved, Ross said, “We developed a plan for strategic workforce readiness, with five IT imperatives: maintain service while we change; secure the enterprise; implement shared enterprise systems; build platforms guided by architecture; transform the IT organization.”
Moving forward in terms of creating a single, unified, enterprise-wide EHR, Ross and his colleagues named that initiative “The Plummer Project. We wanted to honor Henry Plummer’s legacy,” Ross noted. And, within the context of the initiative, Ross and his colleagues have implemented a number of new systems, including the enterprise-wide EHR implementation. “One of the things we felt we needed to do was to put as much data into the EHR as we could,” he added, with regard to the idea of making the EHR as useful to Mayo clinicians as possible. The Rochester campus went live with the new EHR implementation on May 5, while the Arizona and Florida campuses are scheduled to go live in October. Meanwhile, a number of new systems, including a new dictation/transcription/speech recognition system, a new electronic fetal monitoring system, and a new real-time eligibility system.
“Lesson number two” in this journey, Ross said, “is that table stakes don’t win; and maintaining a stable enterprise core is table stakes.” In that regard, he said, “The absence of that enterprise core might break us, but its presence won’t ‘make’ us.”
The bottom line for CIOs? Creating and optimizing an exceptional information technology foundation; maintaining the highest level of service possible for clinicians and all end-users; and continuing to innovate forward, to support the clinical and operational innovations constantly evolving forward at a pioneering patient care organization. And, Ross said, providing a continuous level of information technology and IT service, to the high-performing clinicians and staff at a high-performing patient care organization, remains a continuous challenge, but with tremendous opportunity.
