At the Southern California Summit, a Broad, Frank Discussion of Implementation Challenges and Opportunities

Feb. 7, 2020
At the Southern California Healthcare Innovation Summit, a distinguished group of HIT leaders held a discussion on implementation that spanned a very wide range of topics—and organizational experiences

At the Southern California Healthcare Innovation Summit, held on February 4 and 5 at the Hyatt Regency La Jolla in the San Diego suburb of La Jolla and sponsored by Healthcare Innovation, senior healthcare IT leaders sat down together to discuss the important topic of “Managing Real World IT Issues to Support the Mission of Your Organization,” on Tuesday, February 4.

Kara Marx, R.N., vice president, applications, information services, at the four-acute-care-hospital, three-specialty-care-hospital, San Diego-based Sharp HealthCare, led the panel discussion. Marx was joined by Prudence August, Strategic Consultant, San Diego Health Connect; Tracy Elmer, chief innovation officer at North County Health Services, a federal qualified health center system serving the northern part of San Diego County and the southern part of Riverside County; Clark Kegley, assistant vice president, information services, at the five-hospital, San Diego-based Scripps Health; and Julie Reisetter, senior director, product, at the 150-hospital, St. Louis-based Ascension.

The lively panel discussion ranged over a wide variety of topics. To set the stage for the conversation, Marx noted that, “At Sharp, we start all of our staff meetings with a reflection,” which she noted helps to focus the minds of those involved. Often, that reflection is contained in a quote. Marx chose the following quote by noted business leader Peter Drucker: “The greatest danger in times of turbulence is not the turbulence, it is to act with yesterday’s logic.” And she immediately asked her fellow panelists, “How are you making sure you’re aligning your work and planning along with your organizational mission?”—and noted that, “It’s not often that mission statements change: it’s what we do, it’s who we are. But there’s so much going on the world that several external drivers are constantly impacting us.” And she showed the written missions of all five organizations on a screen behind the stage.

Marx noted from her experience at Sharp that “IT is often involved integration and security issues. We found that projects that struggled involved a lot of soft-skilled competencies, where the vendor and operations might not have appreciated what was involved. Example: contracts are done on a regular basis, and the administration of that is a skill we know very well. An operational leader may not know when to push, when to pull, when to have a discussion about negotiation.”

She went on to note that change management is a huge element in this. “We found that we would have points and projects that would stall, because the customer and vendor weren’t used to having these conversations. So our leadership at Sharp under the CEO, created a matrix and included everything, testing, training, contract management, application management, testing and training, security; and IT has become an active participant in these discussions. And we’ve found that every single project has checkmarks in different categories. We’ve found that as an organization, we weren’t as ready as we thought we were. So this matrix tool is creating dialogues and awareness. And we’re hoping it will continue to help us hit our goals and values.”

She then turned to Prudence August and asked her, “Prudence, what’s the next thing your organization needs to do at San Diego Health Connect? You were Palomar’s CIO prior to joining San Diego Health Connect.”

“It’s important to understand that it’s become the given, the norm, everybody expects that health information will be exchanged,” August noted. “So we had to think about what the value is that we can bring to each of our customers and providers, and look to how we might shift the technologies to better provide value. It’s not just the data-sharing component, but what elements can add to the quality or patient safety? Or adding the social determinants of health” to data and information processes. “So we would say, we have the basics, so what else can we provide?” And I was very excited in coming to San Diego Health Connect,” to be a part of processes, including creating “that real-time connection between field paramedics and the ED,” with paramedics now being given access to allergies and medication lists. “So we have to think beyond just data-sharing, and how we provide that value,” August said. “That’s a given now. And we’re moving on, and developing standards,” and working along multiple dimensions at the same time, particularly in terms of health information exchange (HIE).

“I agree, HIE is evolving forward, around interoperability, etc.,” Marx said. “Let’s start to leverage the impact on quality and safety.”

She then turned to North County Health Services’ Tracy Elmer, and asked for her perspectives. “I am the chief innovation officer for North County Health Services, a vital safety net in North County San Diego and southern Riverside County. I have a very cool job, focusing on people, process, and technology to drive change and improvement. My roots are in HIM [health information management], but also with a master’s in healthcare informatics. Our mission is most vital in keeping that laser focus on what we’re there for and who we’re there for. Technology is always going to be an enabler. But staying focused on the lives will always be mission-critical. And looking at adding value; and we’ve been focused on experience.”

In that context, Elmer said, “We’re so proud of our high quality, and we have incredible support; and one of the things that I’m doing is bringing in new process improvement methodologies. We recently began implementing Lean and Lean-Six Sigma, to eliminate waste and improve processes. Ultimately, it’s about serving our patients, and meeting them where they are”—and continuous process improvement will aid in fulfilling that mission, she said.

“I’ve been with Scripps 22 years,” Clark Kegley said. “As the technologist on the panel, I will tell you that we’ve been doing everything wrong, and we need to blow it all up. We need to provide goods and services to our customers—we need to meet their needs based on their wants and desires; and that’s been different for healthcare IT. We need to learn how to co-create, and become process engineers aligned with business and clinical operations, and to ask what the clinical or business problem you’re trying to solve? And that is a change that is very difficult for many IT to implement.”

Kegley went on to note that “We’re the largest corporate service within the organization, with 600 people. And that’s a whole lot of cultural change that needs to happen. So when we revamped our strategic plan over the summer, we limited its length to one side of one page.” What’s more, he testified, “We laminate our strategic plan and hand it out.” Very importantly, he said, it’s very important for healthcare IT leaders to be able to communicate what they and their departments can and cannot do, in clear, professional ways.

Reisetter noted that Ascension is not only a huge organization, but one facing IT integration challenges. “We’re in 21 states, with 150 hospitals and 2,600 sites of care,” she said, pointing to a slide that showed that the St. Louis-based system has 156,000 associates and over 30,000 aligned providers. And she drew a gasp from the crowd when she noted that, “Yes, we’ve got over 50 EHRs in one health system.” She later noted that “We have a partnership with Google whose details I can’t discuss,” but made it clear that the healthcare IT leaders at Ascension are working hard to create an IT systems integration that will solve that problem.

Meanwhile, “I’ve been there a little over a year, and it’s a really fascinating time right now,” Reisetter reported. “We’re literally decoding the DNA of one of the oldest organizations in the US. We have a clinical products division and a consumer products division. And we’re actually really talking to our patients, consumers, and families. And we’ve brought in a team of designers, ethnographers—and before we jump in and build these products that we’re sure everyone will need and want and then can’t believe it when people don’t use the tools—we’re asking them. Price transparency is one of the products that we’ve tackled, and the researchers were out there for 75 days, and they just did a debrief for us, complete with visuals on patients’ bills. So we’re actually aligned with what people need. And we’ve challenged ourselves to see whether we could build a digital health plan that wouldn’t cost more than $50 a month.”

“So how do we connect with the teams that we support?” Marx asked her fellow panelists. “We’re members of leadership teams, of frontline teams, we create teams with vendors and other partners. Tracy, your mission talks about a diverse community.”

“Maintaining a focus on the criticality of our partnerships, and making sure we’re able to care for the diversity of our patients, remains part of our DNA. And technology becomes an enabler, and being able to integrate new tools—and we’re implementing an EHR—and to make sure we can close gaps around referrals, etc.—and we’ve talked about external factors of influence. And politically, it’s really scary for many of our patients. So we need to ensure the continuity of care in every way possible, and technology is an enabler, in terms of telehealth, and remote monitoring, all connected tour mission as an FQHC.”

“When you start to think about things like mobile, video streaming, etc., digital transformation journey, what are your thoughts?” Marx asked the panel.

“It’s important to keep in mind that technology for the sake of technology only gets in the way of mission. We have to focus on our goals as an organization. If we align with goals, it just works. So we lead for less with a cool piece of technology, than with a discussion of the goals and objectives, and our job is to go off and deliver a robust platform that enables a goal.”

What’s more, Kegley said, “As we began to approach digital transformation, a lot of people approached that idea with siloed thinking. You have to create a platform that you don’t own or oversee but that will scale across the organization. Extending ease of communication to folks who don’t live in the technology world, is so important. No one wants the technology that gets in the way. And that speaks to partnerships. We’re spending a ton of time with Apple, Amazing Web Services, and Google. We will never compete with them, so let’s stop trying, let’s develop partnerships.

“Julie, per Clark, that makes me think about mind-mapping, etc.—strategies that have traditionally not been in HIT’s toolkit,” Marx said. “What have you been doing at Ascension, in terms of getting buy-in for new strategies?

“There were and continue to be, gaps. This is a whole new approach,” Reisetter said. “It was a gap for me. I’m sure some of you have taken on a new position, have moved into a new specialty, you take on a new role, have had to learn new things. Well, having a consumer product division—it’s like standing up a technology company inside a patient care organization. We’ve divided up the technology division at Ascension into parts, and it’s enormous. We’ve divided into ‘run’ and ‘build’ parts.”

What that means, Reisetter continued, is that “We have consumer and clinical studios in different cities. And we’re working on very specific products. So I now have three product managers reporting to me, and five projects in my portfolio. We have daily standups, we have huddles, etc. And the gap has been enormous. How we’ve tried to chip away at it—for each product, we have a cross-functional product team. I may need a finance function on a project team; may have an operational function that I need; so I pull in the right people. I’ve got a legal person on my product team, a marketing person on my product team, and their roles are very specific, they have to be able to act with authority and make decisions. So it really is creating a different culture; and we’ve got a long way to go. And we’ve created an internal Google site, where anyone can look at the products we’re developing. And it’s going to take a long time.”

“I also heard a little bit about the clinical studio,” Marx said. “I think many of us have been dabbling in the clinical side for a few years. But the clinical side is starting to do journey-mapping about the daily life of the physician, and how I impact that by creating a persona, to get to know the customer. Historically, some of our traditional informatics and training from vendors, haven’t always allowed us to have a view of that. Are the clinical studio people setting things up the way the customer studio people are?”

“Yes, they are,” Reisetter responded. “This is new and is being led by our design team. And we’re doing journey-mapping, and it’s a live project. We’re actually mapping how people think and how they feel, as they interact through that journey—the clinician or the patient. We map weaves, based on deep interviews. But the other piece is that we’ve focused on this big map that gets reprinted and has sharpie marks—and a bunch of little red dots, which represent pain points for clinicians and patients.”

“We’re starting to track value and benefit now, and so changing the just-transactional pattern of interactions, and that’s important,” Marx said. “And it’s happening.”

“There’s significant difference between a vendor and a partner,” August noted. “You need partners to achieve success. We need partners.”

“The openness, partnership, and collaboration, are critical today,” Elmer added. “And bringing in that partner, not just ‘vendor,’ is a really high-quality add to the process.”

“We’re always having this conversation,” Marx noted. “Do we refer to them as the operational areas, the business, the customer, our partners? How are you engaging the operational areas more? As you said, Clark, they don’t know I’m here until something goes wrong, and then they know my number/ So, models that are sustaining?”

“We have model care in our clinical operations areas, driven largely by nursing and other clinical folks looking to develop consistency of practice,” Kegley reported. “We plugged into that process very early upstream. We sat and listened, knowing and expecting that we would get to a point where our clinical partners asked us for technological support. There are reasons why ‘technology’ is the third word in ‘people, process, and technology.’ What’s great is that we learn a ton about how things are being used. It’s been a great learning process for us.”

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