One-on-One with Christus Health CIO George Conklin, Part II

Headquartered in Dallas, Christus Health is a Catholic, faith-based, not-for-profit health system comprised of about 350 services and facilities, including more than 50 hospitals and long-term facilities, 175 clinics and outpatients centers, and dozens of other health ministries and ventures. Christus serves patients in 60 cities in Texas, Arkansas, Louisiana, Missouri, Georgia and Utah as well as parts of Mexico, and is listed among the nation’s Top 100 Integrated Healthcare Networks. Conklin, who has held the CIO role at Christus since 1999 when Sister of Charity Health System and Incarnate Word Health combined to form a united system, is focused on providing patients with the guidance and support needed to make them patients accountable for their healthcare. He faces a significant challenge in the near future as Christus begins a long-term project of integrating information from across the organization as it seeks to continue to grow acute care while also building non-acute and retail areas as well as international operations.

Part I

KH: So you’d be using information from the patient’s record to steer them in the right direction and away from possible adverse events.

GC: Yes, and also to customize care. It’s about using the system to provide personalized care to the largest extent possible and steer patients away from making a mistake. If you’re a well-insured patient, your appearing in one of our emergency rooms is actually good news for us because we usually get a pretty good fee for that. But it’s not a very good thing from a healthcare mission perspective. Our mission is to help people. Our whole focus is around how do we provide the best care and service to you and apply what we know about you in as many different circumstances across all of Christus to make that care, service, product and/or interaction the best that we can and the most customized for you.

It goes back to the hotel analogy. I frequently stay at Four Seasons hotels. At every Four Seasons I ever stay in, they always know about me. I’m what’s called a curbside patron; I come in and they hand me my key at the front door, I don’t have to go to the desk. They take all my stuff to my room when I’m there — the stay is customized to meet my needs based upon things that they’ve learned about me over the years and that they sometimes ask me about. That’s the kind of personal interaction and relationship that we’re looking to establish with our patients.

GC: The imputes for all of this is, in 2000-01 we undertook something we call our Futures Taskforce, and that was an effort that was facilitated by an outside company called the Global Business Network. They don’t exist any longer but are part of what is now called the Monitor Group. At that time they were run by a fellow named Peter Schwartz. He and another fellow named Arie de Geus, back in the 1970s, thought up the concept of scenario planning when they were working with Royal Dutch Shell and they asked what would happen if, for instance, the Arabs decided to cut down on oil supplies — what would Royal Dutch Shell do? And Royal leadership brushed it off and said that would never happen. Well, they laid out a bunch of scenarios and they laid out a bunch of things on the economic impact and brought it back to leadership, who said, it would be stupid of us not to investigate further what our options would be in the event that the Arabs decided to tighten up on oil supplies. So they went through a scenario planning exercise and began to make some investments in Southeast Asia and other oil explorations around the world. And when the Arabs actually did what the planners envisioned, Royal Dutch Shell was in a very good position from a financial perspective to A) survive the Arab oil embargos and to B) ride on a wave of very high oil prices.

In recent years a lot of other stuff has happened with them, but bat that time, it sort of crystallized for the rest of the world the importance of this kind of technology and it ability to be able to create a great foresight on the parts of organizations.

We went through that process in 2000-01 and in July of 2001, we presented the results of our work to combined meetings of our boards at a meeting in San Diego. One of the four scenarios we presented (which I wrote) had to do with a terrorist attack in New York and the subsequent impact on healthcare and healthcare services. I presented a significantly drearier picture of what would go on, but was shocked 60 days later when we had 9/11. So, the predictive power of these technologies is extraordinary.

GC: We came out of that with 19 major implications to our organization — things like we have to rethink our acute care investment, that science is moving healthcare services delivery out of traditional hospitals. We have to be much more flexible and we have to be much more thoughtful about monstrous capital investments that we make in building big hospitals. We have to think about how we invest our capital better to handle a world where technology is driving services out of the hospitals every day. We have to reorganize the business, we have to reorganize the organization — a whole ton of different things came out of those 19 implications. We did a lot to address those implications.

Sadly, we couldn’t have planned or been able to react to what happened as a result of 9/11 because the time frames were too short. But we’ve been, as an organization, much more robust and resilient in the face of the changes we predicted 7-8 years ago would be occurring and we see occurring now.

We’ve reinitiated that effort and have been for about the last 12 months involved in a new Futures Taskforce that’s going to be in February of next year, laying out what we believe to be the future model for Christus, at a combined meeting of our boards, this time in Mexico.

But the impetus for all of these changes that I talked about was the result of those discussions and deliberations back in 2000-01 and those that are now occurring. All those tell us that acute care institutions are going to morph into something else in a very short period of time, well within the windows that we typically depreciate those large capital assets. So if a hospital costs $150-200 million to build, we depreciate it over 30 years, but by year 5 or 6 or 10 of that, the building itself is useless because the business has moved on. We’ve not been good fiduciary stewards of or organization’s money. So we need to be thinking of how we can repurpose those buildings for other uses in a very rapid sort of way as the business changes around us.

GC: Well, a part of the whole acute care piece of this is looking for A) profitable acute care but also, B) building locations in ways that will support the changes that we see occurring in the hospital industry. So our tact for things is very different than, for example, some of the other hospitals and providers in Houston, who are into building great big buildings with hundreds of beds. Our facilities are much smaller and much more compact. They’re designed along lean processing methodologies applied to healthcare, and are designed to be able to morph and change as the needs of communities and people and science and technology change.

Our facilities are closer to centers of population. You’re not going to have to drive 40 or 50 miles in a Houston neighborhood to get to one of our hospitals; they’ll be much closer to where your home is. They’re designed primarily for outpatient services, not inpatient services, but we’ll have a small number of beds in surgical suites, stuff like that.

We have a couple crown jewels within the organization – the Mexican hospital that I mentioned before and our facility in San Antonio. We use these for very complex procedures like transplants, stuff like that. The hospital in San Antonio, for example, just did a disjoining of conjoined twins who were joined at the head. Not a lot of them have happened, and not a lot have been successful. This one, knock on wood, has been successful. But that’s the kind of stuff we do at our crown jewel facilities. The other kinds of services which you’re seeing now are more high-intensity capability being driven out of hospitals or into alternative kinds of settings. Things that a few years ago could only be done in hospitals are now being done in higher-tech clinics and in some cases, doctors’ offices.

So our acute care efforts are designed to quickly repurpose and support what the trajectory is that we think hospitals are going to be on, non-acute and retail is designed to focus around the more community and locally-based services — we own and manage a lot of doctor’s offices; we have homecare services; and we have hospice services. We have partnerships in imaging services; we own surgery centers; we partner in surgery centers — the full array of stuff that you can talk about there. We also have a number of stores and spas. We’ve hired a guy from Neiman Marcus who is remaking all of our stores into real retail presences. Where $900 or $1,000 was a really good day in one of those stores, we’re turning over $4000-5000 a day. We’re also adding spas, exercise facilities, things like that. We’re even looking at partnering with a hotel to put a health spa attached to a hotel.

Much like Village, California, where there’s a Four Seasons that has a medical spa attached to it. You can get a traditional massage like at Four Seasons, but you can also get an MRI or cat scan or visit with a homeopathic physician.

GC: We’re not quite there yet, but we’re looking to provide that kind of service. We’ve opened services focused specifically around mothers and children, so the breast pump you might need after having a baby, you can buy that along with the other services such as training associated with that, right in one of our stores, specially designed for privacy — and all the things that make it the right place for you to go. We established a relationship when you had your baby, and we’re now beginning to extend that relationship beyond the hospital walls into other kinds of services that we can provide for you.

So that’s the scope of the non-acute and the retail piece. The international piece is to grow that business. We have seven hospitals today, shortly planned two more hospitals. We have a border strategy where we’re going to be opening hospitals in communities along the borders, where there are things called Maquidoras, which are the large manufacturing facilities that grew up after NAFTA and attracted thousands of people to communities like Reynosa, Rio Bravo — places like that who are unable to support those thousands of people. A not-so-pretty fall-out was the fact that these places acted like huge bug lights; thousands of people from southern Mexico, Central America migrated — some of them illegally — to our border communities, and had severely stressed social and infrastructural services in those communities.

We’re going in to provide healthcare. We have a clinic service structure that we’ve developed in association with the Mexican government to help us provide services in those areas to hopefully provide a dent in the needs of the people in those communities. We’ve had positive experience with the ones we’ve put out to date.

And then there’s the whole medical travel business with using our connection with Mexico as a magnet for bringing people in for care. We have over 60 people now who have had services provided since we started that operation last October or November. Those people actually come from all over the world — the majority from America.

My job, from an IT perspective is to tie of all that together.

GC: It is. The question is how do I get patient X’s information together from all of these different locations to be processed in a way like we talked about before, with the gluten allergies, but also to the concierge, to a clinician, and when you to go Mexico for an physical, that all the information is available down there to them as well — how we provide that in a safe and secure way. That’s what we’re planning and implementing and developing right now.