One of the key ingredients in creating a world-class healthcare delivery system, says Ed Babakanian, is a commitment to invest in IT. However, it’s just as important to have a CIO who is willing to educate fellow leaders about the power of an integrated record. It’s that “push and pull” that can elevate an organization, according to Babakanian, who has played a key role in UC San Diego Health System’s transformation over the past two decades. In this interview, he talks about IT’s role in the growth of an organization, the concept of “true optimization,” and what it takes to foster innovation. He also discusses the trust that’s required to facilitate change management, and why CIOs should never shy away from “uncomfortable” situations.
- Change management — “We’re putting a lot of workload on our providers.”
- Achieving “true” optimization
- UCSD’s rapid growth
- Evolving CIO role — “90% of the meetings I go to have nothing to do with technology.”
- Chicken or the egg?
- Clinician relations — “Without trust, nothing can happen.”
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When you go from paper to electronic, you’re really shifting the workflow. Sometimes it feels like we are taking administrative clerical work and shifting it to our highest paid people.
Technology is built in to any kind of planning, and my job is to translate the bits and bytes into organizational strategy.
It took foresight for the organization to create the position. It took me to partner with folks and provide education over time to convince the organization to do more and more with IT. So it’s kind of a pull and push.
It’s a question of, is there trust that the organization will use technology in a way that takes them into account? Are they partners in decisions about future technology, or is the administration just throwing at them tools and saying, ‘Sorry, you have to use them.’
Gamble: As far as what you’re looking at now, is a lot of your focus on optimizing the system and just making improvements wherever they’re needed?
Babakanian: Yes. Clearly, across the country, with Epic being so successful and having been implemented in many, many leading edge organizations, we’re all beginning to realize — and we’ve realized this a long time ago — that it’s a dynamic environment. When you go from paper to electronic, you’re really shifting the workflow. Sometimes it feels like we are taking administrative clerical work and shifting it to our highest paid people like physicians and nurses. And that improves communication of information; it’s a tremendous benefit in terms of patient safety and responsiveness and reducing service time to patients and improving organizational efficiency, but also we’re really putting a lot of load on our providers — nurses, nurse practitioners, doctors.
Even though we give them all kinds of capabilities and tools — remote, wireless, handhelds and so forth — oftentimes physicians end up finishing their clinic work, then they go home and spend some time with the family, and then still get back on the system and complete their work. So from that perspective, optimization and simplification of work has to go on. It’s going on across the country. Epic, along with other EMR vendors, are beginning to look at not just automating but how to optimize and make life easier for providers and patients. We will be doing that, and we’ve already initiated that process of optimization.
But we are in a growth mode, and for us, technology really is all about how do you measure improvements in quality, improvements in patient safety, and improvements in organizational efficiency. We believe that needs to be meaningful. It needs to be measurable. And so we don’t invest in technology just for the sake of technology or for sex appeal. It has to be relevant to one of those missions, or hopefully all three of those missions — improving quality, improving safety, and improving organizational efficiency. And we measure all of those. For instance, when you do CPOE or medication barcode scanning and you can reduce the number of pharmacists sitting around entering orders so you can deploy those pharmacists with physicians and students and residents to improve quality of medication ordering, or when you eliminate the nurses from having to write on a piece of paper and give them scanning capabilities so they can spend more time with their patients, you not only improve quality of care, but the improvement in turnaround of medication is tremendous. When a patient is waiting for their medication, you’d prefer to do that within minutes versus hours, but all of that really flows to the bottom line.
We have been pretty healthy from a margins perspective, and so we’re able to take that and invest in growth. We’re growing not only within UCSD with our own physicians and bringing on board world-renowned specialists and expanding our primary care, internal medicine, and women and infant services, but we also are building affiliations with other non-UCSD specific physicians. The reason why we can do that is because we have the kind of electronic medical record that we can expand to those entities if we wanted to. And so we start looking very attractive for an independent group of physicians who may not have the capabilities that we have. They can align themselves with us and maintain their own independence and their patient population, but use our services in electronic medical records and contracting. Those are the kinds of things that I’m heavily involved in.
As CIO here, as is probably the case in most larger organizations, CIOs really sit at the executive committee level and do planning and run the business of the organization. They don’t really necessarily spend a lot of time talking about technology. Ninety percent of the meetings I go to have nothing to do with technology. We all know that without technology, most of our efforts would not be as successful and profitable as we would like them to be, so therefore technology is built in to any kind of planning, and my job is to translate the bits and bytes into organizational strategy so that you don’t scare people. Years ago, people used to just run away from technology people because they could not understand what we used to say. Now, I translate that to make sure technology is strategic and not just tactical stuff that people have to deal with.
Gamble: It has to be that way when you’re talking about an organization of your size that’s always looking to keep expanding and strengthen yourself. At one point, you were the CIO of the University Medical Center and then your role grew from there, correct?
Babakanian: Yes. When I came here, I was the CIO for the medical center. Our medical group was a separate entity, and the teaching and medical education groups were separate entities. About a year into me being here, we reorganized and put the medical center and medical group together as part of the health system. That then became part of health sciences, reporting to the Vice Chancellor of Health Sciences and the Dean of School of Medicine. So that integration between medical center and medical group created a corporate structure, so we ended up with one corporate CFO and one corporate CIO, and I assumed that role. Our marketing and some of the activities became corporate.
About three or four years ago, when we were really mostly done with our strategic plans for further integration of the organization, I was asked to also assume the responsibility as CIO for the health sciences for the research and academic component. And so our core technology — networking and security and all of that — services the entire health sciences, and so we have robust researchers who really need different IT services as compared to clinical care. We do that. And so now the function is really across the entire health sciences. Our health sciences here is about 50 percent of UCSD — at UCSD obviously we have schools of engineering and humanities and lots of other things, but half of UCSD approximately is the health sciences component.
Gamble: It shows a lot about how the CIO role has evolved, especially in these larger organizations, to become more of the role where you have a seat at the strategic planning table.
Babakanian: You’re absolutely right. Clearly it’s got to be that way. For me, it’s been that way ever since I joined the group here. Before I got here they used to call information services ‘data processing.’ And so you have the question of which comes first, the chicken or the egg. Do organizations get the sense that IT is important for their strategic success, or do they need someone to teach them that? I think in this organization, there was a realization that they couldn’t really move forward with looking at IT as a cost of doing business; that they needed to elevate it. So they created the CIO position that didn’t exist prior to that. And then they needed someone who would come in, like myself, to partner with our physician community and our senior management to be the educator for them to gradually begin to migrate focus from IT being an expenditure and trying to reduce that expenditure to one that essentially is a core component of the organization.
In our environment, even though budgets are always things that we look at, I’m fortunate to have the opportunity to spend what we need to be able to do what we need. And because we’re able to show results that translates to the bottom line, that gives us more of an opportunity to have more credibility and be able to invest in our future. It took foresight for the organization to create the position. It took me to partner with folks and provide education over time to convince the organization to do more and more with IT. So it’s kind of a pull and push.
Gamble: That’s interesting. You talked before about the changes that come — whether it’s implementing an EHR or moving to a different HER — and the burden that puts on physicians. How have you dealt with things like clinicians having added work at first or more administrative type work? How do you deal with their possibly dissatisfaction?
Babakanian: It’s not necessarily dissatisfaction, because I think that fundamentally, those who are in the business of healthcare — especially those in academic medicine — know that they need to use technology to help them do what they do, especially in research. You need to be able to have technology to then do your research later. It’s a question of, is there trust that the organization will use technology in a way that takes them into account? Are they partners in decisions about future technology, or is the administration just throwing at them tools and saying, ‘Sorry, you have to use them.’ Every step of the way for everything, I’ve had not only key physician leadership involved and key nursing leadership across the board, but also the hands-on physicians and the hands-on technologists and pharmacists so that they are a part of decisions of the future.
I’ll give you an example. When we were starting to look at switching from Invision to a more robust inpatient system, at the time we were looking at it, it was traditional to say that the ICUs — and we have lots of ICUs — need to have a separate ICU-focused system, and the medical/surgical units can have things like Epic. We said, okay, the ICU directors can come together and find a system that works for them, and then the rest of the medical/surgical group can look at systems that work for them. In the meantime though, we started providing education that even though some specialty-based systems that only focus on ICU could have had a few more bells and whistles, the integration between ICUs and medical/surgical units — especially since patients float from med/surg to ICU or back and forth and so forth, mostly from ICU to med/surg — it would be better to have an integrated system.
When we started that process, the medical center ICU directors would have absolutely not considered the system for both med/surg and ICU. But over a six-month process, we took them to various sites and provided them with education. They spent a lot of time looking at Epic’s capabilities. They came back to us and said, ‘We don’t want two systems. We are going to make one system work, because that integration is very important.’ So it was their choice. I didn’t have to push it down on them, and neither did the CEO. They knew that the work load for them would change in a way that would shift work perhaps from others to them, but they chose to do that and our responsibility was to make sure to give them whatever resources they needed to be able to then compensate for that shift of work load.
For instance, handheld devices using iPhone, iPad, etc — we give technology to our physicians and nurses with no limitation of cost. If anyone wants to get a laptop or iPad or they want 30 other work stations in their area, we immediately give it to them. It never becomes a matter of cost. And so we’re working together, realizing that healthcare is changing. Practices are changing. Without the sophisticated tools, it simply is not possible to practice safe care. We want to get people to a point where they’re not dissatisfied, and they want to know that the administration is always looking for their best interests and is not going to limit resources to make it difficult for them. So there’s a trust that, yes, things are being shifted, clinicians are expected to work harder, but that’s true for all of us, and we will help them make it through that transition.
Gamble: It seems like a big factor in that is being transparent and really explaining why you want to make certain moves and making them part of the decision-making process.
Babakanian: Absolutely. Without trust and confidence, nothing can happen. It’s a collaborative environment, especially in academic medical centers — they are by nature more collaborative, but even in community hospitals when you rely on community physicians to bring their patients to your facility, it’s got to be collaborative. The trust and honesty and integrity has to be there. For instance, most recently, when we switched to an electronic way of capturing patient vital signs in the operating rooms, we just implemented a change for anesthesiologists. The work that they used to do years ago — and it’s probably the case in most organizations — was to record patient vital signs that are coming out of all of those sophisticated equipment around the patient in the operating room. We’ve just recently interfaced that with the machines through Epic, so it makes it easier for the anesthesiologist now to completely focus on the patient rather than have to focus on capturing pieces of information on a piece of paper. That obviously improves the ease of use for the anesthesiologist. They appreciate that and that echoes through the organization that there are better ways of doing things that might appear in the beginning to be disruptive, but after a few weeks, become part of just a total equation of improving quality of care.
Gamble: Yeah, I’m sure.
Babakanian: And they like that.