People, Process and Platforms: How Dignity Health Is Transforming Care And Positioning For The Future
It’s been a busy few years for Dignity Health. In 2012, the 39-hospital system embarked on major initiative to move all of its hospitals and clinics onto a single clinical platform. It was clear from the beginning that the $1.83 billion deployment — which included both clinical and business applications — would require a mammoth lift, and a whole lot of collaboration, to stay on track.
To say it was a tall order is putting it mildly.
But the deployment — one of Cerner’s largest to date — is right on schedule, largely due to strong clinician leadership, an engaged user community, and a heavy emphasis on training and support, all of which are critical in any major project. Perhaps the biggest factor, however, has been the strategic partnership between IT and business leadership that has broken down the typical siloes and created an environment where IT’s expertise is leveraged to help prioritize business needs and provide support, according to Deanna Wise, EVP and CIO at Dignity Health.
“That partnership is so critical to understanding what are the needs of the organization, what are the strategies, and how do we help deliver that in the most cost-effective, high-quality way for our patients,” said Wise.
And it’s that spirit of collaboration that she believes will help propel the organization forward as they turn their focus toward “the important part,” which is transforming information into actionable data that can improve the delivery of care. Of course, in order to get to the “importance,” Wise’s team must complete the Cerner implementation, while also devoting resources to patient engagement, security, telehealth, and countless other issues.
It’s no simple task, but for Wise, leading the IT team at the fifth largest health system in the country during such an “exciting” time in the industry is the chance of a lifetime. In this interview, she spoke with healthsystemCIO.com about how the organization was able to overcome early challenges with the EHR implementation by incorporating lessons learned; the tremendous opportunity her team has to push the envelope with innovation; the enormous value of having the right people in place; and where she believes the industry is headed in the next few years.
Q&A With Deanna Wise, EVP & CIO, Dignity Health
Gamble: Hi Deanna, thank you for joining us. To start off, can you give a brief overview of Dignity Health — what you have in terms of hospitals, ambulatory care, etc.?
Wise: Dignity Health is one of the nation’s largest healthcare systems. It’s a 21-state network of 9,000 physicians. We have 59,000 employees and more than 400 care centers, including our hospitals, urgent care, occupational care, imaging centers, home health and primary care clinics. We’re headquartered in San Francisco, and our IT department is primarily based in Phoenix.
Gamble: And what’s the size of the IT department?
Wise: We have around 1,300 employees and around 500 IT contractors. Depending on the projects we have going, we may scale down or scale up.
Gamble: You’ve been in the midst of a largescale clinical transformation project for the past three or four years. Can you talk a little bit about it?
Wise: We’re deploying Cerner across all of our facilities. We’re nearing the end; of our 39 acute-care hospitals, we have eight facilities to go. It’s been a five-year, $1.83 billion initiative, and we’ve been able to remain on track.
Gamble: What do think has been the biggest factor in being able to stay on track?
Wise: Laura Young [SVP of Enterprise Healthcare IT Services] leads this initiative and keeps the team focused on driving successful outcomes. An additional key is that we wanted to be able to leverage knowledge along the way to make sure that we were enhancing the system to the best of our ability. So we added a governance component that allows us to make improvements based on feedback from our physicians and clinicians.
Dr. Shez Partovi [Chief Digital Officer, SVP of Digital Transformation] has been a key member of our team. He was CMIO of our Arizona Service Area, and as we rolled out Cerner to that market, we found that we really needed to have more physician engagement. For Dignity Health, it is really important that this is not an IT project; that this is really a clinical-based project, and having him in that role is critical.
Gamble: With such a large number of hospitals and physicians, does it become challenging to deal with so many different opinions and preferences and decide which improvements need to be made?
Wise: It can be. When we first started our deployments, we had eight hospitals that had been running Cerner for several years. We had a really strong clinical informatics group led by Elise Dempsey [VP of Nursing Research, Chief Nursing Informatics], and so we had the benefit and the experience of already knowing how to do governance from the nursing side. The next wave was CPOE and how do you add the governance and the voice of the physician with such limited time.
Because Dignity Health is mission-based, we already had a successful governance structure in place. It was really just getting the voices that have an interest to participate in that knowledge base, whether it is cardiology groups or primary care, and break it into logical segments so we can get the feedback we needed to create the best system.
Gamble: What do you think has been the biggest challenge with the implementation?
Wise: One thing people tend to underestimate is training as you’re deploying these systems, and at-the-elbow support when you begin to roll them out. That plays a tremendous role in helping to understand where the gaps are as people learn these new processes. It really is people, process, and platforms. I think many CIOs fail from the standpoint of implementing systems and expect that they will be used. In order to be successful with something that is so interwoven within the day-to-day business, you really have to focus on the training and the process change that goes along with it.
Gamble: You’ve been with the organization for five years. Talk about where this project was at that point.
Wise: When I first started with Dignity Health, they had just had a failed deployment of EHR and they were in process of evaluating whether it was a system issue or a process issue. The immediate priority was to assess everything that happened and why, and really take a step back and look at it.
Gamble: What were some of the key issues that surfaced?
Wise: It was simple things like a lack of training. Because they were already on a somewhat similar platform, they underestimated the amount of change that was needed. And so we determined that we needed to increase training going forward, and make it required. The other factor was that the vendor they were using had just done a platform change where it was more of a beta platform than a fully baked system. I think the platform would have been fine if it had been for a single facility, but because they were trying to use it at a multiple facilities, it wasn’t quite ready. That was part of the challenge as well.
Gamble: As you near the homestretch as far as EHR deployments, is the organization focusing on optimization and getting more out of all the data?
Wise: We are. I think what’s really interesting about deploying these EHRs is it’s not the end; it’s really more the beginning. Finally you have the information in a digital state, and so you have actionable data, which is what we’ll need to do population health and other digital strategies.
Gamble: What are some of the ways that analytics are being leveraged to improve care outcomes?
Wise: We’ve partnered with SAS to create an enterprise data warehouse, and that really allows us to understand the data in a real-time, actionable way, and then place that information back in the hands of the clinicians directly within their workflow. We’re doing some work with sepsis and readmission risk scoring that’s very exciting. Whereas in the past it was left to the clinicians at discharge to have that knowledge base, now we can program that data into our systems and really understand what are the best options to prevent readmission.
Gamble: When you present clinicians with more actionable data, are you seeing an increase in satisfaction?
Wise: Well, the challenge is that all of these tools can distract from patient care, and so we’re on that journey of making sure these tools are easy to use and aren’t intrusive. I don’t think any of us are quite where we need to be on that journey. I think about going to my own physician and watching them document on a chart. It’s interesting, because we’re currently doing our Human Resources annual performance review process online, so it was quite an “a-ha” for me to be sitting across from one of my employees doing a review; I felt much like physicians do spending more time looking at the computer, rather than the person I was speaking with. It really is an interesting transition, and it was a fascinating look at where our expectations are going, and where the physicians are in this journey.