Few arguments have sparked as much ire (and eye-rolling) than the comparison between the healthcare and banking industries when it comes to consumer engagement, and it’s understandable. Healthcare is extremely complex; the mere suggestion that the same strategies used to manage finances can be used to manage care is ludicrous.
But what if we looked at it in a different way? What if patients were given tools to help diagnose and treat conditions that don’t require an in-person visit? What if, rather than being directed to a message during peak hours, patients can use an automated system to make an appointment? The banking industry has empowered consumers to perform certain tasks, while also establishing parameters and proving human assistance when needed. Craig Richardville, former CIO at Carolinas HealthCare System (now Atrium Health), believes they’re onto something.
In this interview, he spoke with healthsystemCIO.com about the key lessons learned during his 30-plus years in the CIO role, why he believes taking a sabbatical can be extremely beneficial, and his thoughts on where the industry is headed. Richardville also provides advice for CIOs on a number of issues, from the importance of collaborating with leaders outside of healthcare, why IT steering committees should be eliminated, and why optimization “never really ends.”
- 20-plus years with Carolinas HealthCare (now Atrium)
- Significant growth through M&A and management contracts
- Large-scale implementations without the “rip and replace.”
- Change management hurdles: “one step forward, two steps back”
- Never-ending quest for optimization
- Collaboration with leaders in energy, finance – “It’s the same consumer, just a different vertical.”
- Flipping the script with consumer engagement
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It was always to our benefit to be aggressive and to accelerate the execution of our plans, because we know there are going to more things coming up down the road. And the more we can get things off our plate, the better we’re able to handle the changing environment.
To me, it was important to preserve the investment from a business standpoint; try to reduce change management as much as we could, because we knew there was going to be more coming down the road; and do what’s right for the patients.
There were some growing pains that came along with it. It’s hard to change processes. It’s hard to change people, especially those who may have been practicing a certain way for a couple of decades.
It’s time to corroborate and collaborate with others. It doesn’t have to be either you or me. I think there are ways that everybody can share in the healthcare aspects of what we’re doing and what we’re changing, and I want to be part of that change.
Gamble: Thank you so much for taking some time to speak with us and take a look at your career, as well as where the industry is headed and what you’re up to now.
Richardville: Thank you for the opportunity. It’s been quite a journey, and the journey certainly isn’t over yet. I’ve got about another decade to contribute and be part of the healthcare community. I’m really looking forward to it.
Gamble: Great. Let’s talk about the time you spent in the leadership roles with ProMedica Health System, and then Carolinas HealthCare System (now Atrium Health), which experienced significant growth during your tenure.
Richardville: Sure. The nice part for me is when I came to Carolinas back in 1997, they had just become Carolinas HealthCare System. Most people probably don’t know this, but the healthcare system is actually a county facility called Charlotte-Mecklenburg Hospital Facility, which does business as Carolinas HealthCare System. When I got here in 1997 we were three hospitals, and when I left, we were around 42.
When you look at the healthcare industry and the role that Carolinas played, certainly the growth and consolidation and relationships over those last two decades were really strong. Carolinas had a major part in that and became the largest healthcare system in the southeast and the second largest public healthcare system in the country (the first being the VA).
I was very fortunate to be part of the company for over 20 years. We had acquisitions, we had management contracts, and we had some mergers. From that standpoint, we’re always a different company and always being very nimble and flexible to meet the changing needs of the market.
Gamble: Was that growth fairly gradual, or were there different times when it seemed to really ramp up?
Richardville: It started at a very consistent pace. Certainly some of the relationships were larger than others, but typically every year there were a few things. I remember being a few years into working for the system and jokingly saying to my boss, ‘this is not what I signed up for — we’re already twice as big as what we were when I came here.’ But that growth continued at a very nice pace.
In some cases, the system wanted to continue to be aggressive in its standardization and consolidation of different areas, whether they were service lines or corporate areas, so that we were a single-facing unit to the patients and to the community. That was the intent.
Plus, we knew what we needed to do. The management agreement or the merger or acquisition was signed, inked, and ready to move forward. But we didn’t know what was coming up next. So to me, it was always to our benefit to be aggressive and to accelerate the actual execution of our plans, because we know there are going to more things coming up down the road that are unanticipated. And the more we can get things off our plate, the better we’re able to handle the changing environment.
Gamble: Right. That seems like a sound strategy for growth. As far as clinical transformation, when did the organization enter the EHR space?
Richardville: We were one of the first ones. It was right after Y2K. When I came here, a lot of the work was refreshing data and replacing some of the accounting systems, the networks, and a lot of devices and equipment in preparation for Y2K. Those of us who have been a while know that Y2K was really a non-event. However, there were a lot of investments made in the technology that prepared us for the EHRs of the world that would be forthcoming. We signed our first contract right around 2003 or 2004. We went live in 2005-2006, and aggressively continued those rollouts over the next decade.
As other systems came onboard, the advantage we had is that some of those hospitals, practices, and healthcare systems had recently made investments in the EMRs, and so we always made a very concerted effort not to rip and replace. I believe it’s important to make sure you’re trying to get the return back on your investment. And so, for those that had just recently implemented or were in the process of implementing, we didn’t want to throw that money away. Typically that funding comes from the community, either through the payer system or through self-pay. For us, it was really important that we preserved that. And when it was time to reinvest or replace or upgrade, we looked at it from the business lens of how it makes sense to fold them into a larger system.
As you can imagine, back in those days, especially when we weren’t cloud-based, there was a lot of discussion around whether the systems could handle an organization of our size. So from that standpoint, it was always better for us to make sure that we did it at the right time. Some had different philosophies. They’d do a replace, because they felt it was important to have everyone on the same system. To me, it was important to 1) preserve the investment from a business standpoint; 2) try to reduce change management as much as we could, because we knew there was going to be more coming down the road; and 3) do what’s right for the patients and make life simpler for them. If they were already used to a system, we didn’t want to turn around and switch it back over. So at that point, it didn’t make sense to consolidate.
Gamble: In terms of being early in the game as far as EHR adoption, was there some resistance, or were users somewhat receptive to this change?
Richardville: When we started down that road almost 15 years ago, I think everybody understood the business and the clinical reasons. But when you look at the software and the business processes, it was fairly immature at the time, and from that standpoint, there were some growing pains that came along with it. It’s hard to change processes. It’s hard to change people, especially those who may have been practicing a certain way for a couple of decades. The tools weren’t the best — even today you hear comments about how they can still be improved, and you’re seeing some of the technology pieces come into it.
So I can’t say it was fully embraced. I think people understood the reasons why. But when you introduce a major change, there are lessons learned, as you continue to grow as an industry and within your own healthcare system. And that’s why when you look at the change management piece, you need to take a step back with the intent you’ll be taking two steps forward when you’re done. But it is a step back, and that’s why preservation of recent investments is important. If you’ve already gone through one change in the last three to five years, to put the organization through a major technology change may not be in the best interest of providers and patients.
We always tried to pick the right time to make that change take place. In some cases, it was very welcome depending on where you were coming from or what you were looking forward to. So it was a mixed bag. I think today we’re starting to see a more of a lean toward the positive but you still look at efficiencies. You still look at processes. You can still pick up any healthcare IT publication and find and article or two looking at how some of these tools could get better and ease some of the burden that’s been placed on the physicians.
I’m fortunate that one of my sons is actually a physician at the Cleveland Clinic. From that standpoint, it’s great to bounce things off of somebody who’s rather young in his practice and new to delivering care, and so he doesn’t have some of the past behaviors or processes built into him. He’s seeing things a lot differently. But I understand. I get the frustration when people are being asked to change something they’ve been practicing for the last 20 years, but we’re starting to see that shift with the next generation.
When we first started putting these in during the 2005-2006 timeframe, I remember sitting around one of the executive tables and hearing administrators asking why we were hearing so many complaints. And I looked around the table and saw everybody writing in their notebooks. It was like, ‘what if I took away all of your pens and paper and gave you a computer, and you have to use that computer to do all of your work. How would you feel about that?’ I think that opened their eyes a little bit.
Even today, you see some people taking notes on a phone or using a tablet, but the majority are still using pen and paper. Some of us who are being critical of the users haven’t gone through that change. But the providers who have gone through it are taking notes electronically and are more adaptable to it, because they’ve had to do it for more than 10 years. In some cases they’re more accustomed to it than some non-clinicians.
Gamble: Was part of the rationale for the implementation strategy ensuring there was an opportunity to correct or improve upon processes as you go along?
Richardville: Yes. And I don’t think that ever really ends. It still goes on today. I consider myself a student; I’m always listening and learning and trying to help understand so that things can be better tomorrow than they were today. The culture we’ve built at Carolinas HealthCare System was around learning; one that continued to get better at engaging and involving providers, patients, focus groups — all aspects of clinical delivery. On the same side, a lot of the corporate areas went through change with ERP systems and different types of communication, switching from pagers to phones to email, moving services to the cloud, and other aspects on the technology front that were impacting different areas. I don’t think that ever changes. I think once you realize you’ve got it, you should probably get out, because it’s going to change tomorrow.
Even now, when you look at some of the new entrants coming into the market — some of the technology leaders coming in, and they’re not going this time. They’ve been in and out for a few decades, but they’re going to be in, and they’re going to stay in. From that standpoint, I think it’s a whole new environment for us. For me, having a competitive spirit, it’s also time to corroborate and collaborate with others. It doesn’t have to be either you or me. I think there are ways that everybody can share in the healthcare aspects of what we’re doing and what we’re changing, and I want to be part of that change.
Certainly there are some that will fall out — probably those who haven’t learned to adapt to a changing environment. But for those of us who have been successful, I think the next decade or two are going to be really fun, because the change is going to continue to accelerate and increase. To me, that means we’ll have a better product and a better service for the patients and the community in the end, and that’s what we’re here for.
Gamble: Innovation has certainly been a priority at Carolinas HealthCare, and one of the areas that’s most ripe for innovation is patient and consumer engagement. Can you talk about the approach you used to leverage technology to improve some of these processes?
Richardville: When you look at how things evolve, how they’re changing, and some of the things we’ve been able to accomplish, you have to also look also at other industries and look at the rhythm of life that people have to see where there are opportunities. I was fortunate to be chair of the Charlotte CIO Leadership Association (CharlotteCIO) this past year; we formalized a program we had been using for years that focuses on learning from others.
And so, if I see Duke Energy doing something to educate consumers on how to better use electricity, I can take that strategy and their method of communication, and apply that to healthcare, particularly as we’re starting to look at value-based care and more effectively manage care and promote health. They’re doing the same thing in the energy sector, and so there’s no reason why we can’t use the same tools and technologies. It’s the same consumer; it’s just a different vertical.
The same goes for financial services. There are a lot of great analogies between financial services and healthcare, especially as we migrate from everything being done on paper or face-to-face to a virtual approach. They’re moving a lot of those clerical tasks into the consumer’s hand. Healthcare is going through a very similar change — maybe not as fast, but I think and I hope it will accelerate to move away from the physical plant being where you receive care, to the physical person. So that no matter where I am, I can receive the care that I need via my phone or whatever connectivity I have. And I don’t have to go to you — you actually go to me.
That’s one of the things we looked at when we were trying to make decisions on what to do and how to do things from a decision perspective; and being in the technology sector is really advantageous. There are different things we can bring to the table. There still has to be a very strong business or clinical decision to make those types of investments. You just don’t do technology for technology’s sake because it’s cool or you think it’s something that would be highly recognized. It has to contribute back to the organization’s mission, vision, goals, and strategic objectives. It has to contribute back, and there’s only a limited amount of resources to put into it.
Chapter 2 Coming Soon…