Like many who have spent time in the CIO role, Drex DeFord had his misgivings about the Most Wired designation. He wondered how a survey that had remained static for years could provide an accurate measurement of where organizations stand in terms of IT advancement. And beyond that, was it serving the industry in the best way possible, or was it more of a marketing tool?
He wasn’t the only one who felt this way — not by a long shot. Many industry experts believed it was time for a change. So when CHIME acquired the HealthCare’s Most Wired hospital survey from the American Hospital Association, the organization quickly recruited several former healthcare IT executives to help reshape the program, including DeFord, a consultant who has held CIO roles at Seattle Children’s Hospital and Scripps Health, among other organizations, and Bill Spooner, who spearheaded the transformation at Sharp HealthCare.
The Governing Board, which is led by Spooner and includes no active CIOs, established a clear set of objectives: to create new questions that reflect contemporary practice; to increase transparency by adding an auditing and validating process to verify results; to implement a new scoring methodology to capture both basic and advanced healthcare IT functions; and, perhaps most importantly, to provide each recipient with a benchmark report with their overall score and a breakdown in each section of the survey, which can then be used as a gap analysis tool.
CHIME also released an industry trends report, which can be accessed here.
“I think we made significant improvements,” said DeFord, who spoke at a CHIME Sunrise Session with Spooner and Dr. Bobby Low of KLAS about the changes that were made to the survey, the key findings regarding the biggest areas of opportunity for CIOs, and how they hope to further improve it going forward. “It’s not complete and it’s not perfect. But it was meant to be better than last year, and I believe we hit that target.”
In this interview, he speaks about why he became involved, and how he hopes CIOs and other leaders will leverage the information it provides.
Kate Gamble: The first – and biggest – question I have is, what made you want to get involved in the Most Wired Governing Board?
Drex DeFord: To be honest, it’s something I’ve complained about for years. So when I got a call from CHIME last fall asking if I could help with this, I wanted to be part of it. And so I sat down, looked at the questions, and built a team of people who could provide expertise in different areas. We needed to make it better, and quickly. The goal was to have it done so that it could be released in March.
Gamble: So you were working with a very short timeline. What was the first priority?
DeFord: The first thing we did was to throw out several questions that were no longer appropriate. Their expiration date had passed, and so it didn’t make sense to include them.
On the other hand, there were issues around patient engagement and treating the patient as a customer and making the transition from fee-for-service to value-based care that weren’t in the survey, and so we added them to reflect what we believe are big priorities across the industry.
As Bill Spooner said, we’d love for this to take on a Magnetic-type of status that healthcare organizations aspire to. I think we’re still figuring out how that’s going to shake out. What we do know is we don’t just want to be another version of HIMSS Level 7. This isn’t just about IT adoption; it’s helping health systems move toward the goal of making the patient the center of the universe. A lot of health systems talk about doing that, but in reality, the provider is still the center of the universe.
But there are some organizations that are doing great work in this area. They’re doing everything they can to try to keep patients with chronic diseases out of the ED by building mechanisms that they can engage with and use to stay healthy. That’s where we’re trying to pull everyone with this survey. And if it turns out to be some type of certification, that’s great.
Gamble: Overall, what were your thoughts on the process and the results?
DeFord: We went through such a rapid process to have the survey ready for this year’s release. Being a perfectionist, there are still things I don’t like. I would tell the group, ‘I don’t like this part of the survey. I don’t like the way we asked this question. I don’t like the choices we provided — but I can’t think of anything better right now.’
If we had more time, we would’ve made it better. But it was a significant improvement from the previous survey. Now with the involvement of KLAS, which enables us to bring professional question writers into the mix, I believe next year’s survey will be even better.
Gamble: Is there anything specific you’d like to change, or is it just a matter of incremental improvements, as you and Bill stated in the presentation?
DeFord: I think we have a decent question set, and we know the direction in which we’d like to go. Some of the results have shown us what we can revise to get a more accurate picture. For example, in response to one question, nearly 70 percent said they can recover all of their systems and return to normal operating procedures in 24 hours. I don’t believe that. That’s one of those times where you ask, does it pass the giggle test? If not, it doesn’t necessarily mean someone is lying; to me, it means we didn’t do a great job of asking the question.
One factor that made a big difference was having KLAS on board. Bobby Low is incredibly smart, and he offered some suggestions on how to improve it. He actually sat down with Kent Gale, who offered some subtle changes that we believe can make a tremendous difference in how questions are formed. I’m excited that they’ll continue to be part of this. And this year, the CHIME team will have more time to build it out and staff it more effectively. But for the first year, I think we did a good job, and the hope is that it will continue to get incrementally better. We’re looking for continuous improvement.
Gamble: You mentioned wanting to get away from the mentality of participants just ‘checking boxes.’ What did you mean by that?
DeFord: When Most Wired first started, it was a nice award to win, but then it became almost an entitlement. We want it to be more of a continuous effort, not something where you take the survey once and don’t think about it again for a year.
Now, participants can get results back quickly, perform analytics around it, and compare against other organizations. The value is in being able to take the data and build it into the strategic plan. It’s sitting down with C-level executives and saying, ‘these are areas where we’re short.’ And you may want to be short in certain areas. Being Most Wired isn’t the end-all be-all, but taking the survey gives you some perspective on where you are compared with everyone else, and that perspective helps you go through the governance process. You might be saying, ‘our answer to this is still no, but here’s where some of our competitors are going. It may still be 10 years down the road for us, and that’s okay, but we should be aware of where other organizations stand.’
Gamble: I noticed a lot of heads nodding during the session when you brought up that point.
DeFord: Exactly. It has to be useful. This survey is more than the banner that goes up on the side of the Emergency Department entrance. It should be useful from the perspective that it drives conversation, and it drives inquiry. ‘How are we this far behind?’ or ‘Why are we this far ahead? Is this where we should be? We’re spending a lot of money in this particular area, and it looks like we’re way off the scale compared to everyone else. Are we overspending on some of these things?’
Whatever the conversation that comes out of this, I think it’s good. Again, it’s not perfect, but I believe we’ve made it better.
Gamble: I also like the point you made about how it wasn’t just the big organizations who earned recognition.
DeFord: I thought that was really interesting. The biggest reason you hear for why organizations can’t do certain things is around funding. ‘We’re not Sutter; we’re just a small community hospital.’ What we found is that there are some small hospitals that did really well compared with large systems. It shows that you don’t necessarily have to have deep pockets — you just have to put your nickels in the right places.
And we know that a lot of people don’t like the name, ‘Most Wired,’ because it really pushes the technology end of this. But the way we structured many of the questions, it was about people, process, and technology.
I think it comes down to experience over time; buying a silver bullet and putting it into place doesn’t solve the problem. A lot of other things have to go into that. When you look at solutions in the clinical or business operations areas, they have to be implemented in a particular way — are you taking all the steps to make sure it all works together? You can buy all the tools you’re supposed to buy and still not be recognized as Most Wired. It isn’t about buying things; it’s about doing things well. It’s about delivering great health and great services to patients and families. If you’re doing things well, you’re probably going to do well in the survey, especially going forward.
Kate Gamble: The first – and biggest – question I have is, what made you want to get involved in the Most Wired Governing Board?
Drex DeFord: To be honest, it’s something I’ve complained about for years. So when I got a call from CHIME last fall asking if I could help with this, I wanted to be part of it. And so I sat down, looked at the questions, and built a team of people who could provide expertise in different areas. We needed to make it better, and quickly. The goal was to have it done so that it could be released in March.
Gamble: So you were working with a very short timeline. What was the first priority?
DeFord: The first thing we did was to throw out several questions that were no longer appropriate. Their expiration date had passed, and so it didn’t make sense to include them.
On the other hand, there were issues around patient engagement and treating the patient as a customer and making the transition from fee-for-service to value-based care that weren’t in the survey, and so we added them to reflect what we believe are big priorities across the industry.
As Bill Spooner said, we’d love for this to take on a Magnetic-type of status that healthcare organizations aspire to. I think we’re still figuring out how that’s going to shake out. What we do know is we don’t just want to be another version of HIMSS Level 7. This isn’t just about IT adoption; it’s helping health systems move toward the goal of making the patient the center of the universe. A lot of health systems talk about doing that, but in reality, the provider is still the center of the universe.
But there are some organizations that are doing great work in this area. They’re doing everything they can to try to keep patients with chronic diseases out of the ED by building mechanisms that they can engage with and use to stay healthy. That’s where we’re trying to pull everyone with this survey. And if it turns out to be some type of certification, that’s great.
Gamble: Overall, what were your thoughts on the process and the results?
DeFord: We went through such a rapid process to have the survey ready for this year’s release. Being a perfectionist, there are still things I don’t like. I would tell the group, ‘I don’t like this part of the survey. I don’t like the way we asked this question. I don’t like the choices we provided — but I can’t think of anything better right now.’
If we had more time, we would’ve made it better. But it was a significant improvement from the previous survey. Now with the involvement of KLAS, which enables us to bring professional question writers into the mix, I believe next year’s survey will be even better.
Gamble: Is there anything specific you’d like to change, or is it just a matter of incremental improvements, as you and Bill stated in the presentation?
DeFord: I think we have a decent question set, and we know the direction in which we’d like to go. Some of the results have shown us what we can revise to get a more accurate picture. For example, in response to one question, nearly 70 percent said they can recover all of their systems and return to normal operating procedures in 24 hours. I don’t believe that. That’s one of those times where you ask, does it pass the giggle test? If not, it doesn’t necessarily mean someone is lying; to me, it means we didn’t do a great job of asking the question.
One factor that made a big difference was having KLAS on board. Bobby Low is incredibly smart, and he offered some suggestions on how to improve it. He actually sat down with Kent Gale, who offered some subtle changes that we believe can make a tremendous difference in how questions are formed. I’m excited that they’ll continue to be part of this. And this year, the CHIME team will have more time to build it out and staff it more effectively. But for the first year, I think we did a good job, and the hope is that it will continue to get incrementally better. We’re looking for continuous improvement.
Gamble: You mentioned wanting to get away from the mentality of participants just ‘checking boxes.’ What did you mean by that?
DeFord: When Most Wired first started, it was a nice award to win, but then it became almost an entitlement. We want it to be more of a continuous effort, not something where you take the survey once and don’t think about it again for a year.
Now, participants can get results back quickly, perform analytics around it, and compare against other organizations. The value is in being able to take the data and build it into the strategic plan. It’s sitting down with C-level executives and saying, ‘these are areas where we’re short.’ And you may want to be short in certain areas. Being Most Wired isn’t the end-all be-all in all of this, but taking the survey gives you some perspective on where you are compared with everyone else, and that perspective helps you go through the governance process. You might be saying, ‘our answer to this is still no, but here’s where some of our competitors are going. It may still be 10 years down the road for us, and that’s okay, but we should be aware of where other organizations stand.’
Gamble: I noticed a lot of heads nodding during the session when you brought up that point.
DeFord: Exactly. It has to be useful. This survey is more than the banner that goes up on the side of the Emergency Department entrance. It should be useful from the perspective that it drives conversation, and it drives inquiry. ‘How are we this far behind?’ or ‘Why are we this far ahead? Is this where we should be? We’re spending a lot of money in this particular area, and it looks like we’re way off the scale compared to everyone else. Are we overspending on some of these things?’
Whatever the conversation that comes out of this, I think it’s good. Again, it’s not perfect, but I believe we’ve made it better.
Gamble: I also like the point you made about how it wasn’t just the big organizations who earned recognition.
DeFord: I thought that was really interesting. The biggest reason you hear for why organizations can’t do certain things is around funding. ‘We’re not Sutter; we’re just a small community hospital.’ What we found is that there are some small hospitals that did really well compared with large systems. It shows that you don’t necessarily have to have deep pockets — you just have to put your nickels in the right places.
And we know that a lot of people don’t like the name, ‘Most Wired,’ because it really pushes the technology end of this. But the way we structured many of the questions, it was about people, process, and technology.
I think it comes down to experience over time; buying a silver bullet and putting it into place doesn’t solve the problem. A lot of other things have to go into that. When you look at solutions in the clinical or business operations areas, they have to be implemented in a particular way — are you taking all the steps to make sure it all works together? You can buy all the tools you’re supposed to buy and still not be recognized as Most Wired. It isn’t about buying things; it’s about doing things well. It’s about delivering great health and great services to patients and families. If you’re doing things well, you’re probably going to do well in the survey, especially going forward.
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