Sue Schade, CIO, Brigham and Women's Hospital, Partners Healthcare
As hospitals in other countries look to expand their health IT presence, they often look to organizations like Partners Harvard Medical International for guidance. It’s precisely why Brigham and Women’s Hospital CIO Sue Schade recently took a trip to India. For Schade, however, sharing her expertise on IT planning helped open her own eyes to both the similarities and differences between healthcare in the United States and India, and helped her develop a better understanding of the strategies employed by major US-based vendors. In this interview, Schade, who has been CIO of the 793-bed hospital since 2000, talks about the experience she had with PHMI, and the value of taking time away from work.
Chapter 1
- About PHMI
- About the project
- Evaluating vendors for an international project
- Physician attitudes in India toward advanced clinicals
- Similarities and differences
- Lessons to be learned on the world scene
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Bold Statements
I think in the end, when I realized what they were looking for, I probably was a pretty good choice—given the breadth and depth of my HIT experience—to do this type of short-term assessment with them and make some recommendations.
With everything we have going on here in this country with advanced clinical systems, Meaningful Use, etc., we have one view of the vendor market. You take yourself out of that and put yourself in another country that doesn’t have some of those same pressing needs but is still looking to move forward and advance in terms of a comprehensive integrated HIT, and you say, ‘What are the options? What might the options be in the long run?’
I would say the physicians were hungry for more, and were open and willing to look ahead to that. They were open to looking at they how could leverage their existing system more fully than they currently were, and they were certainly open to more advanced IT.
Some of the similarities that were very apparent are issues around training, issues around adoption in general, and issues around really looking for a comprehensive view of the patient; a very integrated system as opposed to a best-of-breed approach, and the importance of ease of use.
Guerra: Good morning, Sue. I look forward to talking with you about your work at Partners Harvard Medical International (PHMI).
Schade: Good morning.
Guerra: Let’s start with a little background on PHMI and what it’s all about, and we’ll go from there.
Schade: Sure. PHMI is part of Partners Health Care, and its tagline is: “Transforming health care delivery globally by building strategic collaborations with regional leaders around the world.” PHMI assists hospital organizations in different parts of the country with the planning, design, and development of innovative health care that meets international standards and enables our clients to advance their missions. And it can take a broad range of activity. The particular thing that I was pulled into was a multihospital client in India that PHMI has worked with over the past 10 years. They had done a lot of work in the quality and safety space and they wanted some help with IT assessment and tapped me to do that. So that’s really my first experience directly with PHMI, and certainly my first experience with in India and its health care and health IT systems. It was fascinating to see some of the similarities and differences with what we do in this country.
Guerra: How does that work as far as your involvement as CIO at Brigham and Women’s, which part of Partners HealthCare? Is it something where whoever you report to just assigns you do this, or do you put your name in a pool of people who are willing to volunteer? How does that work?
Schade: That’s a great question, and I’m not sure. I will tell you that the way this came to me is that someone else had been asked if they would do it, and that person was not available. So then the request came to me from our Partners CIO, who asked me if I was interested in doing it, and I said, ‘Yes, absolutely.’ So I just kind of found the time to do it and added it into my normal workload. I think in the end, when I realized what they were looking for, I probably was a pretty good choice—given the breadth and depth of my HIT experience—to do this type of short-term assessment with them and make some recommendations.
How it’s going to happen going forward is unclear, but having worked with PHMI, I am told that I may be called upon again when they have similar IT needs, so we’ll just take it case by case. There are several full time people on the staff for PHMI, but nobody that has IT expertise. So I think as these engagements come up, they will look to me or someone else to see if we can fit it in and assist.
Guerra: So that’s probably going to be a big part of what these organizations that ring up PHMI are going to need.
Schade: I think going forward that’s the case, yes.
Guerra: I remember from speaking to you previously that you have consulting experience in your background, correct?
Schade: Correct.
Guerra: So this is a consulting gig actually, right?
Schade: It was a consulting gig, yes. We reviewed their materials, did a pre-questionnaire to get the information in advance, and reviewed it with them by teleconference, and then we were actually on the ground for four days. We spent a day with the leadership group at the corporate offices trying to understand where they were and where they wanted to go in the future. And then we spent two days on the ground at one of their existing hospitals in another city, touring, interviewing, listening and looking at the system currently and where they want to get to. We wrapped up on the fourth day—went back to the corporate office with our initial conclusions and recommendations, and then did a final report and recommendations about two weeks later.
Guerra: Without naming the client, what more details can you give us about the IT challenge that they brought you in to help them with?
Schade: Sure. They have an existing system that is from a vendor in India. They’ve had it for 10 years and they’ve got eight existing hospitals now that are running it. They are building several new state-of-the-art hospitals in the next few years and really wanted to look at, ‘Does the current system meet our future needs, or do we need to go in a different direction as we open the new hospitals and then eventually circle back to the existing hospitals and bring in a new system there?’ So that’s what they wanted me, at a high level, to take a look at.
Guerra: When you’re in this kind of an engagement, obviously you know the US-based vendors well, but there are probably some major advantages to dealing with the local vendor, and even the client may prefer that. Or they may be totally open to whatever you recommend.
Schade: Right.
Guerra: So I guess there are number of factors that go into your evaluation of the best way to move forward.
Schade: They didn’t ask me to do a vendor selection or evaluation, as such. It was more a high-level assessment of current and understanding of future needs, and kind of directional recommendations. And the market is a challenge coming into play here. There are in-country or India-based vendors that they have been looking at over time, and then there are major vendors that are going into India and other markets in Asia. So it’s really a matter of looking at what those broad options are.
It’s interesting and it’s an eye-opener, because I did have contact afterward with some of the major US players to talk with them and just explore what their plans are in the Asia market and whether they might be open to talking with this client going forward. With everything we have going on here in this country with advanced clinical systems, Meaningful Use, etc., we have one view of the vendor market. You take yourself out of that and put yourself in another country that doesn’t have some of those same pressing needs but is still looking to move forward and advance in terms of a comprehensive integrated HIT, and you say, ‘What are the options? What might the options be in the long run?’
Guerra: Did you maybe find that some vendors are interested in the Indian market and some may be interested down the road, but they’re a little too busy handling the US market right now?
Schade: Are they too busy handling the US market? That was not my sense as much as where are they strategically in terms of expanding internationally, and what parts of the international market are they starting to look at and willing to look at. That was more what I found. It was a mix.
Guerra: And probably as a vendor, you don’t want to do one-off, if it’s not part of your strategic plan, to learn that country and be in that country.
Schade: Right.
Guerra: Well, this would be part of the expertise you would want to develop if you get more involved in these projects and go into in different countries—to know which vendors are interested in playing where would help you make your decisions.
Schade: Exactly. So if I were to do this again, I’ve got that in my back pocket now—just a better understanding of the US vendors and their intentions and plans. And it’s going to evolve over time obviously.
Guerra: So in this country, HITECH has totally shaped what’s going on, and that’s not going on in India. Is the Indian government doing anything to promote healthcare IT along the lines of what the US government has done?
Schade: I didn’t get that sense. It was pretty much that the needs were all driven by the particular organization.
Guerra: Did you have much contact with physicians, and are they as reluctant in times to go along as physicians in the US?
Schade: That’s a great question. We did interview physicians when we were at the hospital, and they were very open and willing to move forward with much more advanced clinical systems. One of the physicians in particular talked about experience training in another country in the Asia market, and how it compared to the system he was using from an IT perspective. It was far more advanced, and his thinking was, ‘Why can’t we be doing that here?’
So in some respects, I think I saw some of the same dynamics that you see here with physicians can be generational. The younger physicians training now who are more new out of school are interested in pushing the envelope and questioning why we aren’t doing more. They’re embracing all the technology, while some of the older physicians are maybe a little bit more resistant, and maybe they’re a little closer to retirement, so if they don’t have to do certain things now, that’s okay. So there are some differences, but overall, I would say the physicians were hungry for more, and were open and willing to look ahead to that. They were open to looking at they how could leverage their existing system more fully than they currently were and they were certainly open to more advanced IT.
Guerra: Is there anything you’ve picked during the trip where you said, ‘This is an interesting way to do it,’ and maybe saw something that was applicable back home?
Schade: Not in particular. I think that there some things where I said, ‘This is interesting and clearly a difference.’ I would say that the physician nurse and physician and other clinician relationships are probably where we were in this country several years ago. I think, with all due respect to US physicians, I think that they are probably viewed in India by hospital staff as more godlike than we may view them here. I just think the dynamics have changed over the time in terms of really looking at respective roles in the clinical setting and the overall care team. And I think you maybe have a little less of that and more power in the physicians. There are certainly some differences in terms of how they handle referrals. I don’t think they have the same kind of regulations that we live with in terms of referral patterns.
And they have interesting cultural differences. The family comes to see a patient, regardless of how sick the patient is and regardless of where they’re from, so the hospital is full of family visitors wherever you look in the waiting areas, outside the ICU, etc. So managing the flow of people in and out of the facility and making sure that they are able to see the patients is one of the interesting comparisons as well. The host told us that it doesn’t matter what the illness is, family members will come from all over the country.
Guerra: You mentioned the status of the physicians as having even more power than they do in the United States. We always talk about the independent physician having a lot of autonomy, and we say that you can’t force them to do anything. You have to encourage them and get them excited about CPOE and all these types of things. If that’s even more acute or more pronounced in India, then they may have even a larger challenge changing physician behavior.
Schade: They may. We interviewed with residents and house staff, and they were eager. The nurses were eager, and I think the physicians were certainly open. They will have similar challenges in India, and maybe some different challenges.
On another note, some of the similarities that were very apparent are issues around training, issues around adoption in general, and issues around really looking for a comprehensive view of the patient; a very integrated system as opposed to a best-of-breed approach, and the importance of ease of use. Those themes came out loud and clear as we interviewed people on staff at the existing hospital, and looked that how they were using their current system and how they underutilizing their current system—and if they didn’t think it was good enough for the future, were they really leveraging everything that they could.
Guerra: Are they as fragmented as we are in this country, where we are trying to move toward an ACO model and the government just put out the NPRM? Do they have a fragmented system where patients are the only ones that are going to be able to pull all of the information together and bring it to the next specialist who has to see them?
Schade: I would say so. The hospitals are either privately-owned hospitals by large corporations, or government-owned hospitals.
Guerra: So they have some of the same work cut out for them.
Schade: Yes.
Guerra: One of the premises I’ve had is that US-based CIOs want to hear from other US-based CIOs, especially now with HITECH, because if you speak to someone outside the country, they’re not going to be able to relate to the Meaningful Use requirements. So if I were to interview CIOs from hospitals in other countries, the value would be marginal in interest to US-based CIO. Do you think that’s true, or do you think there is some appetite among out there among US-based CIOs for some international flavor?
Schade: I think there is some appetite, and I’m certainly not a world traveler, but I would give you three examples. I spent a few days in India interacting with this client, and one take away there is that they are willing and able to move very fast in their decision making process and their implementations, and that appears to have to do with more top-down decision making and a much greater degree of standardization. We’ve got a lot of organizations here where that may not fly, but if you just step back and say, ‘What are you able to accomplish if you take that approach,’ it’s kind of interesting.
The second data point is that I just got back from a two-week vacation to China; I went with a tour group. It’s an amazing country, and one of my takeaways there, although we saw the spectrum, was in how fast they were able to do some things in a growth economy. And we saw that predominantly in Shanghai, which is just amazing. In terms of the population of 23 million and just the growth over the last 30 years in that city, it’s phenomenal. They have 4,000 skyscrapers over 20 stories. In this one area downtown, they’ve taken pictures every year of the skyline; it’s just amazing how quickly some of the world’s tallest buildings are going up. So in terms of the ability to move fast, labor does not seem to be an issue. There is no labor shortage in this country.
The third example I would give you is that I had the opportunity last year to go to Oslo, Norway, for a few days as part of a trip with one of Partners’ major vendors where were looked at digital hospitals there. That was an opportunity to learn how they are doing some pretty innovative things in terms of leveraging technology. So yes, we always have something to learn from everyone.
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