They say everything is bigger in Texas. But Memorial Hermann Healthcare—a system that certainly qualifies as ‘big’ with 11 hospitals and a large network of affiliated physicians and specialty programs—is trying to make healthcare better. One way the organization looks to change the game is by offering different organizational models for physicians and letting them choose the option that best meets their needs. In this interview, David Bradshaw talks about the challenges he faces in establishing connectivity between the hospitals and the various groups of physicians who work with Memorial Hermann, managing an application environment that includes multiple vendors, working with fiercely independent physicians, wearing different management hats, and competing with big oil for IT talent.
- The Memorial Herman Information Exchange
- DICOM Grid for image sharing
- The importance of disseminating IT success stories — “If you’re not selling, you’re dead”
- Project prioritization is everything
- Mastering the Apple — iPhones, iPads, etc. “It’s a tsunami moving through our industry”
- Thoughts on ACO, Meaningful Use — “It was like a bouncing ping-pong ball”
When we signed the contract with DICOM Grid, we had high aspirations and big hopes, and we actually met our go-live date of April 2011. Those in the IT world know that hitting the first stated go-live is usually not what happens.
We love when we hear these kinds of stories. We publicize them, and there’s a little internal marketing that we do so that we can connect the feature and the function and the benefits that we propose in these technology solutions with real-life examples.
As a CIO, you have to do the basics. You have to refresh. You have to keep your technology going. But then every once in a while, in your personal portfolio, you take a risk. You may buy an individual stock or some kind of a global fund, and that’s what we do here. We drive toward innovation. We are willing to risk failure to try to invent and create new things.
We are pushing those two parts of our organization together through medical home initiatives and through disease management initiatives, because we fundamentally believe that we have to create a new model for healthcare. And we will partner with payers, private payers, and employers for that new market.
What was onerous on us was the constant lack of clarity of what their requirements were; the constant changing of the interpretations and our frustration as a recipient. It was like a bouncing ping pong ball, and we tried to keep figuring out where it was going and where it was going to end.
Guerra: Let’s talk about the information exchange that you’ve put together. I understand that there’s an image sharing component, so why don’t you talk about that a little bit.
Bradshaw: That’s a key component of our Memorial Hermann Information Exchange. We operate a Level 1 trauma center, one of two in the Houston area. By all accounts, based on our population, we should have four. Last year when Hurricane Ike came through, our Level 1 trauma center at Memorial Hermann Texas Medical Center was acknowledged as the busiest trauma center in the country that year.
We run six helicopters as the originator of the Life Flight program with Dr. Red Duke, so trauma is a very key service for our system. We had a set of radiologists at UT in the emergency and trauma department that actually started pushing the IT organization for a solution to automate these DVDs that were coming in with these trauma patients. They typically came in sitting on the chest of the patient. So the patient would come off of a helicopter or come off of an ambulance, and a little bit of the medical record would be coming from the sending hospital or the referring site and there would be a DVD of a prior head or a prior chest X-ray or an MRI. And our physicians were extremely frustrated with the incompatibility of those file types. Getting them into our PACS system so that they could start the therapy process was a big frustration.
So we spent some time looking in the marketplace and ended up signing a contract in November 2010 with a company in Phoenix, Ariz. called DICOM Grid. When we signed the contract with DICOM Grid, we had high aspirations and big hopes, and we actually met our go-live date of April 2011. Those in the IT world know that hitting the first stated go-live is usually not what happens. But in this case, we actually hit our first stated go-live where we brought up the image exchange. And with DICOM Grid, we have the capability to connect to other hospitals and other physician offices for the exchange of images.
Let me give you a great example of an event that happened the first week we brought the DICOM Grid image exchange up. There’s a hospital 90 miles to the east of us called Baptist Beaumont. We have a referral relationship with Baptist Beaumont, and there was a 10 year-old girl that had been involved in an automobile accident and had broken her femur, which is the big bone between your hip and your knee. They did a CR of the femur in the ER and the decision by the Beaumont Baptist ER doctor was to transport to our children’s hospital. We run a children’s hospital at Memorial Hermann which also operates a Level 1 trauma center. The decision was made to transport her, and through the image gateway, a technician in the ED at Beaumont was able to upload the image through the DICOM Grid cloud service, and we auto-forwarded that into our PACS system. So our orthopedic-pediatric trauma surgeon at the University of Texas was able to actually see that image and concur to the transfer. When she arrived via ground ambulance, we already had the image, and the surgeon went to the OR, where we have these big high-end monitors in our ORs with the image from Beaumont.
If you look at that and you think about quality of care, we did not take another x-ray, so we did not expose that child to a second round of radiation. From a cost standpoint, we reused a perfect image that was created in Beaumont. And thirdly, from a productivity standpoint, all of this happened without messing with DVDs and uploading and missing this and looking for that. It was just a smooth workflow.
Guerra: How do you hear about these types of stories? Are told about it in real time, or do they bubble up to you afterwards?
Bradshaw: Well, they bubble up afterwards, and I think that our IT organization really is honed in on value-creating. I observe various groups that are interested in doing things for the purpose of technology and because they are able to. We have a gentleman that runs this part of our business named Robert Weeks who actually was a paramedic and is focused on how we can use technology to deliver better patient care. We love when we hear these kinds of stories. We publicize them, and there’s a little internal marketing that we do so that we can connect the feature and the function and the benefits that we propose in these technology solutions with real-life examples.
Guerra: I’m wondering if in a lot of hospitals, the CIOs don’t expressly get out there and communicate with some of the front-line clinicians and say, ‘Hey, don’t just tell us when things don’t work, but please let us know when things do work.’ Is that important to do that? Otherwise, maybe some of these stories don’t get to the IT team.
Bradshaw: I think if you’re not selling you’re dead. And actually, I’ve had two jobs in my career, and for the first 14 years of my job, I was actually an IT salesman working for IBM. And I’ve been here now 12 years, as the CIO and I think that as the CIO, a big part of our job is to sell every day.
Guerra: Actually your title includes marketing and planning, doesn’t it?
Bradshaw: Yes, we have a theory at Memorial Hermann. I call it the glom-on theory, where you get things kind of glommed on to you as your career goes. And so about five years ago, I got marketing and planning glommed on to me. So I spend about half my day worrying about technology and whether we are doing the right innovative projects and creating the right value for our patients and our clinicians, and then I spend the other half of my day thinking about our brand and our marketing messages. I also run a sales function inside of the organization, and I guess, ultimately, share accountability with our hospitals for our growth volumes.
Guerra: When we’re talking about the DICOM Grid project, I was wondering about prioritization. How do you decide that is a project that needs to happen now versus probably dozens of others on your plate?
Bradshaw: I think you’ve hit the nail on the head in terms of the challenge of a CIO in a shrinking world of resources, which is where we are. We simply have chosen that we want to slow the growth of IT but the demand is growing, almost exponentially. It’s about making good bets and it’s the equivalent of your own personal portfolio; you have some stacked away in cash and bonds, so as a CIO, you have to do the basics. You have to refresh. You have to keep your technology going. But then every once in a while, in your personal portfolio, you take a risk. You may buy an individual stock or some kind of a global fund, and that’s what we do here. We drive toward innovation. We are willing to risk failure to try to invent and create new things.
Guerra: One of the biggest things going on in health care right now that CIOs are grappling with is the impact of Apple devices like iPads and iPhones. I believe you were very early to this game, if my research is correct. I saw something from December 2009 where you were really embracing the iPhones. Tell me about that.
Bradshaw: Yes, you are correct. We actually did a little video vignette for Apple. Personally, as an IT professional, I never really took Apple seriously until probably 2009, before that interview. The intuitiveness and the user friendliness of the device—it’s just a tsunami moving through our industry. We struggle, quite frankly, with keeping up with the demand, but we have built applications for it, and we have enabled an environment where it flourishes. We are actually working with Cerner and DICOM Grid to make custom views of their applications available on those devices.
Guerra: I’ve interviewed other CIOs who’ve said they’ve never seen anything do what the iPhone and iPad have done in health care. I’m guessing you would agree.
Bradshaw: Yes, it’s been quite significant.
Guerra: Let’s talk a little bit more about the ACO work. What do you think about what the government has put together in terms of integrating the ACO requirement with meaningful use, things like that? CHIME was not in favor of it. Give us your thoughts on ACO regulations that have come out.
Bradshaw: Well, first, from the hat that I wear as planning officer and in looking at it from a strategic standpoint, we think that the regulations as written are not appealing to us as a healthcare system. So we have not moved forward on anything from a formal standpoint with CMS. However, we see the private market place moving rapidly around those general concepts. And so through the integration of our clinically integrated physicians with our care delivery footprint in Houston, we are pushing those two parts of our organization together through medical home initiatives and through disease management initiatives, because we fundamentally believe we have to create a new model for healthcare. And we will partner with payers, private payers, and employers for that new market, as well as with our own insured employer solutions company. We will take our capabilities directly to employers through our own entities.
Guerra: And sticking with the government programs, how do you feel that the government has done putting together Meaningful Use?
Bradshaw: That’s a hard one to comment on, especially for an interview that’s going to be recorded and posted on the internet, but I’ll make some general comments about it. First of all, we appreciate the money. So if the government is going to define a goal line that we have to reach, we will reach that goal line to cash our checks. Unfortunately, for us though, we have already chosen, as a healthcare system, to use IT to innovate and create a new model of healthcare. So when we read the regulations we just said, ‘Yes, done that, done that, done that, got that. Okay, we can fund that project, get that one done. That one was two years out, but let’s go ahead and bring that in and do it now.’ So it was not terribly onerous on us as a health care system to meet the Stage 1 Meaningful Use guidelines. What was onerous on us was the constant lack of clarity of what their requirements were; the constant changing of the interpretations and our frustration as a recipient. It was like a bouncing ping pong ball, and we tried to keep figuring out where it was going and where it was going to end so that we could actually produce the reports to prove in our attestations that we had accomplished the meaning of the stimulus requirements.
Guerra: Do you feel like you’re in the same position? And I don’t just mean you, but do you feel like the industry is in that same position of trying to figure out how Stage 2 is going to come down?
Bradshaw: Well, hopefully CMS has learned a lot from writing the Stage 1 requirements. We’re just hoping Stage 2 will be better articulated and more clear. We don’t mind the challenge—we love goals. We’re a very outcome-oriented culture at Memorial Hermann. We just want clarity of where the bar is set so that we can jump over the bar. We’ll get it done, but our frustration is when it just keeps moving. When the goal line keeps moving, that’s very non-productive for us.
Guerra: There was some waste in the industry trying to follow those regulations and going two steps to the left when you should’ve gone two steps to the right because things weren’t clear.