Art Glasgow, VP/CIO, Duke Medicine, Chapter 1

Having spent most of his career on the vendor side, Art Glasgow knows about deadlines. Now the VP and CIO Duke Medicine, which includes Duke University Health System, he’s bringing all that experience to bear in handling the new, breakneck pace at which healthcare, and healthcare IT, are hurtling forward. To learn more about the organization’s massive Epic rollout, which Glasgow describes as almost stakes to play in today’s environment, healthsystemCIO.com recently chatted with the North Carolina-based executive.

Chapter 1

• About Duke Medicine
• The Epic rollout
• Joining Duke — “Had Duke decided to remain best of breed, it may have effected my decision to come here … The enterprise EHR becomes a service bus for information”
• Evaluating Epic
• Glasgow moves to the provider side
• Taking a portfolio view of your projects

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BOLD STATEMENTS

… we just did our 30-day assessment, and it looks green across the board, so we’re expecting a good roll out.

I think had Duke decided, perhaps, to remain best of breed, it may have affected my decision to come here …

Integration is a big key, and I think systems that have largely disparate departmental systems are going to struggle with that unless they have a very strong integration strategy.

I think more and more you have to take a portfolio view of everything you do, and manage it as if it were a portfolio of products and really position yourself as an internal service vendor to your organization in order to be successful …

Guerra:  Good morning Art. Thanks for joining me to talk about your work at Duke Medicine.

Glasgow:  Thanks for having me.

Guerra:  All right great, let’s start with that actually. I think a lot of people refer to your organization as Duke University Health System but, if I’m correct, that’s just one component of Duke Medicine, and you’re responsible for the whole thing, is that right?

Glasgow:  That’s correct. Duke Medicine, think of it as a brand that encompasses all of the healthcare assets of Duke University, so that includes our health system which is primarily composed of our three hospitals – the main hospital and our two community hospitals. We also have a children’s hospital that’s part of the main hospital and our primary care organization. It also encompasses our school of medicine and school of nursing, as well as our faculty practice plan, which is the private diagnostic clinic.

Guerra:  So if people think you’re just handling Duke University Health System, you have to disabuse them and say, “I have a little more on my plate than that.” J

Glasgow:  I think all three of our missions are pretty tightly connected, so I’m fine with however people want to refer to it, because it doesn’t change what I have to do day to day.

Guerra:  Right. Your big project is an Epic rollout, correct?

Glasgow:  That’s one of our big projects, it’s definitely the most immediate. For anyone who’s gone through an Epic rollout, you can understand how all consuming it becomes because (1) it is large in scale and complex, but (2) it’s so ingrained with your work processes. But what we’re doing is not limited to just Epic as well. We have a number of different efforts, both in our research and on our education side of the house that are equally strategically important.

Guerra:  We’ll get into those, but why don’t we just talk a little bit about the Epic rollout first, but we have to bring in your career path at this point. You’ve been there about a year and three moths, correct?

Glasgow:  That’s correct.

Guerra:  Just for a little background, tell me where the Epic process was when you joined, at what stage it was and what you’ve done over the last year and a half or a year and three months, and maybe some milestones of this rollout going forward.

Glasgow:  When I joined, the organization was just at the decision point. It had not yet made the final decision to move to Epic Enterprise. When I came on board, I revalidated the work that had been done around choosing Epic as an ambulatory platform, and then built the larger strategy around moving towards Epic Enterprise overall, including revenue cycle and patient care. For the past year and a half, year and three months, we’ve been building the team, organizing the work and really driving the plan in conjunction with Epic and our implementation partners. Our first go-live will be all of our primary care clinics, and that will be on July 18^th and we just did our 30-day assessment, and it looks green across the board, so we’re expecting a good roll out.

We’re really running in two separate tracks right now. Our ambulatory track is four phases, the first phase going live on July 18^th of this year, the last phase going live July of next year. Parallel to that, we’re also running an enterprise and revenue cycle implementation, which will go live on the main hospital and the full system rev cycle in July of next year as well. So July 2013 is a big date for us because it brings together our ambulatory, our main hospital and our rev cycle, and then post July 2013, we’ll implement our two community hospitals in order.

Guerra:  Do you think that the organization intentionally waited until a new CIO was on board before making the final decision?

Glasgow:  I don’t. I think the organization had reached the point where they understood they needed to do something. There was an internal team that included much of the team that I’m responsible for now, that did the analysis for the ambulatory environment and I believe — whether or not I came on board when I did — they would have made the decision to move towards Epic ambulatory anyway.

Guerra:  I wonder, for other folks that are in the position of investigating a new opportunity, tell me about the dynamics on your end. You’re looking at this organization, they’re about to make a major decision, it could happen before, it could happen after; was the direction they took going to affect your decision or your interest in the position?

Glasgow:  Quite potentially, and it was a long recruitment for me to come to Duke. I was aware of some of the issues they were facing. I’m also somewhat unique in that I’ve lived in this area for the better part of 20 years, and this is where my family has received care. I had a firsthand patient’s view of both the positives and the minuses.

I think had Duke decided, perhaps, to remain best of breed, it may have affected my decision to come here because, from my understanding of what the challenges were, I think getting the Enterprise EHR out of the way is an important first step in order to be able to do much of the things that we want to here in the future, regarding data analysis, integrated informatics and really taking things to the next level.

Guerra:  It sounds like we’re almost at the state in the industry where having an Enterprise EMR is part of having a sound infrastructure and then things go on top of that. It’s become part of the infrastructure, has it gone that far?

Glasgow:  I would agree with you. We refer to it as kind of the first big level of a platform. The Enterprise EHR almost becomes like a service bus for information, and I think the big trap in that is, especially with the price of these things today, you expect it to do everything, and I think you have to realize that what you’re putting in is a foundational platform that you’re going to have to continue to innovate around.

Guerra:  It’s interesting because many organizations cannot do a rip and replace, and so they’re working with what they have. I wonder if we’re going to see a real separation in terms of the quality of care between organizations that can get that infrastructure level EHR in place and those that can’t, just because of the things you you’ll be able to do once you have it in place. What do you think about that?

Glasgow:  I think it’s an interesting question. I do think the key isn’t necessarily what software platform you put in. I think we all have our personal opinions as to which are better, which are maybe easier to implement, but there isn’t a one size fits all. I think it’s important to think though how you put these tools in the clinician’s hands and how their work processes and clinical workflows really benefit from it. Integration is a big key, and I think systems that have largely disparate departmental systems are going to struggle with that unless they have a very strong integration strategy. The systems that have chosen to go to Epic have clearly said that we’re going to handle that through having a single database, fully integrated system. Even then though, in a place like Duke, even a platform like Epic cannot do everything. There are holes in it, there are gaps in it, and we’re going to continue to have to integrate stuff.

Guerra:  Right. One of the things people are looking for – not looking for maybe fearing, especially customers – is that as Epic grows, takes on big clients, that there is some dip in the service level. Obviously, Duke is a large engagement for Epic. How have you found their performance as compared to what you had heard of their reputation or expected?

Glasgow:  It’s somewhat of a unique question for me because my background is largely on the vendor side where, for the majority of my career, I competed against Epic. Now being on the other side I can say without reservation that they’re definitely one of the top vendors I’ve ever worked with. They’re extremely ethical, extremely honest and they really focus on the success on their processes. That does come with, I think, some gaps, because they don’t necessarily understand all the nuances, especially of a very involved academic medical center like Duke. I have not seen them struggle to meet the demand, and they are winning quite a bit out in the marketplace right now.

Their model has always been to build and train their own, and I think that gives them somewhat of an advantage, as long as they can keep up their training pipeline. But what you trade off for that is you’re not necessarily going to get someone working on your implementation that has 15 or 20 years experience. They bring with them a strong understanding of their software and a strong understanding of what makes it successful and, to be a good customer, you have to bring with it a strong understanding of how it’s going to be successful at your place. It’s really creating a partnership, so I have been very pleased with Epic. They’ve been a very, very strong partner, and someone who we trust throughout this process.

Guerra:  I wonder if existing customers of Epic have a common reaction to seeing a new major signing which is “uh-oh” as opposed to being happy, because you just wonder about them handling each new big, big contract. Does that happen?  Do you have that feeling when you sign a big deal?

Glasgow:  Jim Noga of Partners is a friend of mine and, when that news broke (that Partners was signing with Epic), of course part of me was like, “That’s great,” and part of me was like, “Wow, I’ve got to make sure people don’t end up fleeing my implementation.”

I don’t think the problem is really Epic. Epic has built in rules around ethics regarding shifting people and recruiting from each other, and I think that side of it works very well. But especially for the larger systems and the systems that don’t necessarily have a long track record in implementing an Enterprise EHR, you’re typically looking for some third party help, and whether that’s through a Deloitte or Accenture or whoever, I think those firms, even the largest and most well respected of them, are struggling to find people in the marketplace today, just because of the demand. You do have to manage your partners and your vendors to make sure that you’re getting the proper focus, but it’s definitely doable.

Guerra:  You mentioned that most of your experience is on the vendor side. I know you spent quite a bit of time at Ingenix. You didn’t have experience at a hospital or health system in the CIO position, correct?

Glasgow:  That’s correct.

Guerra:  It’s interesting that you got the job, congratulations. They must have been open to that, that it was not an absolute prerequisite that someone had that direct type of experience. What made you confident you’d be able to handle the new role?

Glasgow:  I think a couple of things helped me quite a bit. The first is having a strong background in the subject matter of HIT. One thing that I found, as I’ve learned more about the provider side, is that there really isn’t the depth of knowledge regarding health information technology on the provider side that exists on the vendor side. The people here are wonderful, the people are truly understanding of their workflows and their subject matter, and they get how technology is applied, but they don’t understand the nature of the industry and the scope of it as well. I think one of the things that I brought with me was a strong understanding of software development, a strong understanding of the maturity of software products out in the marketplace today and where, quite frankly, some of them work and some of them don’t.

Ingenix was also a really good training ground because Ingenix is a unique company. It’s not just a software vendor. It’s a very large services organization that really services more than just the provider organizations. It’s the payer’s side. It’s the health and life sciences side, and it’s a very big research center as well. Ingenix does quite a bit of both informatics, as well as supporting clinical research through many of its consulting organizations. My experience at Ingenix was built around data analytics and informatics and supporting research. I think that is a prerequisite for anyone who’s going to come in and take a CIO role at an academic medical center — to at least understand the business of research and IT’s role in supporting it.

Lastly though, I think the reason why Duke was open to looking at me, and why the fit worked, was the challenges that are facing health systems today, both from a regulatory and a market perspective, are quite unlike anything that most of us have seen in the provider side. They’re more like the time-based competition that people live in on the vendor side. You’re used to working under more strict deadlines, and you’re used to making more trade off decisions, I think, on the vendor side than you are on the provider side. The leadership aspect of it can’t be understated and, more and more, I think you’re going to see some trading between the two sides of the equation here — between the vendor side and the provider side — because the vendors are also looking for people who have experience in their customer’s shoes. For me, this was a great opportunity to leverage what I learned over my career on the vendor side to try to do some good within a place like Duke, while at the same time bringing to Duke a different perspective.

Guerra:  I think that a very good and very interesting point, which is that the dynamics of being a CIO in a health system are more vendor-like than they’ve ever been before because of the deadlines based on the government programs that are in place. Maybe health system CIOs used to be able to operate on a bit of the more leisurely pace, take things as they come, make small incremental improvements. Is that essentially what you’re saying?

Glasgow:  Well, I wouldn’t say that previously CIOs were taking things at a leisurely pace but I think…

Guerra:  Maybe I overstated it. J

Glasgow:  I think more and more you have to take a portfolio view of everything you do, and manage it as if it were a portfolio of products and really position yourself as an internal service vendor to your organization in order to be successful because, quite frankly, the resources don’t exist to do everything that we have to do. If you focus just completely on developing your own solutions to meeting regulatory requirements, you’re going to miss the innovation boat. More and more, I think this move you see towards Epic isn’t necessarily about everyone buying into the religion but, I think, it’s people reaching a point where they understand that if there is software that is off the shelf that works from the vendor community, put it in place because you have to marshal your resources to focus on areas where the vendors really haven’t innovated well enough yet. That’s what we’re doing here — bringing that portfolio management approach.

Chapter 2