One of the core philosophies of military leadership is to train the person who will eventually replace you to help ensure a smooth transition. That’s precisely what happened at Seattle Children’s Hospital this past summer. When Drex DeFord resigned as CIO, Wes Wright was ready to fill the role. Recently, healthsystemCIO.com spoke with Wright about what it was like to move from CTO to CIO, what he learned from working with Drex, and how the organization incorporates Continuous Process Improvement into its overall strategy. He also discusses the clinical application environment, managing multiple vendors, why leaders must be willing to take risks, and how his organization is working to foster innovation.
- Juggling multiple projects — “There’s no rest for the weary on EMR implementation.”
- Leveraging desktop virtualization to increase efficiency
- Incorporating CPI into integrated facility design
- Breakthrough projects and incremental gain — “We went big, now let’s chip away at this”
- Lessons learned from a failed iPad pilot
- Working with Windows 8 and VitalHub to improve the EMR experience
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As we’re doing ED physician documentation, we’re also looking at pharmacy barcoding. And as we’re looking at pharmacy barcoding, we’re looking at point-of-care barcoding, and so forth. There’s no rest for the weary on EMR implementation.
The speed with which folks can move around and connect, reconnect, and disconnect is, I think, pretty remarkable. We saw in one shift the nurse moved 48 times from 48 different stations, and the only way he or she could have done that is through the virtual desktop initiative.
Everything we do is focused on taking the waste out of the process. CPI tells us that at least 50 percent — and more like 95 percent — of what we do is non-value added, which means it is waste. And if you can cut 50 percent of that out, you’ve really made some progress.
We’re in that incremental improvement area, not the ‘go big or go home’ area. It’s ‘you went big, now let’s chip away at this.’
We have to fix the software to work with the devices that are out there. The iPad has its place, and so do other tablet-type devices. It just doesn’t play well with a keyboard mouse-driven application.
Gamble: You said that Cerner’s your primary with the EMR and you have Epic revenue cycle. As far as the other applications, are there a couple of different vendors involved in there or is it primarily those two? How is that working with the different vendors?
Wright: It’s primarily those two. We have GE for our PACS system and Siemens for our cardiology system, but our lab, pharmacy, and so on is Cerner. As far as dealing with the two vendors on the one hand we’re just using Epic for our patient management application — appointments and revenue cycle. That’s a pretty easy HL7 feed to and from both of the records. It’s like dealing with any other kind of interface, so there’s nothing remarkable about that relationship really.
Gamble: You mentioned ED physician notes in December. As far as the strategic plan, are you looking beyond that now, or are you pretty much saying, ‘let’s focus on this one first and then kind of move on with our broader strategy.’
Wright: Oh no, we’ve got different projects laid out on our timeline, so as we’re doing ED physician documentation, we’re also looking at pharmacy barcoding. And as we’re looking at pharmacy barcoding, we’re looking at point-of-care barcoding, and so forth. So there’s no rest for the weary on EMR implementation.
Gamble: Right, absolutely. I read that as CTO, one of the big projects that you spearheaded was the desktop virtualization initiative. Where does that stand at this point?
Wright: It’s alive and well and I’m pretty happy with it. We have about 3,900 Zero Client devices deployed. At any one time we’ll max out at about 2,800 virtual desktops running at a single time during the peak of our day. The speed with which folks can move around and connect, reconnect, and disconnect is, I think, pretty remarkable. We saw in one shift the nurse moved 48 times from 48 different stations, and the only way he or she could have done that is through the virtual desktop initiative.
On the clinical side we still have about a 20-second reconnect time, although we have another project coming and I think we’ll get that down to about 13. But before VDI, that nurse would have had a hard time moving those 50 times. Could have done it, but it would have taken another extra hour out of his or her day.
Gamble: Yeah, absolutely. That’s one of the things you hear about is how it can take clinicians minutes to log in each time, and that’s a whole lot of wasted time.
Wright: It is, and in our CPI journey, one of the wastes in the chain is time. At the time Drex [DeFord] was CIO, so it gave me the top-cover I needed to get this done. But that’s what we wanted to do — give that time back to the provider so she or he could spend that time with the patient.
Gamble: You definitely seem to have a strong emphasis on Lean at Seattle Children’s. I know we’ve talked about in the past with Drex, but can you just talk a little bit about how much that impacts your strategy — that emphasis on cutting out the waste.
Wright: Sure. It’s embedded in our strategy. It’s embedded in everything we do at Seattle Children’s. We’ve been on this journey for something like 12 years now, so it’s kind of embedded in our culture. All my new folks, the managers and supervisors, attend a week-long CPI leader training class that gets them initiated in what it is and how we use it at Seattle Children’s. But everything we do — like the integrated facility design that I told you about earlier — the reason we walk that out and the reason we mock things up is so that we can improve processes. We do count how many steps is it from here to here, and we ask is, is this design the best design to get that particular work done? Everything we do is focused on taking the waste out of the process. CPI tells us that at least 50 percent — and more like 95 percent — of what we do is non-value added, which means it is waste. And if you can cut 50 percent of that out, you’ve really made some progress then.
Wright: It’s embedded in everything we do, and we’re not satisfied with that 20-second reconnect time. Every day our engineers are looking at, okay can I rewrite this script to do this and maybe take a half-second out? It’s that incremental improvement that we keep trying to get every single day.
Gamble: So it’s like a ‘go big or go home’ type thing where you don’t just think about cutting out the waste a little bit, but every project really revolves around it. It seems like that that’s the way to go.
Wright: Yeah, there’s a term for that. There are breakthrough projects, which is that ‘go big or go home’ thinking, and then there’s the incremental gain. And I think VDI was the breakthrough project that took that big chunk of time out, and now we’re in a ‘go small and stay here’ mentality. We’re in that incremental improvement area, not the ‘go big or go home’ area. It’s ‘you went big, now let’s chip away at this.’
Gamble: Another topic I wanted to talk to you about was device use among clinicians. I know you guys had an iPad pilot in 2011 and it ended up being kind of a big deal because you were quoted in an article in CIO Magazine about how the clinicians did with the iPad and how some of them had problems viewing the EMR app. There was a bit of a firestorm from that and you were seen as kind of an anti-iPad guy. Were you surprised with how everything kind of blew up?
Wright: Yeah, I was a bit surprise because I thought I was pretty clear that it’s not the iPad. It could have been an Android device as well or any kind of tablet device that was the problem. It was the EMR; it’s the software that’s not written and not designed to be touch-enabled or viewed on a tablet. So I was a little bit surprised at a time and maybe even still now, but if you put iPad in the title, more people click will on it, so I can understand how that happened.
Gamble: Right. It must have been kind of frustrating for you though because people did kind of jump to conclusions with it, and like you said, they see ‘iPad’ and they want to make it a headline.
Wright: Yeah, it was a bit frustrating, but Drex subsequently wrote an editorial defending me a little bit and saying exactly what I said in the article, which is it’s not the device, it’s the software. So that was good of him to do that, and then with everybody I’ve talked to since then, I’ve really tried to make the point that it’s not the device, it’s the software, so we have to fix the software to work with the devices that are out there. The iPad has its place, and so do other tablet-type devices. It just doesn’t play well with a keyboard mouse-driven application.
Gamble: Have you done anything with the iPad since that original pilot?
Wright: Well, we’ve done some stuff with the iPad. We have some of our on-call folks use it, and our transplant folks that go out to a website also use it. And it works well for that. We’re looking at program now with Microsoft Windows 8 and VitalHub. We’re hopeful we’ll be able to do something from an EMR perspective with Windows 8 and VitalHub that may be pretty cool.
Gamble: Right. Looking at improving that user experience for the clinicians?
Wright: Yeah, VitalHub is an outfit that kind of puts a shim in between the end-user device and your EMR and kind of translates coming out of the EMR into a touch-based, tablet presentable format, so that’s their play on that.