Earlier this year, Ed Martinez received the 2012 Innovator of the Year Award from CHIME for his efforts in leading the mHealth program that is transforming the way care is practiced at Miami Children’s Hospital. But Martinez’s innovation goes beyond that. In this interview, he talks about his unconventional methods for winning over naysayers, the enormous role that process improvement and change management play in a successful implementation, why his organization chose Cerner over Epic, the importance of taking risks, and what all CIOs need to keep in mind during a sales pitch.
- Garnering CHIME Innovator of the Year honors
- What does being innovative mean?
- Focus on telehealth — “How do we get these sub-specialists in front of the kids who can’t walk in here”
- Improving access to care while cutting costs
- The importance of a clear organizational vision
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People who are innovators look at things from a different perspective. They look at things and say, ‘there’s got to be a better way. There’s got to be a better mousetrap.’
The cost alone is in the billions of dollars, but it’s changing healthcare. It’s getting physicians to change the behavior. It’s getting the physicians to change the way they think. It’s getting managed care payers to think differently.
Our CEO gets all the credit for that one, because he is very innovative, and he said, ‘we’re going to do this. We’re going to be the first in the country to do this and we’re going to be out there. While everybody else is dabbling in it, we’re already going to have that vision laid out.’
Our decisions have been very well scrutinized. We know where we want to go. We know where we want to be. And so every decision — every path we make, every movement we make — has the same end goal in mind.
I think CIOs in healthcare have a really demanding job nowadays. Our role is not only to be operational, but to be a strategist, to be technical, and to wear many different hats.
Guerra: I wanted to congratulate you on being awarded CHIME Innovator of the Year.
Martinez: Thank you.
Guerra: I want to talk to you about innovation. I know a lot of the things that you won that for were based on telemedicine and telehealth and extending out the enterprise for remote visits and things like that.
Guerra: It might sound silly, but tell me — at a high level, what does innovation mean to you?
Martinez: Innovation to me personally — and I want to quantify this, in healthcare — is looking at how we do what we do and realizing why we do it that way. There’s such a better way of doing things differently. If I question myself on something that I see in clinical, in the OR, in the operation space, then that means we’re missing something. Obviously, people who are innovators look at things from a different perspective. They look at things and say, ‘there’s got to be a better way. There’s got to be a better mousetrap.’ And if you can ask that question in healthcare — which you can in many, many areas because in healthcare we’re the most resistant to change — it works and it works and it continues to work. Even clinical practices are evidence-based, so it works and it works and it should continue to work.
But when you introduce something like personalized medicine, which is based on genetic principles, you throw the whole thing out of whack. Because now, even though you’re probably going to improve that mousetrap and provide a better outcome for that kid or that patient, the change itself is unheard of. So innovation, for me, is knowing that there’s something better; that the way we do it today can definitely be improved. And how do we improve it? In our case, being CIOs, by bringing technology that can help automate, bringing technology that can help streamline, and bringing technology that can help minimize risk. If we can do that successfully, we innovate.
We’re doing that with telehealth right now. Our belief is that we have some of the world’s best subspecialists in cardiac care, in neuro, and in ortho. I’ll give you an example. There are probably two or three people in the world that can operate open-heart on a little kid with a heart the size of a peanut. We have one of them. There’s not enough of him to go around through the whole world. So what happens if a kid from another part of this country or another part of the world needs access to that physician? Today, they send the documents to the surgeon, and the surgeon reviews the case. The kid comes from wherever they are in the country or in the world, and they’re here for a few days. They do some tests and they run tests left and right. If it’s not an emergent situation, they finally decide where they’re going to do the surgery and how they’re going to do the surgery. And so this whole process can take weeks or it could take months.
How about if that kid was sitting in his home hospital somewhere, and this surgeon connects in, looks at his entire medical history, looks at the heartbeat remotely, hears his heartbeat, understands what’s going on, and, working with the other physician on the other side, can make that interpretation and that diagnosis, decide what is the next best treatment, and rather than spending two or three weeks in the preparation of travel and bringing him here and all that kind of stuff, within a matter of 15 or 30 minutes to an hour, that same effort has now undertaken, changed that kid, and now that parent and that family doesn’t have to wait a month before determining what’s going to happen next. They only have to now make the decision: do we have the surgery or do we not have the surgery, if that’s the outcome.
So it changes the way we do healthcare. That is innovation. Now, is it an innovative thought? Maybe. It’s been thought about before; maybe 10 years ago we talked about it. We’ve seen it here and there. But now it’s a time where you can innovate this in such a way that it becomes a critical or integral part of your operations. For us, we’re not doing this haphazardly. We’re looking at a full video concierge service. We’re looking at ability to take the service nationally and internationally. I mentioned the Vatican, Russia, and the Caribbean. We also have locations in South and Central America. In fact, I’m traveling there next week. How about in the air? How about on the sea? These are things that are uncharted territory, because typically what happens is when that kid gets sick, you put him on a helicopter, you put him on a plane, you ship him to the nearest facility that has that level of subspecialists, and then you make the decision.
How about if you can do that real-time when that kid is having that seizure? How about if that neurosurgeon can look at that seizure real-time and say, ‘oh boy, this kid’s got a problem. He’s not even going to make it over here. Let’s get him to the nearest hospital and we’ll talk to the surgeon over there.’ Those are life-saving changes in innovation. Those are changes in the way we do healthcare.
Fast forward to the way we do primary care today. You see all the minute clinics opening up in CVS and places like that? That’s a licensed PA that’s doing that or a licensed nurse practitioner. That’s cool, but I want to see a doctor. I don’t want to see a nurse practitioner necessarily. Let’s say that’s my prerogative and that’s what I want to do. Well, why not set up mobile or permanent kiosks throughout malls, airports, and other facilities where now you walk in, you put in your symptoms — what you’re feeling, you swipe a credit card, and you connect to a primary physician remotely who can now, from his location, hear your heartbeat, see your blood pressure measurements, look at how much you weigh, hear your lungs, do everything remotely, and then say, ‘You know what? I think you’re fine but I’m going to prescribe to you a couple of amoxicillin and tell you to see your primary doc when you get back to your hometown.’ And now that kiosk sends out two little pills and he takes the pills and the patient’s happy for another three or four days. If you can imagine what that individual that single session can do, that in itself will change the way healthcare works throughout the world.
And not to mention the cost. A visit to a subspecialist today can run you $200 or $300, if you’re going to pay for it in cash. How about if we swipe a credit card and have that very similar consult for $25 or $30? The cost alone — the savings nationally — is in the billions of dollars, but it’s the way it’s changing healthcare. It’s getting physicians to change the behavior. It’s getting the physicians to change the way they think. It’s getting managed care payers to think differently. I will tell you this: 22 states in the union right now provide telemedicine and telehealth services. The Canadian Provinces do over a million lives a year on telehealth services. In states like Florida and in most of the other states, you can’t do it. You can’t get reimbursed.
So those are the initiatives they’re after; saying, ‘hey Mr. Congressman or Mr. Senator, whoever it is — realize something.You can save money, improve access to care, and perhaps even save lives if you change the way you think about things. It doesn’t have to be face-to-face anymore. Technology is far more advanced now. That’s where we’re bringing innovation. We want to bring innovation to a point where we make access to care a lower price point for anyone, and we want easier access to our subspecialists.
Guerra: So it definitely starts with an organizational vision about what you want to be as a healthcare system and where healthcare is going, and the tools just fall in under that. You can’t do it the other way around, right?
Martinez: You can’t do it the other way around. I’ll tell you what, that’s a great point you bring up. A lot of organizations are dabbling in telehealth services. They’re doing bits and pieces of it, and that’s good for them. But they’re not really putting a vision behind it and a strategy. I will tell you that one of my four goals and strategies is telehealth. And it is on the books. It’s looked at by our technology committee of the board — they want to know when our ROI is going to be there. We have a two-year ROI on this thing. We’re looking at making money, but right now, we’re looking to improve care and access to care.
Eventually, everything else will take care of itself. If you start this endeavor looking at how you’re going to make extra money, that’s not the right mindset, unfortunately. Even though it’s the business mindset and it’s the right mindset in certain areas, you have to also think about how it is you’re going to be able to move care to a different level when it’s never been accepted before. Once it gets moved into that different level, now you can start incorporating cost and savings and looking at where are the advantages and disadvantages for the payers. That’s all part of the process. No one is saying it’s not going to be part of the process, but it’s very clear and evident that the first thing we have to figure out is how do we actually bring the same level of quality care remotely as we do in person. That is where our focus is right now.We do not want to sacrifice quality to do something that’s innovative. We want to make sure that the innovation also improves that quality.
Guerra: It’s very interesting. You go to where you want to go, and then you work on convincing the politicians and insurance companies and say, ‘look what can be done and look what we can save,’ as opposed to just sitting there and waiting until the reimbursement changes, right? Is that what you say you’re up to?
Martinez: That’s absolutely correct.
Guerra: That’s certainly innovative. That’s courageous and innovative, and a lot of credit to the CEO and CFO for buying into a vision that doesn’t have the dollar signs right now.
Martinez: That’s key. And it wasn’t an easy sell; I want you to know that. Our CEO gets all the credit for that one, because he is very innovative in his way, and he said, ‘we’re going to do this. We’re going to be the first in the country to do this and we’re going to be out there. While everybody else is dabbling in it, we’re already going to have that vision laid out.’ And our vision is well ahead of everybody else. We have an international telemedicine command center that has over a couple of million dollars’ worth of investment in technologies and allows us to control and manage remote robots, devices, OR equipment, and to look at patients anywhere in the world and have a physician sit inside that booth and basically take command of care.
We’ve taken that and adapted it to an iPad application as well. So now if that physician is not sitting in front of the booth but needs to have a primary or secondary consult and is in a situation where he has no choice, he can bring his iPad up and have a very similar level of access and level of quality care that gives him at least a viewpoint into that patient to say, “You know what? I think I’m going to need to see this kid a little sooner.’ Imagine the perspective in kid’s care. If you go to a primary care doc and the kid’s knees are a little out of whack and he needs to see an orthopedic specialist, that could be a four-month wait or three-month wait.
However, let’s assume in that office they have a telemedicine booth or set-up that allows them to connect at a block time to one of our orthopedic surgeons and say, ‘Hey Joe, I have Billy Smith here and it looks like he’s got a little problem in one of his ligaments. Can you help me out here?’ And now remotely, that doctor — whether a neuro, cardio or orthopedic surgeon—is looking at that kid, diagnosing him, and saying, ‘I better get him in my office tomorrow because it’s important.’ You’ve just provided access to care to a kid that really, really needed to have access immediately and not be at the bureaucracy of the paperwork in terms of scheduling and be able to go right to the front of the line and say, ‘I have to have this kid tomorrow,’ where another kid is not so urgent and can probably wait a few weeks for the visit.
Now you start changing access to care from a perspective that the kid that needs the most care is the kid who is going to have the first access to care, and that’s important. Typically, it doesn’t work like that. It’s first come, first serve. And that doesn’t always work out well, because the sicker kids may lose out. If we can change that paradigm, now all of the sudden you also start improving care at the same time that you get access to care.
Guerra: What I really see — and it’s really nice about what your organization is doing — is that you can see how a clear vision will inform all decisions. I want to take that to the beginning of our conversation to the decision to go with Cerner. In your opinion, Cerner, based on your overall vision, worked better for your plan. If you didn’t have the overall vision, you might have made a different decision and then not been able to pursue the path you wanted as robustly. I’m not making any judgments on the products.
Martinez: I think you’re absolutely right. You’re right on target. Our decisions have been very well scrutinized. We know where we want to go. We know where we want to be. And so every decision — every path we make, every movement we make — has the same end goal in mind. How do we provide subspecialty care internationally to provide better care for kids who don’t normally get the same level of care? Like I said, when there’s one or two or three of these docs, everybody wants to see them. How do you make that available? It’s physically impossible to bring everybody here.
Well, how about if we extend that using applications and using telehealth and using retail telemedicine — things that are new. Some people consider it disturbing in terms of the way care is taken, and others think it is as innovative as anything else that has ever been invented. But if we can actually figure out how to improve quality, reduce cost, and gain access to care, we have a winning product, and that’s where we’re at right now.
Guerra: Well, Ed, I think that’s about all I have for you. I’m sure we can go for another half-hour, but I think you’ve got to go innovate. Is there anything else you want to add before I let you go?
Martinez: No. I thank you for your time. I think this has been wonderful. Hopefully we can help other people think about not only how to become innovative, but how to go to the next level and really bring up the game. I think CIOs in healthcare have a really demanding job nowadays. Our role is not only to be operational, but to be a strategist, to be technical, and to wear many different hats. But one thing we have to always remember is we all have to do it for the patient, and how we figure out how we put the patient in the middle is always a challenge. I think little by little, these innovative things we’re doing — these creative things that bring that care and that access to these individuals — only add to reasons why organizations require CIO experts to be able to manage their IT infrastructures and technologies. So thank you again.
Guerra: Thanks so much, Ed. You have a wonderful day.
Martinez: Thank you, you too.