You don’t get named CHIME-HIMSS CIO of the Year Award by being afraid to take a few risks — for Jim Turnbull, thinking out of the box has been like second nature for more than three decades. From his first Meditech install in the 70s, when going electronic “felt like an experiment,” to Utah’s initiative to increase transparency by posting physician reviews online, Turnbull has always believed in pushing the envelope. In this interview, he talks about what it takes to foster innovation, his plans to move to an integrated system, how the organization works to retain top talent, and the work they are doing in a host of areas, from telemedicine to patient portals to population health. He also discusses his career background and why he supports a unique patient identifier.
- Posting physician reviews online — “It made the docs really pay attention.”
- Using Amazon’s strategy to pilot new initiatives
- MU attestation challenges — “They’re leaving money on the table”
- ICD-10 on the backburner
- Positioning the organization for innovation
- Groundbreaking genetic research
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It’s been an interesting experiment because as we’ve rolled out new features, we haven’t advertised them. It’s sort of a Google approach. We just put them up there and see if they get used.
We’ve been quite successful on the hospital side, but we’re having our challenges on the professional side. We’ve just re-launched an initiative here in the last couple of weeks to get the medical staff more engaged in it, because they’re definitely leaving money on the table if they don’t.
Because of our conversion to Epic, we’ve put ICD-10 a bit on the back burner, realizing that we’re only going to have a four-month window next year to do the final testing after the conversion. That’s going to be a little bit tight.
The relationship between the researchers and our faculty in the hospital has become much tighter. It’s not like we’re making big breakthroughs right now, but I think we’re at the positioning stage.
We’re really trying to work toward developing care paths, care tracks, and rules and alerts, and to push them into the open-source environment so that we’re not discovering things and then keeping it to ourselves.
Turnbull: There’s something unique about Utah in that way and I was quite surprised to see our comparisons versus other states.
Gamble: Yeah, I wonder what the secret is there. I don’t know if it’s just better follow-up, better programs that have put into place, or what, but that’s something that so many people are looking at and really struggling with.
Turnbull: I think part of it might be that there’s a very strong family environment and culture here. And I think in a lot of cases, when they get home they’ve got that support. I think it’s a little bit stronger here than you might find in other states where there may be less support in the family environment.
Gamble: Sure. And when we’re talking about any kind of chronic disease or chronic condition, having any kind of support like that is huge in terms of just being able to incorporate better health into the everyday routine.
Turnbull: Yeah, it certainly helps us stay under the radar here and under the average in terms of return rate.
Gamble: I had read on UUHC’s site about an initiative where physician reviews and comments are being posted online now, and I thought that was interesting. I just wanted to ask you, is this something that’s being done to increase transparency or was this something that the patients we’re looking for?
Turnbull: I think it’s both, actually. One was increasing transparency; that was probably the biggest motivator. And part of it was to get the physicians more engaged in our exceptional patient experience program. Our scores have gone up and up, but they kind of leveled off, and we realized we had to get the docs more engaged. So by putting their scores online — and I believe we were the first hospital in the country to do that where we actually published the Press Ganey survey scores as well as the comments — it made the docs really pay attention, and as a result, our scores are certain to bump up again.
Of course it was very controversial. There was a lot of discussion around it, but the medical staff leadership was very insistent and pushed it through. I don’t think it’s caused any real big issues from what I’ve heard. But it’s been really well received. We’ve had a lot of comments from the patients in the community — even in my own family. I have a sister who comes here as a patient at the hospital for a number of issues, and she really enjoys being able to go online and see the different reviews for the docs that she anticipates using. It’s an interesting service.
Gamble: We know that patient engagement is such a huge issue and it’s something that a lot of organizations are really looking to bolster, especially as part of Meaningful Use. In a way I could see that this really is helping to get patients more engaged, and by becoming more active in this way, maybe they’re more likely to then participate in things like portals. I don’t know — have you found that to be the case?
Turnbull: We use the MyChart patient portal from Epic, and it’s been pretty successful. We quickly ramped up to around 50,000 patients. It’s kind of leveled off since, but it’s been an interesting experiment because as we’ve rolled out new features, we haven’t advertised them. It’s sort of a Google approach. We just put them up there and see if they get used. The most recent one was where we put the ability to pay online for self‑pay situations, and immediately people started using it, even though we never advertised it and we’ve had several hundred thousand dollars come in that way.
That was kind of a fun one. I think we’ll continue to do that — just put things out there and see if they get any hits. If they don’t, we’ll probably turn that part of the service off, and when it’s successful, we’ll just continue to let it run. I think both Google and Amazon use that type of approach where they’ll put something out there and just see what happens rather than spending a lot of money on advertising. People figure it out.
Gamble: That’s an interesting way to pilot something.
Turnbull: From what I understand, I believe it’s Amazon. They put a new feature out almost every day, and only 10 percent of people that signed on to Amazon will see that feature in a particular day. Then they monitor it, and if it’s successful, then they deploy it to the rest of the users. If not, they just turn it off.
Gamble: That’s interesting. It makes me wonder if I’m paying enough attention when I go to Amazon.
Turnbull: That’s what I wonder too.
Gamble: I know we’ve talked about a few things, but what are some of the other big priorities on your plate from an IT standpoint?
Turnbull: There are so many things going on. With the Meaningful Use piece, we’ve been quite successful on the hospital side, but we’re having our challenges on the professional side. We’ve just re-launched an initiative here in the last couple of weeks to get the medical staff more engaged in it, because they’re definitely leaving money on the table if they don’t. That’s one way we’re just putting an additional focus more than anything else. The program’s been underway, but we haven’t been getting the benefits out of it financially that we had hoped.
Looking further down the line, because of our conversion over to Epic on the inpatient side next May, we’ve put ICD-10 a bit on the back burner, realizing that we’re only going to have a four-month window next year to do the final testing after the conversion. That’s going to be a little bit tight, but it’s definitely not off the radar at all. In terms of our gradual expansion, we’ve got I guess three offsite locations that are currently in the design and planning stage. That seems to be a constant focus for us — rolling out more facilities, all of an ambulatory nature. I think that’s pretty consistent with a lot of things going on in other communities around the country.
We have a relatively new senior vice president — she came here from NYU about 18 months ago, and she is really into innovation. That’s where she I think really wants to leave her mark here. And so the relationship between the researchers and our faculty in the hospital has become much tighter. It’s not like we’re making big breakthroughs right now, but I think we’re at the positioning stage. We do have a couple of fairly significant announcements coming out probably in the next three months.
I’m not free to divulge what they are, but we’ve already got one Nobel prize winner here on campus, and I wouldn’t be surprised if one of these two will also be a Nobel prize award somewhere down the line, maybe in another 10 years or so. This campus is pretty interesting. They do a lot of technology development in that they try to get into new companies and the development of new companies. The technology transfer is a big agenda here, and for the last two years, we’ve actually done more start-ups in any other campus in the country. MIT tied with us two years ago but we were number one last year, so there’s a lot happening in this little community.
Gamble: You talked about how the new senior vice president really wants to foster innovation. What does it take to create that environment where you really are able to foster innovation and encourage people to be really thinking outside of the box and creating new ideas?
Turnbull: I think one of the big opportunities here is that we have a chance to do a lot of genetic research in a very unique way. We have this capability called the Utah Population Database; it’s a database that actually was started by the church and now a lot of different organizations contribute to it. It goes back something like six generations. They hook that database together with our genetic research group, and it’s a very large one here on campus. Being able to map back and look at how the genes have passed from one family member to another over the generations really gives us an advantage.
We have a program underway called the Utah Genome Project, and that is a very big initiative here on campus. It’s a little unique to the history of this state. The first markers for breast cancer were identified here, and we just seem to be very fortunate to have this capability here. So that’s our big push on the genetics side. The other thing that we’re very lucky to have here is the Moran Eye Center, which is a very large research institute. That’s one of the areas where I expect we’ll have a really major announcement here, probably over the next three to six months.
Gamble: That’s interesting when you talk about the population databases and doing all this type of research. To me, that seems like what we really mean by Meaningful Use. I hate to use that phrase, but I’m talking about actually looking back and mining through the data and doing what we should be doing with it.
Turnbull: Yeah. We’re linked very tightly to them. With our own data warehouse on campus, the medical side of things goes back to about 1993. And we have a very active knowledge management program underway. Part of it is just focused on doing data mining, but the other side of it is really trying to develop what we call open CDS or open clinical decision support. The individual who used to work at Duke and kind of developed this concept is on my staff now so he works 60 percent for me and about 30 percent for our biomedical informatics program here on campus. We’re really trying to work toward developing care paths, care tracks, and rules and alerts, and to push them into the open-source environment so that we’re not discovering things and then keeping it to ourselves. That’s been a really fun initiative, and it’s starting to gain significant traction at this point in time.
Gamble: Very cool.