As one of the regional CIOs at Vanguard Health, Kristin Darby is tasked with guiding the IT strategy for seven hospitals located in the Chicago and Boston areas. It’s a role that requires a lot of juggling, and constant communication — which Darby facilitates through “huddle meetings” with the staff. In this interview, she talks about the work her team is doing to enable data flow between facilities, increase patient engagement, and lay the groundwork for ACOs. Darby, who was named one of Boston Business Journal’s Top 40 Under 40 in 2010, also discusses the key advantages in being part of a large system, the changes she is seeing in physician acceptance of EHRs, and why community involvement is so important to her.
- Online scheduling — “There’s a lot of resistance.”
- Vanguard’s growth strategy
- CIO with a CPA
- From Fresenius to Harvard — “It allowed me to get my hands dirty again.”
- The culture at Vanguard
- Mentoring young girls — “I’ve learned so much.”
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I saw this as something — and maybe I was being rather naïve — that physicians would be pretty excited about, especially those that have open spots in their panel to expand their visibility. But there’s a lot of resistance.
We’re definitely going to continue to have this type of activity, whether it’s through acquisitions, mergers, or strategic alliances — that’s just the world we’re going to be in for the next few years.
I was coming from a very large organization to a much smaller organization, and it allowed me to really get my hands dirty again and touch everything throughout the entire system development life cycle.
It’s truly the best culture I’ve ever been exposed to; there’s such a heavy focus on taking care of our employees, which we feel strongly translates into taking excellent care of our patients.
I like to get involved in some things in the community that aren’t as tied to work. It allows you to expand your skills and utilize different parts of your brain that you don’t in your day-to-day work, so that’s very rewarding.
Gamble: That seems like something that’s a win-win, and I can eventually see it becoming the standard where patients are booking appointments online and booking them before they are even discharged. It’s a huge advantage, and I’m sure the likelihood that they’ll keep the appointment is probably a lot higher.
Darby: We haven’t seen a large cancellation rate with these. I think it’s been somewhere around 7 percent, which is pretty minimal. We’re only a few months into this, but we have seen very impressive results, in my opinion. When we first approached this, I never saw it as a disruptive technology. Certain things are often considered disruptive technologies, and I saw this as something — and maybe I was being rather naïve — that physicians would be pretty excited about, especially those that have open spots in their panel to expand their visibility, and new physicians or physician that have changed practices. But there’s a lot of resistance to opening up that appointment book.
Certainly the tool supports manual appointments, but there’s a difference from a patient perspective between requesting an appointment and then waiting to hear back and often being given alternative slots, and ‘I booked it and now I have a confirmation and the process is complete,’ which is more of that immediate gratification many consumers are looking for — ‘I’ve completed my task.’ In healthcare, that’s going to expand as an expectation of our patient community.
Gamble: Absolutely. It’s like the example you used before with booking airline flights. You have that flight booked. It’s not, ‘okay, we’ll get back to you and see whether or not you’re on this flight.’
Darby: I do think this will grow. It is a transition for physician offices to adjust to. For specialists, they can restrict who has access to book appointments to only PCPs or hospital staff, for example, so that way if you’re a neurologist or a thoracic surgeon, you don’t have individuals booking online with you through the hospital website or your provider website. You have offices that have already pre-screened and are making referrals specifically to you, but you are able to book that appointment immediately versus calling around and finding an office that has an appointment open that fits with the patient’s schedule.
Gamble: You mentioned before about looking to expand in Connecticut. Is that something that’s in the early discussion phase?
Darby: It is. We are in the due diligence phase with four hospitals in Connecticut, looking to certainly take advantage of Vanguard’s organization and expand that into those facilities in those areas. You see the trends of horizontal integration across the healthcare market, and we’re very excited about the opportunity to expand there. We certainly hope that as those discussions continue to develop and go through the regulatory process in Connecticut, that we will be successful in partnering with those hospitals and expanding our footprint there.
Gamble: Looking on your LinkedIn page, I see that you’ve had a good deal of experience with M&A. Is that something you think was an advantage in getting your current role?
Darby: I think it certainly helped because Vanguard has a real focus on growth and acquisitions, which is certainly how most of the expansions with Vanguard have been accomplished. Historically I was on the ambulatory side, but I went through many IT integrations through acquisitions, and it’s allowed me to develop a very thorough process here, and I’m certainly looking to leverage that through full integration of those facilities within the Vanguard family.
Gamble: It is an absolutely huge trend now and one that I don’t think we’re going to see calm down for quite a while.
Darby: I agree with you. I think in the next few years, we’re definitely going to continue to have this type of activity, whether it’s through acquisitions, mergers, or strategic alliances — that’s just the world we’re going to be in for the next few years. And with that expansion comes a lot of benefits. We’ll continue to see those things develop, but I think healthcare reform is something that has led the need to really build these alignments and partnerships across the entire continuum of care within the healthcare industry.
Gamble: It’s going to be interesting to watch in the next few years.
Darby: I agree.
Gamble: Now prior to Vanguard you were CIO at the Risk Management Foundation at Harvard Medical Institute. What made you become interested in pursuing the CIO role?
Darby: At that location, they’re the captive malpractice carrier for all of the Harvard-owned hospitals. They operate under the name of CRICO. At the very beginning of my career I had split my time between IT and accounting. I’m a CPA, and I had done accounting for an insurance defense firm. As part of that, I had gotten involved from a political perspective, being a campaign manager and campaign consultant trying to increase the number of elected officials that were supportive of the healthcare industry and also physician-friendly, and that was kind of my first exposure into healthcare.
So with that focus and the insurance defense, I think that that really made the CRICO role very attractive to me. I was coming from a very large organization to a much smaller organization, and it allowed me to really get my hands dirty again and touch everything throughout the entire system development life cycle. The previous company I had been with was so large that you weren’t able to get into the operational details, where at CRICO, I had that opportunity. It was nice to get that exposure again and reuse skills that I hadn’t used in many years. It was also looking at the healthcare industry from a perspective of, how do we make ours the safest facilities to operate? How do we put the best practices and protocols in place to ensure our providers and patients are well-protected?
I definitely learned a lot from there from the analytics perspective, which was heavily focused on predicting patterns that would lead to a potential risk and then decided how we could proactively remedy those. It’s an extremely effective way of doing things, and I think that the results with the lower malpractice occurrence certainly reflected those efforts.
Gamble: It’s an interesting background and a great perspective to get going into the CIO role.
Darby: Absolutely. I’ve really touched all areas now, which is great because you get a different perspective when you sit in each seat. When I was with Fresenius Medical Care on the ambulatory side, we did contract some acute, and so I certainly have some acute exposure in the hospital areas. I worked with them to facilitate continuity between our patients going from the ambulatory setting into the hospitals and then returning and making sure we had transparency of information throughout that process. But you certainly have a different perspective once you’ve sat in the hospital seat. It’s nice to see the full picture and understand the connectivity and the physician perspective and understand the operational details of each type of organization.
Gamble: It seems like you found a great fit with your current role.
Darby: I love my position here. It’s been extremely rewarding. I think it’s a fantastic organization. It’s truly the best culture I’ve ever been exposed to; there’s such a heavy focus on taking care of our employees, which we feel strongly translates into taking excellent care of our patients. I think it’s been extremely rewarding to see that at all levels within the organization. Leadership truly is committed to that across every one of the markets within Vanguard, and I think that consistency is rare.
Gamble: I think that that’s a really great point. When the people who work with you and work for you see that they’re being taken care o,f it’s just a better environment for everyone.
Gamble: on one more thing. I want to talk about your involvement in the community, because this is something I think is such a great thing to see. Obviously, as a CIO you’re spread pretty thin, but I just wanted to talk a little bit about the work you’ve done with the Rotary Club and also the adolescent girls’ organization.
Darby: Sure, I’d be happy to. I grew up in a family that was always heavily focused on community service, and one of the things that both of my parents were active in was Rotary. At the time it was Rotary Anns for my mom prior to women being members, but I grew up with a heavy exposure to Rotary. We often hosted international exchange students within our house, and it really made me aware of the impact that some of the service organizations within the United States have, not only in the US, but internationally. And so I’ve carried with me the importance of always having to give back. So with that, I was one of the cofounders of the Downtown Boston Rotary Club. We certainly do a lot of service work that tends to be educationally focused here within the Boston area.
I’ve been part of a few organizations, but one in particular that I involved with through the Junior League was Germaine Lawrence, which is the only adolescent girls’ home within the state of Massachusetts. It takes the high risk girls that are often without any type of family connection and typically from a pretty tough past, and tries to be the last stop of correction, hopefully, before detention facilities. Many of these girls had not survived in or have been successful in foster care settings or other types of homes prior to getting to Germaine Lawrence. I was a mentor one-on-one for a girl from age 13 to 16 and then I also ran the mentoring program and matched a lot of girls. It was tremendous learning experience for me, certainly not being exposed to many of the issues and factors that those young girls have gone through in their life prior to that. Sometimes problems aren’t as easy to fix as we often think before we get exposed to them, and so I got a lot of value out of that personally. I sat on their advisory board once I completed that mentorship, and I still stay in touch with my mentee.
It’s really a rewarding situation, and I encourage everyone to take some time and get involved in whatever facet that is. I try to always reach outside of my industry because we certainly all do technology work on a regular basis, and so I like to get involved in some things in the community that aren’t as tied to work. It allows you to expand your skills and utilize different parts of your brain that you don’t in your day-to-day work, so that’s very rewarding.
Gamble: Sure. And I imagine being able to put in that time with the mentee is really meaningful.
Gamble: I have a lot of respect for that. I think its great work that you’re doing. I hope that others who listen to this will maybe get inspired.
Darby: I agree. I would certainly encourage them and I’d be happy to talk to anyone about different ideas, because I certainly think it’s important. Rotary also has done great work. One of the things that has always attracted me to them is that 97 percent of everything that is invested or donated to Rotary, I believe, actually goes directly back to community service, where it’s intended to go. There are very few organizations that are able to make that commitment and don’t have a larger administrative overhead. I always feel very happy knowing that whether it’s financial investments or time investments, it’s actually going to the intended recipients, and I get a little bit more out of the limited time that I have to volunteer.
Gamble: Well, honestly, I could talk to you a lot longer. There are so many interesting things to discuss. But I’ve already taken more time than I promised, and I apologize for that, but thank you so much for taking the time to speak with me. I really appreciate it, and I think that this is going to be really interesting for others to read about and hear about.
Darby: Thank you very much. I appreciate the opportunity and hope we can do this again.
Gamble: Yeah, definitely me too. Thank you so much.
Darby: Thank you.