One of the key ingredients in creating a world-class healthcare delivery system, says Ed Babakanian, is a commitment to invest in IT. However, it’s just as important to have a CIO who is willing to educate fellow leaders about the power of an integrated record. It’s that “push and pull” that can elevate an organization, according to Babakanian, who has played a key role in UC San Diego Health System’s transformation over the past two decades. In this interview, he talks about IT’s role in the growth of an organization, the concept of “true optimization,” and what it takes to foster innovation. He also discusses the trust that’s required to facilitate change management, and why CIOs should never shy away from “uncomfortable” situations.
- About UC San Diego
- IT’s role in hospital construction — “Technology is in the middle of everything.”
- UCSD’s EHR journey
- Achieving Stage 6 with Siemens Invision
- Going Epic across the organization — “We need a more robust system.”
- Being leading edge — “Somebody’s got to do it.”
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Especially in our environment where we’re essentially paperless, it is impossible to think about anything — whether it’s a program enhancement, adding physicians, or building a building — without IT involvement.
My experience with having been involved in building new care facilities has given me perspective about how to leverage technology to achieve not just a state of advanced technology, but to do our core mission, which is patient care.
We determined that we needed to have a more robust ambulatory system. We couldn’t do what we needed to do with Siemens.
Leading edge feels good. Sometimes the cutting or bleeding edge doesn’t feel so good, but somebody’s got to do it.
Gamble: Hi Ed, thank you so much for taking the time to speak with us today.
Babakanian: You’re welcome, Kate. I’m happy to do it.
Gamble: To get us started, why don’t you give us a little bit of information about UC San Diego Health System?
Babakanian: University of California San Diego (UCSD) Health System is part of the University of California San Diego Health Sciences. UCSD in San Diego is one of the 10 campuses of the University of California going up and down the state, and UCSD Health Sciences is the teaching program for UCSD — medical and pharmacy. The components of health sciences are the medical centers and the medical group, and together those two are called UCSD Health System. And then beyond that we have a school of medicine, a school of pharmacy, and a school of research and medical education, and all of those three components together are referred to as health sciences. I have responsibility for information technology and a host of other departments for the health sciences. The health system portion of it, of course, is direct patient care, and that’s where we focus our attention in terms of creating EMRs and so forth.
Gamble: What do you have in terms of the number of hospitals and number of beds?
Babakanian: We have a total of 580 licensed beds in three facilities. One of our facilities is the major teaching facility down in Hillcrest, close to downtown San Diego, and that’s the Hillcrest Medical Center Complex. The other hospital is in La Jolla. It’s called the Thornton Hospital. There’s a medical center around it, and then next to the Thornton Hospital we have a cardiovascular hospital. In addition to that, in the La Jolla campus we have a number of other centers of excellence, a regional cancer center, an ophthalmology center, and a host of other medical office buildings. So we have three facilities with 580 beds and a number of other medical office buildings.
Gamble: Okay, so a lot going on there. Do you have physician practices that are owned by the system or a medical group?
Babakanian: Yes. Our medical group is essentially our faculty, which about 1200 physicians ranging from primary care to tertiary and quaternary care throughout San Diego in a number of sites. Beyond our major campuses, we have primary care and specialty care throughout San Diego and Orange counties. Essentially, all of our physicians are employees of UCSD. And then we link up with community physicians because we’re a major referral site, and so we give them access to our patient information. There are several hundred community physicians that refer patients to us.
Gamble: I saw on the site that you have the Jacobs Medical Center project. Can you talk a little bit about that?
Babakanian: That’s going to be our fourth hospital. It’s a 10-story building in La Jolla. It will be connected to our existing Thornton Hospital and to the cardiovascular center, but it’s a 10-story building that is essentially three hospitals in one. The three hospitals will include women and infant services, which is the top three floors, and then an oncology hospital and advanced surgery and robotics. So it’s three hospitals in one. That will add about close to 260 beds to the 580 that we have. We just had the topping off ceremony of that building, and that marks the halfway mark. We’re supposed to open that in 2016.
Next to that, we’re also building a clinical translational research institute. As you might imagine, being an academic medical center, we are big in research and translational research. This is going to be a huge building with lots of researchers doing bench-to-bedside research in genomics, cancer research, and a host of other things. We also just had approval to build an ambulatory pavilion to add to our medical office building. That’s going to be a building on that side as well, so you see lots of cranes right now.
Gamble: I’m sure. So now with the Jacobs Medical Center, you’re building from the ground up. Is that something that you’ve been a part of before as a CIO?
Babakanian: Absolutely. It’s the same as with our cardiovascular center, the cancer center and others. Obviously, these days, technology really is in the middle of everything. And especially in our environment where we’re essentially paperless, it is impossible to think about anything — whether it’s a program enhancement, adding physicians, or building a big building like that — without IT involvement. And so we have been part of the planning process, and obviously, the building process.
Gamble: It’s a hugely different experience, I imagine, than going into a building and having to put in the IT component after the fact.
Babakanian: Right, although many CIOs have done that as well. But when you have an opportunity to build a building from scratch and put in all the advanced technology with a lot of innovation design to improve quality of care and safety, that really is a once-in-a-lifetime opportunity. For me, it’s been five opportunities in my lifetime so far.
Gamble: That’s great. So you’ve done this before.
Babakanian: Yes, years ago and also here at UCSD. We’ve been growing; we have buildings being built all over the place for both direct patient care as well as research, and they all need technology to be able to do what they do.
Gamble: I would imagine it’s been helpful having the experience of doing this before. Maybe there are even lessons you’ve learned or things you now know you could have done differently.
Babakanian: Of course. By the way, I’ve been here at UCSD as CIO for 19 years. I came here from my previous engagement having had experience focusing on the space of clinical systems to ensure that technology will be leveraged to improve quality of care and patient safety and improve organization efficiency. That probably was the reason why I was recruited to come here. Since then, we have integrated the organization from both an IT perspective as well as its corporate structure to integrate all components of our health sciences — the medical center, medical group, and all of the practices — to make sure that we have a continuum of care model with technology cutting across all of them in a longitudinal and integrated fashion. My experience with having been involved in building new care facilities has given me perspective about how to leverage technology to achieve not just a state of advanced technology, but, in a meaningful way, to actually leverage technology to do our core mission, which is patient care.
Gamble: Right. And you said 19 years, so in terms of the IT environment when you got there, are we talking about mostly paper, or were some systems in place at that point?
Babakanian: It was a hybrid of the two. The organization had attempted to build electronic systems, but the focus really had mostly been on financials — how do you capture information so you can do all the business and billing and so forth? There had been attempts to implement clinical systems, but they were very limited. The electronic record didn’t exist; we still had paper all over the place. Nursing documentation, physician documentation, CPOE, electronic medication administration, bar coding — none of those existed.
Gamble: You’re on Epic at this point, right?
Babakanian: We are using Epic now.
Gamble: At what point was that?
Babakanian: Just to give you a brief history, Epic initially started off as being an ambulatory EMR and didn’t really have a lot of strong inpatient capabilities. At the time that Epic was beginning to get into inpatient capabilities, by then we had Siemens Invision and we were able to achieve HIMSS Stage 6 with Siemens Invision. I don’t know if you know about that system, but it wasn’t really designed to really be a heavily robust system for inpatient and ambulatory. It did an okay job in inpatient. We had a tremendous success with it and we achieved HIMSS Stage 6, meaning we had full CPOE and full medication administration record with a closed loop with medication administration. We leveraged Invision as much as we could.
At the time — this was about nine years ago — we determined that we needed to have a more robust ambulatory system. We couldn’t do what we needed to do with Siemens, and so I focused on getting Epic, only from an ambulatory perspective. We implemented Epic in all of our ambulatory sites in a way that it was integrated with Siemens Invision so that as a physician, you could be in your ambulatory setting or inpatient, and you would see the same information. For us, the goal back then was to automate across all of our ambulatory, which we did. Subsequent to that, we waited to see if Epic would develop a robust inpatient system, which they did, and then we contracted to do that piece as well as all of our ICUs, all of the device integration with bedside monitors, and so forth. We did that as well as the implementation of Epic’s Beacon, which is the oncology module.
Recently, in the last several weeks, we also initiated Epic’s Revenue Cycle, and so we now have Epic clinicals across all of our facilities — ambulatory, inpatient, ED, cancer center, cardiovascular — and then we just switched over to Epic’s Revenue Cycle, down from two different billing systems. We had GE/IDX for our medical group and Siemens Invision for our inpatient, and both of those have been combined in Epic. So for us now, from beginning to end, clinicals all the way through financials, it’s one database, including our clinical data warehouse and our research data warehouse. It feels good. It’s nice to be able to have information in a way that we can leverage to do more effective business planning.
Gamble: I can imagine that with the size and scope of your organization, like you said, having one database makes a difference for everyone involved.
Babakanian: Right. Post Siemens Invision, which really did a good job for us based on its capabilities having reached HIMSS Stage 6, we switched over to Epic inpatient. That’s where we went through the certification for HIMSS Stage 7, and we’ve been in that stage for about the last three years.
Gamble: I guess you’re kind of considered what they call leading edge.
Babakanian: Leading edge or bleeding edge, depending on. Leading edge feels good. Sometimes the cutting or bleeding edge doesn’t feel so good, but somebody’s got to do it.
Babakanian: We’re having fun doing it though.
Chapter 2 Coming Soon…