Edward Babakanian, CIO, UC San Diego Health System
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.
Chapter 3
- Expanding image access with Merge iConnect
- “People expect to be able to do online healthcare.”
- Piloting telemedicine with managed care patients
- A culture of innovation — “It’s really about collaboration.”
- San Diego’s connected community
- “Don’t limit yourself to being an IT person.”
- His parenting philosphy
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Bold Statements
That’s an expectation that consumers are going to have. In this world of server-connected online banking, I think people expect to be able to do online healthcare.
It’s really about collaboration and having a team that is robust yet nimble enough to come together and do things that are unexpected.
You do things to improve quality of life rather than any one person wanting to take credit for it. Because in the end, doing the grant for Beacon really created a value for the community, but not for any one of us individually.
My colleagues who feel like they haven’t had an opportunity need to step in and make the opportunity happen. Oftentimes you can recreate your own job description based on doing and demonstrating that you can do it.
Gamble: I saw that you worked with Merge iConnect Access to enable physicians to access images from devices. Is that something where you’re just taking steps to make it easier for physicians to provide quality care?
Babakanian: Yes, absolutely. We are investing in moving information as close to point of care as possible. All of our physicians have access to our robust PACS environment, but what about our referring physicians in remote locations? We wanted to give them the capabilities to not only look at a radiologist impression of a CT exam, but also actually see the CT. We decided we needed to do that, and Merge appeared to be one of the solutions for that. Because of the business growth and expansion, if I can’t deliver those kinds of capabilities to our referring physicians, they might just decide to refer their patients someplace else. It’s both improving quality of care and access to information, as well as being more competitive in the marketplace, and so I needed to do that. All of our providers have access to images, and they like to look at those images.
The other component is related to patients. Patients really need to be partners in their health. We have over 55,000 patients with access to their records on our system, and that makes a big difference. It makes life easier for a patient to request an appointment at 11 o’clock at night when the call centers are closed, and they can communicate with their physicians and their care teams. That’s an expectation that consumers are going to have. In this world of server-connected online banking, I think people expect to be able to do online healthcare.
Gamble: Exactly. But to get those numbers that you have, that’s something we know a lot of organizations are struggling with, in having to meet those numbers for Meaningful Use 2. That’s one of the big challenges.
Babakanian: Absolutely. For us, it turned out that Meaningful Use Phase 1 ended up being a bonus because we had done everything we needed to do for other reasons, and not necessarily to meet Meaningful Use. We ended up benefiting from those financial incentives without really having to do anything more than what we were doing anyway. And then for Stage 2, that is consistent with what our plans were.
We also learned from our patients that when they want to visit their doctor, some of them may not want to actually go to the office, and so patients have the capabilities to actually schedule an office visit and do it over the telemedicine from home. Some people do that. They like that. If you have a cold and you don’t necessarily want to go to the office, you can just schedule to see your physician over telemedicine and have all of the information in front of them. They see their physician and they can be remotely examined. It’s all about providing flexibility for providers and for patients.
Gamble: Do you have widespread availability for telemedicine?
Babakanian: We initiated that with our managed care population because when we initiated it, the insurance companies and payers were not necessarily tuned into paying for that. Our managed care population is based on capitation so there’s only a copay, but to get insurance companies to actually pay for an office visit that is conducted at home was a little bit too advanced for its time. Now a lot of payers are beginning to offer that as an option, and so we have the framework expanded, but right now we’re limiting that to our managed care population and also our concierge service.
Gamble: One of the other areas I wanted to touch on was the idea of fostering a culture of innovation. You’re a large academic organization and you’re on the forefront with innovation, and it seems like it takes a certain style of leadership to really foster that among your team. I wanted to get your thoughts on that.
Babakanian: Absolutely. It’s really about collaboration and having a team that is robust yet nimble enough to come together and do things that are unexpected. I’ll give you an example. About three and a half years ago, I heard that CMS was giving out what they call Beacon Awards. It was announced that the federal government would provide 15 Beacon Awards for communities to create Health Information Exchange. I saw that and I called my friend who’s the medical director and chair of the Department of Medicine, Dave Guss, and I said, ‘Here’s an opportunity. We know how to do these sorts of things. We’ve done these. Why don’t we come together and do it?’
And so he brought a couple of his physicians and I brought my technology people. We brought a few people from our campus to write a request for grant. It was right around Christmas time. We spent hours — weekends, nights — putting that together. We submitted it and one day I was sitting in a meeting and somebody said, ‘Vice President Biden just announced the 15 Beacon Awardees and UCSD is one of them.’
Gamble: Oh wow.
Babakanian: We were the only one in the State of California. The next step really was then to create collaboration across all of the competitors in the healthcare market here in San Diego. It took a lot of time; in a year and a half, we put together a collaborative unit with Scripps and Sharp and VA and Navy and Kaiser and lots of community clinics, and we were able to create an organization that now three years later has become a non-profit community connect in San Diego. So it was pretty successful. That created a lot of work for me and for various people here. You don’t get paid extra for that, but it’s certainly in our DNA to do things that are creative, that are challenging, and that require more time at work and less time with your family. An academic environment tends to be composed of people who like those kinds of challenges.
There are a number of those examples. For instance, we created a connection with our 911 services so that when they pick up somebody for a heart attack, we begin to see their vital signs, and our cardiologist can know whether or not they need to prepare the cath lab. Shaving off eight minutes from the responsiveness of when you begin to intervene in a heart attack can save somebody’s life. Those are the kinds of things that can only happen when you have a collaborative environment where people trust each other. You bring in clinicians, you bring in technology folks, and you do things to improve quality of life rather than any one person wanting to take credit for it. Because in the end, doing the grant for Beacon really created a value for the community, but not for any one of us individually. We just get the recognition of having done that, which fades away over time. To do that, you need to have that sense of trust, collaboration and fun working together and I think we have that here.
Gamble: Sure, and the willingness to put in the extra work, especially in the beginning when you’re getting something like that set up.
Babakanian: Yes, absolutely. Christmas and New Year’s that year essentially were non-existent for most of us, because we were just working on putting together the grant request. It seems like it was a decade ago, but it’s only like three and a half years ago.
Gamble: What’s really impressive is that three years later you still have that going. One of the concerns is always sustainability, and the fact that you’ve been able to get over that hurdle is significant.
Babakanian: Right. Most healthcare facilities compete with each other, but we have now created a common board, non-profit, and we’re all putting in money now to keep that organization alive because we want to be able to share patient information irrespective of where they go. We think that’s a good service to the community. You can transcend beyond day-to-day competition and actually end up doing the right thing, which feels good.
Gamble: Absolutely. Now, our audience includes CIOs at organizations of different sizes who are always looking to create more opportunities for themselves, and I wanted to know if you had any advice on really going beyond the CIO role to take more of a role as a key person in the organization.
Babakanian: As I get older, I tend to want to become a little more philosophical, especially when you have your kids. I have two — a 13-year-old and a 16-year-old — and you want to teach them how to succeed. I spend a lot of my time with my kids talking about leadership traits. What do you do — do you put yourself in a box or do you let other people put you in the box? Either one is not good. You want to empower yourself to not get stuck in a very limited line of thinking. For me, I always joke with people and say that every position I’ve ever taken—any new expanded position — I really was not qualified for in the beginning. Because you become a director, then you become a CIO, and then you become a larger CIO. You really cannot know everything that you need to know to be competent for that job, but you need to know how to learn and how to become creative. I tell people, don’t be afraid of putting yourself in a situation where you feel uncomfortable, because what you think you don’t know, other people may not know that you don’t know.
I think it’s just a matter of time. You work harder, spend few more hours researching, and you get yourself in that situation because success will bring more success. We are not necessarily a large organization. There are certainly a lot of other academic medical centers that are much bigger than we are. I have a lot of colleagues who are certainly much smarter than I am. But for those who want to make a difference in the quality of life for those in their communities and in general for the healthcare in our country, they need to not limit themselves to being an IT person, or be limited based on the fact that they don’t have a budget to do something, or they’re waiting for CFO or CEO to approve something. Things don’t happen unless somebody makes them happen. IT people are very knowledgeable about what goes on across the entire organization, because we have to deal with all the components of the organization. So we’ve become very uniquely knowledgeable about seeing the strategic picture of the organization, and that’s very valuable. My colleagues who feel like they haven’t had an opportunity need to step in and make the opportunity happen. Oftentimes you can recreate your own job description based on doing and demonstrating that you can do it.
Gamble: I think that that’s a real great perspective. It’s important to hear that. I like especially what you said that just because you think you might not be qualified for something, you can’t let that stop you. You have to get in there and find a way to make it work.
Babakanian: Right. To me, I think once you become a parent, you become responsible for kids that you cannot just return. I’ve always said, you can buy a car or clothes and if you don’t like them, you can go get something else. With kids though, you have to teach them how to be successful. It isn’t a question of giving them what they need; it’s a question of teaching them how to be successful. You become philosophical and you can apply the same parental sort of responsibility to organizational responsibility. If something needs to be done for your kid you’ll do it, even if you’re not good at it. It’s the same thing with your organization. If I’m not good at something, yet it needs to be done and no one else is going to do it, then I’m going to learn how to do it.
Gamble: That’s great. That’s so true. I’ve been learning that over the past year and a half, so I can concur with you.
Babakanian: Yeah, and you can have fun doing it too. It takes an organizational culture that is not punitive. With my team here, we seriously make things happen, but it’s not punitive. No one really has to feel bad about having made a mistake, and you create a culture and an organization where people genuinely care, and they do things based on their level of care. If they make a mistake, that’s okay. You just learn from it. If the organization has a culture that’s punitive where you make a mistake and you get prosecuted for it, then it just kills creativity.
Gamble: That’s definitely true. Okay, well, I could talk to you for a while longer, but I should let you go. I really appreciate the time you’ve given us. It’s been really interesting to hear about everything that you guys are doing and a lot of your thoughts on the industry. So I want to thank you so much for taking the time to speak with us. I really enjoyed it.
Babakanian: You’re welcome. It’s been a pleasure speaking with you, and if any questions come up, feel free to give me a call.
Gamble: I will. Thank you so much.
Babakanian: Thank you, Kate. Take care.
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