Marc Chasin, MD, CIO & CMIO, St. Luke’s Health System, Chapter 1

It was early in his career that Marc Chasin learned a critical lesson in change management. While deploying an EHR system into his practice, he had trouble getting buy-in from one of the partners — his father. From that experience, “I learned how to engage stakeholders appropriately,” said Chasin, who is applying those lessons at St. Luke’s, where he is leading an Epic transformation. In this interview, he talks about what it’s like to hold dual roles, the invaluable role of physician leaders in change management, and the innovative work his team is doing with telemedicine and population health management. He also discusses when he realized his affinity for IT, his passion for being involved, and how moving to Idaho has changed his perspective.

Chapter 1

• About St. Luke’s
• Going from the east coast to Idaho
• Affinity for “the intersection of technology & clinical practice.”
• Having dual roles — “You have to have a strong team around you.”
• Moving to an integrated system
• “We’ve made a significant improvement but we’re nowhere near finished”
• The keys to change management

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Bold Statements

What it comes down to is building relationships and learning what your end users do and the problems and the workflow issues that they are experiencing, and trying to work with them as a partner to really drive home efficiencies and improve their experience.

Where we fall down as an organization is in understanding how much heavy lifting has to be done.

We’ve learned that early and ongoing communication is key — understanding and emphasizing the clinician’s apprehension to change. That has been the key to improving our go-live success.

It’s often a double-edged sword. Being a clinician in IT, a lot of my colleagues feel that my decisions are solely based on the clinical perspective, but I have to look at things from a health system perspective.

Gamble:  Hi Mark, thanks so much for taking the time to join us today.

Chasin:  My pleasure, thank you.

Gamble:  To start off, why don’t you tell us a little bit about St. Luke’s Health System — what you have in terms of hospitals, ambulatory, things like that.

Chasin:  Sure. St. Luke’s Health System is based in Boise, Idaho. We span around 22,000 miles from eastern Oregon to northern Nevada, comprising of seven hospitals, including three critical access hospitals. We have presently around 500 employed clinicians.

Gamble:  So obviously a pretty decent sized system. In terms of the area, I imagine it’s pretty rural. This is coming from someone who’s in the most densely-populated state in the country, so can you us an idea of what it’s like it terms of geography and the patient population?

Chasin:  St. Luke’s is very diverse. We have two hospitals that are in a major metropolitan area in which we do cardiac surgery, and then we have critical access hospitals where there are no roads, there are limited services, and it’s difficult to get there. Going from the east coast in a major metropolitan area where all the services are closely located, to rural Idaho, has really changed my perspective, not only in terms of clinical practice and clinical medicine, but how I can deploy technology to extend the reach of our tertiary center.

Gamble:  That’s hard to even picture, from someone with my experience. How do you access there areas?

Chasin:  Some are accessible only by plane, and some of our clinicians actually need a horse to get into some of these very rural clinics. We use not only the traditional freeways and roads, but also other methods.

Gamble:  Now in terms of physician practices, do you have both owned and affiliated practices?

Chasin:  We have MSOs, we have employed physicians, we have other partners, and of course we have affiliated physicians. And we try to engage each one of them to improve the overall care that we’re rendering to our common patients.

Gamble:  Right. I see you’ve been in the CMIO role at St. Luke’s since 2010?

Chasin:  Correct. I came to St. Luke’s in October of 2010 as the CMIO to oversee the deployment of an integrated electronic health record as well as the associated clinical technologies. In November of 2012 I was appointed the interim CIO and CMIO, and in December I’ve dropped the interim designated and I now serve both roles — CIO and CMIO — for the entire St. Luke’s Health System.

Gamble:  First off, congratulations on that. Now is this something where you expected to have both titles for a certain period of time? How did this come about?

Chasin:  I didn’t expect initially to have both titles. I came up through the Bon Secours Health System, where I was the chief medical officer and vice president of medical affairs, but I always had an affinity for technology and the intersection of technology and clinical practice. As I was moving through and developing my skills and deploying clinically related technology as CMIO, I realized that a convergence or a merger of these two roles would be ideal. And when I met with my executive team as well as the CEO of the health system, I proposed this as a way that a physician can oversee clinical technology and improve care from that perspective, as well as the business operations technology on the business side, and really drive efficiencies and improve care of the populations we serve.

Gamble:  That certainly makes sense, but I can imagine it’s not an easy task, especially with the health system the size of St. Luke’s.

Chasin:  You’re correct. It is a large role, and you can’t know everything. You have to have a strong team around you. I employ a very strong team of directors and I have the support of my executives, but what it comes down to is building relationships and learning what your end users do and the problems and the workflow issues that they are experiencing, and trying to work with them as a partner to really drive home efficiencies and improve their experience with technology in doing their work.

Gamble:  When you started at St. Luke’s, had the integrated system already been selected? What was the status at that point?

Chasin:  We probably weren’t unique to any other developing integrated delivery network. When I arrived in 2010, the drive or the approval of moving toward an integrated electronic health record was already solidified, and bringing in a chief medical information officer was part of the plan. But if you understand St. Luke’s, of the seven hospitals, every single one had a different ambulatory EHR and a different inpatient EHR, and some of them had more than one. My initial goal and task was to take 26 different practice management solutions and 16 different electronic health records and move them into one. We’re still in the process of it right now. We’ve moved down to an aggregate of seven now, so we’ve made a significant improvement, but nowhere near finished.

Gamble:  I can imagine that’s a really lengthy process.

Chasin:  Yes.

Gamble:  Where it stands right now, are you moving toward Epic?

Chasin:  Yes, we presently have 500 clinicians on our ambulatory Epic system. We still have Meditech in one of our hospitals, Centricity in one, and Soarian. We also have CPSI and HMS in our other facilities. But within the next couple of years we’ll be on one system, which will be Epic.

Gamble:  When you’re talking about a task of this magnitude, what would you say are the biggest challenges? Is it in getting buy-in to convert to one integrated system?

Chasin:  I have been blessed here with the most engaged physician group that I could have been privileged to be exposed to and to work with. They are on board and understand what they want. Where we fall down as an organization is in understanding how to do it and how much heavy lifting has to be done. It gets back to what other organizations are feeling with change management and really critically looking at your workflows and preparing for the go-live; reviewing your work flows before and tailoring them to how it’s going to be when you deploy technology. As you know, if you put technology on a very poorly designed workflow, it’s going to exponentially magnify the inefficiency that you already have.

Gamble:  Just in terms of logistics, is it something where you start with one hospital and then you take some of the lessons learned from that and do one hospital at a time, or do you have to try to do multiple hospitals at once? How does that work?

Chasin:  Our approach for the ambulatory environment was specialty-specific. We did have a little bit of a delay because we realized some of the operational components weren’t in lockstep with IT, which again is a common finding across the country. From our inpatient perspective, we are going to start with one of our smaller sites, but again, with an integrated electronic health record or an enterprise wide IT initiative — let me rephrase, a clinical transformation initiative with an IT component — you need the entire buy-in of across the system. Even though you may not be going live in the first hospital, we still need to understand your workflows and understand where the best practices are happening throughout the organization and deploy them and build those to leverage a best practice.

Gamble:  I imagine that there’s a whole lot of communication that has to happen to identify a best practice and then educate others on that.

Chasin:  I would say the majority of the work that is done is around communication. My IT group will take care of the technology; they have the expertise on that. It’s engaging the operators, the end users, the physicians, the nurses, and the respiratory therapists and understanding the higher goal of transforming the patient care experience and providing the best care possible at the right time for the right patient.

Gamble:  You talked about change management; obviously that’s something that a lot of organizations struggle with. What have you found are some ways to help ease clinicians through this change in the way they’ve been doing things?

Chasin:  I’ll tell you that we’re not unique. We haven’t found the magic pill to address this, but what I can tell you is what we’ve learned. We’ve learned that early and ongoing communication is key — understanding and emphasizing the clinician’s apprehension to change. That has been the key to improving our go-live success.

Gamble:  Do you have physician leaders or other people you lean on in meetings or things like that to just communicate this out?

Chasin:  We have a clinical leadership council that we’ve developed — it isn’t an IT-specific or an EHR-specific council. It’s our physician leadership group that is helping us transform from volume to value. These are leaders in their own specialty that are respected from both a clinical and a political perspective. We bounce things off them first and utilize them as our first go-to place for communication, which we then trickle down to the masses.

Gamble:  I’m sure that makes a huge difference. I imagine that this might be an area where you can maybe use your physician experience to your advantage.

Chasin:  I can. It’s often a double-edged sword. Being a clinician in IT, a lot of my colleagues feel that my decisions are solely based on the clinical perspective, but I have to look at things from a health system perspective and be very aware that some technologies aren’t the best for the organization, and I have to choose these wisely and based upon our overall strategy going forward.

Chapter 2