When people hear that a health system completed a major EHR rollout three years ahead of schedule, it’s going to raise a few eyebrows. But it’s precisely what Dave Garrett and his team were able to accomplish at Novant Health, which went from having 90 billing systems and a dozen EHRs to one consolidated system. The strategy? Start with small waves, gain confidence, then go bigger. The keys to success? Governance, executive buy-in, and super-users. It may sound simple, but it required a great deal of trust and collaboration. In this interview, Garrett talks about what it takes to complete an enterprise-wide transformation, and how they’re working to achieve the goal of “one patient, one record, one remarkable experience.”
- Consolidated billing
- Iris biometrics for patient ID
- Shared service agreements
- 30 years in healthcare — “Once I got in there, I stuck with it.”
- Previous roles in the banking & vendor worlds
- His leadership style — “I expect a lot from my team.”
- Staff retention challenges
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Retinal scans are more accurate than anything else in terms of fingerprints, handprints, or palm prints. Plus, by not having to use fingerprints and palm prints there’s nothing for people to touch, so we also reduce the opportunity for spreading infectious diseases.
It gives them the ability to remain independent, yet still take advantage of some of the opportunities that Novant Health can offer by reducing their costs through the supply chain, and giving access to systems and actually expertise that they may not have available to them.
Be honest and upfront with them about what’s realistic and what’s not. I’ll tell you, you can get a whole lot done a whole lot faster when you take that approach versus trying to dictate and pushing a rock uphill.
You’ve got a lot of folks obviously coming up on Epic. They’re looking for talent, and people can move. There’s a high demand for those resources out there, and a high demand for our infrastructure people.
Garrett: And that’s just on the patient care side, not to mention the billing side. The patients have one bill, and that bill has a consistent look and feel. We get the stuff out to them accurately. They’re able to pay online. They’re able to pay in person when they come in. It’s easier. We’ve implemented kiosks now out in the acute care facility.
We had mentioned before that we’re starting to roll out positive identification, if they elect to do it — not everybody wants to. Not only can they use a kiosk like they do at the airport, but if they want, we take their picture. And the camera just looks like a normal built-in camera you’d see in a kiosk. You stand about 18 inches away and it takes a picture of your face, and then it provides a retinal scan and digitizes the retinal scan into a unique proprietary identification number. We’re able to use that for positive patient identification going forward. So far we’ve got about 40,000 patients that have actually elected to do that. Some people don’t feel comfortable with it. They don’t want their picture taken for several reasons. They don’t have to do it. But we’ve got 40,000 people, and climbing, that have opted in to do that. That’s another one of those transformational items.
Gamble: That’s a really good number. Like you said, I’m sure there are patients who have the reservations about it, but is it something where once you start to see a certain group that does it, others patients start to see that it’s safe enough to use?
Garrett: Exactly. And again, with as much concern as people have around their identity management, this is a very, very secure process. It’s not like where you have to grab your driver’s license and you scan that, or your Social Security number. Once we’ve got their retinal scan as part of the picture, we’ve got a positive patient identification process. And the retinal scans are more accurate than anything else in terms of fingerprints, handprints, or palm prints. Plus, by not having to use fingerprints and palm prints there’s nothing for people to touch, so we also reduce the opportunity for spreading any kind of infectious diseases or the common cold as people come and go within an acute care facility.
Gamble: And that integrates with the EHR system?
Garrett: It does, as a matter of fact. We’ve got that working with Dimensions today.
Gamble: Okay, so you’ve got quite a few things on your plate right now.
Gamble: You talked a little bit about some of the shared services agreements. I saw that there was one recently with Hugh Chatham Memorial. So this is something where you are reaching outside of Novant to have these agreements in place. Is that something that you’re going to look to continue to do in terms of developing these types of partnerships?
Garrett: Absolutely, and these guys have really taken off as a matter of fact and are moving pretty rapidly. They’re structured to where they’re pretty flexible, so it depends on the needs of the facility as to what they’re looking for. Our shared services group is able to meet their needs. It’s simple as buying off of our contracts, like at Hugh Chatham. Obviously given its size and given the size of Novant Health, we can offer much better pricing on things that they need in their facility, whether it’s items within the supply chain, pharmaceuticals, etc. It could be beds. It could be paper supplies, all the way to large pieces of equipment.
We also provide the capability to do clinical engineering services to manage and maintain their fleet of diagnostic equipment. We’ve done some things with others — not Hugh Chatham at this point, but others to where we’ve done some things with helping them with their data center design. We’ve helped them with consolidation of some of their service lines in different areas within IT services. We’ve helped them improve their pricing on their computers, their software, some of their maintenance contracts, phone systems, etc.
We’re even looking now and talking to some people about Novant Health becoming a disaster recovery backup site and potentially even hosting the facility for some. Because we already host Epic for our Novant Health Community Connect customers, we’re looking at opportunities for us to even host other organizations. The Novant Health Community Connect today is ambulatory; we do have the ability to do acute in the future as well. So when we feel more comfortable with having more acute care behind us — and that will be probably after the second or third wave of implementations — we’ll be able to actually extend the Epic system out to small independent community hospitals. They’ll be able to get Epic whereas normally they would not be able to get it. It wouldn’t be something where Epic would sell to them, because they’re too small. Again, all that would come through the doors of shared services.
Gamble: It’s something that certainly makes a lot of sense for the smaller organizations that are looking to remain independent.
Garrett: Exactly. It gives them the ability to remain independent, yet still take advantage of some of the opportunities that someone the size of Novant Health can offer to them by reducing their costs through the supply chain, and giving access to systems and actually expertise that, quite honestly, they may not have available to them in their facility. And it’s more than information technology services. We do those kinds of things in shared services around human resources, joint commission, risk management, legal — all kinds of different activities and services across the breadth of the healthcare service.
Gamble: Okay, so you have been at Novant since 2008.
Garrett: Yes, I’ve been with Novant Health for, I’ll say, five and a half years now.
Gamble: So obviously you had a significant career path before then, but as far as other CIO positions you’ve held, you were at other health systems but at a smaller scale?
Garrett: Yes I was. Prior to Novant Health, I was with Palmetto Health in Columbia, South Carolina. I was the CIO there for a little over five years. They’re slightly smaller than Novant Health. Prior to that, I was with Baptist Health Care in Pensacola, Florida for 10 years, and they were slightly smaller. I’ve been in healthcare IT for 30 years; I started out on the vendor side, as a matter of fact. I worked for a vendor writing software systems, and that gave me an opportunity to understand the vendor’s perspective. Prior to that, I was in banking and hospitality, so I’ve been in the technology business for about 40 years now, in healthcare for 30. Obviously, I like healthcare. Once I got in there, I stuck with it.
Gamble: As far as your role now being CIO at this organization, which really is a pretty large size, do you think that having the previous experience at organizations of a different scope has kind of shaped your leadership philosophy?
Garrett: I would say it did. As a matter of fact, I can point back to many different aspects of my career that have done that. When I was working in banking — and this goes back a few years — that was when ATMs were coming out and the banks were not sure if they really wanted to participate in ATMs. They were concerned that other banks would gain access to knowledge, and they didn’t want competitors to know that stuff. It’s very similar in healthcare today with HIEs. For a while there, a lot of the health systems didn’t want to participate, because they were concerned about the competitive nature. So it’s very similar; it’s just in a different field. There are a lot of things occurring in banking and hospitality that I’ve been able to parlay into my career and into my experience.
Working for a vendor for 10 years certainly gave me a different view of the world and what it was like on the other side of the coin developing, implementing, and supporting products and doing those kinds of things and working in a for-profit kind of sector. Today, I’m in the not‑for‑profit at Novant Health, but all those things kind of helped shape where I am today.
Gamble: Do you have an open-door type policy? What kind of leader would you say that you are?
Garrett: I’m very much an open-door, working with others-type leader, getting out there and understanding the business and working with the business. I’ve never really subscribed to the ivory tower, dictate-from-the-top scenario. It’s very much about incorporating the customer in the process and working with the end users. I learned a long time ago that it’s a whole lot easier to work with the users, the customers, and help them understand and help them pull their thoughts and ideas together. Be honest and upfront with them about what’s realistic and what’s not. I’ll tell you, you can get a whole lot done a whole lot faster when you take that approach versus trying to dictate and pushing a rock uphill.
I expect a lot from my team. I’ve got a great team of people. One of the things that allows me to be successful is that I surround myself with excellent people. That’s what I’ve been able to do, and that’s one of the reasons I’m at Novant Health. It’s a great organization. My thought process and my philosophies line up very, very well with Novant Health, and I’ve got a great leadership team around me. We subscribe to working hard but playing hard, so we work extremely hard but then we have fun. We play hard as well.
Gamble: That’s a big thing. A lot of organizations are struggling to hold on to their good people — health IT talent is at a premium, so that’s got to be an important thing to make sure you’re holding on to them.
Garrett: Absolutely, and it continues to be that way, especially in our Dimensions area, because you’ve got a lot of folks obviously coming up on Epic. They’re looking for talent, and people can move. There’s a high demand for those resources out there, and a high demand for our infrastructure people. In general, the folks that are on my team are just in high demand all over the place. Some of them are even in high demand in other fields. With our infrastructure people, I compete with banking, hospitality, insurance companies — I compete with everybody when it comes to all of our technical infrastructure people.
Gamble: Sure. You’re in Charlotte, right?
Garrett: Yes. We have folks that are spread out in several areas, but predominantly in the Charlotte market.
Gamble: That’s a big banking area, so that’s got to be on your mind.
Garrett: It sure is. We’ve got the banks. We’ve got the Duke Energy Headquarters here. We’ve got a number of folks that are bringing their headquarters here in Charlotte, so it’s good competition.
Gamble: That’s a good way to look at it. Alright, well, we’ve talked about a lot. You guys have so much going on. I really appreciate you taking the time. I don’t know if there was anything else you wanted to add but I just really wanted to thank you so much for taking the time to speak with me.
Gamble: Thanks again and I’m hoping we can catch up down the road. You have so much going on in the future, and so I’d like to check in in a little while and see how it’s going.
Garrett: Absolutely. I’d be glad to.
Gamble: Thank you so much.
Garrett: All right, you take care.
Gamble: You too.