Jeff Young, CIO, Children’s Hospitals and Clinics of Minnesota, Chapter 3

Last year, Children’s Hospitals and Clinics of Minnesota became the first pediatric hospital in the US to achieve interoperability between infusion pumps and EHRs. Although the initiative required a great deal of effort, leadership saw it as an opportunity to leverage IT to improve patient safety. Projects like this are precisely the reason Jeff Young made the leap from the pharmacy benefit management world to health IT five years ago, and he hasn’t looked back. In this interview, we talk about Childrens’ efforts to create a clinically integrated system, the special considerations of IT when it comes to pediatric patients, and Young’s unique career path.

Chapter 1

Chapter 2

Chapter 3

• MU – Stage 1 in hospitals, stage 1/year 2 for EPs
• Teenage patients & confidentiality—“It’s definitely a challenge”
• Children’s Hospital Network
• eClinicalWorks’ CCMR
• His early CIO days — “I spent quite a bit of time out on the floors.”
• Looking ahead to 2020

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Bold Statements

We need to ensure that these policies live anywhere patients and families can have access to their information, so this has definitely been both an opportunity and a challenge for us.

You want to ensure that as we make decisions as an organization, that we very much understand obviously how this impacts our patients, but it’s also ensuring that we hear the voice of our providers and that voice is a consistent voice.

I spend a lot of time rounding in the hospital and on the units and shadowing to just try to understand, first of all, from a system perspective, what are the real needs as we work through the process of really managing and caring for our patients.

We spent the past year taking that step back and refreshing our long-term, forward-looking organizational strategy, and with that, we had the opportunity to not only look out three or four years, but to look all the way to 2020 to understand what the market is going to look like.

Young:  Another area is Meaningful Use. Everybody’s been focused for a Meaningful Use perspective. As I’m sure you may be aware, the rules for adoption are a little bit different from Medicare to Medicaid, and we mostly support Medicaid patients. So we have a little bit more runway to adopt, and we’re currently working toward stage 1 certification from a hospital perspective, and stage 1, year 2 certification from an eligible provider perspective. The rules seem to change year by year. In other words, the rules now for this year are that even though we’re stage 1, we’re closer to stage 2, so we have a significant amount of work and effort there. But we’re making very good progress.

Gamble:  As far as Meaningful Use, one of the issues that poses different challenges for children’s hospitals is the patient engagement piece. Obviously, you’re dealing with the caregiver and families in many cases, but then you also have the older patients, the teenaged patients. I’m sure that’s been interesting water to tread.

Young:  It very much has been, and I would say as we look at challenges, it kind of drives into some of that as well. It depends on which state you operate in, but we need to consider that many times parents are the users of our systems and typically our first point of contact and not children, but as they grow older, many times children once they reach 13, 14, or 15 want to become that point of contact and want to have more control over their information. We need to ensure that we manage, first of all, the confidentiality appropriately between the child and their parents based on really their wishes. It is something that we’re very focused on, but it’s something that is definitely a challenge. From a Meaningful Use perspective, as we continue to make more things electronic and we offer portal capabilities, there are some goals that relate to offering and then accepting and using our portal, and so we’re making more and more things electronic. In the past, we used to manage medical records from a paper perspective, and we could manage those needs between child and parent much, much differently. Now we need to ensure that these policies live anywhere patients and families can have access to their information, so this has definitely been both an opportunity and a challenge for us. It’s something that we’re closely watching and playing a role with our EMR vendors on, absolutely.

Gamble:  As far as population health, are you doing anything in that area or kind of looking toward anything? I know that you’d talked about really wanting to improve the health of the community, and again, it’s unique when you’re working with pediatric patients. What are you looking at in that area?

Young:  We absolutely have been, and as with many, we’re moving down the population health path in a fairly measured way. As I had mentioned previously, we’ve been working with our community providers to create a clinically integrated network that we called Children’s Hospital Network. In looking long-term at where we need to be, we made the decision that we really needed to implement some technology to help us get there. And so we did spend a significant amount of time about two years ago really vetting out what type of technology and capability made sense for us, and we ended up choosing eClinicalWorks’ care coordination medical record product. Granted we were mostly eClinicalWorks on the EMR side, but it’s a fully functional capability that includes network management, patient engagement, care coordination, care planning, and analytics, so we did decide as a community to move down that path. We started that implementation over a year ago, and we’re pretty happy with the progress that we’ve made.

But again, that’s only one piece of the larger picture, and so we’ve spent some time really ensuring that as we move down this clinically integrated network path that we’re doing this together; that we have the right policies in place, that we’re working toward the right quality goals, and then ultimately, we’ll work toward potentially even contracting together based on the quality that we can provide as a community. And so we have a start to this. We have a ways to go, but I think we’re off to a very good start.

Gamble:  It’s a place where everybody wants to move to, but there are a lot of moving parts, and it’s not something that’s going to happen overnight.

Young:  That’s right.

Gamble:  I wanted to switch gears a little bit and talk about your background. You mentioned spending several years in the PBM world — that’s not something that we hear a lot from the CIOs we speak to, as you can imagine, and I just wanted to talk a little bit about making that move. I know you’d said that IT is something that was close to you, but just talk a little bit about making that move. What had been some of the challenges and what really made you interested in pursuing it?

Young:  When I initially came in and interviewed with Children’s one of the things that hit me right away is in Minneapolis, I drove into the Minneapolis Hospital and you walk across a skyway to come into the main hospital, and then up to the administrative group. One of the things that was compelling for me was that I walked in next to a mom that was holding hands with her son and walking him into the clinic; he was bald and he was going through cancer treatment. I think it hit me right away that a PBM that serves 60 million members is something very, very different from a mission perspective than a hospital where you can see the value that you and the group bring every day.That’s something that right away hit me that was very, very different.

Secondly, making that transition into the hospital world, my perspective was, ‘I’m in healthcare, I know a lot of the terms and a lot of the vernacular. I understand the pharmacy side of the world.’ But the provider side of the world is much, much different, and it took a period of time to really learn all the idiosyncrasies of working in a hospital and a clinical environment, as well as the fact that making decisions many times can be a little bit different. You want to ensure that as we make decisions as an organization, that we very much understand obviously how this impacts our patients — that’s what we always look for and try to understand, but it’s also ensuring that we hear the voice of our providers and that voice is a consistent voice, and then ultimately, that the decision is well understood. So that’s something that was a little bit different for me than coming from the PBM world and a for-profit organization.

The other thing — and I love this about Children’s — is we’re a very, very kind of warm and friendly organization. It’s something I guess I didn’t expect right away, but I very much appreciate that when I’m walking down the hallway, everybody smiles and says hello. Everybody is very much focused around care for our patient, first and foremost, outside of the business of a hospital. It was something that took me a little while to adapt to, but I very much appreciate it.

Gamble:  When you were in the adjustment period, which I’m sure probably lasts a while, were there people or organizations that you relied on to get accustomed to the way things are done, because it’s a very different world?

Young:  Absolutely. I spent quite a bit of time early on with our chief nursing officer and I spend a lot of time rounding in the hospital and on the units and shadowing to just try to understand, first of all, from a system perspective, what are the real needs as we work through the process of really managing and caring for our patients. So I spent quite a bit of time out on the floors. Our chief nursing officer did a great job of mentoring me as well to help me understand the reality of some of the things that I was seeing. I also had the opportunity to work with our head of nursing informatics, Bobbie Carroll, who has been with the organization for a number of years, to really mentor me related to the different parts of the organization — what their needs are, how we can best work with them, etc. And so yes, there were a number of individuals that I ended up working with that helped guide me down that path to really learn the organization, and it was great.

Gamble:  Now that it’s been about five years, do you feel more comfortable in the role?

Young: Absolutely.

Gamble:  I know we’ve talked about a lot; I didn’t know if there was anything else you wanted to just touch on as far as some of the big priorities you have.

Young:  You hit on a number of the larger priorities. A couple of additional things that may be of note from a priority perspective — first of all, we spent the past year taking that step back and refreshing our long-term, forward-looking organizational strategy, and with that, we had the opportunity to not only look out three or four years, but to look all the way to 2020 to understand what the market is going to look like, what role should we play in the market, what are the expectations of our patients and families going to be in 2020. I’ve now had the opportunity and we as a team have to decompose this into really what it means to IT. Typically you want to pick a couple of things that you can really help enable the organization with. There are a couple of things, and one of them was that we believe that the needs of our patients and families and really the expectations are going to change quite a bit. And so providing access anywhere is something that we believe needs to happen. Providing the ability to really wrap technology and process around our patients and families wherever they’re at, and so mobile health is something that becomes very important, and telemedicine is something that we’re starting to very much focus on in that whole side of the world.

The other big thing is that organizations that have the ability to measure themselves and use that information to drive improvement, whether it’s operationally, care-based or something else, will have the ability to move more quickly and achieve our goals more quickly. Business intelligence, analytics, and data mining are something that from our perspective will be significant over the past few years. We have a data warehouse with 12 years of data. We have a lot of dashboard products. We have dashboard products and some business intelligent products to really turn that data into information, but looking forward, we believe we need to take that capability to a different level. And so there’s some fairly major areas that we’re going to be focused on in the next three to six years.

Gamble:  So enough to keep you pretty busy.

Young:  Absolutely.

Gamble:  Okay, well, that covers what I wanted to talk about. I’d definitely like to get back in touch with you down the road just to see how everything’s going, especially with all the interesting things you guys are looking at.

Young:  I’d be happy to have another discussion, and I definitely appreciate you reaching out.

Gamble:  Thank you very much, and I will be in touch soon.

Young:  Great. Thanks, Kate.

Gamble:  Thank you.