CIOs often say that their experience in consulting played a key role in helping to prepare for an IT leadership position, but perhaps it was never truer than with Matt Chambers, who was called in to assess the IT strategy at Scott & White. That firsthand knowledge came in handy when he stepped in as CIO of Scott & White, then led the organization through a merger with Baylor. In this interview, Chambers talks about what it’s like to guide the IT team through dramatic change, the logistical challenge in leading a system with 40-plus hospitals, the clinical transformation layer cake, and why it’s critical to remember that time is money.
- Laying out an IT vision — “This was a great time for us to reboot.”
- Epic at S&W, Allscripts at Baylor
- “If it ain’t broke, don’t fix it.”
- Clinician engagement — “That warms my heart”
- Lessons learned along the way
- The clinical architecture layer cake
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I said, “Hey everybody, my name is Matt Chambers. I’m the new CIO. Keep doing what you’re doing. Keep doing good things, and hopefully I’ll be here for a little bit.”
The number one question I get is, when is Baylor going to Epic? My response to that is, I don’t know that we need to. We’re still trying to figure that out.
They’re the ones that are having the input and the debate around systems. That warms my heart because then it’s not the IT guy talking about the systems, it’s the users — the people who should own them taking that ownership stake.
A lot of different vendors would say that they can abstract that clinical record so that it’s invisible and you can create that virtual patient record and that connectivity layer. That’s something that remains to be seen for us.
Gamble: One of the things I had read was that Scott & White was in the middle of a big bang EMR and revenue cycle implementation when the merger happened. How did those plans change, if in fact they did change, just because your role all of a sudden was different?
Chambers: Actually, they didn’t. For Scott & White, the EHR implementation and revenue cycle implementation went on as planned. When I became the CIO of the merged company, we laid out a very simple vision for IT just for the first six to 12 months; just a few things that we wanted to focus on.
Number one is stability. There had been turnover in both organizations at the executive level as there had been changes in leadership, obviously. The prior CIO at Scott & White had retired and I’d come in, and so I was relatively new there. We had launched an aggressive IT transformation effort that went beyond the EHR. It went across everything, our ERP, ITIL process implementation, IT service management implementation. There were just a ton of things we had going on and as you said, a big bang in EHR implementation going on. And then at Baylor, there’d also been some turnover as the longstanding CIO that a lot of folks know in the national stage is David Muntz, who went on ONC Health as a deputy director. I was fortunate to work for David. He was a great friend of mine for many years. I have a ton of respect for him, but I think he had us calling to go do things in DC and so there had been a time there where Baylor didn’t have a permanent CIO in place.
And so the first thing we said is that we just need stability. I said, “Hey everybody, my name is Matt Chambers. I’m the new CIO. Keep doing what you’re doing. Keep doing good things, and hopefully I’ll be here for a little bit.” The other thing we talked about is to continue on working on those important platforms that we’re working on. Like you said, we had a big EHR implementation going on at Scott & White, a big EHR implementation finishing at Baylor, and so we said, let’s finish those things we started.
And then the last thing we said is, let’s define our vision for what are we going to be going forward. This was a great time for us to reboot our strategy, and it wasn’t just a strategy for merging. It was really a strategy for how we become the IT engine for the organization. Joel Allison says he wants to be one of the top three systems in the country. Personally, in my mind, it’s win, place, or show. I like to win, so I want to be the best IT shop in healthcare. And frankly, I don’t know why I’d limit that to healthcare. I’d like to be the best IT shop there is.
Gamble: What system is in place at Scott & White, which EHR system?
Chambers: The work that I did at Scott & White as a consultant was to come in and do an IT strategic assessment and understand where Scott & White was in terms of our EHR and our revenue cycle capabilities, as well as just the overall IT support and staffing to support it, to find out if we were adequately prepared for ICD-10, Meaningful Use and all the things. We did the assessment, and we had a longstanding outsource arrangement that wasn’t really giving us the best value in terms of an integrated clinical record.
Scott & White is relatively unique. There are probably like a dozen systems like that in the country. There was actually a Dr. Scott and a Dr. White that opened a clinic for the Santa Fe railroad over 115 years ago in Texas. It started out as a clinic first and then started building hospitals so they could control the quality. It’s all about integrated care and that ambulatory inpatient post-acute integration.
When we did the market survey, what we found was that the best choice for us was Epic. The market is clearly going to the integrated clinical record; a single patient record. I know there are a lot of solutions around HIEs and other things to help integrate it, but I grew up as a software developer years ago, and I’d say there’s a big difference between having one record, and trying to integrate to build one record. And so that’s the route that we went.
Baylor, of course, is a longstanding Allscripts customer, originally Eclipsys’ inpatient EHR with GE Centricity in the outpatient setting at Health Texas Provider Network, and so the number one question I get is, when is Baylor going to Epic? My response to that is, I don’t know that we need to. We’re still trying to figure that out. We’re trying to understand the benefits and the risks and the costs. There’s a huge switching cost when you start to ponder these things. And Allscripts has been a good partner for Baylor for many years, and so we’re not in a big rush to go and make a bunch of changes that aren’t needed. This is one of those, to put it very simply, “If it ain’t broke, don’t fix it” types of scenarios. We’ve got to understand what’s the best model for us going forward.
And then in our central division, as the former Scott & White footprint is known, we’ve got another big bang left in September. Then we’ll be done and we can focus on continuing to optimize that platform in central just as with the north.
Gamble: You talked a little bit before about people being attached to the system that they have. I’m sure that for the people who came from Baylor, you’re now the CIO, and maybe it’s something where you didn’t want to necessarily walk right in and say, “Okay, now you are all switching to a different system,” because I’m sure that that has to be handled in a certain way.
Chambers: Absolutely, and it goes beyond just IT. As the IT operator, the easiest way for me to drive synergies and ensure that we’re reducing internal costs so that we can reduce per capita healthcare spending, is to go to one platform wherever possible. And in some areas that’s really simple.
Let’s start with email. Ironically, there’s a lot more emotional attachment to email than you might expect, because it’s the one piece of IT where nowadays people work out of it 90 percent of the time. We had an outsource arrangement with Microsoft in the central division and we have hosted internally in the northern division, but the good news is they’re both Exchange. So we’re looking at this and understanding what’s the model that we want to use going forward? There are some interesting things out there in the marketplace now that Google will sign a BAA. All of a sudden corporate Google is a possibility.
We’re going through that in every single spectrum of IT — the applications, the infrastructure, staff capabilities. We’re doing that in EHR as well, but you can’t just come in and say, “Hi, I’m from IT. I’m here to swap out your EHR.” We’ve had a new governance structure we developed that has very, very active involvement from a multitude of clinicians, both in north and central. That’s the most rewarding part of my day is when we have one of these discussions and the clinicians are the ones driving the discussion — our chief medical information officers, both the north and central, and some of the chief medical officers of our largest hospitals. They’re the ones that are having the input and the debate around systems. That warms my heart because then it’s not the IT guy talking about the systems, it’s the users — the people who should own them taking that ownership stake. Then you sit back and let them drive that discussion, and I think that’s important that they own it.
Gamble: Absolutely. You want to have that engagement from the clinicians too. Nobody wants to feel like something’s being done to them.
Chambers: Right. I worked for a guy years ago when I was an IT in another industry and that was one of his key tenets in implementations — ‘we’re going to do this with you, not to you.’ You pick up a little bit from everybody you worked with along the way; that was an important one that I learned back then.
Gamble: Sure. You talked about some of the things you’ll be working on going forward; that post-implementation optimization. Are you also looking at things like analytics?
Chambers: Absolutely. There are four big things that we’ve got on our plate right now. We call it our clinical architecture. We’re really trying to define in healthcare IT what is our clinical foundation and operations foundation for the next decade, and we’ve developed something that I’ve taken to calling the layer cake. I actually heard somebody else describe the architecture as a layer cake the other day. I thought I was being innovative — maybe I’m copying, I don’t know.
The layer cake, as we designed it, is really four distinct layers that are really all merged together where they work effectively. Number one is the EHR. It’s the foundational layer. That’s the single, enterprise patient clinical record that we’ve talked about, and that’s the underpinnings of everything. Some people have said, “Why are you even talking about that? EHR has become a commodity.” I don’t disagree but the true definition of a commodity is it’s got to meet a certain set of criteria before it begins to be differentiated on price. Some of those players in that space don’t really meet that definition because they don’t all have the same set of capabilities. I think you can call it a commodity as long as it meets the entry criteria. That’s part of the evaluation we’re going through.
Moving on, the next layer is the connectivity layer, and that’s where you hear a lot of discussion around HIEs and different models. Of course, a lot of different vendors would say that they can abstract that clinical record so that it’s invisible and you can create that virtual patient record and that connectivity layer. That’s something that remains to be seen for us, but that’s another exception of our strategic study that we’re going through is that inner connectivity or interoperability layer.
The next layer up is the analytics layer. Once you’ve abstracted all those various data sources and governed them effectively and found unified architecture to describe those different elements, then you can drive value out of the analytics. That’s that third layer, and that’s something that we’re going to be focused on. That’s one of our subcommittees that we’ve formed. We call it our business intelligence and analytics subcommittee, and it’s actually chaired by one of our chief medical information officers and one of our senior leaders in finance, one from each division, so that it gives us a broad overview of the organization and our needs.
Then the last layer on top of that is one that we haven’t invested in as much historically but you’re really starting to see more investment and more attention paid to it, and it’s that care coordination, which is really a population health mechanism. That in my mind, from an IT perspective, is how do you draw a closed loop back that says layer one is you’ve got this patient record and layer two is you connect it across all points of care in a continuum of care, because we’ve got a lot of different sites now, some with joint ventures that will never be on that single EHR or that single clinical records. How do you connect them?
Then once you’re able to connect all that, you go up to the third layer and you derive intelligence around it, and if you identify that 5 percent of our population that produces 50 percent of our costs, then you take it to that top layer and that care management/care coordination piece. And then may need to intervene in the care of those patients — in the care of that population and our most fragile and most at risk, etc. That’s the closed loop that goes back down to the bottom layer that says these are the interactions you need to be taking in the lives of those populations.