A few years ago, the leadership team at the University of Chicago updated its strategic IS plan to make predictive and real-time analytics a key priority. Since then, the organization has undertaken a significant effort to clean up and prepare the data, and is looking to leverage predictive modeling not just to improve patient outcomes, but to “transform the organization and change the way we do business,” according to CIO Eric Yablonka. In this interview, he talks about the multi-year Phoenix Project at U of C, what it’s like to be work in a translational research environment; and where his team stands with Meaningful Use. Yablonka also discusses why he recruits analysts from other industries, what it takes to foster innovation in the hectic health IT environment, and why “the learning doesn’t end.”
- About University of Chicago Medicine
- Phoenix Project: multi-year Epic implementation
- Phased approach vs big bang
- “You’re often stuck in a hybrid environment between systems.”
- Focus on optimization
- Closed staff model
- Bench to bedside research: “It really is a team sport.”
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It hasn’t matured as a marketplace like Boston, Minneapolis, and Northern and Southern California where we’ve seen a lot more merger and consolidations of healthcare provider organizations and physician practices, although that is speeding up quite a bit.
It takes longer and the transformation takes time when you stretch it out. You’re often stuck in a hybrid environment between systems, and that is often challenging from a change management perspective.
It really is organization specific. For some organizations, it could also be a question of their ability to invest and their capital budgets. There can be lots of reasons to phase and to go easier.
Beyond the day-to-day duties of being a CIO in a healthcare organization, getting to work on some particularly interesting research projects is very exciting.
Gamble: Hi Eric, thank you so much for taking the time to speak with us today.
Yablonka: Good morning.
Gamble: To get things started, can you tell our readers and listeners a little bit about University of Chicago Medical Center — what you have in the way of hospitals, ambulatory, things like that?
Yablonka: The University of Chicago Medicine is on the south side of Chicago. We are associated with the university; they are our parent. And as with many academic medical centers, we have three missions: we have our patient care mission, for which I’m primarily responsible for the information technology, and we also have research and we have teaching. The three of those together make up the medical enterprise of the University of Chicago.
Gamble: How many hospitals do you have?
Yablonka: We have a large hospital campus on the south side and we have a couple of separate buildings. We have a standalone children’s hospital, the Comer Children’s Hospital. Last year, we opened the Center for Care and Discovery, which is our new adult inpatient facility. We have an outpatient ambulatory center which we call the DCAM where we house most of our on-campus clinics. Those are our primary on-campus facilities. And then off-campus, we have assorted clinics and other facilities spread around Chicagoland.
On campus, we see about 400,000-plus outpatient visits here in our clinics, about 80,000 emergency room visits, 25,000-plus admissions, 26,000-plus surgeries. We’re a pretty busy place. We’re licensed around 600 beds and right now, we’re really running at full capacity. It’s been a very challenging last six months as we work very hard on servicing our patients and providing the best care and experience for them while we’re literally full.
Gamble: Being located in Chicago, I would think that that’s pretty interesting because there are a number of hospitals and health systems in the area. I’m sure that that makes for an interesting environment.
Yablonka: The Chicago marketplace is a very interesting environment. It’s traditionally a very competitive environment. It hasn’t matured as a marketplace like Boston, Minneapolis, and Northern and Southern California where we’ve seen a lot more merger and consolidations of healthcare provider organizations and physician practices, although that is speeding up quite a bit in Chicago, and we expect that to happen much more going forward over the next 12, 18, 24 months. But Chicago does have a rich tradition of excellent healthcare organizations that provide great care. It’s a very, very big geographic area, so it’s not unusual for some healthcare organizations to have specific areas that they are stronger in geographically. We are a university-owned academic medical center, which is unusual in Chicago — there is one other left in the area. Our place in this marketplace is quite strong.
Gamble: As far as the clinical application environment, what type of EMR do you have in the hospitals?
Yablonka: We’ve implemented Epic. We took the multi-year journey on the Epic implementation and are pretty much fully implemented except for the revenue cycle piece of Epic. We’re planning to implement that over the next 18 to 24 months, and that is our last transformation project in the Epic program, which we call the Phoenix Project. The Phoenix Project is getting pretty much wrapped up and we’re now really focused on optimization of the tools and systems that we’ve put in.
Gamble: When did you start the process as far as the Phoenix Project?
Yablonka: We’ve gone through many phases. Originally, probably going back to the early 2000s, we had Epic installed just in our ambulatory side for administrative functions. We went on a journey of planning and selecting and then an implementation process that took a fair amount of time early in 2002-2003. We began implementing in 2004, and as I said, we’ve done it in chunks. Just about every year we put in very large pieces of it or done major upgrades to it. It was more of a classic phased implementation than a big bang. And in that respect, we’ve put in just about all of their systems other than the revenue cycle, which is coming next.
Gamble: Has the phased approach served you well? Do you think that was a better way to go for your organization?
Yablonka: I could see it going both ways. The phased approach served us well. We did a very good job and really delivered high quality implementations and services but it takes longer and the transformation takes time when you stretch it out. You’re often stuck in a hybrid environment between systems, and that is often challenging from a change management perspective. We saw it through and we did a pretty good job. The only other reason to consider a big bang is to drive value creation in much quicker way.
Looking back on it, we could have gone either way. I would certainly always prefer to go faster than slower, only because, again, the change management process is a big challenge in the organization. Going as fast as the organization can handle and absorb that change is likely a good thing.
I think it really is organization specific. For some organizations, it could also be a question of their ability to invest and their capital budgets. There can be lots of reasons to phase and to go easier; there are other business imperatives or priorities in the organization. But it worked out just fine for us. I really don’t have any complaints.
Gamble: As far as ambulatory, you have a physicians’ group. Are the physicians all on all on Epic at this point?
Yablonka: Yes. We have the University of Chicago Practice Plan and that practice plan is part of the university, so we all work together. They are sitting on Epic right now for all their clinical activities as well as schedule and registration. They will be part of our revenue cycle transformation project as well, but they’ve been using Epic the longest of anybody here in the organization.
Gamble: Then do you have physician practices that are affiliated as well but not necessarily owned by the system?
Yablonka: That’s a great question. Currently we’re a closed staff model. Physicians generally are faculty at the university. They have appointments at the university and they practice in the medical center, the hospital, and the clinic. That’s been the traditional configuration here for quite a while.
We are working on developing our physician network, and it’s likely that we will have physicians who are faculty members or have another kind of arrangement that could be owned, affiliated, partnered with in some form or fashion, and that’s all under development right now. Like most healthcare organizations around the country, we are dealing with those exact same issues.
Gamble: I wanted to talk a little bit about data management and what you’re doing with analytics. Before we do that, I wanted to get a little bit of perspective on what it’s like being in this translational research environment and the opportunity it offers for both IT and clinicians to be able to bring research from bench to bedside.
Yablonka: One of the great privileges of working at the University of Chicago is working with our outstanding faculty and some brilliant research minds. We work on some very interesting projects, everything from systems that help link people to care services in the community in an automated way that are quite inventive, to doing predictive analytics around cardiac events and other things.
The university has an organization called the CRI or the Center for Research Informatics. We work very, very closely with them both from a data management and provisioning perspective but also from a translational research perspective. It really is a team sport where the faculty and our researchers together with the CRI and other groups work with our clinical care side to put together these translational research initiatives.
We’re a very large research and teaching organization doing really great work, and that’s actually quite a lot of fun. Beyond the day-to-day duties of being a CIO in a healthcare organization, getting to work on some particularly interesting research projects is very exciting.