Ken Gilles, Associate CIO, Essentia Health, Chapter 1

When an organization is acquired, it’s easy for the CIO to feel like it’s the end of the road. But Ken Gilles, who was CIO at Innovis when it was bought by Essentia in 2008, saw it as a new beginning, and six years later, his role with the organization is going strong. In this interview, Gilles talks about the approach he took during the M&A process, the Epic migration effort that has evolved from “organized chaos” to a “science,” and the “big leaps” his organization is making in telehealth. He also discusses being a Pioneer ACO, Essentia’s big plans with data analytics, and the tipping point when it comes to in-house software development.

Chapter 1

• About Essentia Health & the West Region
• 5 systems in 5 hospitals
• The Epic journey from “organized chaos” to “science”
• Community Connect
• Beyond post-implementation optimization
• Essentia’s Clinical Informatics Committee
• Avoiding the “IS black hole”

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Bold Statements

We’re more prepared. We know what things we’re going to get hit with and we’ve done everything proactively at that point to prevent problems and that sort of thing. Now, it’s down to a science.

It was the opposite of what I would have expected. I would have thought we’d roll into a small facility and make it happen very quickly, but we’ve run into some challenges there.

We can turn those changes around quicker in most cases than having the CIAs simply being the messenger back to our IS group; they can actually make changes now. That’s been very, very effective.

We do everything we can to say, ‘we hear you, and here’s what we’re going to do, and here’s when we’re going to do it.’ When you can turn things around that, it really makes a difference.

Gamble:  Hi Ken, thank you so much for taking the time to speak with us today.

Gilles:  How are you doing, Kate?

Gamble:  I’m good, thank you. To start off, let’s get a little bit of background information about Essentia Health for our readers and listeners — number of hospitals, things like that.

Gilles:  Essentia Health is 17 hospitals and roughly 65 clinics. We have a few long-term care facilities, 750 physicians, 750 advanced practitioners, about 13,000 employees. Then we’re across what we call regions — West, Central and East, which is basically North Dakota, Minnesota and Wisconsin, and we’ve got a few facilities out in the Idaho area. In general, that’s our size.

Gamble:  In the West region, how many hospitals are included?

Gilles:  There are five hospitals in the West region which are smaller in nature. Four are critical access and one here in Fargo we’re adding on, so it will be about 150 beds when we’re done.

Gamble:  And that area covers North Dakota?

Gilles:  North Dakota and parts of Minnesota.

Gamble:  I imagine it’s pretty spread out.

Gilles:  I really is. We cover a pretty wide geography.

Gamble:  As far as the clinical applications, are all the hospitals on Epic?

Gilles:  All of the hospitals except one. We’re actually getting close to being complete here. Graceville is one critical access hospital that’s left, and we’re going live with them on November 5^th, so we’re within striking distance.

Gamble:  Yes. I can imagine that has been a pretty big undertaking. Were the hospitals on different systems prior to Epic?

Gilles:  Yes. Every one of them was on a different system with different vendors, from Meditech to CPSI to Cerner, etc.

Gamble:  As far as the strategy just to do that, how was it something that was approached? Was it to go through one hospital at a time? What was the thinking there?

Gilles:  We knew early on that if we’re going to be successful as an accountable care organization, we’re going to have to get everyone on one record. That was our vision. In terms of our approach to meeting that, we started out in the East region because we had Epic in the clinics up there. So we got the East region completed in terms of the hospitals, and then through the acquisitions of the folks in Brainerd and the folks in Fargo, we went from region to region. Then some of these smaller facilities within some of the regions, I’d say, weren’t ready, or from a geographic perspective were too many miles away that we couldn’t pull them off in a big bang. So we did some of the critical access hospitals separately just because of the distance.

Gamble:  Were there lessons learned where you maybe tweaked some things just going from one implementation to the next one?

Gilles:  Absolutely. At the end of each implementation, we would actually create a lessons learned document. Quite honestly, it’s amazing from the first implementation now to the end, where I would say it was organized chaos at first — or at least it felt like it, to now when we’re going to go live in another site, it’s okay. It’s what we do. We’ve done it how many times, and the staff is very relaxed and we’re more prepared. We know what things we’re going to get hit with and we’ve done everything proactively at that point to prevent problems and that sort of thing. Now, it’s down to a science.

Gamble:  You said you have one left and that’s going live in November.

Gilles:  Right, and then we’re getting into an affiliate program with Community Connect. So we have a couple of those lined up but in terms of our own internal organization, that would be the last one.

Gamble:  Can you talk a little bit more about Community Connect?

Gilles:  Basically, it’s a way for us to extend the Epic system to an affiliate. We’ve seen organizations smaller in nature that are unable to meet Meaningful Use per se, or they just need a better system strategy, or they just want to affiliate with us for our accountable care organization expertise. Those types of things are driving some organizations to us where we can extend Epic. We’ve done it in a couple of instances and it’s been very successful.

Gamble:  And it’s something where other organizations have reached out to you?

Gilles:  Yes.

Gamble:  What about physician practices — do you have practices that are both owned by and affiliated with Essentia?

Gilles:  For the most part, our physicians are employed. I think in some sense it makes it easier for us to do things.

Gamble:  And what are they using?

Gilles:  They’re all on Epic.

Gamble:  Okay, the physicians are using is as well. So going through the different hospitals, I imagine some of them were smaller than others. Did you have to adjust your strategy or did it not necessarily depend on the size of the facility?

Gilles:  This is going to sound a little strange, but actually, in some ways it was easier in the larger hospitals than the smaller hospitals. I say that because when I just think of the Graceville implementation coming up, they’re just strapped for cash or capital, and they have legacy systems that they just want to keep because of the cost to replace them. Some of the cost structure doesn’t fit on some of these very small facilities, and they have people who wear so many hats. So when you’re going through the training process, it’s real difficult to get to the point where you can send them the trainer who’s going to train them on orders management or notes or some other functions, because they wear so many hats. It was the opposite of what I would have expected. I would have thought we’d roll into a small facility and make it happen very quickly, but we’ve run into some challenges there.

Gamble:  That’s interesting. As far as post-implementation optimization, I imagine that’s something that you’re going through with several of the hospitals. What are you looking at with that?

Gilles:  We are, and actually, we’ve moved even beyond that. Here’s an example.  We have clinical informatics analysts where we partner up with their group of physicians, and they round daily or weekly. They’ll provide other ways of doing things and watch the physicians do their work and show them better ways to use the system and provide tool tips and tricks and that sort of thing.

Now we’ve actually converted them into what call clinical support analysts. That’s still a part of their job but now, they’re able to make more changes in the Epic system. We can turn those changes around quicker in most cases than having the CIAs simply being the messenger back to our IS group; they can actually make changes now. That’s been very, very effective.

We’ve built over time a better governance structure in place for our clinical changes. I think we’re starting to see a lot more progress there and less frustration. When you go live with some of these big bang approaches, you might have a thousand issues when you get through the implementation and to try to get that narrowed down and prioritize is sometimes very difficult.  We’re seeing a lot of really good momentum.

Gamble:  What were some of the changes made to as far as governance structure?

Gilles:  It actually boiled down to each of the regions having what I’d call an ambulatory and an inpatient working group — or you could call it a steering committee, but each of the regions had that and then those regions were sharing their need for change across the other regions in what we call the CIC or Clinical Informatics Committee, which is at the Essentia level. Certain changes can just be made because they’re not going to affect other regions or they’re not going to have an impact. We’re trying to do all the standardization that we can, but other things then we would push up to this Clinical Informatics Committee, so they could prioritize and vet out all the changes that should be taking place and should get resourced.

Gamble:  I can imagine something like having clinical support analysts went a long way toward improving user satisfaction.

Gilles:  It really did. When the physicians and nurses can see the turnaround happen very quickly, they’re much more willing to share ideas and that sort of thing too. You’ve heard the term ‘the IS black hole’ — we really dislike that term, and we do everything we can to say, ‘we hear you, and here’s what we’re going to do, and here’s when we’re going to do it.’ When you can turn things around that, it really makes a difference.

Gamble:  Sure. Being a large organization, there’s that perception that any type of change takes a long time because there are all these layers. Is this a way of saying that’s not necessarily the case?

Gilles:  We still do have our challenges. I’m going to be very honest with you. They would still like things quicker than they get it. Here’s one other thing that just comes to mind too when you think about what slows down the process. What we’re trying to do with this change process is also get the organization across regions to work together.

I’ll give you an example. The lab group across Essentia Health is like a well-oiled machine. They’re functioning together across all regions. If we know we have a change in the lab area, it’s going to move very quickly. Other areas within the organization haven’t been as tightly integrated yet. And so IS may broker the discussion to get the regions to talk about a particular issue or change, but if you could imagine trying to get the regions together if they’re not integrated yet or fully integrated, it just takes a lot more time.

I know there’s frustration when we have to go through that process before we can make our changes. And if you’re a customer of the system, they’re honestly saying, ‘I really don’t care. I just need this changed.’ So it takes some conversation there to get them to understand sometimes, but for the most part, it’s really good. But you can just see it in the areas where we’re not as tightly integrated.

Gamble:  That’s an interesting thing having the large health system divided into these regions. How does that work — does each region have its own CIO?

Gilles:  No. The way we’re structured is Dennis Dassenko is the CIO of Essentia Health and I’m the Associate CIO. In a sense, I cover the West and Central regions and Dennis covers the East. He’s up in Duluth and that’s the largest region. Then we each have corporate level responsibilities. He has the clinical systems, and I’ve got the business of financial, the analytics and the technology group. Dennis also has the health information services group. We split up the corporate level and we split up the region level.

Gamble: I imagine that you’re in contact pretty often.

Gilles:  With Dennis? Absolutely, yes.

Chapter 2