Ken Gilles, Associate CIO, Essentia Health, Chapter 2

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

Chapter 2

• Making “big leaps” in telehealth
• Pioneer ACO
• ‘Epic First’ strategy
• Focus on analytics — “You have to be able to measure to improve.”
• Leveraging data to prevent leakage
• The tipping point of software development
• Fostering innovation — ‘We can help you.’

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That’s actually probably one of our top initiatives right now. That’s the secret sauce to making all this work.

We realize we’ve got a lot of work to do and this thing will never be done. As you look at predictive analytics, we’re doing a lot of descriptive or retrospective things — here’s the data, now drill down to it.

To tell people versus having them to go figure it out is really where the next value layer is here.

If somebody comes up with a metric, we can layer it into this framework very quickly. But with that comes the challenges of developing software. You have to stay current. You have to have the team. You’ve got to keep the team. It’s a little bit costly.

It’s really trying to get that message out that ‘hey, we can help you. If you define a use case where you want to improve something, there’s a lot of things we can do now that we couldn’t do a year ago.’

Gamble:  Being in an area that is fairly rural, are you doing anything at this point with telehealth or are there any plans to do so?

Gilles:  Actually, we’ve got a fair amount of that underway already and we’ve got some pretty major plans going forward here. We’ve done some things with Tele-ED — that was really our starting point, and like you mentioned, with some of these rural facilities we’re really seeing a benefit of the patient not having to travel and us remotely being able to provide some of those higher level services.  We’ve gotten into TeleWound, TelePsych and probably the big thing I would say that’s on our radar right now is TeleStroke.

We’ve got a very high-level stroke program here at Essentia Health, and particularly in the West region, and so we’re reaching out to other organizations that have some of these outreach types of networks in place and potentially partnering with them to provide the stroke service across their networks. And actually, we’re getting very close to signing a contract for about 85 sites. So we’re going to make some big leaps, big strides forward there.

Gamble:  Is that something where it started on a smaller level or a smaller scale and just built up from there?

Gilles:  The whole telehealth program did, yes.

Gamble:  Were there hurdles early on or anything major you had to work through?

Gilles:  The basics about the reimbursements, licensure across states and those typical things.

Gamble:  You mentioned before about accountable care. Are you part of an ACO at this point?

Gilles:  We are. Essentia Health is one of the pioneer ACOs. We’re an integrated delivery network and in just a great position in terms of having the services and the providers that we need for our own ACO. So we are in the process of signing a contract with an affiliate who wants to join our ACO along with getting access to Epic and that sort of thing, but everything to this point has been just internally within Essentia Health.

Gamble:  Right. I wanted to talk a little bit about data management and what the strategy is there, and what plans you have or what work you’re doing with analytics at this point.

Gilles:  That’s actually probably one of our top initiatives right now. That’s the secret sauce to making all this work. You’re aware that with having this electronic health record implemented in all the sites except Graceville, which will be up very soon, plus all the information now we can get from being part of the Medicare Shared Savings Program, we’re actually able to load the claims data, and then the integration we’ve got with other Epic organizations in North Dakota here, plus the North Dakota Health Information Exchange — the point being, we’re getting all of these data. Now what do we do with it?

Organizationally, we made a major initiative and investment into quality and safety and those types of things a couple of years ago, and those dividends are paying off. So basically, here’s our strategy. We call it Epic first. If Epic has the analytics available that we’re looking for, we’re absolutely going to install and implement their functionality, realizing Epic was pretty late to the game here. A little over a year and a half or two years ago, they were just a PowerPoint presentation. I was just at the Epic user group meeting just last week and they’ve made a lot of strides, so now what we’re doing is taking a lot of the internally developed applications that we did — take registries, for example. We built our own registries, and now we’re going to migrate those to the Epic registries. So that’s one half of the strategy is Epic first — utilizing their functionality. The other piece is where that functionality is not available, we’ve got a development team that’s building this internally. And actually, we’ve made a lot of progress there.

One of the key things in the ACO is you have to be able to measure to improve. We built a quality dashboard that probably has maybe 40 metrics on it now that you can actually drill down all the way from Essentia to the region, to the hub, to the site, to the department, down to the physician. It’s got sparklines and the target and the trends and all those kind of things on it. So it’s just magnificent, and it’s been adopted through all the regions across the whole organization, which sometimes is a huge challenge. So those are two of the fronts we’re moving forward here.

Gamble:  Okay.

Gilles:  We realize we’ve got a lot of work to do and this thing will never be done. As you look at predictive analytics, we’re doing a lot of descriptive or retrospective things — here’s the data, now drill down to it. The other thing we’re trying to do is rather than forcing people to go to the data and drill down to find out what’s good or what’s bad, is to use analytics to tell them the story. I’ll give you an example. With these claims data from Medicare, we can determine now where our physicians are referring people outside the organization when we have the capabilities inside the organization. We call it leakage.

The first thing we did is to create a report that let’s people drill in through that hierarchy I mentioned to find out if somebody is referring somebody out. They’d have to get down to the point of, let’s say, physician A is sending somebody for an orthopedic visit to Sanford Health in Fargo, for example. They would have to deduce that we have an orthopedics program — why would they be sending it to Sanford? But you have to get down to that level.

What we’re doing now is basically building in. We know the area where we have our specialties, and we know what the competition has. And basically we can now say, ‘hey, here’s a report that physician A referred out these services to these specialties where you have them’ internally, versus having them go down through all of these layers in the organization to figure it out. To tell people versus having them to go figure it out is really where the next value layer is here.

Gamble:  Then you said you have a development team that was looking at some of these analytics pieces. Could you talk a little bit about that and how that was put together? Because I imagine that that’s a really nice thing to have or and it’s a positive to be able to work on these things internally, but I’m sure there are challenges as well.

Gilles:  We started to develop this team because we knew there was a void in the vendor marketplace. Now everybody has some type of analytics they’re trying to sell, but when we started thinking about our vision and some of the strategies we were going to employ three or four years ago, there wasn’t much out there. So we knew to get started we were going to have to do something internally, and we took a very cautious approach. We built what’s called a metric framework. Literally we could lay any type of metric into this framework and commoditize it, if you will, once we had the infrastructure in place.

That’s where we’re actually getting the big gains right now — if somebody comes up with a metric, we can layer it into this framework very quickly. But with that comes the challenges of developing software. You have to stay current. You have to have the team. You’ve got to keep the team. It’s a little bit costly when you think of the amount of resources you put at it, all of those types of things that go into software development.

Now, when we take a step back, and I actually had this conversation last week with one of my directors — when you look at Epic, they have hundreds of people developing these tools now and that’s why they catch up so quickly. We have, say, 10 people. There’s the point in time where it doesn’t make sense for us to develop if we can buy these things. We’re definitely going to have that challenge as we go forward here.

Gamble:  Right. It’s just a matter of determining when that point is, and if the vendor products are meeting your needs enough.

Gilles:  Yeah. There’s going to be a tipping point in there at some point.

Gamble:  That also goes to the point of innovation and how CIOs can work to foster that. It’s something that maybe isn’t quite as easy as it sounds, especially when you have so many other things to focus on that are immediate priorities. What are your thoughts on that?

Gilles:  I look at some of the ways that we can help drive innovation. We need the operational folks to be in lockstep with us or us with them, but I think there’s a lot of areas that we’re working with our customers on right now related to readmissions, falls, sepsis, a lot of these never-event type things. Where can we use analytics to show what’s the likelihood of this patient being readmitted? There’s a lot of metrics out there that you can put some if/then’s around and help the customers in that regard. What we’re trying to do is engage with them enough so that they know these things are possible. I think in the past, they haven’t had the time to think about it because they just assume we didn’t have the data or we couldn’t do that. So it’s really trying to get that message out that ‘hey, we can help you. If you define a use case where you want to improve something, there’s a lot of things we can do now that we couldn’t do a year ago.’

Gamble:  That’s interesting. Now, as far as Meaningful Use, where does the organization stand? Have you attested to stage 1?

Gilles:  Yes. Actually, we’ve done very, very well. We got almost everybody through Stage 1, and we’re just in the process getting close to attesting to Stage 2. That’s been a very, very positive thing for us as an organization.

Gamble:  It’s obviously something that’s brought up a lot of challenges for organizations. I can imagine it’s a nice thing when you can say, okay, this hasn’t been a major struggle for us.

Gilles:  I wouldn’t say that. I would just say we’ve done very well. We still had the work and the challenges of getting end-user adoption — as an example, a physician having to click that they did something versus being a byproduct of actually documenting something. We still have those challenges and we can continue to work with our vendors to try to improve those processes, but I’m just saying our operational leadership was there. IS leadership was there. We did well, but it’s still a challenge, and there’s still more to come.

Chapter 3