Chad Brisendine, VP & CIO, St. Luke’s University Health Network, Chapter 1

For Chad Brisendine, there were a few selling points during the interview process with St. Luke’s six years ago, but by far the most compelling was the organization’s readiness for change. And it’s a good thing; when he took over as CIO, there was a lengthy list of tasks to attend to — including an ‘aging’ data center and an infrastructure that needed revamping. But although the challenge was a daunting one, Brisendine was up for it, and the hard work he and his team put in has paid off. In this interview, he talks about the virtualization project that turned out to be a game changer, what he’s learned about change management, and the prioritization challenges facing CIO. He also discusses the Epic transformation he’s currently leading, and the career path that brought him to the Lehigh Valley.

Chapter 1

• About St. Luke’s
• Going Epic in 2016
• 12-month selection process — “We were looking for a development partner”
• Focus on operational engagement
• Stepping into “break-fix mode” as new CIO
• Lessons in change management
• Improving user experience — “It was a lot of tuning and changing.”

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They engage their customer community to help them decide which codes need to be written, and we feel that’s very valuable because Epic actually listens to their clients and actually tries to feed in their ideas into their product to make it better.

I don’t see us moving away from that because not all physicians want to be employed, and they don’t want to conform to all standards within one particular organization. Some continue to work with multiple healthcare systems and they feel like having a system keeps their autonomy, so we want to support that.

We know there are a lot of successful Epic implementations, and we also know that the key to that is a well-tuned operational engagement plan. We’re really laser-focused on that.

We worked hand-in-hand with some technical people that are brought in, as well as McKesson and some consulting firms, to really streamline how to get into the system and how to access it. We were saving anywhere from 30 minutes to an hour and a half per day per provider.

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

Brisendine:  Thanks for having me.

Gamble:  To give our readers and listeners a little bit of background information, can you just talk a little bit about St. Luke’s University Health Network?

Brisendine:  St. Luke’s University Health Network is a six-hospital (soon to be seven hospital) system, we’re close to 1200 beds. We opened up a 72-bed new campus in December of 2011 and we plan to open up another smaller campus in the Pocono Mountains roughly at the end of 2016. We also offer about 200 different ambulatory locations, we have about 700 employed providers, and we offer services through a network of about 1200 affiliated providers. We support a little over a million people throughout the community of what’s called the Lehigh Valley. So that’s a broad brush of St. Luke’s. We’re about a $1.4 billion organization and continuing to grow.

Gamble:  I actually spent some time there so I know a little bit about it, but just in terms of where you’re located and kind of the type of area it is.

Brisendine:  We’re in Bethlehem, Pennsylvania, which is north of Philadelphia, and about an hour and a half west of New York City, and we’re within a valley. It’s a great community area with two really good hospital systems, of which St. Luke’s is one of the well-known regional providers.

Gamble:  As far as the hospitals, the six that you currently have, what EHR system is being used?

Brisendine:  Today, we’re a HIMSS Stage 6 Healthcare Hospital Organization using the McKesson Horizon platforms on the hospital side and we use the Allscripts TouchWorks product on the ambulatory side for all of our physicians. We also share clinical information through our health information exchange called eVantage. Those are our three primary offerings, and we plan to actually change those. We’re in the process of implementing Epic on the acute side for all of our hospitals. We plan to go live in January 2016, and then we’ll begin working on our ambulatory implementation as well.

Gamble:  Okay, that’s obviously a pretty huge thing on your plate. And you said that that’s scheduled for about a year from now?

Brisendine:  Correct — January 9, 2016.

Gamble:  Can you just talk a little bit about the selection process and what the main goal was in selecting that particular system?

Brisendine:  We went through a pretty extensive, over 12-month, system selection process. We evaluated five vendors and we landed on Epic for a number of reasons. One, our organization is fairly advanced in clinical quality and outcomes, and we need to be integrated more from a patient perspective. Our CEOs has always had the vision of one streamlined process and one easy access of information, easy access of delivery of care, standardized across the system, and Epic provides the modules and support for that.

We were really looking for a development partner, and we believe Epic is focused on the development of the Epic product in making the product better and better and better. And the way that they do that is they engage their customer community to help them decide which codes need to be written, and we feel that’s very valuable because Epic actually listens to their clients and actually tries to feed in their ideas into their product to make it better. They spend their time on developing and working the relationships with their customers, and we felt that was very positive and synergistic with our culture.

While we also know that EHRs are going to change multiple times and generations and what’s going on with the accountable care and the reform of the health industry, we feel like if there is a player that can transform with that it would be Epic, and so kind of having that both strategic vision, as well the ability to tackle our current vision, as well as having a good development partner for the future.

Gamble:  Are you hoping to roll out Epic also to the ambulatory locations that are affiliated with the organization?

Brisendine:  We support a subsidized EHR offering today, and we’ll probably continue to extend that. We support both a subsidized EHR offering, as well as a bring-your-own EHR offering. And so we have the health information exchange — we’ll connect you and share clinical information with you. We have clinical data sharing agreements in place to support that, and we also offer a community patient portal on top of that that the providers can leverage for their patients, so within our HIE we have a community patient portal offering as well. I don’t see us moving away from that because not all physicians want to be employed, and they don’t want to conform to all standards within one particular organization. Some continue to work with multiple healthcare systems and they feel like having a system keeps their autonomy, so we want to support that.

Gamble:  How would you describe what the strategy is right now — if you’re looking at a goal that’s about a year away, what is actually going on right now?

Brisendine:  Today, we’re probably about 75 percent done with our build phase of the Epic implementation. We’re moving into our testing phase and beginning some work in that area, but then we’ll move into testing, integrated testing, etc, and then we’ll move into training, go-live prep, and basically go live. And so there’s lot of work around operational engagement — super users, trainers, policy and procedure work, showing off the system, etc. We’re doing a workflow validation walk through. And so there’s a tremendous focus in our project around operational engagement.

We know there are a lot of successful Epic implementations, and we also know that the key to that is a well-tuned operational engagement plan. We’re really-laser focused on that — communicating and discussing, and then we’re still in the process of build. We’re building CPOE order sets and vetting all that through our process that we have around CPOE in clinical content and revenue cycle content as well. So lots of activities, but that’s the overall status of where we are.

Gamble:  Okay, so obviously that’s going to be a pretty big change, but you’ve already led some transformation at St. Luke’s. You’ve been there since 2009, is that correct?

Brisendine:  Yes, that’s correct.

Gamble:  I wanted to talk a little bit about how things have changed since that time — what the systems looked like when you arrived, and what you were tasked with this as far as leading a transformation.

Brisendine:  Sure. When I arrived, we were kind of in more of a break-fix mode. We had kind of an aging data center that needed investment. We had infrastructure that wasn’t refreshed or invested in. We had a lot of leadership changes that need to be made within the IT department as well as changes to the governance structure and how much we were funding IT, what we wanted to fund it in, and prioritization of the funding. Obviously we had McKesson at the time and we had had some challenges with that because we were on what was considered to be a beta version of that, and so there were a lot of performance issues related to infrastructure, as well as the application.

A lot of the first couple of years was changing a lot of the management team within IT and getting investment and funding for some of our important projects. We just spent a tremendous amount of effort and energy in our infrastructure. We basically moved out of our current data center and went to two redundant data centers with an optical ring and re-did our entire infrastructure and basically tried to virtualize everything that we could. We virtualized over 98 percent of our environment on VMware with Cisco, UCS, and EMC products, and did all that over a couple of years.

While we did that, we were really trying to get the Meaningful Use and improve the performance of our systems, which we did. We spent a lot of time looking at how long does it take to access the application? How long does it take to do functions within the applications? And we worked hand-in-hand with some technical people that are brought in, as well as McKesson and some consulting firms, to really streamline how to get into the system and how to access it. We were saving anywhere from 30 minutes to an hour and a half per day per provider following a lot of the changes that we did within the infrastructure. It was a lot of tuning and changing within that environment to improve the user satisfaction so that they would actually use the system.

Then we got through that phase so we made a heavy investment into Meaningful Use, and we’ve met all of our Meaningful Use stages. We have a very high rate — 90 percent of all CPOE order sets with everything combined, as well as all the Meaningful Use criteria through all the stages. So a lot of change over probably three and a half years, and then for the last year and a half, I’ve been fairly head-down on Epic working through all of that.

Chapter 2