Randy Gaboriault, SVP & CIO, Christiana Care Health System, Chapter 1

In 2010, Randy Gaboriault left an industry that thrived on innovation to answer the call of another that “had not incurred disruption in decades.” Healthcare, he believed, offered him an opportunity to “reshape it from my backyard,” and he accepted. Five years later, Gaboriault is leading a top team at Christiana Care that is focused on creating a ‘true community health record’ and harnessing the power of predictive analytics to improve outcomes. In this interview, he talks about the major IT plans on his plate, what he believes are the core competences of health care, what leaders should mean to their teams, and what surprised him most about the CIO role. He also discusses the innovation challenge that was issued to his team, and the trend that CIOs must work to reverse.

Chapter 1

• About Christiana Care
• Cerner as “core backbone on the inpatient side”
• Migrating ambulatory onto one platform
• Co-development to integrate Cerner & Soarian Financials
• “It’s how you get data at the right place and the right time to create a richer patient experience.”
• Delaware HIN — “It creates a platform to really start thinking about team-based care.”

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Bold Statements

Let’s ask questions here in the health services space and actually apply those hypotheses into our own environment, and then, as a result of that, publish specific results into the ecosystem based on what we found in our environment.

Patients don’t live in a closed ecosystem, they live in the real world where they’re going to get either diagnostics and/or emergent care at different points, and they don’t live in a closed convenient system for us as a provider.

The state and the constituents and providers are able to rally very quickly around something, and I’d say that is definitely a catalyst, which I think really helped the HIE flourish as well as build functionality and get real adoption.

The number of services and value-creating functions that we’ve been able to build on it have just been amazing, and I think it’s a true testament to thinking about what’s important to the community, to the patient, in how we actually begin to reduce friction for how information moves.

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

Gaboriault:  Thanks, Kate. It’s great to be here.

Gamble:  Just to give our readers and listeners a little bit of background information, can you just talk a little bit about Christiana Care in terms of your number of hospitals, which you have in the way of ambulatory, things like that?

Gaboriault:  At a high level, we have two acute care centers. Just a little bit of background, the organization was founded in 1888. We’re the largest private employer in the state of Delaware. We’re also the fourth largest in the Philadelphia metropolitan region. From a healthcare perspective, depending on which index you’re scoring against, we’re somewhere probably between the 15th and the 25th largest institution in the nation. We’re a teaching center as well, so we’ve got somewhere in the range around 300 residents and fellows in our environment. From a size and a scale perspective, we’re probably somewhere around the $2.5 to $3 billion range, more precisely probably about $2.7 to $2.8 billion in gross revenue as an organization. But we’re affectively a community health provider where we also look at ourselves in ways where we are able to actually relate to a lot of different organizations because we perform in a lot different dimensions, one of which is as a teaching center that’s sort of the academic component so we feel like we’re able to make a connection that direction as well. Our CEO, who just retired in the fall, was the president of the council of teaching hospitals as well.

On top of that, we have a faculty practice, a component of employed physicians, as well as a large component of basically private practitioners that participate. So when you look at things that we do and deploy, they’re effectively really extensible in either the academic space or up and down the channel into the community health space, because we can we can tackle those things and have to face those same sets of problems.

From a perspective of other things that make us unique, we are 1,400 beds, two acute care centers, 100 ambulatory centers, and we’re touching kind of four states as well. But we have what I define as sort of a super campus here just south of Wilmington, Delaware, which is known as the Christiana campus. It’s a large scale environment that kind of pushes the boundaries of about 900 beds of capacity. That’s something that we see as kind of unique around the nation; you can probably count on two or three hands the number of entities that scale to that size and those large campus environments. We also have an NCI Community Cancer Center here.

On top of that, in terms of thinking beyond just laying hands on patients and delivering services, we also have we call the value institute and the learning Institute. Those are the cognitive and applied entities to really ask questions and do research — not necessarily just to publish, but actually to really do the applied component of those things. So let’s ask questions here in the health services space and actually apply those hypotheses into our own environment, and then, as a result of that, publish specific results into the ecosystem based on what we found in our environment. I hope that gives at least a quick overview.

Gamble:  Yeah, definitely. A lot going on there. Looking at the clinical environment, what EHR system do you have first off in the hospitals?

Gaboriault:  The core backbone on the inpatient side is the Cerner platform; that’s the load-bearing wall that we’ll build the core set of transactions around. And then as we look into the ambulatory space, we’re in the middle of our process to actually migrate everything actually also onto the Cerner platform. Effectively, that enables at least a component of integration where IT doesn’t have to figure out how to move appropriate information; moving these things onto the same database platform establishes as a certain capability.

We also are running the Soarian Financials platform, which the organization had purchased about three years before I arrived. We stood that up about 24 months later, and we are actually in the process of working with Cerner as a co-development partner, since we have effectively integrated the Cerner and the Soarian Financial platform, to bring those together as a single integrated product.

Gamble:  You talked about migrating ambulatory to the Cerner — that’s referring to the employed practices?

Gaboriault:  Exactly.

Gamble:  Up to this point, what has that picture looked like just as far as data exchange within the organization among physician practices and the hospitals?

Gaboriault:  For data exchange, let’s start with the simple component. Obviously, when you own system A and system B, you can produce a pretty rich integration interface to move information back and forth, and so obviously that’s been done between historical systems. We look across the portfolio and say, what do clinical and patient experience workflows look like and how do we design the information flow, the logistics of the information that support that process? And that’s not really particularly difficult to do; to build those interfaces. It’s about how you actually get the information at the right place and the right time to create a much richer patient experience, as well as provider experience.

But if I jump around the thinking about the non-employed piece, for us what’s unique in Delaware is we have a highly functional health information exchange known as the Delaware Health Information Network, and that’s what allows us to move information. It’s what I find to be the real world, which is that patients don’t live in a closed ecosystem, they live in the real world where they’re going to get either diagnostics and/or emergent care at different points, and they don’t live in a closed convenient system for us as a provider. On that approach, that’s where we recognize and leverage the statewide health information exchange.

Gamble:  You have some history with Delaware HIN. What do you think has been the catalyst to it being able to have success on a somewhat of a long-term basis?

Gaboriault:  One of the things that I maybe hadn’t necessarily recognized, at least when I came into this organization and into Delaware, is that Delaware is a really unique place from a standpoint that given it’s not a particularly large state in terms of degrees of separation, the ability to get things done is tremendous. I often joke that it takes three phone calls or less, and you can make tremendous progress in terms of organizing in Delaware. It’s very easy to access the congressional delegation if you’re looking for support. It’s really easy to access the governor. And so I think from that standpoint, the state and the constituents and providers are able to rally very quickly around something, and I’d say that is definitely a catalyst, which I think really helped the HIE flourish as well as build functionality and get real adoption, and for people to utilize this technology versus actually going on building other technology.

Part of the whole piece behind it was, when I got deeply involved, for us to frame this concept of what we call a community health record so that as a resident of Delaware, an individual can traverse the real world of healthcare, but their information is effectively sitting in a shared record that can be accessed. So if you live in the northern part of the state here, kind of outside the major Philadelphia region, and then you travel to the beach for the weekend and you have an emergent visit, all that information is effectively available to your primary care doctor or specialist. Any diagnostics, transcribed reports — all that information is effectively available for any individual care provider, and it also creates a platform for us so we really start thinking about team-based care in the future and a platform for building and delivering care through clinically integrated networks.

Gamble:  It’s a concept that sounds simple, but obviously has been a struggle for a lot of organizations.

Gaboriault:  Yeah. I’ll give you a sense of it. From our perspective, we’ve got somewhere in the range of about 2 million patients catalogued from all of 50 states. We also have connected our HIE to the Maryland State HIE, so we move information back and forth there. We’re also doing syndromic surveillance. We’re doing an immunization registry and a cancer registry. We connect with the department of corrections. And so the number of services and value-creating functions that we’ve been able to build on it have just been amazing, and I think it’s a true testament to thinking about what’s important to the community, to the patient, in how we actually begin to reduce friction for how information moves so it’s at the right place, at the right time, on demand when needed.

Gamble:  As far as the other states involved, you mentioned Maryland’s HIE. I’ve read that the HIE picture in Pennsylvania is not really as clear at this point or it’s a little bit more fragmented, but what have you found?

Gaboriault:  I understand there’s some activity and they’re working on something called HealthShare or HealthShare Exchange. And so, at least my outside perspective right now, and I’m not privy to all the details, they may be architecting as a starting point around the directed exchange for information. I’m hopeful that we’ll be in a position to be able to share information as robustly with our counterparts in Pennsylvania.

Chapter 2