At St. Joseph Health, a primary focus across the organization is to give time back to clinicians by improving flow and ease of use. And to the IT department at the 16-hospital system, that has meant transforming the way they interact with care providers, and adopting the mantra of ‘people before tickets,’ according to David Baker. In this interview, he talks some of his team’s key initiatives, including efforts to standardize all of the hospitals to the same version of Meditech, create a platform to facilitate better communication among the staff, and move toward a virtualized environment. Baker also discusses the importance of leadership buy-in with any project, why it’s critical to push the boundaries, and the unique path that took him to his current role.
- About St. Joseph Health
- Standardizing 16 hospitals to 5.6.5 — “It’s been a long journey, but it’s been necessary.”
- 80-15-5 formula
- Virtualization with Citrix, Imprivata & UniPrint
- Rebranded IT approach — “What do you want to see from an IT system?”
- Getting feedback from users on the floor
- “Entrepreneurial spirit” at St. Joseph
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It’s really taking any of the headache and the thought process out of getting into the applications you need to best serve the patient so can spend time with the patient. I think we’ve done a good job at giving caregivers back time in their day.
Rather than us trying to ram an IT project into the business and say, ‘use it, this will make your life better,’ it was a case of turning it around, rebranding it, and saying, ‘what would you want to see from an IT system?’
I’m really pleased that we’ve got the foundation, because now is really the time we focus on the fun stuff of improving the workflows, the user experience, the interfaces — the stuff that’s really going to revolutionize healthcare.
They’re used to getting what they want in seconds, and sometimes they’re like, ‘why can’t we do this at work?’ So our aim is to make it as easy as possible at work and align them with their home application stack, which is very intuitive.
Gamble: Hi David, thank you so much for taking the time to speak with us today.
Baker: Sure, I’m glad to be here.
Gamble: So to give our readers and listeners just a little bit of an idea, can you just talk a bit about St. Joseph Health — what you have in terms of hospitals and ambulatory care and where you’re located?
Baker: Sure. We are Orange County, California’s largest healthcare provider. We have a total of 16 acute care hospitals and they’re spread between southern California and northern California, and west Texas. We have about 152 ambulatory facilities as well.
I’m the vice president for IT and my responsibilities incorporate what I would call the end user experience ultimately. I look after all of the desktop guys around in the fields, supporting our caregivers — the first line responders, the service desk scout in Texas, and then we do some really interesting stuff with our capsule projects which involve a lot of research and development and some of the fun new technologies we get to pilot internally and then eventually deploy.
Gamble: And approximately what size of IT staff are you dealing with?
Baker: Our IT staff is currently about 240, and we have several other businesses through our group with various other contract resources. There’s probably a healthy balance of about 100-plus contract resources on top of the core group.
Gamble: Are you mostly in California or do you travel among the sites?
Baker: The IT corporate office is based down in Anaheim, California. We have a corporate office in Irvine, and I travel relatively extensively, obviously looking after our entire group across all of our hospitals. I’ve been to all of them. I’ve spent a lot of time out in west Texas in sunny Lubbock, and also up in the Napa Valley area and up in Eureka in northern California.
Gamble: So now in terms of the clinical application environment, what EHR systems are you using in the hospitals?
Baker: On the acute side of the house, we’re a Meditech shop, and for our ambulatory providers, we are an Allscripts shop.
Gamble: And so all of the hospitals are on Meditech?
Gamble: Different versions or pretty much the same?
Baker: We recently standardized, I think it’s 5.6.5. We worked towards a mass consolidation really from I think 14 different rings down to 3. We’ve broken out by SoCal, NoCal, and Texas. They’re the three regional rings, and the thought pattern behind it is what they called the 80-15-5 formula. So 80 percent of that EMR would be standardized enterprise wide, 15 percent could be customized as needed regionally, and then 5 percent would be customized based upon very specific administering needs as required. That was the original formula, which I believe we’ve worked pretty well toward.
It’s been a long journey, but it’s been necessary. So many builds really had a large impact on the operational support model. We’re undergoing a huge application rationalization drive as well as we standardize and move things to our central colocation and the private cloud. There are huge benefits in moving hundreds of traditional applications into a more streamlined virtual environment, and I think we’ve become very mature at doing that. We’ve done some exciting things in the clinical systems and the way that we serve up those applications.
Gamble: Now in terms of the 80-15-5 formula you used — is that something that for the most part has worked out and you would do again, or has that proved to have significant challenges?
Baker: I can’t speak for CI specifically, but I think there’s a good thought behind it in that initially you’re taking away some user functionality for the advanced users who are great to good, so you standardize and then you bring everyone up together to a better level. I think it works. I’ve definitely used that approach myself on the virtual environment. All of our clinical systems we’ve deployed are standardized across the house. We’re a big Citrix shop and we use a single sign-on product called Imprivata, and that’s also now fused with UniPrint. We deliver a really, I would say, world class clinical platform that will deliver the applications that the caregivers require.
Our system is set up to be pretty standardized so that when the caregiver badges in, the apps they require are standardized and ready to go. Some of the magic behind that system is they can tap and roam wherever they go. So from nursing station into patient room, they’ll badge in and it will drag their whole session, with anything they were working on, to another work station. And then we simplify it down to the level that instead of scrolling through the lists of tens and tens of printers, they’ll literary just click on ‘laser 1’ and it will point them toward their closest laser printer, or ‘prescription 1’ for the closest prescription printer, for example.
We’re trying to simplify the workflow as much as possible. I like to say I’m trying to make IT boring so that users can just enjoy a consistent experience. They know the time it’s going to take to lunch, they know the app is going to be required where they need it. It’s really taking any of the headache and the thought process out of getting into the applications you need to best serve the patient so can spend time with the patient. I think we’ve done a good job at giving caregivers back time in their day.
When we started out with the Easy Pass platform, the VDI environment, we really went out with the selling point of, what would you say if we could give you 15 minutes back in your day every day? That was our opener to get folks interested in IT, which doesn’t always interest a lot of providers because they’re so busy. They just want to get about their day.
Gamble: And Easy Pass is the name for the Citrix deployment?
Baker: Yes. We’re now on Easy Pass Version 3, which has been deployed. It’s a really advanced set of the virtual technologies from Citrix, Imprivata, UniPrint, and also Nuance — we’re doing a lot of roaming dictation. I think we’re the first hospital system in North America to be able to do that. We’ve worked really closely with Nuance on getting some really cool features out there. So we’re on iteration 3.
About three years ago, we started on version 1. When I came and took over the project, it was branded ‘SSO.’ Everyone knew it was single sign-on. It was a real mixed bag. People weren’t happy. So we came in and leveled the architecture; we thought about really what does the business want, we went back out and listened to them, and we sat down with them. So rather than us trying to ram an IT project into the business and say, ‘use it, this will make your life better,’ it was a case of turning it around, rebranding it, and saying, ‘what would you want to see from an IT system?’ Back when we started out, there were just multiple and varied fat client builds, traditional PCs, and break-fix was someone coming out with a USB stick trying to load drivers up and tweak each machine individually to get it working.
So we went through a series of retraining, internal marketing campaigns, and focus groups and deployed this in phases, hospital by hospital. We’re now 14,000 daily active users into this, and the feedback is good. You don’t get people calling you up raving about how amazing something is, but when you go out on the floor, I like to ask the question, ‘What would you say if I said I was going to have to rip Easy Pass out?’ That’s usually my prompt to try and get some kind of feedback, and 90 to 95 percent of the time, people will say, ‘there’s no way that we’ll ever let that happen. This makes our lives easier. We don’t have to worry anymore about will the EMR open up? Will it print to where I need it to print?’
It’s really just the basics, but I’m really pleased that we’ve got the foundation, because now is really the time we focus on the fun stuff of improving the workflows, the user experience, the interfaces — the stuff that’s really going to revolutionize healthcare; the tipping point of the portals and the way we interact with physicians and patients. If we didn’t have a standardized platform that was vanilla and we just know works 24/7, we wouldn’t be able to get on to the fun stuff, as I call it.
Gamble: Right. A lot of interesting stuff there. When you said that you rolled it out hospital by hospital, I can imagine that there were things that were tweaked from one to the other just based on maybe getting feedbacks from providers, things like that?
Baker: Absolutely. It’s just ongoing. My advice would be although we’ve got a really nicely baked system, it’s never going to be perfect. There’s always going to be the next iteration — Citrix of launched better technology as we went through between 1, 2, and 3. Version 3 for us now really is moving away from XenApp to XenDesktop, which is a lot more customizable and we can do a lot more in the backend so things are faster and even more consistent. We’ve got great new tools available on units for things like scanning and roaming dictation that just further gives time back and make workflows easier.
It’s always going to be kind of reinvented. The thing that’s great about St. Joe’s and working here is that it’s very entrepreneurial and aggressive in embracing technology and getting in front of some of the great new technology before users bring the technology to you. Users are used to logging in the way they want to log in and acting with applications at home the way they want to very instantly. There are apps for everything these days, so they’re used to getting what they want in seconds, and sometimes they’re like, ‘why can’t we do this at work?’ So our aim is to make it as easy as possible at work and align them with their home application stack, which is very intuitive. We’ve invested heavily in apps like Box and just bringing your desktop up wherever you are. File interaction should be as easy as they are for users at home. We’ve introduced that at work.
I think we’re just consistently evolving. We need to always the offering more to that end user and listen to what they want. Like I said, we try not to ram it down their throat, but have those regular focus groups where we know our R&D dollars can go into solving problems that the business generally has.