What motivates the CIO of a large health system? For Steve Hess, it’s “picturing that day when we save someone’s life through the use of informatics.” Of course, it will take — and has already taken — a great deal of blood, sweat, and tears to get to that point, from getting five hospitals and hundreds of clinics onto an integrated EHR system, to creating standardized workflows, to turning data into “actionable clinical decision support.” In this interview, Hess talks about merger that created UCHealth three years ago, why he’s a big believer in going big bang, the “why not Epic?” philosophy that has helped increase buy-in, and how collaboration is more of an art than a science. Hess also talks about the three tiers of analytics, the “real heavy lifting” when it comes to data, and the exciting direction healthcare IT is taking.
- Merging 3 health systems — “It’s still a work in progress.”
- MU as a carrot
- Focus on telehealth, e-visits
- 3 areas of growth: construction, affiliation & acquisition
- Reflecting on the days of mainframe-based email
- Personalized care — “It’s a journey.”
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We ultimately used the IT systems and the IT strategic plan of integrating and optimizing common IT platforms to help bring the organization together.
That was the other cool thing about having that integrated Epic platform and then being able to take that to the other hospitals and doctors. The day you implement, you have a Meaningful Use stage 2 certified EHR and you have a lot of those workflows, best practices, and reports that you need to have to actually attest to Meaningful Use already there.
The growth strategy — new construction, affiliation and acquisition — very much is part of our future, and although we’re fairly large, we do need to get larger and have even a bigger footprint to really make population health and the new world of value-based contracting successful.
It’s going to be a journey, and there are probably going to be many, many years before we can really get to that precision-based personalized care, but a lot of the foundation is in place, and now we’re figuring out how to actually make it work.
What gets me out of bed — what takes my head off the pillow — is actually picturing that day when we’re actually saving somebody’s life through the use of informatics.
Gamble: I wanted to talk a little bit about the merger — and actually, I’m not sure if that’s the right terminology for when the systems joined together to form UCHealth. But how did you approach different organizations coming together, and what did it take to try to create that shared culture instead of having two or three different ones?
Hess: I think it’s still very much a work in progress. We’re still very young. When you take a step back and look at UCHealth, we’re still very young and we’re still maturing, and so, again, it’s not perfect by any stretch. What’s interesting and exciting was that we actually used IT to help bring the system together. So to get cardiologists to talk between the academic medical center and the community hospitals is not easy; it’s not easy by any stretch. To get cancer docs or primary care docs to talk is a little bit easier because of the way patients flow between primary and secondary and tertiary care settings. But we ultimately used the IT systems and the IT strategic plan of integrating and optimizing common IT platforms to help bring the organization together.
Three and a half years into this, we’re still not perfect. I would say that there’s still not one organizational culture. There are a couple of cultures that we’re still trying to bring together and really get to the next level, but it’s been an amazing three and a half years. And having IT and the IT plan to bring all of the systems together not only saved a ton of money from collapsing systems and getting rid of legacy systems and so on, but also has created a foundation for patients to have seamless experience across the care settings, for doctors to be able to help each other out, for telehealth capabilities to be able to take care of patients in remote locations — all of that is through having IT in the middle of that integration. It’s been extremely hard and it’s been challenging, but it’s also been extremely exciting and rewarding.
Gamble: Yes, it really is fairly new. I don’t know if it made it more challenging or not with the timing with Meaningful Use, but maybe it’s something where that was the backdrop and you just kind of proceeded on?
Hess: We’ve always looked at Meaningful Use as kind of a double-edged sword. We never did the integrated EHR because of Meaningful Use. We never said okay, we’re collapsing 26 systems to a single Epic instance because of Meaningful Use. Meaningful Use, in our minds, came along for the ride. We’ve been very successful with it, not only with the hospitals but with the eligible providers. And that was the other cool thing about having that integrated Epic platform and then being able to take that to the other hospitals and other doctors. The day you implement, the reality is you have a Meaningful Use stage 2 certified EHR and you have a lot of those workflows, best practices, all the reports that you need to have to actually attest to Meaningful Use already there.
We went live with Memorial Hospital in November 2013 and they were ready to attest by February. So literally within 90 days of implementation, they were already ready to attest for Meaningful Use. That’s how solid what was already in place was. So again, we’ve always looked at Meaningful Use as more of a kind of a carrot. We really never looked at it as just the reason we’re doing things. It came along for the ride, and we’ve been pretty successful with it.
Gamble: Moving forward, I imagine that there’s a lot of things that you’re focusing on, many of which you’ve mentioned, but in terms of being able to engage with patients, is that something that you’re really kind of focusing on a lot going forward?
Hess: Absolutely. And I think that the whole concept of telehealth and e-visits is something that we really have to get better at. The reimbursement models, the policies — all of those things are kind of triangulating toward successful capabilities to implement telehealth. So a big focus on population health and telehealth, because there’s lots of overlap in terms of how to watch over patient populations that aren’t in necessarily your traditional care settings, your physical walls.
We’re very much focused on growth and affiliation using IT as a tool in the toolbox. We have three areas of growth. The first is new construction. We’re building a new hospital and we’re building some more ambulatory locations. We have affiliations, so we’re affiliating with a standalone ED company to have standalone EDs across the Colorado footprint. And then we’re acquiring folks as well.
So the growth strategy — new construction, affiliation and acquisition — very much is part of our future, and although we’re fairly large, we do need to get larger and have even a bigger footprint to really make population health and the new world of value-based contracting successful.
So growth, in addition to analytics, population health, advanced CDS, telehealth — those are really our big focuses. It’s almost like the foundation of EHR, it’s never done, but it’s there; the foundation’s there. Now we’re trying to optimize it and make it better and more efficient for the docs. And we’re really trying to use it for population health, use it for telehealth, use it for advanced analytics, use it for affiliations, etc.
Gamble: You mentioned earlier that between this role and some of the past roles you’ve had, you’ve been in this industry for a while, so I’m sure it’s interesting for you to look back and see how things have changed. Twenty, 10, or 5 years ago, these weren’t the kinds of things that were on the CIO’s list of priorities.
Hess: No, and I got into healthcare IT back in 1991. At that point, we had PCs that didn’t even have hard drives. The big focus back then was lab and radiology systems and mainframe revenue cycle systems. Email was just becoming a tool. I remember the email back in 1991 was actually a mainframe-based email. The CIO’s role was very much around networks and data centers, and everybody was proud of the number of servers or the mainframe that was in their data center. And then obviously the world started turning to more of the clinical systems and the EHR and order entry and PACS, and now it’s really about using all of that; using all those investments to really change the way we deliver care.
So it’s all about transformations, all about the banking industry going from physical banks to ATMs to everything being done on your mobile device. That’s the same kind of trajectory that we are on with healthcare. Obviously we’re patients; we’re people. We’re not widgets, we’re not financial transactions. That’s what makes healthcare and healthcare IT so awesome, that every single person is different, but it’s being able to use these systems to actually change the way we deliver care. I want to be part of a health system where one of our patients walks into our ED and we’re able to look at their genetics. We’re able to look at them from the perspective of a person — not as a problem and not as a diagnosis — and really take care of them as an individual based upon their biomarkers, based upon how they reacted to medications in the past, based upon their allergies, based upon their desires in terms of how they want to be taken care of. That’s what we have the ability to do with healthcare IT today. And again, it’s not perfect. It’s going to be a journey, and there are probably going to be many, many years before we can really get to that precision-based personalized care, but a lot of the foundation is in place or is being put in place, and now we’re figuring out how to actually make it work.
Healthcare is so interesting because if we think about the customers we have, we have many, many different customers, some with aligned goals and some with misaligned goals. Obviously, we have the consumers and we have the patients. We have the payers, and we have doctors or other care providers. All those are customers of ours, all again with mostly aligned goals, but sometimes misaligned goals. That’s what makes healthcare and healthcare IT so challenging, but also so exciting and rewarding.
Gamble: When you see some of these things slowly start to come to fruition with talking about personalizing medicine, that has to be a really exciting thing.
Hess: Absolutely, and that’s what’s so great about being part of an academic medical center as well. There is a huge research mission; we have brilliant scientists and doctors every day coming up with new ways of treating patients based upon biomarkers or based upon other factors — environmental or clinical, and being able to tap into that research and that research informatics infrastructure, and then being able to loop it back into that transactional electronic health record. That is the Holy Grail, and that’s what we’re all trying to pursue. We’re probably still years away from that, but we’re not decades away from that, and that’s what’s so valuable. There will be a day when we actually can make a difference to that individual based upon what we know about that individual. And no matter where they actually enter the UCHealth System, we’ll see that and be able to actually take care of them as a person rather than, again, a diagnosis.
Gamble: That’s great. It’s cool for me when I talk to somebody and I can really hear that passion coming through, and I imagine that you really do have to have that with a role that sometimes can get really difficult with so many things to juggle. That’s not always the easiest thing, I’m sure.
Hess: No, but that’s what gets me out of bed. And you still have to deal with the network; you still have to deal with the data center and figure out what we actually should have on premises versus in the cloud. And obviously information security underlines everything that we do — we have to deal with all the bad guys that are out there.
But what gets me out of bed — what takes my head off the pillow — is actually picturing that day when we’re actually saving somebody’s life through the use of informatics, the use of these tools; the information being predictive to actually help the process be more efficient or seamless. Bringing a new life into the world from an L&D perspective or saving somebody’s life or extending somebody’s life from a cancer diagnosis perspective and using all these tools and all the processes, that’s so exciting.
I think there are a lot of people in my team here in IT that could go work for another vertical. They could go work for another industry. They could go work for Microsoft, they could go work for Google, they could work for almost anybody across this country or the world, but they choose to work for a healthcare system and there’s usually always a meaningful story behind the decisions they made to get into healthcare IT. Just like with myself, it’s because you’re talking about people. Whether it’s a family member or just a stranger, you’re taking care of people, and that’s what’s different about healthcare.
Gamble: It seems like you’ve kind of found a home in Colorado, like you’re in the right place.
Hess: Absolutely. It’s a really interesting place because in Colorado, obviously there’s a lot of population around Denver and in Fort Collins and Colorado Springs, but if you go east and west, there a lot of rural locations, a lot of critical access hospitals, and a lot of hospitals with 25 beds. And so part of what we’re doing right now is taking advantage of what we’ve already built and being able to extend that some of these other care settings. We have doctors who are going to remote parts of Colorado to take care of patients. We have doctors going to Nebraska or New Mexico or Montana to take care of patients. Enabling tools like telehealth, like population health, like these common EHR platforms really makes their jobs easier in taking care of those patients. And if the patient does need to travel to a cancer center or to subspecialist takes care of a disease, they can, and we enable some of that capability.
That’s what’s so exciting. And unlike the mid-Atlantic region where there’s a lot denser populations along the New York, Philadelphia, Baltimore, DC corridor, Colorado is just very different from that perspective. There’s a lot more opportunity for rural health outreach and telehealth, those types of things.
Gamble: Yeah, definitely. I know all about the densely populated area out here. Well, it sounds like the organization is really doing some great work, and I really appreciate you taking some time to share your thoughts because I think that that’s another thing that makes this industry what it is right now, is the willingness to share and talk about the challenges, and that’s really appreciated.
Gamble: Thank you so much. I’ve really enjoyed speaking with you and hope to catch up with you again down the road.
Hess: Kate, a pleasure talking to you as well.
Gamble: Thank you, Steve.