As site CIO at Loma Linda University Health, Dan Howard’s goal is to strike the right balance between helping facilities meet their individual needs while ensuring that they align with the health system’s overall strategy: kind of like the old bumper sticker saying, ‘Think locally, act globally.’ Not an easy job, but one he hopes to accomplish, particularly as the industry transitions toward a value-based reimbursement model. In this interview, Howard talks about how Epic CareConnect is helping to position the organization for population health, why hospitals sometimes need to act more like a vendor, and how payer incentives are changing the game. Howard also talks about how he’s able to leverage his experience in project management, and the question CIOs should constantly be asking.
- About Loma Linda
- “Roving CIO role” working with partner hospitals
- Local vs global strategy
- “Interesting conversations” around IT governance
- Acting as a service provider with CareConnect — “It’s new territory, but we’re excited.”
- Helpdesk support during an EHR go-live — “That has definitely strained our resources.”
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There are some IT governance discussions about that — who owns the data, what do the workflows look like in terms of optimization, what can Loma Linda extend to that partner in terms of EMR instance, what is global to the whole shared single database, and then what also would be considered an optimization at a facility level?
For the most part, they are productive conversations. But Loma Linda has been pretty intentional about ensuring that globally, we all agree on the guidelines of what’s being offered, and so it is a shared collaborative as we try to build the clinically integrated network.
We’re almost turning into a vendor because now we’re beholden to these other organizations — we’re extending our version of Epic to them, but they’re also using us as a service provider. And so it is a little bit different situation, and it’s definitely new territory for Loma Linda, but we’re very excited about it.
There are a lot of things that we’ll be able to collect from a data perspective in terms of are we meeting our metrics, are we meeting our SLAs, what are the complaints that we’re hearing. All those will become lessons learned for future implementations.
Gamble: Hi Dan, thanks so much for taking some time to speak with us today.
Howard: Thank you, Kate. I appreciate it.
Gamble: Sure. So to give our readers and listeners some background, can you talk about Loma Linda University Health — what you have in terms of hospitals, things like that?
Howard: Yes, absolutely. Loma Linda University Health is located in Southern California. It is a six-hospital, faith based teaching institution with revenues in the six billion dollar range. But we have an adult acute care hospital, children’s hospital, a heart institute and two-multifaceted community hospitals, and we are the level one trauma center for the San Bernardino and Riverside Counties.
Gamble: And there’s a facility or a campus that opened recently?
Howard: We do have a Murrieta campus in Murrieta, California; which is about an hour south of the main campus, and that has been opened since 2012. That’s 106-bed community hospital.
Gamble: Okay. And in terms of your role, you’re a site CIO at a certain location? How does that work?
Howard: I’m a site CIO for the partner hospitals, and that comprises of one community healthcare district, which is San Gorgonio Memorial Hospital. And then I have a roving CIO role where I work with other partner hospitals who are CareConnect initiatives that we’re doing at Loma Linda currently.
Gamble: What are like the main things that fall under your purview as that site CIO?
Howard: Site CIO basically covers everything under IT infrastructure, telecom, health information management, revenue cycle services, and biomed and engineering.
Gamble: And the partner hospitals you talked about — are those outside of the organization?
Howard: Those are outside the organization or have an affiliation typically with our CareConnect platform, which is an extension of our Epic platform.
Gamble: Who do you actually report to?
Howard: I have several masters. For two of the partner hospitals, I report to the CFO and CEO, and within Loma Linda proper, I report to the corporate CIO.
Gamble: And that’s Mark Zirkelbach?
Gamble: How often are you in contact with him?
Howard: Relatively frequently, probably several times a month.
Gamble: Okay. And so obviously you have Epic — is that in all of the hospitals that are part of Loma Linda at this point?
Howard: No. Five of the main hospitals run Epic in inpatient and also on the ambulatory side. The partner hospital in San Gorgonio Memorial Healthcare District runs a version of McKesson, and our campus in Murrieta is on Cerner.
Gamble: Are there plans at this point for moving over?
Howard: Yes. Murrieta is a little bit of a different situation because that contract is in place for a few more years, so we’ll have to see. But for the San Gorgonio Memorial Healthcare district facility, we are actively engaging in pursuing an Epic implementation.
Gamble: So it’s in the very early stages at this point?
Howard: I’d say we’re at the RFP stage.
Gamble: Okay. In terms of the work you’re doing with the organizations that are also part of Epic CareConnect, what does that work mostly entail?
Howard: The majority of that work is a little bit more strategic in nature. It’s kind of upfront, so it’s basically looking at that organization and understanding what are the current systems they have, and then aligning that with the master document that we have. We’re basically saying, what are all your systems? What are you running from a Legacy perspective, and what would be replaced with an Epic instance through Loma Linda University Health? And so there are some IT governance discussions about that — who owns the data, what do the workflows look like in terms of optimization, what can Loma Linda extend to that partner in terms of EMR instance, what is global to the whole shared single database, and then what also would be considered an optimization at a facility level? And at that point, we’ll have discussions about specialized CPOE order sets or other things that a facility level might want outside of what the global EHR offers.
Gamble: I’m sure that those are interesting discussions when you talk about the governance and who owns the data. What have those discussions been like?
Howard: Interesting conversations. They bring up a lot of points. For the most part, they are productive conversations. But Loma Linda has been pretty intentional about ensuring that globally, we all agree on the guidelines of what’s being offered, and so it is a shared collaborative as we try to build the clinically integrated network. So everybody’s going to share in the ownership of that information. At a facility level, you’re talking about revenue, claims, billing — that’s going to be separate, and obviously it belongs to that entity.
Gamble: Okay. Is all of ambulatory for Loma Linda on Epic at this point?
Howard: Yes, all of Loma Linda’s ambulatory clinics are on Epic.
Gamble: How recent did this start as far as the organization-wide conversion?
Howard: The ambulatory conversion for Loma Linda and its affiliates went through several waves in the summer of 2011 and the fall of 2011 into 2012. And then Loma Linda did the big inpatient upgrade in early 2013.
Gamble: Now, as far as talking to the other hospitals about switching to Epic, did you really have to learn the system and really be able to talk about it and address their questions?
Howard: Yes, we had to learn relatively quickly. We’ve been very fortunate that our program director for our CareConnect initiatives was actually an individual that worked with Epic directly for many, many years. And so we were all to bring him on board. He has a lot of deep experience in terms of the Epic Community Connect initiatives, and so he has been an extremely valuable resource for us in terms of helping us interface and helping us for roadmap what this really looks like for the organization.
It has been a challenge for Loma Linda because we’re really treating ourselves as really a healthcare provider and institution. Now that we’re going through these CareConnect processes and we’ve already had two large organizations that we’ve taken live, we’re almost turning into a vendor because now we’re beholden to these other organizations — we’re extending our version of Epic to them, but they’re also using us as a service provider. And so it is a little bit different situation, and it’s definitely new territory for Loma Linda, but we’re very excited about it.
Gamble: That is a really interesting take, having to act in a vendor-type role. What are some of the challenges with that?
Howard: I think some of the challenges were probably yet to be seen. We went live with really our first big client back at the end of August, and I know our initial challenges are going to be resolving the call volumes. When things come in from the service desk based on the model we currently have, we’re taking all the inbound calls for that entire organization. So that has definitely strained our resources at Loma Linda. We’ve been proactive as much as possible to staff up in those situations, but there’s still a lot of unknowns. Talk to Mark Zirkelbach or someone else in a year from now and we’ll probably have a lot better idea of how well it’s working, but we’re really happy with it so far.
Gamble: So the interest is certainly there among the partner facilities?
Howard: Absolutely. It is.
Gamble: Okay. So as far as the Epic implementation that’s in the RFP stage right now, is the hope that the organization will be able to use some of these lessons learned and apply it to that?
Howard: Absolutely. From Loma Linda’s perspective, having two large organizations under the belt with going through go-lives — and we’re still in the first 90 days post go-live — there are a lot of things that we’ll be able to collect from a data perspective in terms of are we meeting our metrics, are we meeting our SLAs, what are the complaints that we’re hearing. All those will become lessons learned for future implementations.
From an organizational perspective, we’ve really templated it out. If we have an organization that’s a couple hundred bed facility, we have a cookie-cutter process because we’ve put all the time, effort, and diligence into those documents. And so it’s really a templated format where we can provide that, and then we can just reduplicate that process. So obviously anything we learn from our current go-lives then gets baked into the cake at the same time.