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.
- Rolling out Epic’s CareConnect to manage patients across the continuum
- Offering a mobile, “nimble” tool for patients
- Eye on predictive analytics
- Benefits of project management training
- 30,000-ft view versus “in the weeds”
- IS as a “value accelerator”
- Communicating with execs — “They’re looking for expert opinion and advice.”
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Pushing out CareConnect is helping because now we’re at least going to have the ability to look at that patient information, look at a single database, and see if they were seen at any of these other tertiary facilities, and that makes it easier for managing care across the continuum.
What we want to focus on initially is looking at comorbidities and disease registries and being able to look at statistics and determine where are our 30-day readmissions, what are we commonly seeing, and how quickly can we get in there with care coordinators and do interventions before that person shows back up to the ED.
It gives me a real foundation of understanding the basics of project management in terms of communication, but then being able to look at a project charter or looking at a stakeholder sheet and understand how that workflow goes through an organization and be able to keep individuals on task and make sure that things are delivered on time, within the scope, and within budget.
If you can come in there and easily explain to them in layman’s terms what the objectives are and show them from an infrastructure perspective or an IS perspective of how we can help you meet those goals and provide some structure to that and some priority around it, that makes our jobs a lot easier.
Gamble: What else are you really looking at right now as far as the really big initiatives?
Howard: I think for Loma Linda obviously population health is one of our biggest initiatives, and so doing our CareConnect initiatives is sort of meeting one of those metrics that we have. Within the San Bernardino-Riverside County, Inland Empire region that we serve, we have a large managed care HMO provider called IEHP, and there’s about 1.3 million lives at risk. Loma Linda sees a lot of those patients, and some of the partner hospitals we’ve been working with see the same demographic. And so pushing out CareConnect is helping with that population health because now we’re at least going to have the ability to look at that patient information, look at a single database, and see if they were seen at any of these other tertiary facilities, and that makes it easier for managing that care across the continuum, across these different organizations. That’s huge for us.
We are looking to do more with My Chart and Healthy Planet with Epic to be a little bit more proactive on the population health side and give patients the ability to take a little bit more ownership in their healthcare.
Gamble: Right. You mentioned the clinically integrated network, is that something that’s in place or kind of coming together?
Howard: It is coming together kind of really between Loma Linda, the IEHP bodies, and other partners and affiliates.
Gamble: In terms of the patient population, what type of initiatives do you have? You mentioned Healthy Planet — what are you seeing so far in terms of the interest?
Howard: I’d say the interest is there. We do get a lot of requests — and I hear this from multiple facilities — for mobility; mobile is the big thing. And so we’re trying to take what consumers or patients want from a consumer perspective in terms of having something that’s mobile and nimble that they can reach from a smartphone or a tablet. Having that information is definitely valuable, even from the perspective of something as simple as refilling a prescription or being able to book your appointment with your PCP, basic stuff like that. So we’re looking at how can we go to the next level beyond that. We’d love to say we are going to do predictive analytics — I think that’s still several years off, but that’s something that’s definitely on our radar.
Gamble: Right. And as far as the patient population, I imagine you have a good variety as far as what they prefer and what they’re looking for.
Howard: Yes. Among all of our partners and affiliates in the hospitals in Loma Linda, there there’s a large demographic of individuals that either have no insurance or are unfortunately underinsured. We see a lot of demographics, and so we are aware that those individuals lots of times don’t have access to as many devices as some people do in terms of access to their records, and so that’s one of the things that’s on our radar — how can we provide this information to individuals who maybe don’t have access to cellphones or tablets or a personal computer?
Gamble: Right. And as far as things like predictive analytics being in the future, I imagine a big piece of that is first completing the Epic conversion and then going from there.
Howard: Yeah. We could probably do some of it now, but it makes sense that as we have more individuals within our geographic area that are on the same Epic instance, the data that we’d be able to pull from that is obviously going to be much more valuable from a predictive standpoint. Obviously what we want to focus on initially is looking at the comorbidities and disease registries and being able to look at statistics and determine where are our 30-day readmissions, what are we commonly seeing, and how quickly can we get in there with care coordinators and try to do interventions before that person shows back up to the ED, or we can funnel them to their PCP in a timely fashion and let them know hey, these areas need to be addressed before they show up in the ED somewhere.
Gamble: Right. And that’s where as you alluded to, that those partnerships are really going to come into play down the road.
Howard: Absolutely. It’s a huge thing. And with IEHP being the large HMO Medi-Cal provider in the area, they’re incentivized to reduce what they’re paying out. So they’re very active in terms of working with Loma Linda and the other partner hospitals very directly in terms of coordination of care to make sure that there is proper follow-up with those patients post discharge.
Gamble: Interesting. Do you really notice more of the collaboration with the payers now than in the past?
Howard: Yes, and this particular payer has been very generous in terms of even incentivizing the organizations to meet certain metrics. And so, even though we’re not fully integrated on Epic with all the partners and other affiliates, they have put some incentive dollars on the table for essentially how much interoperability can we have in today’s state. In the future it’s going to be a little bit easier going forward as most of these organizations will be on Epic or an Epic instance, but what do we do today to get some of that? So they have been very helpful in assisting the organizations in getting the information they need.
Gamble: Right. Very interesting. So you’ve been at the organization in different roles over the years?
Howard: Yes. I came in from the clinical side. I was an RN for Loma Linda way back in the day, and then I left the organization and then came back in 2012 and had a few different roles before I landed in my current CIO role.
Gamble: And some of those roles, or at least one of them, involved project management, right?
Howard: Yes, it did.
Gamble: That’s really interesting to me. When I’ve spoken to people who have project management training, it really comes out. Can you talk about how that has helped impact your role now?
Howard: Absolutely. My previous job before Loma Linda was on the vendor side in healthcare but it was really on the revenue cycle side. But that business obviously was for-profit, and so it was very driven obviously by the bottom line. I ended up basically managing a large PMO, and so for me, coming from initially from healthcare and not being exposed to a whole lot of project management, you get used to just managing projects based on how good your organizational skills were. Way back in the day, I learned I had to really increase those skills relatively rapidly to satisfy people.
I’d say my PMI methodology has really been beneficial for me, even in the CIO role, because it gives me a real foundation of understanding the basics of project management in terms of communication, but then being able to look at a project charter or look at a stakeholder sheet and understand how that workflow goes through an organization, and be able to keep individuals on task and make sure that things are delivered on time, within the scope, and within budget.
If I didn’t have any formal PMP training, I think I would have only gotten so far, so it’s definitely been an asset for without a doubt. That is one of the certifications I do keep up. Every three years I have to do X number of hours of CEs. But without a doubt, I find it invaluable.
Gamble: I think that it would be pretty difficult to have the type of role you do right now without that training, just because of the amount of things on your plate and having to go through all that in a methodical way.
Howard: You’re right, absolutely right. And I’m really fortunate at my level. Mark [Zirkelbach] is the CIO for the entire enterprise and so he deals with things probably on a 30-thousand foot level. I’m fortunate enough to get involved with that, but I also have to be involved in smaller initiatives with a partner or a hospital, and that’s great because it I get to be involved into a little bit more of the operational day-to-day stuff. For me that’s very rewarding, and I’m able to bring some of those project management skills to that and it’s very helpful for me.
Gamble: Interesting. In talking about the role you have, one of the real evolutions we’ve seen with CIOs is more alignment with the business. What are some of your thoughts on that?
Howard: Within Loma Linda proper, we’re pretty intentional about doing our IS strategic plan and roadmap for the next few years — we’re actually going through it right now. We’re very intentional about looking at the organizational roadmap, their goals, and making sure that there is alignment there. And Loma Linda is a large organization, so there’s a lot of processes and workflows in place to do that.
Working with the partner organizations and entities has been valuable for me. And I’ll use San Gorgonio as an example — it’s a little bit smaller of an organization with not as much bureaucracy in place, not as much process in place. And so being able to come from Loma Linda and provide a little bit more insight in terms of what the executive team and the hospital board are doing and then being able to specifically come in from an IS perspective where there had no IS steering committee, and build that from the ground up and build in consensus and gates and stages for how work happens and what IS does. And so being able to take that and really make IS a value accelerator for the organization has been really exciting.
Gamble: Right. It’s something that really needs to happen with the changes we’re seeing in the industry.
Howard: Yes. What I hear typically from the executive teams and the boards is they talk at the very high 30 thousand foot level but they’re looking for easy solutions; they’re looking for expert opinion and advice. And if you can come in there and easily explain to them in layman’s terms what the objectives are and show them from an infrastructure perspective or an IS perspective of how we can help you meet those goals and provide some structure to that and some priority around it, that makes our jobs a lot easier.