One component that cannot be overlooked when planning a project? The need for agility, according to Matthew Kull, who says that when Parkland Hospital’s newly opened campus was designed 7 years ago, the strategy was to build a platform to support technology — but defer decisions on which devices would be implemented. It’s this kind of decision-making (which may have avoided having a hospital full of BlackBerries) that has made Parkland one of the most respected hospitals in the country. In this interview, Kull talks about the organization’s strategy to move away from customization, how his team tests technologies in mock environments, and their big plans with big data.
- Testing technology in a mock environment
- IT’s objective “to be as invisible to our patients as possible.”
- $1.3 billion hospital development project
- “It’s the biggest thing I’ve ever done.”
- Key to big projects: “Talk to as many people as you can.”
- Eyeing predictive analytics
- Learning from the vendor & consulting worlds
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Since we had some idea of how these technologies were going to work, and how they were going to interoperate together in the mock environment, it eliminated a lot of the guessing.
Talk to as many people as you can who have done projects like this. We all like to share our story to help people avoid some of the problems that we encountered. But I think having a truly good understanding of scope and making sure that everyone comes to the table early to talk about what needs to be accomplished is critical.
We believe that information truly is going to be the key to better outcomes, and so we’re investing heavily in various technologies to allow people within our organization to have not only access to information, where appropriate, but to be able to really dive in and ask meaningful questions of the data.
What we’re finding is that the continuum of any of our patients’ care is so much bigger than just the information we have in the EMR. We’re trying to tap into things like social determinants and where else they’re getting care, and looking at non-traditional points of care to serve some of our most in-need patients.
Gamble: In planning for all of this, did you and the other executive leaders talk to people at other organizations or do site visits or how did you kind of get a picture of what things might look like?
Kull: We certainly did a lot of site visits. We had a mockup environment that was an exact replication of a number of areas in the hospital, whether it would be a hospital room, physician work rooms, or the OR. There was an offsite facility that was largely an identical replica of significant portions of the hospital, scaled down, where we had vendors come in and bring their different technologies so that we could do day-in-the-life studies of how these technologies were going to interact with actual usage. It wasn’t limited to technology; we tested lighting systems for the operating rooms. We had a lot of different vendors come in and show what was available to us, and we actually got to select them by, to some degree, mock-using them in true-to-life scenarios.
Gamble: Interesting. Did that turn out to be pretty accurate for how things went once the hospital was live?
Kull: It really was. Since we had some idea of how these technologies were going to work, and how they were going to interoperate together in the mock environment, it certainly eliminated a lot of the guessing. And on the day we went live, it wasn’t the first time we saw a lot of these things.
When we opened the new building, we did not stage the go-live. We picked a day and we started rolling people across from the old hospital to the new hospital. And the technology systems, as well as all operating systems, were intended to be ready to go on that day.
We spent a number of months in preparation doing day-in-the-life scenarios. We had New Parkland Fridays where we would staff the new hospital and have people walk through and test their badges and make sure they had access where they needed to go. We also did supply drills and ran through all of the technologies from patient monitors to all of our very new and comprehensive mobile platforms.
Gamble: If you had to do it again, would you do it the same way?
Kull: I would. Frankly, our main objective was to be as invisible to our patients as possible to make their move as easy and as comfortable as possible. We have patients with all different levels of acuity, and truthfully, the patient’s comfort and the patient’s well-being was our primary focus. We built the deployment and the go-live plan around that, and I don’t think there would have been a more effective way of keeping our patients comfortable than the speed at which we moved everyone across and got them settled in to their new place of care.
Gamble: With some of the technologies that were deployed in the new hospital, what was the level of engagement by executive leadership in development plans? Did you work with vendors a fair amount to make sure that the technology would meet the needs of clinicians and patients and make for a smooth transition?
Kull: We certainly did. And not only did we have participation from the leaders throughout our organization — our clinical and operational leaders — but we also had buy-in from executive leaders at organizations that are partners in deploying the various technologies, as well as the technology manufacturers themselves.
One of the things that was unique about Parkland was the sheer size of the project. When you look at it, it was a $1.3 billion hospital development project. A lot of people had truly never had an opportunity to work on something so large, and so that in and of itself certainly gained a lot of attention. But we were also working in conjunction with several large hardware and software vendors to develop technologies that frankly had never been brought to market until the opening of the new Parkland campus. Working on a lot of these emerging technologies, new development initiatives, and partnerships with very large well-known software and hardware vendors was really exciting. And the visibility, the attention, and the participation we received not only from our executive and line-level staff, but from the vendors as well, was a very positive experience for Parkland as well as now our patients in using all of these great technologies that we brought to bear.
Gamble: That sounds like a really great opportunity for leaders to have.
Kull: It’s the biggest thing that I have ever done and probably ever will. It was very, very fulfilling to work on such a project, especially with such a great team of people that we have here in Parkland.
Gamble: Is there any advice or best practices you might offer for others who are going to be in the similar position of opening a new hospital?
Kull: Talk to as many people as you can who have done projects like this. We all like to share our story to help people avoid some of the problems that we encountered. But I think having a truly good understanding of scope and making sure that everyone comes to the table early to talk about what needs to be accomplished and then focus on those things is critical.
The volume of change requests right before go-live can be overwhelming to a project. In our case, we applied very good change control and scope control methods, and I think that’s what made our go-live as smooth as it was. In terms of managing change and managing the perceptions around what all of the constituents feel that they will need prior to actually putting foot on a project like this, it’s better to keep some of those reserved until we have a chance to operate and function in a new facility like this, and then make decisions based on what we know, as opposed to what we’re trying to predict.
Gamble: Good advice. You mentioned that you’ve recently upgraded to the new version of Epic. What are some of the other really big focuses right now from an IT standpoint?
Kull: We’re very focused on predictive analytics. We’re focused on some of the new opportunities for machine learning and data science that Epic is bringing to bear in its next release. We continue to build out what is our self-service analytics capability. We believe that information truly is going to be the key to better outcomes, and so we’re investing heavily in various technologies to allow people within our organization to have not only access to information, where appropriate, but to be able to really dive in and ask meaningful questions of the data that we hold in our repositories.
As an early adopter of Epic and other health technologies, we are quickly working on consolidation. We’re trying, where possible, to eliminate some of the once upon a time, best-of-breed applications and work to consolidate with some of our bigger partners on solutions that are more holistic and enterprise-wide. And then as always in the public health spectrum, we’re looking for new and unique ways to apply our care resources to the growing demand for healthcare in our population.
Gamble: When you talk about the idea of leveraging data for better outcomes, it’s such a big concept that it seems like it has to be tackled in pieces and looked at as a long-term strategy.
Kull: I would agree with that. When you look at it in little pieces, I think for a long time that was the approach — trying to eat the elephant one bite at a time, but what we’re finding is that the continuum of any of our patients’ care is so much bigger than just the information we have in the EMR. We’re really trying to tap into things like social determinants and where else they’re getting care, and looking at non-traditional points of care to serve some of our most in-need patients.
We also are looking at prescription fulfillment history outside of our environment. As we know, people who are compliant and persistent with their medications tend to have better outcomes. We have large scale diabetes management and large scale cancer and oncology management to try and keep people healthy.
There are a number of public outreach types of initiatives that we’re focusing on, and at the core of them, we’re utilizing our data to determine where is the best place to apply these outreach programs, and then also what factors and what determinants are relative to the outcome that our patients may have as a result of some of these interventions. I think that looking at a patient more longitudinally from a data perspective is really what’s going to be able to start to drive some of the predictors — not just about their health conditions, but how to achieve the best outcomes.
Gamble: It’s really interesting; these concepts have been talked about for so long, and now to see organizations moving closer to that goal is really exciting.
Kull: We are very excited about the work that we’re doing here. I’m fortunate to have a very amazing and committed team of people that are all incredibly focused on the mission of Parkland, of bringing care to Dallas County patients who are most in need.
Gamble: The last thing I wanted to ask was about your career path and the previous experience you had before this role. I’m sure having spent time in both the vendor and consulting worlds has given you a unique perspective. Do you feel like you’re able to leverage that experience in this role?
Kull: I think so. I think that having a mix of public as well as for-profit experience has definitely served me well. When you can take for-profit-type constructs and apply them to public healthcare or public initiatives, you find ways to bring efficiencies. I think having had background in multiple industries has been helpful.
My eyes haven’t been on healthcare for my entire career — a large portion of it, but not all of it. And so, seeing the way other industries solve problems has definitely brought some intuition to this role in solving some of the problems that we have here as a hospital or some of the challenges or initiatives we want to move forward as a hospital. The learning experience of other industries has really been invaluable.
I think on a very personal level, there is something profound about public health. It is very fulfilling to know that we’re here to care for the people. We certainly are financially conscious. We have to be good stewards of our financial resources, but the main objective at Parkland is caring for people and helping those who are most in need, and it’s very personally fulfilling to be able to do this kind of work as a profession.
Gamble: Right. In talking with you, your passion comes through. That’s really great to see, and that’s exactly what I believe the industry needs right now. Really great stuff.
Kull: Thank you, that’s very nice of you to say.
Gamble: Sure. Well, I could definitely talk to you more, but I’m going to let you go. I know you have things to do, but thank you so much for your time, I really appreciate it and I think that our readers will benefit from hearing about the work you guys are doing.
Kull: Terrific. Thank you, I appreciate the time.