Robin Sarkar, CIO, Lakeland Regional Health System, Chapter 1

When it comes to retaining top talent, many organizations are missing the point, says Robin Sarkar, who believes the key is to focus less on annual performance reviews and more on meaningful dialogue. What that means, says Lakeland Regional’s CIO, is asking questions that focus on where employees want to go and how leadership can help them get there. In this interview, he talks about how this strategy has helped strengthen his team, as well as the work they’re doing to bring data closer to the point of care and push population health forward. Sarkar also talks about why innovation can’t happen without failures, and what it was like coming to healthcare from the business world.

Chapter 1

• About Lakeland Regional
• Achieved HIMSS Stage 7 in 2013, recertified in 2016
• Being an “aggressive user” of Epic capabilities
• Focus on translating data into insights
• Using monitors to make information visible — “It’s helping us save lives.”
• “Two in a box”: integrating IT & clinical minds
• Extending pilots to ambulatory

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Our focus right now is on trying to move our EHR capabilities to the next level, which is to try and see how we can move more and more data to the point of care and make it visible and measurable.

A lot of information in healthcare, even for those who support our patients, is hidden in the system, locked up somewhere. You log in. You drill down a couple of times, you hunt and gather, and you figure it out.

Our physicians and nursing teams are starting to huddle around these boards. It’s a very visible, visual, and simple way of bringing our EHR and our vital signs information right in front of the providers in an interesting way.

Like two in a box, they work together. The clinical partner says, ‘What’s the information that would really help the clinical teams drive patient safety and better patient outcomes?’ Then the IT teams work to try to provide that system in the best visual way possible.

Gamble:  Hi Robin, thank you so much for taking some time to speak with us today.

Sarkar:  Thank you, Kate. It’s a pleasure.

Gamble:  I think the best way to start would be to get some basic information about Lakeland Health — what you have in terms of number of beds, ambulatory clinics, and where you’re located.

Sarkar:  Lakeland Health is located in Southwest Michigan. We are a three-hospital system with 400 beds and approximately 4,500 employees. Even though we are a smaller health system, we do have a lot of importance placed on technology and leveraging technology in order to make it best use for our patients and providers.

Gamble:  And you’re an Epic user in the hospitals?

Sarkar:  Yes. Our core EHR is Epic and we’ve been on Epic since 2012. We were also rapidly moved to HIMSS Stage 7 in 2013, and at the end of 2016, we were recertified at HIMSS Stage 7 for another three years.

Gamble:  What does the process of getting recertified entail?

Sarkar:  That’s a great question. HIMSS Stage 7, to keep it simple, is leveraging health IT to a high extent for the benefit of our patients and providers. I would say it’s representative, to a certain extent, of a paperless health system, leveraging technology as much as possible. When you first get certified, there are evaluators who come onsite and make sure that you’re meeting all the standards, which we met in 2013.

In the last three years, they’ve upgraded their standards. HIMSS continuously looks at and evaluates this, and they upgraded their standards in 2016 in a number of areas; blood administration is one example. Again, they come on site and do a rigorous site visit and have various documentation which we provide to make sure that we are continuing to meet the highest standards of HIMSS Stage 7.

Gamble:  As far as getting that recertification, did you see that as a validation of the work the organization is doing to keep the patient at the center of care?

Sarkar:  Yes. We do look at these as both a validation and a learning experience. A couple of years ago, we received the HIMSS Davies award, which is given to three or four health systems across the world for leveraging health IT. We also participate and have received the Most Wired award in 2015 and 2016, and we look at these in two ways. Number one, it’s a recognition of the work which we continue to do and the emphasis we place on technology, but more importantly, we look at this as a benchmark and an opportunity to learn from our fellow health systems and what are they doing which we can learn from.

Gamble:  Okay. Now, you said Epic has been in place in the hospitals since 2012. In terms of the focus right now, is optimization what you’re looking at?

Sarkar:  Yes. We have had Epic for a number of years. We have Epic embedded in our health system as the operating engine of our health IT. And we are one of the health systems which has leveraged a large number of Epic modules — not just the basic modules, but even the oncology module, the population health module, and the home care module. We are an aggressive user of our Epic capabilities.

I think our focus right now is on trying to move our EHR capabilities to the next level, which is to try and see how we can move more and more EHR data to the point of care and make it visible and measurable. We have a couple of exciting initiatives which I can speak about in terms of bringing information closer to the point of care. The second point is, how can we get the EHR data and translate that into insight and wisdom and action so that Epic doesn’t become for our providers a black box but its information is visible and measurable.

Gamble:  Can you talk about some of the initiatives focused on moving data to the point of care?

Sarkar:  Sure. We have a few really exciting initiatives, one we really looked at as an analogy to the airline industry. A lot of information in healthcare, even for those who support our patients, is hidden in the system, locked up somewhere. You log in. You drill down a couple of times, you hunt and gather, and you figure it out. But if you look at the airline industry, you go to the airport. You see a large, electronic board, and you know this is your flight to New York. It’s at Gate D17 and it’s on time. You’re able, as a customer, to quickly get the information which you need.

Using the same analogy, we’ve put in a large, electronic board with vital signs, and EHR information, with patient room numbers in one row and nurses’ name on the other so we have that element of confidentiality. All of the key metrics are color-coded on the screen, and this is in a secure location available to nurses and physicians. At one glance, you can take a look at see if the patient is having any deteriorating signs for alert, or if a specific area needs attention.

And these are large touchscreen monitors. If you click a patient name, it immediately drills down to the patient’s chart. You can click something else and find out how the blood pressure has been going for the last 24 hours, or find a test result you want to see. We’re finding our physicians and nursing teams are starting to huddle around these boards. It’s a very visible, visual, and simple way of bringing our EHR and our vital signs information right in front of the providers in an interesting way. This is being rapidly rolled out through our hospitals and is proving very beneficial and is helping us to save lives.

Gamble:  Right. I can see how something that could definitely speak to increasing efficiency and improving workflow, which is really the goal of probably every project that you have.

Sarkar:  Absolutely. Also, it helps us to ensure that if there’s a particular metric which is continuously red, it helps us to understand what’s going wrong, why is this metric continuously red for all the nurses? Everybody can’t be doing something wrong. It’s a great way to make sure that we continue to provide exemplary patient care in our facilities.

Gamble:  Right. What was the impetus for this — was it something the clinicians asked for? How does that process go as far as how you decide to display the information?

Sarkar:  This is another area which I think Lakeland excels in, and that’s our clinical collaboration approach. The way we work these projects is pretty much two in a box. We don’t work these as IT projects; we work them as clinical projects. What we’re trying to do, sometimes successfully, is try and integrate the clinical mind with the IT mind. And so we try to have a clinical partner.

In this case, it was a charge nurse on the floor with an IT analyst. And so, like two in a box, they work together. The clinical partner says, ‘What’s the information that would really help the clinical teams drive patient safety and better patient outcomes?’ Then the IT teams work to try to provide that system in the best visual way possible. And the only reason why we’ve really been able to succeed in this is with clinical collaboration.

And this is a project in which the cost us literally zero. We had an in-house IT analyst working with one of our charge nurses on the floor initially when we developed it, and the subsequent rollouts have been the same thing. And we just repurposed a few monitors that were flashing information which was not really relevant, so a literally minimal cost for a health system using the standard Epic monitor capabilities which were existing already.

Gamble:  Right. That’s another pretty significant benefit especially since, as you know, the costs are always an issue especially with so many priorities on the plate and so many areas that are in need.

Sarkar:  Absolutely, yes.

Gamble:  Okay, and that’s being rolled out now. Was it a pilot at one point and now it’s being rolled out more widespread?

Sarkar:  That is correct. We first rolled it out in one floor as a pilot. The pilot went through many iterations, but we had a rapid deployment. The pilot finished in six weeks and now, we are rolling it out floor by floor in our ortho/neuro units or surgical. Floor by floor, we’re rolling it out.

Gamble:  Are there plans for future similar initiatives in terms of using things you already have to try to improve workflows and efficiencies?

Sarkar:  Yes, absolutely. Another similar initiative we have in terms of providing information to the point of care is in our outpatient area. We also support 30 to 35 clinics, and we observed that when a physician comes in to work in the morning at 7 or 8 a.m., the physician had to do a lot of hunting and gathering. Who am I seeing today? Who’s critical? Physicians were taking some time to get started and gather his or her mind around who are the patients and who needs more attention and who needs less attention.

We have a similar initiative to support physician at the clinics, so that the physician can get started with his or her week or day as fast as possible, and again, doesn’t have to hunt and gather for information. We have one initiative on the inpatient side and another initiative on the outpatient side.

Chapter 2