Albert Oriol, CIO, Rady Children’s Hospital and Health Center, Chapter 2

Care redesign. It’s a concept that can mean different things to different organizations. At Rady Children’s, it goes far beyond cutting costs and improving workflows; it’s about leveraging genomics to enable early diagnoses. It’s about partnering with outside organizations to connect children to the right care providers. It’s about using tools like telemedicine to improve care in the most vulnerable patients. For Albert Oriol and his team, care redesign is at the core of everything they do.

Recently, healthsystemCIO.com spoke with Oriol about the projects his team is working on, the challenges they face from reimbursement standpoint, how they’ve made patient engagement a top priority, and why he believes “we’re just scratching the surface” with telemedicine. He also talks about how Rady has been able to align IT’s strategy with the organization’s overall goals, the advice he received from his mentor before taking on the CIO role, and the key to building a strong team.

Chapter 1

Chapter 2

• Telemedicine – “We’re only scratching the surface.”
• High adoption of MyChart
• Thoughts on MU: it wasn’t perfect, but it started the industry “on the path toward transformation”
• Working for Jim Turnbull – “He’s been a great mentor”
• Rady’s period of “tremendous growth”
• 4-part leadership strategy
• “It’s the people who make things happen.”

Bold Statements

With telemedicine, we’re only scratching the surface. I think it will continue to grow with the younger generations of parents who have grown up in the digital world, because the parents will demand it. This is a trend that’s not going to change.

Anything we can do to have them be more engaged and to have the care for their kids be more convenient, the more likely it is that they will follow through and stick to the regimens that are prescribed.

There have a been a lot of complaints about Meaningful Use and all the things that weren’t quite right with it, and certainly there were a number of them, but I think what it did was provide the impetus for the healthcare industry to come to grips with the 21st century and start that path toward transformation.

I can spot talent. And once the vision is set — and that means helping inform the larger organizational vision on how IT and information management can make a difference, in some cases can make the difference — the rest of the job is connecting the dots.

Gamble:  You mentioned a few of the ways in which we’re seeing digital really have an impact, one of which is telemedicine. What are you doing in this area?

Oriol:  We’ve got a number of initiatives there. We’ve been doing telemedicine to support the six NICUs we run remotely, as well as a couple of pediatric units in adult hospitals. They’re our licenses, our beds, our physicians, our nurses, our EHRs, but we acquire ancillary services from the host hospitals. And in the cases where these clinicians require consultations with attendings or other specialists, telemedicine is very, very useful.

We’ve also a used it in the EDs because we also run a pediatric component of an ED up in Murrieta. We use it to support palliative care, so when the San Diego Hospice dissolves, we took on the pediatric portion, and are able to now do this as homecare supported through telemedicine. We use it for a number of other chronic conditions, as well as for primary care and dermatology. We’ve been doing it for a while.

But with telemedicine, we’re only scratching the surface. I think it will continue to grow with the younger generations of parents who have grown up in the digital world, because the parents will demand it. This is a trend that’s not going to change. There are some things, obviously that will need to continue to be done in a physical manner, but when we see kids that drive from El Centro for a couple of hours each way to have a 20-minute visit with a pediatric sub-specialist, that’s costly to parents, and it’s disruptive. I think that in many cases, we’ll be able to take care of those types of events through telemedicine. Some of it is a matter of reimbursement, and so as we continue to work with other providers in the state and with state legislators to make those changes, I think we’ll see the adoption continue to grow.

 

Gamble:  Along similar lines, when you’re talking about patients and their families who are becoming more and more ingrained with technology in their lives, I’m sure it also shows in the ways that they’re engaging with your system and your providers.

Oriol:  Absolutely. We have a family advisory council that is very active and has been very helpful in giving us input on what’s the priority for families, and of course many of us have young kids and have our own set of expectations as well. They participate in our IPEG (informatics for patient engagement group), and it’s a very useful and symbiotic relationship that we have with them. And you are absolutely right that it’s an expectation that the world is moving in that direction, and anything we can do to have them be more engaged and to have the care for their kids be more convenient, the more likely it is that they will follow through and stick to the regimens that are prescribed. I think it’s a good thing that the world is opening our possibilities to do things differently. And in fact, it’s not just the patients and their families; it’s also newer, the younger providers who would also have that expectation as well.

 

Gamble:  Right. It’s a far cry from portals, which seemed to have a very specific method of engagement, to doing more to cater to the needs of patients, consumers, and families, in the way that they wish to connect.

Oriol:  Like many things these days, it’s become a matter of ‘and’ rather than ‘or.’ We still find portals to be useful. Obviously, we’ve needed to adopt our portals to make sure they function in a platform that is most used by our patients, which means a mobile platform.

Most people nowadays are accessing online resources more through their phones or tablets than their desktops, and so we’ve needed to make those changes. But in that regard, we’re seeing that almost half of our patients are active on MyChart, which has gone way faster than any of us would have anticipated. The same is true as far as exchanging records with other providers; since its inception about seven year ago, we’ve exchanged over two and a half million records. Altogether, I would say it’s been a pretty rapid growth in adoption across the board as far as this digital transformation that we’re seeing for now.

There have a been a lot of complaints about Meaningful Use and all the things that weren’t quite right with it, and certainly there were a number of them, but I think what it did was provide the impetus for the healthcare industry to come to grips with the 21st century and start that path toward transformation. Some of us had started it before, but I think the vast majority still had not or had a very slow start, and this kind of ignited it. And so in that regard, I think history will tell if it was very useful. I think it might have run its course, but that’s a whole different topic.

 

Gamble:  That’s a good perspective to have on Meaningful Use, because it’s easy to get caught up on where the challenges were, but it certainly did move the industry forward in terms of use of IT.

Oriol:  It sure did.

 

Gamble:  In terms of your history, you’ve been with the organization about 11 years, correct?

Oriol:  Yes, I arrived here in October of 2006. This was my first CIO role. I came from Children’s Hospital Colorado, which at that time was called Children’s Hospital Denver, where I was second in command in IT under Jim Turnbull [CIO, University of Utah Hospitals and Clinics). I worked for him for many years in Denver, and before that in Sarasota Memorial Hospital.

In 2006, we were about a year away from opening the new campus and I told him after that was finished, I thought it was time for me to branch out on my own and go be a CIO. And he said, ‘you know, you might want to look into that. With your first job, it’s important to do your homework and take your time. And it might take a few jobs before you find the right match. He was a great mentor to me, and still is, in fact.

As it turned out, that job was the right fit for me. Part of me felt bad because I took the job before we had moved into the new hospital, but we had a great team, and they handled it without a glitch. The fact that I wasn’t there was not a problem whatsoever, and it gave me the opportunity to work in an incredible that’s incredible. I’m really happy I made that choice.

 

Gamble:  I can imagine the fall of 2006 was a very interesting time with the industry on the cusp of so much change.

Oriol:  It sure was. I never thought I would last this long, to be honest. I thought it would be a three-year gig and then I would move on to do other bigger things, but the organization has seen tremendous growth. Our revenues have doubled in size in the 11 years I’ve been here and we’ve expanded tremendously.

There’s a vision that’s been shared as far as how we’re going to leverage technology to support that growth, and it’s just been an incredible organization to work with. My job’s been wonderful. I’ve worked for two great CEOs, Catherine Selleck who was here when I was hired, and then Donald Kerns, who’s been our CEO for the last four or five years.

I’ve been lucky that I was able to build a team almost from the ground up when I got here. We’re budgeted for 50 FTEs, but we’re operating at 37. At first, it was hard to retain folks. We now have over 200 people and my team was able to develop that leadership layer. I’ve been very lucky that I’ve been able to bring in those folks or develop them internally.

I have an awesome team. I’m not very good at many things, but I think I can spot talent. And once the vision is set — and that means helping inform the larger organizational vision on how IT and information management can make a difference, in some cases can make the difference — the rest of the job is connecting the dots for the team by helping them to see the larger picture and then removing obstacles in their way to get stuff done. So it’s about having a vision, connected the dots, listening to the team, and removing obstacles so that things get done.

 

Gamble:  It feels like your organization has been able to walk that line where it’s not about the IT strategy, but the organizational strategy, and that there’s collaboration among different teams and leaders to work toward that.

Oriol:  Yeah. I think we’ve been lucky that way and I think fairly early on we made the implementation of our EHR the big strategic initiative that the organization was taking on, in addition to building a new acute care pavilion. Those were the two main initiatives for about a three-year period, and that got all of the executive team working very closely together. I think it’s helped develop the relationships and the trust to integrate it that way so we don’t have to have a separate IT strategy. We have an organizational strategy, and IT, just like facilities or finance or whoever it might be, is a key part of the overall strategy. It’s all for one and one for all.

The other thing is that we’ve had a relatively stable team at the executive level. We’ve had some turnover, but we have a group of folks that work well together and respect one another and trust one another. That has been key, and that is true as well within the IT team. It’s really people who make things happen, and so having the right folks and the right chemistry makes all the difference.

 

Gamble:  Absolutely. Well, this has been great. It’s been so interesting to hear about what your organization is doing in terms of digital health, genomics, and really working toward the goal of care coordination. I want to thank you so much for your time.

Oriol:  It’s been a pleasure. Thank you for the opportunity to talk about what we’re doing. It’s very exciting, and I think it’s an amazing time to be in healthcare IT. We really do have a chance to help our organizations do things better and take better care of our patients.

 

Gamble:  Great. Thank you so much, and I hope to speak with you again in the future.

Oriol:  I’d like that.