The reality of working in the IT department of a health system — which is often located in a different building or even a different section of town than the hospital — is that it’s easy to become “detached.” When you don’t see patients on a daily basis, it’s nearly impossible to understand how technology impacts their experience, and what can be done to improve it.
It’s precisely why one of Dr. Zafar Chaudry’s first priorities as CIO at Seattle Children’s was to invite caregivers to join the IT advisory committee. But he didn’t stop there; Dr. Chaudry’s team began holding quarterly educational sessions during which parents of patients share their stories to help convey the critical role all staff members play in providing quality care. Each time, it has left the team feeling “energized,” he says.
It’s just one example of how Dr. Chaudry is leveraging the diverse experience he has gained during his career to create a better environment. Recently, he spoke with healthsystemCIO about his team’s top priorities (including an Epic migration), why it’s so important to get the messaging right, and what it was like to go from England to the Pacific Northwest.
- Clinician-driven EHR selection
- “This is an operationally-led project. It’s not an IT-led project.”
- Importance of communication – “How do we give them a consistent message?”
- 643 systems
- Cost reduction: “Can we start turning applications off and retiring them?”
- Meeting user expectations
- Benefits of publicly-funded systems – “There’s a lot more sharing and collaboration than there is here.”
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We can’t continue to do things the same way that we do them now. We’ve had the Cerner system for almost 15 years. And it’s a great opportunity now for the clinical community to take a look at how we do things, and try to change some of those workflows.
As with any change, there’s a level of fear, because people are used to doing one thing, and then we’re trying to redirect their focus. But there’s a lot of energy as well to say, ‘This will be great for our patients.’
We’ll archive the data, of course, because we have to keep it. But at the same time, we don’t need to pay the maintenance. We don’t need to run data centers running those applications, and that will start to reduce our cost.
You don’t have to train anyone to use their Apple iPhone. They’re able to consume an application, and they’re able to download an update, and they’re able to use their device. Why can’t we have the same model in our enterprise?
We’re all duplicating the same function with more people and more cost, when actually, we could come together and have a shared service model, which would bring costs down. That’s what happens in these publicly-funded health systems.
Gamble: You seem to be an interesting position already having that familiarity with Epic. Does that have an impact on how the schedule will come together?
Chaudry: I think what’s quite interesting is when we talk to our clinical community — and this decision was driven purely by them — what you see is that 70 to 80 percent of the medical students that we’re training now have already touched Epic in some way, shape or form. And as we bring in residents, and super smart doctors come here from different parts of the country, most of them tell me, ‘I’ve used this system before in a previous life or a previous job.’ That will help with the training component, and also with familiarity to the system.
The challenge for us is we can’t continue to do things the same way that we do them now. We’ve had the Cerner system for almost 15 years. And it’s a great opportunity now for the clinical community to take a look at how we do things, and try to change some of those workflows.
This is the biggest transformation program the organization has undertaken in a really long time. People are energized because they feel like, ‘Wow, maybe I don’t have to take 17 steps to take care of a patient. Maybe I can do it in seven steps.’ That’s where I want the focus to be for this project.
And so, as I’m evangelizing this with the clinical communities, I’m minimizing the fact that this is all about technology. I’ve had huge support from the CEO and COO to say, ‘This is an operationally-led project. It’s not an IT-led project.’ But it’s easier for me to preach this because of my background — I started my journey as a physician. I know that talking to clinical groups does make it a lot easier if you focus on how it’s going to impact them versus, ‘here’s another cool piece of technology you can have in your hand, but might not be really useful for what you want to do.’
Gamble: Right. And even though the decision was clinician-driven, I’m sure it’s still going to present challenges, or at least take some time to adjust to different workflows. Are you able to draw from your experience as a clinician to set realistic expectations?
Chaudry: I think a lot of the success in a program like this is in how you communicate out to various stakeholder groups. I’ve been working with my associate CIO — who’s actually a pediatrician — and my chief medical information officer to hit all the committees and all the big groups that meet together, be it nursing or physicians, to evangelize what we’re trying to achieve.
The program itself has executive sponsors — I’m one of them, along with our chief clinical officer, who is responsible for all the clinical staff here at Children’s. We’re very much focused on how we get people engaged and how we keep giving them a consistent message. Of course, as with any change, there’s a level of fear, because people are used to doing one thing, and then we’re trying to redirect their focus. But there’s a lot of energy as well to say, ‘This will be great for our patients.’ And of course, you would expect physicians and nurses to focus on that too.
That’s the type of messaging I’m working on with colleagues to try and get them excited about the project and keep them energized. So, there isn’t a lot of talk about, ‘these are the tools you’ll get.’ It’s more, ‘how are we going to change the experience for the patient? How are we going to make the life of our clinicians more streamlined and easier? Because entering data at the bedside or having a one-on-one relationship with a mobile device when using a tool like Epic is very different than seeing a patient, typing in information or sitting in your office and having to dictate all these notes. It changes that whole persona of how you interact with the patient.
Gamble: You mentioned earlier that one of your goals is to bring IT costs down by 2 percent. I’m sure that’s not an easy thing to do. How are you approaching that?
Chaudry: When you look at IT departments in healthcare, most of them are suffering from what I describe as technological debt. Over the years you accumulate system after system — we’ve actually accumulated 642 systems over a period of time. When you go around and ask clinicians about a system they may have logged into and say, ‘Can we turn that system off?’ most will say, ‘no, you can never turn it off,’ even though they may have not logged into it for a year. What we’re doing is taking a look at those application stacks and taking a look at how we deliver what I would call commodity services. That can be anything from end-user computing, to datacenter services, to service desk provision. We have a $115 million operating expense budget, and 65 percent of it is spent on what I would call commodity services — things that people may not care about as clinicians, but do expect to function whilst doing their job. For example, ‘I want my laptop to work, but I don’t really care about my laptop. What I care about is can I do my job.’ And so we’re going to affect the change in cost by taking a look at that application stack and how we deliver those applications and asking, ‘Can we start turning off applications and retiring them? There’s a lot of legacy systems there — can we retire them? Can we turn them off? I can very easily see that 20 to 30 percent of those applications over a period of time will go away.
We’ll archive the data, of course, because we have to keep it. But at the same time, we don’t need to pay the maintenance. We don’t need to run data centers running those applications, and that will start to reduce our cost. We’ve got to shift the 65 percent spend down to probably about 50 percent. With the savings, we can give some back to the organization, and start investing more in innovation. We have a digital health group and a strong analytics group, and they’re playing in everything else that people are playing in. They’re doing predictive analytics. We’ve got a strong telemedicine program that’s spinning up. We’ve hired a whole bunch of data scientists to do AI algorithms to take a look at the data and see if it can be more accurate; whether we can make more data-driven decisions.
It’s about shifting some of that money while saving money, and we feel we would affect that by attacking those areas that I know the docs don’t care about, but do expect to work. The challenge is that the experience at home is better than the experience in the enterprise. Ten or 15 years ago, you had a dial-up connection at home, and you’d come to work and the connection would be a lot better, and you could consume storage and applications much faster. Now you’ve got smart physicians and nurses who have big clouds of data at home, have massive bandwidth into the internet, and can easily commission server or application with the swipe of a credit card. And then they come to the enterprise and we give them monolithic systems and make it difficult for them to consume things. It’s about shifting that model and providing more self-service, because that’s what people are used to. You don’t have to train anyone to use their Apple iPhone. They’re able to consume an application, and they’re able to download an update, and they’re able to use their device. Why can’t we have the same model in our enterprise where they can consume what they want, and therefore, I need less people and less focus on that because I’m using the skills that people already have?
Gamble: It makes a lot of sense. It reminds me of some of the lean philosophies where these aren’t terribly radical ideas, but it’s just a matter of incorporating them into your strategy and into the way that you do things as an organization.
Chaudry: Absolutely. The analogy I always use with my team is, all we really need to do is apply some common sense, but common sense typically isn’t common in healthcare. If we just did that, we’d make life easy for most people.
Gamble: Right. You said you’ve been with the organization for about 18 months. Previously you were with Cambridge University Hospitals, which is a large system. Can you talk about what it was like working in that type of environment, and what were some of your key takeaways from that role?
Chaudry: In my career, I’ve jumped around the world. I’ve probably worked in 20 different healthcare systems, and I’ve seen the difference between working in what you would call a predominantly publicly-funded health system versus the sort of hybrid mix we have. Children’s is about 50 percent funded by Medicaid and 50 percent by commercial insurers, so it’s sort of a hybrid. I’ve found that the publicly-funded healthcare model, whether it’s in the UK or Australia, where I’ve also worked, the focus is always on efficiency and productivity, while keeping an eye on quality. Where they impact that better than the United States is on what you would call back office function; so their finance, HR, and IT functions are much leaner in how they operate.
When you look at an organization’s revenue, the UK government tries to have a maximum spend of about 11 percent of all of those services; whereas if you look at the US, we’re at 8 percent of our revenue just for IT. So when you add the other services together, we’re way over that 11 percent metric. How do they do that? There’s a lot of sharing and collaboration and services in those health systems than there is here.
Seattle Children’s has a health IT group. The University of Washington has a health IT group. Providence has a health IT group. These are all health systems surrounding me, and yet we’re all duplicating the same function with more people and more cost, when actually, we could come together and have a shared service model, which would bring costs down. That’s what happens in these publicly-funded health systems; the government encourages collaboration, because they want to spend most of their money on clinical care, and money always is scarce if the government is paying for all the care and the patient has zero costs. So that’s certainly something I’ve seen as a major difference between the two systems.
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