Q&A with CIO Tom Barnett, Part 1: “It’s Not Always About Technology.”

There’s nothing “easy” about being a healthcare IT leader. But what many have begun to realize is that implementing the actual software that’s meant to change the game was the “easier” part. What has proven more difficult, of course, is the operationalization phase.

Now, it’s about taking the next step: “How do you innovate? What slice of your time or your team’s bandwidth can you put toward that?” Like many CIOs, Tom Barnett is dealing with these precise questions. And although there are no simple answers, there are ways to begin to focus more on transformation itself, and less on the building blocks.

Recently, healthsystemCIO spoke with Barnett about how his team at University of Rochester Medical Center is approaching their core objectives, how they’re organizing teams while maintaining collaboration, and the challenge of prioritization. He also talks about what he learned from previous roles, and what it takes to get IT to the table – really.

Chapter 1

• URMC’s 3-fold mission: clinical, research & medical school
• Multi-year plan to convert affiliate hospitals to Epic
• “We have a variety of strategies for being able to connect & deliver results.”
• Big-bang, go-live of Epic RCM
• The “long and sometimes complicated” optimization phase
• McDonald’s philosophy – “To me, that’s the essence of optimization.”
• Working toward a consolidated EDW
• Creating an ITSM – “We can make sure we’re working on the right things.”

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Bold Statements

It was ensuring we paid attention to the provider experience. That comes with any EMR, but particularly with Epic, where once you get it deployed, there’s a long and sometimes complicated optimization phase.

What was really important was having people who understood how an ambulatory office works, how a physician works, and why something needs to be done.

To me, that’s the essence of optimization, because it’s not always technology; it’s workflow as well. There are lean principles and streamlining tools that can be brought to bear so that the technology supports and optimizes workflow as opposed to the technology trying to drive workflow.

We want to make sure we get everybody’s point of view so we can build an architecture and a plan that will get the medical center where it needs to be.

There were core fundamental and foundational processes and operational considerations that we needed within IT, such as establishing and growing a project management office, and being able to keep track of our in-flight projects.

Gamble:  Hi Tom, let’s start with some information about University of Rochester Medical Center. Can you provide a high-level overview?

Barnett:  The University of Rochester Medical Center is located in Rochester, which is in the western New York region. We’re about equidistant between Buffalo to the west and Syracuse to the east. They’re both about an hour away from us. The medical center itself is part of the University of Rochester. What’s interesting is, the way it’s structured, there’s really a three-fold mission on behalf of the medical center. The first mission, clinical operations, is anchored by our academic flagship, Strong Memorial Hospital, which is an 850-bed teaching hospital. We also have five community hospitals: Highland, Thompson, Jones Memorial, Noyes, and St. James, which cover the southern region. Rochester is in the north part of the state — not that far from Lake Ontario, actually. Our Southern Tier includes some of the smaller and critical access hospitals, and that extends all the way to the Pennsylvania border.

We also have a medical group, as well as employed physicians. There are about 950 physicians in the University of Rochester Medical Faculty Group; they work out of 250 ambulatory sites which are spread over a 74-square mile area. That reaches toward the outer bands of Buffalo and toward Syracuse as well. And so, from a clinical operations perspective, that’s one leg of the three-legged mission.

We also have a very active research community; our UR Health Research center has about 850 researchers, and we have a number of translational studies that are funded either through grants or privately.

The third leg is our medical school. The School of Medicine and Dentistry, the School of Nursing, the UR Clinical and Translational Science Institute, and the Eastman Institute for Oral Health are all under the URMC umbrella. From that perspective, Dr. Mark Taubman, who is CEO of URMC and UR Medicine, is also dean for the schools of medicine, nursing, and dentistry.

From a resident perspective, we train between 800 and 850 residents at any given point in time. It’s mostly handled as graduate education out of our School of Medicine but they work primarily — although not exclusively — out of Strong Memorial.

 

Gamble:  So there’s quite a lot going on, and you cover a very large geographic area, which I’m sure factors into your strategy.

Barnett:  Absolutely, especially from a physician connectivity perspective as we work toward achieve interoperability. University of Rochester Medical Center is an Epic shop. We’re working on a multi-year conversion plan to get our affiliated hospitals onto our Epic instance, and then we have separate strategies in place to deal with it on a broader scale. We have an affiliated health partner, which is our clinically-integrated network — that widens the net to north of 3,000 physicians with whom we work and do referrals. So, we have a variety of different strategies for being able to connect, as well as deliver results back to a multitude of different EMRs.

 

Gamble:  And you’ve been with the organization for about two and half years?

Barnett:  Yes. It’ll be three years this October.

 

Gamble:  When you came to University of Rochester Medical Center, was there a specific driver behind getting a new CIO in place? What was the circumstance there?

Barnett:  The CIO for whom I took over, had been here for just under 40 years. He did a lot of work to bring the IT department from the basement of Strong Memorial Hospital (as he tells it) to the organizational size it is today. When he first worked in the IT shop back in the 1970s, there were about 25 FTEs. Today, we are about 520.

 

Gamble:  Amazing. When you arrived, was the organization already using Epic? What was the status there?

Barnett:  Yes. University of Rochester Medical Center had made the decision to go Epic from a clinical perspective about eight years ago. They were already operating on that front. However, there was still a mix of different legacy billing systems, anything from HPOC to GE FlowCast, as well as some others. When I was recruited and joined the organization, they were in the midst of revenue cycle implementation within Epic. I was able to help lead that initiative. We did a big-bang go-live across our hospital settings and the entire ambulatory network the same day.

 

Gamble:  When did that happen?

Barnett:  That was March of 2018.

 

Gamble:  I imagine that was your immediate focus — or at least one of them — coming in to work through the planning and everything that had to happen.

Barnett:  Yes. When I came here, the CEO had a three-fold charge that he gave me in terms of his priorities. The first was to make sure we fully roll out Epic; obviously we were in the midst of doing the revenue cycle go-live, but it was also ensuring we paid attention to the provider experience. That comes with any EMR, but particularly with Epic, where once you get it deployed, there’s a long and sometimes complicated optimization phase. That was something we really needed to bring focus on for the medical center on behalf of those providers.

And so, from the Epic realm, it was getting the revenue cycle system fully deployed. Then, based on experiences I’ve been fortunate enough to be exposed to at previous health systems, we built an optimization team to work directly with providers. It was small at the beginning, then turned into a much larger effort. As part of that, we overhauled the IT governance that was in place here at the medical center as well.

The key was to create a provider council that could prioritize the number of opportunity points we had from an optimization perspective. We created a dedicated 10-person optimization team comprised of two training individuals, two lean process engineers, and six individuals with a non-IT background. They come from clinical and operational ranks where they were able to go get Epic certification. But what was really important was having people who understood how an ambulatory office works, how a physician works, and why something needs to be done.

This is a bit of a side journey, but my wife and I recently watched ‘the Founder’ with Michael Keaton, which provides some background into how Ray Kroc built McDonald’s. There’s one scene in there — and I’ve used this clip internally quite a bit — where Kroc is selling milkshake mixers, and one hamburger vendor was buying more equipment than anybody else. He went out to see what their secret was, and it turned out these two guys — the McDonald brothers from California — were getting burgers out faster than anybody he had ever seen. When he asked what their secret was, they said, ‘We shut down the entire restaurant one day, went out to a tennis court, drew the proportions and the exact dimensions of the kitchen, and walked the team through the process. We were looking at how can we reorganize this, how can we get the flow, and how can we reduce the time it take to make a fast-food hamburger from 30 minutes to 30 seconds?’ And they just hammered away at it at all day long.

To me, that’s the essence of optimization, because it’s not always technology; it’s workflow as well. There are lean principles and streamlining tools that can be brought to bear so that the technology supports and optimizes workflow as opposed to the technology trying to drive workflow. We’ve employed those principles within our optimization team, and have had several key wins. And the providers and physicians behind each of those wins are gaining more and more confidence, both as a team and on behalf of the providers. So that’s what we’re doing with Epic.

The second area the CEO asked that we look at was around the disparate databases and reporting approaches in place. It was clear we really needed a consolidated enterprise data warehouse. So, one of the first challenges that I undertook here was to work with a few external consulting firms to make sure we got our arms around it. Because it’s not just the medical center perspective we need; it’s the very specific, very unique, very complex needs of our research community, as well as the very unique, very complex, and very specific needs of our medical school community as well. We want to make sure we get everybody’s point of view so we can build an architecture and a plan that will get the medical center where it needs to be. We’ve started building and executing on that, starting with implementing Epic’s Caboodle platform, and then looking to custom-build based on our unique needs, whether it’s in the research space or the medical school space.

 

Gamble:  You mentioned customization. It seems like that’s not always an option, especially when it comes to Epic. How did you work through that?

Barnett:  We’re actually customizing Caboodle from that perspective. We’re building a parallel data warehousing structure that will play to the specific needs we have here at the medical center.

 

Gamble:  That makes sense.

Barnett:  The third area from the CEO’s perspective was to help advance the IT division. It had grown really fast and seen explosive growth, particularly in the number of FTEs over the last several years. In some areas, including governance, there were core fundamental and foundational processes and operational considerations that we needed within IT, such as establishing and growing a project management office, and being able to keep track of our in-flight projects through what I call an IT Service Management Team (ITSM). It’s kind of like what Epic is for our clinical and our revenue cycle customers. A good ITSM suite is like Epic for an IT shop. It has a lot of those same workflows that are built into software, so we’re implementing an ITSM suite, as well as everything that evolves from that (asset database, application catalogues, etc.), so we can make sure we’re tracking our work appropriately and keeping on top of things like trouble tickets and service request projects. This way, we can make sure as an organization that we’re working on the right things via governance, and that we provide transparency back to our customers for progress and updates along the way.

Chapter 2

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