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.
- Migrating affiliated hospitals to Epic
- Using a “small, dedicated team to help map workflows”
- His “extremely valuable experience” at NorthShore
- Digital’s evolution – “It’s an exciting field. There’s just no shortage of things to do.”
- Blockchain’s rising potential
- The “balancing act” with innovation and security
- From service provider to transformational partner
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Rolling out the software out is the easier part. The harder part is figuring out the workflow, and getting operational understanding and awareness in the revenue cycle to understand how the system is going to be different.
There are a lot of tremendous innovations going on, and a lot of new players coming into the space. We’re definitely keeping tabs on that and trying to figure out which ones make the right sense for us to implement.
The smartphone is integrated. Everything works; the drivers are invisible to you; it’s a perfect form factor; and it’s becoming an incredible launching point for the medical world.
Your job, first and foremost, isn’t to understand how the EMR is configured. Sure, that’s important. Understanding server backend structures is absolutely important. But your primary job is to be a healthcare employee.
We’ve all been under so much pressure the last several years, particularly to get EMRs stood up and then to begin operationalizing. Now the question becomes, how do you innovate? How do you transform the organization? What capacity, and what slice of your time or your division’s bandwidth can you put toward that?
Gamble: You mentioned that the affiliated hospitals are on a multi-year plan to go to Epic. Can you talk about where that is right now?
Barnett: Sure. One of hospitals, Thompson Hospital, just went live on all things Epic, including revenue cycle and clinicals, in February of this year. That’s the first of our four affiliate hospitals. As we work through the rest, we have a smaller, dedicated team that’s like an advanced team to help us map the clinical workflows — here’s the typical type of build you’re going to receive, etc. We like to help prepare the organization from a change management perspective.
As complicated as an EMR is — and I do not want to diminish that at all — rolling out the software out is the easier part. I won’t say it’s easy, but it’s the easier part. The harder part is figuring out the workflow, and getting operational understanding and awareness in the revenue cycle to understand how the system is going to be different from the way it operates today. You may have to staff differently or move resources into different areas of the overall revenue cycle. But I think that’s the easiest way to ensure a smooth rollout of any EMR, Epic or otherwise. And so we like to work on that three to four months before we start doing any of the specific build and then ultimately, the launch.
Gamble: Right. Now, you were previously with NorthShore University Health System, which had several big initiatives during your time there. I’m sure being part of a complex organization like that was good preparation for this role. Have you found that you’re able to leverage some of those learnings?
Barnett: Absolutely. NorthShore is a phenomenal organization; they’re doing a lot of very innovative things in the technology space, and I was able to get some background and exposure. NorthShore was actually the first heath system to sign an Epic inpatient contract. They’ve been up for quite a while, and I think having that exposure to a mature organization that’s been doing this for years has offered a wealth of information and extremely valuable experience. I can better understand what goal we’re working toward, having been part of that environment. Seeing how it operates and how it became a well-oiled a machine has definitely been an inspiration for the work we’re doing here.
Gamble: There was also a lot of focus on digital health at NorthShore, which is an interesting area. How has that played into your strategy at Rochester?
Barnett: We do have a digital health and patient engagement initiative here. I think the key is in balancing that priority along with the stabilization phase of having launched an extremely large revenue cycle system. As we’re building the data warehouse, it’s a matter of being able to balance all those different priorities.
I was very involved in the digital health work that was going on at NorthShore. What’s interesting is how fast that field is changing, and it continues to evolve. There are a lot of tremendous innovations going on, and a lot of new players coming into the space. We’re definitely keeping tabs on that and trying to figure out which ones make the right sense for us to implement, given where we are in our overall trajectory.
Right now we’re focusing on making sure we’re rolling out and enabling all of the features within MyChart that are available to us. I think getting that smoothed out and getting adoption becomes the foundation in being able to launch. We’re actively working with some of our medical departments or subspecialties to come up with, ‘What does this workflow look like for how you want to monitor a Parkinson’s patient or diabetic patient?’ There are a lot of different technologies involved. How does that fit back into the workflow, and how do we want to extend this from a digital health perspective? It’s an exciting field. There’s just no shortage of things to do.
Gamble: It’s interesting because a few years ago, there was a lot of chatter about healthcare being late to the party when it comes to digital tools. Do you think that’s starting to change?
Barnett: Yes, but not just in terms of digital. I think as different groups have begun to shape their focus, we’re seeing the enormous inroads that blockchain is making, and some of the opportunities and use cases where it could be really impactful in the healthcare space. We’re also seeing a number of companies starting to incubate ideas around that space. It’s very similar to digital health in that there’s so much going on in the consumer space. That ports itself naturally over to healthcare, even exploring something as mechanical as drone delivery.
But the smartphone has just been the catalyst for a lot of this. From a patient-reported outcomes perspective, it provides a tremendous platform, especially when you look at the older days of the pure Microsoft-type world where you needed different drivers to handle all these different peripherals and plug these things together. The smartphone is integrated. Everything works; the drivers are invisible to you; it’s a perfect form factor; and it’s becoming an incredible launching point for the medical world.
Gamble: It’s so interesting to watch, especially because we’re all consumers of healthcare as well.
Barnett: Yes. And it has to be balanced and tempered with what some of the consumer applications didn’t necessarily have to work with up to this point; there’s privacy, there’s HIPAA, and there’s a tremendous amount of security that comes with the healthcare space. That was an ‘a ha’ moment of technology moving into the space a few years ago, but now they’re embracing it. I think we’re going to see exponential growth as they figure out that there are ways to innovate while keeping information safe. That’s going to be the power.
Gamble: Right. Switching gears a bit, I noticed from your LinkedIn profile that you have done some speaking at industry events to help educate and share best practices across. What would you say are the issues that CIOs really have a thirst for right now? Is there anyone that really stands?
Barnett: For CIOs, it’s definitely interest around data and analytics — how can I get more value out of the data we’re generating? That’s one area. Security is always an area where people want to know what others are doing. Are we doing everything we can from that perspective? I always like to say, it doesn’t matter how well you build a 10-foot wall. The bad guys always end up with an 11-foot ladder. It’s an axiom of life.
They’re also interested in how much time, talent, resources to put toward the transformation of technology in healthcare. We’ve all been under so much pressure the last several years, particularly to get EMRs stood up and then to begin operationalizing, creating workflows, and working with operations to get workflows set up appropriately. Now the question becomes, how do you innovate? How do you transform the organization? What capacity, and what slice of your time or your division’s bandwidth can you put toward that?
That’s a balancing act. If there’s one thing I learned really well at NorthShore based on other initiatives we were doing with other healthcare centers in the digital health space, it’s that you’re never going to be at a loss for different technology finding its way to you and knocking your door down — ‘here’s the latest gadget that does X or Y.’ You can literally exhaust yourself and your organization trying to evaluate and go after that stuff, but there’s a great guiding principle that we instantiated during our work there: ‘Always focus on what problem you’re trying to solve.’
The minute you look at it from that perspective, you see that even if it’s a good solution with very good technology, if it doesn’t go after a specific need or problem that we’re trying to get our heads around and come up with good solutions for, it may not necessarily be noise, but it doesn’t focus on our exact needs right now. That becomes a great screening tool when you focus on what business problem we’re trying to solve.
At any town hall I’ve had, either here or at NorthShore, I ask everyone, ‘How many folks believe you work in the IT field? Let’s see a show of hands.’ Inevitably, the majority of hands go up. But when I ask, ‘how many believe you work in healthcare?’ You might only get a few hands go up. And so I say, ‘I’m going to challenge you to believe that you are all healthcare employees. You don’t specialize in surgery. You don’t specialize in being a radiologist. You specialize in technology. But your job, first and foremost, isn’t to understand how the EMR is configured. Sure, that’s important. Understanding server backend structures is absolutely important. But your primary job is to be a healthcare employee. You learn and stay aware of all those technology aspects in order to know how to apply them to support healthcare workflows, and know when to bring forth to our operational counterparts, ‘Hey, here is something that may help you with X,’ whatever that could be.’ That moves you from being a service provider as an IT shop — which is, ‘tell me what you want me to do and I’ll do it’ — to becoming that transformational partner.’ That’s the key to getting IT folks to be at the table when operations is looking at how are we going to make our business more efficient and affect patient outcomes. You want to be at the table when those discussions are being held, not called in after the fact.
And so it’s keeping the focus on ‘I’m a healthcare employee, but my specialty is technology.’ I think that’s the key. You’re reading all the different information that’s out there, always keeping an eye out toward where is this potentially going to be helpful, and when’s the right time to bring that forward.
Gamble: Right. That’s really important. And it’s evident from what you were saying that there’s a real emphasis at Rochester on making everyone feel that these things are being done to them; but rather, that they have a part in it and can be engaged.
Barnett: The worst conversation a CIO or anybody in IT wants to hear is when operational folks, whether they’re clinical, business, or revenue cycle, say, ‘This process isn’t working for me.’ Why? ‘Because the technology that IT gave me didn’t take into account my needs or my requirements.’ It’s like that old phrase, ‘When the only thing you have is a hammer, everything looks like a nail.’ We want to make sure we’re not leading with technology, but that we’re supporting technology.
Gamble: Absolutely. Well, that about wraps this up. There’s always more I could talk to you about, and I’m hoping we can do this again. It’s been so interesting to hear about what you guys are doing, as well as your own experiences. Thank you so much for taking some time to speak us. We really appreciate it.
Barnett: Thank you, Kate. It’s been my pleasure.
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