Q&A with CIO Jamie Nelson, Part 1: “The Technology Is the Easy Part.”

It’s not about getting things done quickly; it’s about getting things done right. Doesn’t exactly sound like the type of statement one might expect from a leader in healthcare IT, one of the most rapidly changing industries in the world. And it certainly isn’t what one would expect from a CIO based in New York City, where everything seems to happen at the speed of light.

But for Jamie Nelson, who has amassed decades of experience leading successful IT teams, it’s never been about speed. Especially during the eight years she has spent with HSS, which has been ranked number 1 in orthopedics for 10 straight years, according to US News & World Report. Recently, she spoke with healthsystemCIO about the “slow, deliberate approach” her team has employed (and will continue to employ going forward) in adopting technology, and how they’re working to ensure a consistent experience as the organization expands. Nelson also talks about what it means to be a “pilot organization,” what HSS is doing to help curb opioid abuse, and why she believes promoting more diversity should be a priority for everyone — not just women.

Part 1:

• HSS’ growth to meet the “extremely high demand”
• Deliberate approach to expansion – “We want to provide the same experience.”
• IT’s role in planning
• “We’re thinking about what the requirements will be when that building opens.”
• Ongoing infrastructure assessments
• Consistency with IT support
• “Slowly walking” into telemedicine

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Bold Statements

We’re very thoughtful about how we open new facilities because we want to provide the same patient experience and the same level of clinical expertise that we do on our main campus.

We’re thinking about how to increase exposure to our services beyond our physical walls and beyond brick and mortar, and looking at digital solutions to really extend our reach. That’s our main focus from a hospital standpoint, and IT is helping to foster that.

Technology is changing so rapidly. We’re making our best guess to ensure that whatever we put in there is scalable and flexible so that as things change, we can change as well.

You have one chance to make an impression with your patients and with the community, and if you don’t get it right, it’s hard to rebuild that trust. And so our philosophy has been very deliberate and very thoughtful.

The technology is the easy part. The hard part is having physicians free up appointment slots to make telemedicine worth it, figuring out the reimbursement behind it, figuring out the support if a patient or a clinician has trouble logging in.

Gamble:  I know you have a lot going on, but let’s start by talking about what you consider to be the top initiatives on your plate right now.

Nelson:  IT or hospitals initiatives?

 

Gamble:  I’m sure there’s alignment there, but let’s talk about the hospital initiatives. There’s a lot of expansion happening, for one thing.

Nelson:  We just opened an ambulatory surgery facility in West Palm Beach. We’ve had a physical expansion strategy in the tri-state area, which includes New Jersey, Long Island, and Connecticut; this is our first expansion outside of the Greater New York area. We’re partnering with United Surgical Partners International, which is a subsidiary of Tenet. It’s a whole new venture for us. The outpatient facility is open, and we’re going to start doing surgeries shortly.

We’re very thoughtful about how we open new facilities because we want to provide the same customer/patient experience and the same level of clinical expertise that we do on our main campus. So it’s been a very thoughtful, long buildup to what I believe will be a really excellent addition. In fact, our biggest issue from an IT perspective on the first day was having to reconfigure our call tree because there were so many calls coming in from interested patients.

 

Gamble:  That’s a good problem to have.

Nelson:  It is. It’s really exciting. We’re putting up a new building by the East River. It’s going to be a new hospital with all private rooms, as required by New York State. That will start in a few weeks. There’s been a lot of growth here because the demand for musculoskeletal services is high, and the demand for our particular services is extremely high.

So a lot happening there, and of course we’re thinking about how to increase exposure to our services beyond our physical walls and beyond brick and mortar, and looking at digital solutions to really extend our reach. That’s our main focus from a hospital standpoint, and IT is really helping to foster that through our systems and our leadership.

 

Gamble:  With the new facility in Florida, what was IT’s involvement in the planning process? Can you talk about that?

Nelson:  We tend to look at these initiatives as an IT projects, but it’s not just IT. HSS also had to hire clinicians and create clinical workflows, and so we have a fulltime project manager on these types of initiatives. It’s interesting because we wanted to hire some local talent to do a lot of the hands-on work, like wiring for example, along with our own people. We sent Epic trainers down to teach the workflows. So we’re very much involved in these new facilities.

We also sent people to Hudson Yards, which is the new space on the west side of Manhattan, and in Brooklyn where the New York Nets training facility is located. As we open these new sites, it’s always a major IT project that is facilitated with the project management team. We’re always a part of that.

With the new building going up by the East River, it’s a longer horizon. We have teams there thinking about how we can use smart technologies to create a patient-centric, almost digital set-up, because it’s going to be a very different patient experience when we open that building. And so we have a team that’s thinking about what tools are provided through Epic, what we need to do from an infrastructure standpoint, how Wi-Fi has to be set up. If you think about it, everyone is walking in with their own devices, and if we’re going to give out bedside tablets and encourage patients to use those to download their own content and stream their own entertainment, what type of infrastructure do we need? So we’re really looking ahead to think about what the technology requirements will be when that building opens — now what they are today.

 

Gamble:  It’s exciting to be able to think about it that way. It hasn’t always been the case.

Nelson:  It’s funny; you think you know what’s going to happen, but we can’t predict the future. Technology is changing so rapidly. We’re making our best guess to ensure that whatever we put in there is scalable and flexible so that as things change, we can change as well.

 

Gamble:  With the facilities you already have, is it a constant effort to ensure a solid infrastructure is in place to enable all of these devices?

Nelson:  Yes. In fact, our networking team is in the process of doing a whole new wireless survey. We completely redid our wireless infrastructure about six years before we put in Epic, which was four years ago. And so, even though we’ve upgraded, it’s not the latest technology, and our requirement for wireless have completely changed. We’re already looking at how we can upgrade.

So yes, it’s an ongoing effort. Even in our current facilities, we’re constantly looking at what’s happening and what we can do to keep up with these changes. And of course, you have to think about it a year in advance so you can budget for it as well.

 

Gamble:  You talked before about wanting to ensure that people have the same experience at the new facility in Florida as they do in New York. What do you think are the keys to that?

Nelson:  From an HSS side, it’s about making sure the culture is the same as it is here. We actually have surgeons from HSS’ main campus who are going to be operating down there. We’ve hired some new surgeons who are very well credentialed, but we made it a point to also have experienced surgeons from our main campus in the West Palm Beach location. In fact, we have people from the main campus in support functions, clinical, and administration who’ve decided to move to that facility. We’re very lucky to have staff who are willing to move with us; it’s a great way of making sure that the culture comes along.

Our information systems and our clinical workflows are exactly the same as they are here in New York. They’ll be using Epic, and our patients will have the same MyChart experience, which we’ve branded MyHSS. So if they’re being seen in both locations, it feels like the same experience.

What’s really important — number one, in fact — is the people and the culture; how we hire and how we bring our workflows down there, and having seeded it with our staff from existing HSS campuses. That way, we can make sure it feels like HSS — not just from a building perspective, with the types of finishes, the furnishing, and the atmosphere, but also from a technology perspective, for both staff and patients. In fact, a few weeks ago, we were actually able to push the overflow phone calls to our contact center in New York, because we’re using the same system. That was really helpful for the staff as we went through the initial excitement of being able to schedule appointments down there.

 

Gamble:  Is there an onsite IT director? How does that work?

Nelson:  No. We’re managing from up here. We work very closely with the leadership at the West Palm Beach facility, and we have contracted staff there that can do hands-on work. But most of the work that can be done from an IT support perspective is virtual. Support for Epic, for the network, and for the infrastructure can be provided by people here, as well as people down there. We do have local staff that can do break/fix work on desktops, that type of thing. But we absorb it into our support environment here.

 

Gamble:  I’m sure that goes a long way toward having that consistency across the organization.

Nelson:  Yes, and it helps the staff, because the people who are managing the support staff down there — for example, the registrar — are part of HSS main campus administration. And so, for them to be able to speak to the same people in IT when they have a concern or issue is really helpful. That’s how we make sure we provide that same experience for our patients and our clinicians, by having the same support staff.

 

Gamble:  Right. So with the overall strategy for expansion, it seems like there’s a strong emphasis on not growing too fast. Is that an organizational philosophy? Can it be challenging sometimes to take a more deliberate approach?

Nelson:  No, because it’s the right way to do it. It might be challenging because people want to do things quickly, but that very thoughtful approach of making sure you have the right infrastructure to support that — not just in terms of IT, but the organization — is really important. You have one chance to make an impression with your patients and with the community, and if you don’t get it right, it’s hard to rebuild that trust. And so our philosophy has been very deliberate and very thoughtful, because we just don’t want to open up a place, put up an HSS shingle, and say, ‘Come here.’ We want people to know that the same experience they’ve had from the facility that’s been rated number one by US News & World Report for 10 straight years is what they’re going to get, no matter where the HSS brand is. We’re really very careful about that. And honestly, we move fast enough as it is.

 

Gamble:  Sure. Now, in terms of your patient population, it’s somewhat unique from some of the other health systems in that obviously you’re a surgical hospital. But what has your strategy been as far as providing a more digital experience?

Nelson:  We’re looking at a few different types of digital. One is digital caregiver/employee, and the other is digital consumer/patient. Like many healthcare institutions, we’re looking at wellness and enabling consumers to have a digital experience before they even get here. Or maybe, digital tools can help patients avoid coming here. Maybe if they follow our orthopedic clinician-guided exercise programs for specific issues, they’ll avoid getting injured and won’t need advanced orthopedic treatment.

We’re looking to expand out to the consumer population and extend our reach to thousands of people who may not have the opportunity to come here, but can benefit from our expertise. We’re looking at how we can make the digital experience something that our patients want. Our portal, which is Epic’s MyChart (rebranded as MyHSS) has all the typical offerings: making follow-up appointments, viewing test results, and communicating with caregivers. All those functions are there. We also offer telemedicine through our portal. Again, we’re slowly walking to telemedicine, because you really need to have it down correctly so that patients have a good experience.

That’s where we’re focused with digital. And of course, that includes the IT infrastructure underneath it, whether it’s cloud, digital tools, interface, engine, and even CRM tools. It’s a long journey, and there’s a lot of thought and a lot of technology behind it, but we’re on our way.

 

Gamble:  Are using telemedicine for things like follow-up appointments for those who can’t get to the hospital, or are there plans in place for that?

Nelson:  Yes. In fact, our very first telemedicine use case was for ALS patients, who, by definition, have major issues with movement. That was one of the first clinical services that we identified before we had a formal telemedicine program in place. Our neurologists are leveraging telemedicine for ALS support; one of our major uses is for post-visit care and having nurse practitioners speak with patients. That’s our initial foray into telemedicine.

We’d like to look at using it for physician appointments so patients don’t have to come here to see their prescribers, but again, we’re walking slowly into that. We’ve hired someone with a lot of experience to head up telemedicine. Again, we don’t rush into things. We like to do things right, and we only have one shot at that. We want to use tools the right way to figure out those last-mile issues — how do we make sure patients aren’t having issues logging on or getting their connections working? How is that managed? These are things we think about. It’s slow and deliberate, but it will be a good patient experience when we’re done.

Because it’s not just the technology; it’s the organizational transformation behind it. The technology is the easy part. The hard part is having physicians free up appointment slots to make telemedicine worth it, figuring out the reimbursement behind it, figuring out the support if a patient or a clinician has trouble logging in. These transformational pieces are complicated. We have to be thoughtful and do things correctly.

Part 2