“We built trust by getting our act together.”
One of the most challenging tasks for healthcare IT leaders is to get a project back on track — especially when it’s an EHR implementation that was never quite on track. And although may seem extremely complex, as there are multiple moving parts, it’s actually fairly simple: start by fixing the technical issues, said Marc Probst. “It doesn’t matter how good a system is if it’s useless to the end user.” In a recent interview, Probst, CIO at Intermountain Healthcare, talked about his own experience in turning around a doomed roll-out, and what he believes are the keys to building and maintaining a successful vendor relationship.
The 2020 CHIME-HIMSS CIO of the Year also shared thoughts on the transformation Intermountain has undergone in recent years, why he believes Meaningful Use was the right move, the dual functions of the CIO role, and why now, more than ever, healthcare IT needs “visionaries.”
Gamble: Hi Marc, congratulations on being named CIO of the Year. I’m it’s a really tremendous honor.
Probst: It’s humbling, for sure, because there are so many others that I think deserve it. But yes, it’s an honor.
Gamble: You’ve been at Intermountain since 2003; obviously quite a bit has changed since then. Is there a time period that stands out to you as being particularly transformative for the organization?
Probst: The last three years have been very transformative. Our new CEO, Dr. Marc Harrison, is focused on preparing for the future, and it’s changed us structurally, it’s changed us technically, and it’s changed us organizationally. We’ve gone through a lot of transformation to prepare ourselves for the next 20 years.
Gamble: One of those changes is going from a homegrown system to an integrated platform. What was the tipping point in making that decision?
Probst: I think Meaningful Use really drove us to that decision. We had the option to continue to build on our own systems; we’ve done a lot of work with GE and could have stayed on that path. But with Meaningful Use came several new requirements, and it would have taken us a long time to build, test, and deploy. It also would have kept us on this island that was Intermountain Healthcare. That wasn’t where we wanted or needed to be.
Gamble: And where is that initiative at this point?
Probst: We’re done with the migration. The entire organization is on Cerner, both clinical and revenue cycle. Now we’re focused on optimization. To me, that’s foundational work, because it takes a year to fully optimize the system, and there are other things we want to focus on, including digital health. We’re developing our own digital front door, and there are a lot of components that go with it.
From a development perspective, we’re constantly refreshing and modernizing systems. And all the while, there’s a really fundamental level of effort around reducing costs. IT continues to be a huge expense in healthcare. We spend a lot of energy trying to figure out the best approaches to lowering our cost while raising our value in the organization.
Gamble: Can you talk a bit about the digital front door?
Probst: In a nutshell, it’s allowing consumers to access our care delivery system and even early levels of care using the medium they prefer—phones, computers, etc. It’s everything from finding a doctor to scheduling an appointment, to getting a telehealth visit, to early triage. On the backend, it’s consolidating and paying bills, and making sure they understand what they’re paying. It’s a holistic access tool to the Intermountain delivery system.
Gamble: Looking back at the EHR migration, what did that require from a change management perspective? As you said, the homegrown system was in place for a long time, which I’m sure can make it difficult.
Probst: To be honest, we didn’t do a great job. And there wasn’t any group or individual we can point to; it was a decision that put us on a course that was not the best. We had decided to work with Cerner to use their tool to build a next generation of electronic health record. That turned out to be very difficult; we ended up over-configuring the product. We tried to automate too much of what our clinicians needed and so when we went live, it became pretty apparent that we needed to put some true energy into optimizing and cleaning up the system, fixing even very technical things. We had way too many downtimes — that’s when I inherited the project.
Gamble: What was your first priority at that point?
Probst: Other than the people side, our first priority was to stabilize the system from a technical. It couldn’t just keep going down. Our number two priority was to focus on clinical by identifying the biggest dissatisfiers to our clinicians and fixing those workflows. Third was what we call ‘Return to Green,’ which focuses on revenue cycle. The technical piece is pretty much done, but we still have a lot to do the clinical and revenue cycle spaces.
Gamble: From a clinical standpoint, was part of it taking the time to build user confidence and restore trust?
Probst: Yes, but frankly, the first step in restoring trust was to fix the technical issues. It doesn’t matter how good your system is if it’s useless to the end user. I think we built trust by getting our technical act together. And it’s done in smaller pockets; we’re working through specific workflows, we’re working in clinical specialty areas and documentation needs. You regain that trust one step at a time, but we built through trust through the technical work we did.
Gamble: Knowing what you do now, what would you have done differently?
Probst: It’s interesting. In the original contract, we had agreed to install a relatively vanilla system from Cerner, and would go through a process of enhancing it over time. That was the idea, but we got off-course and started to build the system of the future. Had we done it the way we originally thought we would, I think we’d be in a better position.
Gamble: I’m sure it’s an easy trap to fall into, when there’s the prospect of building the system of the future. It seems that’s a big part of leadership — not being afraid to take risks, but at the same time, not putting your team in a position to possibly fail.
Probst: Hindsight really is 20/20. It wasn’t the fault of any individual or group; the decisions that were made put us on a course that didn’t turn out to be the best for Intermountain or Cerner, frankly. But we identified and fixed it, and I think we’re in a good place now. Our relationship with Cerner is as strong as it’s ever been.
Gamble: Right. Building and maintaining good relationships with vendors is so important, but it can be very challenging. Based on your experience, can you offer any best practices in terms of what it takes to maintain a good relationship with vendors?
Probst: Our relationship was incredibly strained two years ago, at just about every level: the team level, the leadership level, and the executive level. I think the number one thing is to understand that it isn’t just the vendor. There are two participants: the purchaser and the vendor, and we both have a responsibility in this process.
You also need to be in it for mutual success. I’ve always gone into a vendor relationship understanding that they’ve got to make money. And so my goal isn’t necessarily to bleed them. I want the best deal for my organization, but part of that is making sure that the vendor is successful as well.
In our case, we literally had to go back and rework our contract. It took us about a year. And the goal wasn’t to get better terms. It was to take what we had originally written and refocus on those things. It was a good process and it really helped bring us closer together as we worked through it. Just like in a marriage, it doesn’t help to blame the other person; what it helps to do is to sit down, discuss your issues, and work through them to reach a common understanding. Only when both parties win is there a win.
Gamble: Sure. Switching gears a bit, I’d like to talk about the policy work you’ve done. From our discussions in the past, I know it’s very important to you. Can you talk about what you’ve gained from experiences like serving on the Federal Health IT Policy Committee?
Probst: By far, it’s benefited me most in the relationships I was able to build. Judy Faulkner and I worked closely together, and although we don’t share political beliefs, we share a passion for this industry and doing the right thing. She’s just one example. Another is Senator Gayle Harrell. As you went around that committee, it was clear that everyone was there to do the right thing. We didn’t always agree on how to do it, but we did agree on what we were trying to accomplish.
Secondly, I gained a much better understanding of the power of advocacy. Things do get done. If you’re willing to invest your time and energy, you really can make a difference and move the ball closer.
Gamble: When you look at Meaningful Use through the lens of a CIO who went through it and an advocate, do you believe it was the right thing to do? Did it help move things along in a way that wouldn’t have happened without it?
Probst: It definitely did. Honestly, if I could have architected the whole process, it would have been different, but for what we need now, it worked. Remember, the goal was to get these things out quickly so health systems could realize the benefits. It was the right thing to do. We have a lot more people using the systems. We have a lot more people paying attention to data. We’re in a position to do things with digital because more healthcare data exists.
Was it worth $36 billion? I think it was. It definitely helped in a time when the economy needed the help.
Gamble: When you look at the CIO role, it really seems to be evolving. As the industry moves forward, what characteristics or qualities do you think would be essential in CIOs?
Probst: I see two roles, which could done by one person. Or at least, two areas of focus. We have to move away from legacy; from having old products and mainframes and even cloud-based systems. They’re servers running in the cloud, but they’re running old applications that are difficult for clinicians to use.
We need visionaries to move us into this next phase. I don’t even think anyone today knows what that next phase is; we need people who can think that way and help drive us to that level. And certainly vendors play a role in that, but the industry itself needs to drive it. We can’t continue to depend on our vendors to define what the future of our technical platform is going to be.
Historically CIOs have played a role in creating a strategic plan. But this future-looking piece really needs to integrate well with our operations and make sure we have all the right understanding.
The other aspect is that this stuff has to run, and it has to run at a cost where healthcare can be affordable. That’s a different set of skills, and so there’s going to be a need for an increased focus on understanding technology, understanding networks, understanding lines of code and how that code interacts, and understand interfaces and how to build them.
If I were to remain in the CIO, I’d be thinking about which of those two I’m going to enhance my skill sets in. For me it would be the strategic side, because I don’t have nearly a strong enough technical foundation, and so I would look for someone to backfill that knowledge around technology.
Gamble: You’ve announced you are retiring from the CIO role in July of this year. Do you expect to stay engaged with the industry?
Probst: I’m definitely going to remain. I have two criteria: one, I don’t want to leave Utah. I love it here. The other is that I’m not seeking at CIO role. I’ve had a great run, and I think there are much smarter people out there who can do the job. But I will be looking at other opportunities in healthcare IT.
Gamble: I’m glad to hear it, and I’m sure many others are as well. Thanks so much for your time, I’ve enjoyed speaking with you.
Probst: Thank you, Kate.