As technology becomes more strategic to the mission of an organization — especially in the areas of research, education, and patient care — information technology needs to be represented at the cabinet level. In fact, discussions about data-driven innovations that can transform care delivery must involve CIOs from the start, said Tom Andriola. That was precisely the thinking at UC Irvine, where last fall he was named Vice Chancellor of IT and Data, after having served as CIO for both UC Irvine Health and the University of California system for six years. Now, the CIOs of UC’s six health systems report up to Andriola, who likens his role to that of a conductor whose focus is to “get the band to play together,” even though they have their own instruments.
Never has it been so important for the different sections of UC Health to harmonize than in the past few weeks, as the organization has banded together to create and implement a COVID-19 response. During a recent interview, Andriola talked about how the “dynamic environment” has shifted his priorities, why he believes virtual care should become “the new norm,” and the incredible opportunity organizations have to help educate the community.
- Named UC Irvine’s first vice chancellor
- “The growing strategic role of technology and data is transforming the way we think.”
- Vision to become a “source of truth” for the community
- Ramping up telehealth incrementally
- Resistance to technology enablement – “Some of those barriers are melting away.”
- Relaxation of HIPAA rules
- Virtual care becoming “the norm, not a one-time event.”
- Public health risks w/ residents & med students
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The way I’ve approached the CIO role over the course of my career has been very much about trying to add more strategic input into the conversation. For the organization, it’s a recognition that they need this role to be involved in every conversation, from the beginning.
Why is it important from the standpoint of ensuring that we reduce the number of deaths that we have? Because flattening the curve is not just about trying to stop people from dying from the virus; it also is about trying to not overwhelm the health system.
There’s always resistance — why are we doing this? Why do I need to change? Some of those barriers are melting away. But it doesn’t necessarily stop the barriers in trying to really understand how do we integrate this into the workflow of the clinician? Who are the real users we’re trying to create these interactions with?
A large residential community at a university is a lot more like a cruise ship than we’d like to admit. You have people living in close quarters, people sharing living spaces, maybe even bathrooms. There’s an inability to create social distancing.
Gamble: I wanted to talk first a bit about your role as Vice Chancellor of Information Technology and Data. You’ve been with the organization since 2019, having previously held the CIO role. Can you talk about what your new position entails?
Andriola: Sure. Just for some context, UC Irvine is a public research university, which includes an academic medical center. When you look across the university — and not just the healthcare component, but the way we’re educating students and doing research — the growing strategic role of technology and data is transforming the way we think about delivering on the mission of the university. The leadership at Irvine decided they needed a cabinet level role to be part of the conversation as we think about what it means to be a 21st century research university, and what it means to be a 21st century academic medical center that’s driven through the innovations coming through technology and through the strategic use of data.
Gamble: I’m sure it’s really interesting to be part of the organization as it is making these changes and figuring this all out.
Andriola: It is. In some ways, the way I’ve approached the CIO role over the course of my career has been very much about trying to add more strategic input into the conversation. For the organization, it’s a recognition that they need this role to be involved in every conversation, from the beginning. In the way that my role is structured, the CIO of the medical centers and the CIO of the campus are direct reports to me from the standpoint that there still is quite a bit of technology operation that needs to go on, and we have technology leaders in place to run those organizations. But the more strategic long-term view is something that I represent; the engines of innovation that we develop. In addition to the operational pillars, strategic positioning also falls under my umbrella; things like community engagement — how we think about engaging the public and government officials within the region to create collaborations and data sharing arrangements.
As a matter of fact, right before this call, we were talking about our community engagement strategy around UC Irvine being a source of truth around the COVID-19 virus during a public health emergency situation. We want to be seen as a source of truth for the community — how do we do that? How are we going to engage the community and how are we going to use data and use technology to engage with them?
Gamble: It’s been a really interesting to watch it unfold. One of the biggest concerns is making sure the right information is getting out there. It’s not an easy thing to tackle.
Andriola: There’s a lot of information out there, but is it credible information? Is it information that helps people pragmatically make decisions that are going to keep them safe versus creating more panic?
Again, this is where we look at our role within the community, which in this case is Orange County. We need to be that trusted source of truth where people can come, not just if they want to get tested, but also if they want to know more about this pandemic — beyond why they need to be washing their hands. Why is social distancing important? What does flattening the curve — which is the soundbite everyone’s using — really mean, and why is it important from the standpoint of ensuring that we reduce the number of deaths that we have? Because flattening the curve is not just about trying to stop people from dying from the virus; it also is about trying to not overwhelm the health system so that I were to have a heart attack and come to the emergency room, I couldn’t get care because everybody in the emergency room is trying to get tested for the virus, and I die from my heart attack. That’s what flattening the curve is, as much as it is about trying to slow the spread of the disease.
Gamble: Right. And we’re seeing so much in terms of telehealth in the last few weeks. I saw a Tweet from UC San Diego Health Information Services that they were doing video visit training, as well as expanding virtual care. That seems to be the trend.
Andriola: Correct. We’re doing the same thing by pulling some of the plans we had forward. We’ve been moving at a natural pace in terms of expanding our virtual visit capability. Now, we’re accelerating a lot of those plans and thinking in terms of far greater capacity, and greater orders of magnitude that what we were originally planning.
Gamble: I’m sure there are concerns with trying to ramp up something that has been in the works for so long. Is it realistic to be able to expand something like virtual visits in a small amount of time?
Andriola: It’s going to be hard. When you’re trying to introduce the next generation of technology enablement, there’s always resistance — why are we doing this? Why do I need to change? Some of those barriers are melting away. But it doesn’t necessarily stop the barriers in trying to really understand how do we integrate this into the workflow of the clinician? Who are the real users we’re trying to create these interactions with?
The recent announcement from HHS that it would waive penalties for HIPAA violations for those who move to virtual visits was really important; they want these visits to happen in a virtual way, rather than people having come into the clinic. What they’re saying is, ‘If you can do it, start doing it. Don’t worry so much about HIPAA issues. We’re going to look past that in the short term, because we’ve got to get more people to interact with the healthcare system and not require them to come in for a face-to-face visit.’
All these things will help us move forward, but ramping up is still going to happen incrementally. What I’m also focused on is not just incrementally ramping this up so we can deal with the pandemic, but also really thinking about how trying to how do we make it so these care models become the norm after this? Because they are essentially opportunities to reduce the cost of care, and maybe even improve the effectiveness and access of care if this is the norm, rather than having someone call, make an appointment, and come into the clinic. We want to look ahead and make this the norm, not a one-time event.
Gamble: What are some of the other ways in which COVID is impacting your priorities and your strategy?
Andriola: At this point, it’s having a more dramatic impact on our campus than the health system. The health system is focused on preparing for patients who need to come and who have complications related to COVID. We’re dealing with isolation and quarantine requirements, extending our services, setting up the tents for drive-by testing — how to manage all of that. There’s a significant capacity challenge.
The campus site, particularly early on in our response, has garnered a larger percentage of my time in dealing with the impact moving our resident population back to their homes, and enabling classes to be taught with remote instruction.
Gamble: I can imagine you’re dealing with some prioritization challenges.
Andriola: Absolutely. When you think about it, a large residential community is a public health risk. In some ways, a large residential community at a university is a lot more like a cruise ship than we’d like to admit. You have people living in close quarters, people sharing living spaces, maybe even bathrooms. There’s an inability to create social distancing, and an inability to maintain individualistic practices. And so a major public health concern we’ve had is trying to significantly reduce the residential population at our university.
We have some students, especially international students, who may not be able to go home; or if they do go home, they may not be able to come back. There are cases where we maybe cannot move people out of residential housing. We have graduate students who are doing research and need to go into a lab.
Again, these are all public health concerns that we are working our way through. Can they be done in a different way with the same level of effectiveness utilizing technology and remote activity? Or do we need to move to a reduced level of effectiveness to balance the public health concerns? That’s what we’re dealing with.
Part 2 Coming Soon…
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