Q&A with Geisinger CIO John Kravitz, Part 1: “You Want to Keep Moving in the Right Direction.”

Given the chance to build a new health system from the ground up, most CIOs would do at least a few things differently. For John Kravitz, CIO at Geisinger Health System, it’s simple: “everything would be in the cloud.”

But Geisinger, a regional health system providing care to patients in 45 counties throughout Pennsylvania, is not new. It’s a 103-year-old system with three physical data centers, which means “changing our mindset is going to be very difficult.” It’s not, however, impossible. It requires a dedication to the vision that Kravitz has witnessed in full force during the past few months, as Geisinger’s IT team has surged ahead with major initiatives — including preparations to go live on Epic’s billing and lab systems — while ensuring providers are able to care for patients during a pandemic.

Recently, Kravitz spoke with healthsystemCIO about the challenges of prioritization during Covid-19, the cybersecurity concerns with going to the cloud, how deploying Microsoft Teams has improved efficiency, and how remote work is “going to change our whole methodology.”

Part 1

• Financial impact of Covid – “It has been a real challenge.”
• Efforts to rationalize IT applications
• “We feel we can get more economics of scale with integration”
• 3-legged stool of IT costs: infrastructure, personnel & applications
• “It handcuffs you a bit to be able to flex up and flex down.”
• Contactless check-in: “We’re starting in a very protected environment”
• Plans for Epic, Workday & Salesforce go-lives
• Dramatic spikes in telehealth and telecommuting – “It’s going to change our whole methodology.”

Bold Statements

We leverage as much as we possibly can, and we feel that we get much more economies of scale with integration as we go with the Epic platform. That’s going to continue.

It handcuffs you a bit to be able to flex up and flex down. If I were a brand new health system, everything would be in the cloud. I would just start there; I wouldn’t fool around with anything on-prem that I don’t need.

We’re a 103-year-old organization, and so changing our mindset and our approach to how we do things is going to be very difficult. You don’t want to steer into the iceberg; you just want to keep moving in the right direction.

We’re excited about these changes, but we’re trying to do it cautiously so that we can make sure we provide the best experience for our employees, the highest quality outcomes, and the highest levels of productivity.

 

Gamble:  Hi John, thanks so much for putting aside some time to talk. Can you give an overview of your main priorities right now?

Kravitz:  The financial impact of Covid-19 has been a real challenge. We have a lot of different initiatives underway, with our digital strategy and everything else we’re moving forward to deploy in the Covid/post-Covid era. A lot of work has been happening for contactless patient check-in using a mobile device. When patients enter a facility, they’re recognized without having to go up to a desk, and they can get the exam room number without waiting in a crowded room. We’re getting ready to do a proof-of-concept in orthopedics, pending a final review from our executive team. We’ve very excited about that.

There are a lot of new opportunities because of all the work we’ve been doing. That’s just one example. We’re also looking at rationalizing IT application portfolios to try to reduce our portfolio, simplify, and streamline. A lot of what we’re doing now involves our core systems, including Epic. And in fact, contactless check-in is part of an initiative with Epic Welcome, Epic Hello, and Epic On My Way. We’re going to be integrating that with a front-end facial recognition system so it can identify patients — whether it’s in their home setting, or on their way via face ID or touch ID through the phone — and connecting that directly into our platform and into our Epic environment. We’re continuing to do a lot of that. We leverage as much as we possibly can, and we feel that we get much more economies of scale with integration as we go with the Epic platform. That’s going to continue.

Looking at scalability, cloud is a potential solution. Another solution we’re looking at is GreenLake, an as-a-service platform from Hewlett Packard Enterprise. They actually meter your equipment so you only pay for what you use. It’s something they’ve been doing for the federal government for quite a while. I’m looking at it very closely and comparing and contrasting the cost of that versus fully going to the cloud.

Now, would I prefer to have the cloud? Yes, but I think the cost is going to be pretty astronomical for at least the first two to three years. Then they’ll start to level out as our equipment depreciates and we migrate more to the cloud while removing more from our data centers.

But there are a lot of factors that go into that, like your cybersecurity posture — which includes cloud access security broker (CASB) and other things for data loss prevention and protection. We already have a multi-factor authentication process, but it would have to all link together, and not all of our applications are AD-enabled. That’s another factor; I’m trying to rationalize and non-AD enable to get those out so we can move toward a more automated provisioning system approach. That’s really where we want to go with this.

 

Gamble:  You and I had spoken recently about Geisinger’s hope to eventually move to the cloud. It seems like there are so many considerations, and that was before Covid-19 hit.

Kravitz:  Right. What I like about the cloud, or something like GreenLake, is the ability to scale up or scale down and lower costs on that three-legged stool. That’s how I look at IT costs: the infrastructure, the personnel to support it, and the applications themselves.

And so our first round going through this is rationalizing about 175 application systems — getting rid of them. That’s to the tune of just under $6 million a year, but it doesn’t include the other two legs of the stool. I’m very inflexible on my hardware because I own it, and it’s scaled across the organization.

The other piece of that is the employees. We have to look at what we can do there and how we would do it appropriately through attrition in other areas. But it handcuffs you a bit to be able to flex up and flex down. If I were a brand new health system, everything would be in the cloud. I would just start there; I wouldn’t fool around with anything on-prem that I don’t need. That’s the only way I would do it.

But we’re not brand new. We’re a 103-year-old organization, and so changing our mindset and our approach to how we do things is going to be very difficult. You don’t want to steer into the iceberg, so to speak; you just want to keep moving in the right direction. That’s a tough balance, but we’ll work through it.

 

Gamble:  So there’s certainly a lot going on. You mentioned contactless check-in, which sounds really interesting. Can you talk more about how you hope to roll that out?

Kravitz:  We’re excited about this. We have 13 hospitals on our platforms and well over 400 clinics. We’re starting in a very protected environment with elective surgeries and things like that. We’ve prioritized surgeries, as everyone else has, but we’re very cautious about our employees and our patients. We are taking every protective measure we can; this is just another component to try to streamline processes.

Of course, everyone going for surgery has to be tested for Covid. We have infrared guns to check people’s temperatures as they enter our facilities. We’re looking at every measure we can take to protect our patients and our employees, and we’ve been very good about that. We’ve had a very low number of employees test positive for Covid, and they may not have been infected at work.

We have a lot underway right now. As I mentioned earlier, we’re putting in big enterprise systems. Because we’re a long-term Epic customer, we haven’t had their billing system in place. We haven’t had Beaker, Epic’s lab system, in place. Those two are scheduled to go live at the end of January, on the same day. We’re implementing the Salesforce CRM in a very phased approach across our integrated delivery network, and Workday is going live at the end of September. So we’re keeping pretty busy.

 

Gamble:  It sounds like it. And you haven’t had to push back those dates?

Kravitz:  We don’t want to. We’ve had people dedicated to that throughout this process. And of course, we’ve attacked COVID head on, doing things like deploying more than 2,000 devices for telemedicine. Before the pandemic, we were doing about 1,000 video visits per month; and that’s specific to video visits. In all, including telehealth encounters, we’re doing about 4,000 per day, and we expect that to continue. In fact, we think it’s a great avenue for our lower acuity patients, and for the younger folks who don’t want to commit to an organization, and would use FaceTime than have to drive to an appointment. For them, it’s great. Most people in our area, including elderly patients, have loved the experience, which is very surprising. We didn’t expect that. We thought it would be very challenging for them, but that hasn’t been the case. They’ve liked it. We have a very high deployment of smartphones — probably around 87 percent in our territory.

We’ve also turned up the switch on remote work. I’d say about 90 percent of my staff is working from home, myself included. A lot of people are working from home and a lot of them want to continue working from home. That’s going to change our whole methodology on leasing space and everything else; it’ll be a big impact.

We’re excited about these changes, but we’re trying to do it cautiously so that we can make sure we provide the best experience for our employees, the highest quality outcomes, and the highest levels of productivity.

Part 2