Having prior experience as a bedside nurse can be extremely valuable for those in health IT leadership roles — but not for the obvious reasons. Although it’s true that those who have walked the walk possess an understanding of the workflow challenges and other pains associated with nursing, the real value comes in understanding the need to be “inclusive of others to get a full picture of what you’re dealing with.”
For Mike Hart, who has served as VP of IT at Arkansas Children’s for the past 7 years, the lessons he learned in previous roles — including stints as a nurse, a clinical informatics coordinator, and a software programmer — have provided a solid foundation as the organization has expanded in recent years. In a recent interview, Hart talked about what his team is doing to get back on track in the wake of Covid, how he believes disaster recovery will evolve, the “all-hands-on-deck” mentality organizations need, and what it takes to be an effective leader.
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- Being a pediatric organization, Arkansas Children’s didn’t have an influx of Covid patients, but it still suffered a financial hit when elective procedures were shut down. As a result, the organization is now in “cash preservation, reduction and planning mode.”
- Rolling out an enhanced telehealth platform in a few weeks – rather than in two years, as had been the plan – “took an army.” Not just because there are so many clinics, but because of the diversity in terms of how the clinics operate.
- Being successful – and even surviving – in a reduced revenue, reduced throughout environment “has forced us to look at how we spend our money,” focusing only on initiatives with long-term implications.
- One way in which Covid has changed the CIO’s strategy? Going forward, “we’ll have a different understanding of what we need to be prepared for and how we need to make decisions in a more meaningful way.”
Q&A with Mike Hart, Part 1
Gamble: Can you start off by providing an overview of Arkansas Children’s?
Hart: Arkansas Children’s is the only pediatric hospital in the State of Arkansas. We’re now a health system; we actually have two hospitals. We opened up a second hospital about two and a half years ago, and we’ve created a clinically-integrated network. I believe it’s the first pediatric clinically-integrated network in the country. All of that has happened in the last few years. We support the whole state; we don’t have a lot of in-state competition. We’ve been around for more than 100 years, and we’re probably one of the top three most recognized name brands in the state, with the others being the Arkansas Razorbacks and Walmart. We’re very tightly connected to our community. If you come here, you see that everyone is very mission driven. They believe in what we do, in who we serve, and the connection to this great state.
Gamble: Let’s talk about Covid-19. How has it affected your strategy?
Hart: It’s had a large impact on us. I’ve talked to people from a lot of organizations about their strategy — what we’re doing and what they’re doing — and had conference call with various groups. And it seems like whether you’re adult or pediatric focused, we’re all facing the same challenges and using some of the same avenues to try to close those gaps. And so, while we haven’t been greatly impacted directly by having an abundance of Covid patients, we have been impacted from a revenue standpoint through cutbacks in elective surgeries and clinic visits.
We saw the same reductions in attendance to clinics and elective surgeries as adult hospitals, when then impacted our inpatient census, ED visits, etc. Our revenues dropped because of the early cutbacks the state had put into place. Once those were lifted, we were able to reinstate our normal operating procedures, and I would say we’ve come back very nicely. We’re nearly 100 percent in terms of returning back to our normal throughput, both in the hospitals and clinics. So we’re very close. We’re not quite at 100 percent, but we’re getting there. We’re on track.
The other way in which we were impacted is that, like other organizations, we’ve had concerns with projects plans. Now, we’re in ‘cash preservation, reduction and planning’ mode, because we don’t know what will happen with Covid in the fall. Is it going to get worse? Are we going to go back to reducing the throughput that allows us to generate revenue? And if so, how can we increase or enhance our revenue income?
In one regard, I would say that what we went through has really helped us think through that. We feel pretty good about where we are now and the plans we have in place if it should get worse — if it doesn’t get worse, that’s good. I think we’re in good shape regardless of what comes because of the planning we did during those early months.
Gamble: Can you talk a little more about what went into those plans? This was such an atypical situation not knowing what was coming, so I’m sure any input would be valuable.
Hart: When things took off with Covid, we started to look at enhancing telehealth. Technically, we had it in place; we just weren’t using it very much. We were somewhere in the neighborhood of around 50 visits per month, and in a very small area. We have 80 clinics, so that really is a low number. Its use was limited; but that quickly changed.
And actually, according to our roadmap prior to Covid, we had been planning to roll out a more robust telehealth program over the next two years. That didn’t turn out to be the plan. Once Covid hit, we had to do it in a matter of weeks. That was the initial component where we said, ‘Okay, we’ve got to shift all of our resources to getting telehealth fully implemented.’ And really, it took an army for us to do that. You’d think it would be easy, but when you have a great deal of diversity in how your clinics operate and in the expectations, you have different leaders and disciplines in all of these places.
In our case, we had multiple technologies at our disposal. And so there was a lot of decision-making that had to be done, a lot of trial and error with the various technologies, and a lot of handholding in terms of educating people on how to do this easily and quickly so that it didn’t frustrate providers or families. We went through that whole process for about a month. It was all hands on deck. Once that stabilized, we began to focus our efforts away from optional engagements and more toward engagements that we knew were going to carry us for the long term.
One of those is population health. And so we focused on our ability to understand how we’re driving our clinically-integrated network, how we’re dealing with populations, and how we’re able to use our data in a meaningful way to help us engage with providers. We’re also looking at how we can streamline all of it so that if Covid numbers do increase and we have to reduce in-person visits again, we’ll be able to leverage that information, both with our insurance providers and our clinically-integrated network, to help drive forward in a way that’s more meaningful and specified based on real information.
That’s how we’ve shifted during the past few months. We’ve focused on increasing that side of our knowledge base so that our strategy is focused on helping us move forward successfully, at least through the next year if Covid remains an issue. Most hospitals have had some form of financial cutbacks; some organizations I’ve spoken with have had to reduce salaries or even eliminate positions. And so, our desire to be successful in this reduced revenue, reduced throughput environment that COVID has put us in, has forced us to look at how we spend our money; to remove some of those optional things and focus on the mandatory things that will make us successful. That’s how our minds have shifted to enable us to avoid those worst-case scenarios.
Gamble: In terms of deciding which initiatives to put on the back burner, is that something you’ve approached on a case-by-case basis?
Hart: We do a lot of that on a case by case basis. You’ve got to look at your return on investment with these things. Some aren’t necessarily expensive in terms of cash, but they’re expensive in terms of resource use — which means people investing their time. When you’re looking at reducing as much overhead as possible — and in some cases some organizations reducing FTEs — you begin to look at project alignment in terms of resource allocation as well as cash allocation.
And so we began to cut back on things that could be very resource intensive. With each project initiative, we do a business case review of what it actually costs us in terms of money and resources, the return on investment from those initiatives, who it impacts, and how big is the impact. We have various rankings for different categories, and we do an overall roll up and quantification of those details into a final weighing of the project’s value. We then compare those to each other to see which ones we think should move forward, and which we’re going to put on hold. We won’t necessarily remove it permanently; it’s more of a ‘not right now’ type of decision.
Gamble: Do you think that the adjustments your team (and other teams) have made will have a long-term impact on how IT prioritizes projects?
Hart: It’s a good question. The short answer is that it depends on how you define long term. If we’re talking about the next 12 months, I’d say probably. If we’re talking about many years, I still think it will have an impact in how we decide what to do moving forward, under the premise that this could happen again. Let’s say COVID goes away — we get a vaccine, we get it under control, and it becomes nothing more than a flu by this time next year. If that is the case, we’d still move forward with a different understanding of what we need to be prepared for and how we need to make decisions in a more meaningful way in case something like this reoccurs.
I think this caught most of us off guard, to some extent. We’ve had crises in the past, but nothing like this. And now that we’ve had it, it certainly raises the idea that it could happen again. I do think the long-term strategies will be different than they’ve been in the past. We’ve always tried to think proactively; now, it takes that to a level where we realize just how much can happen that quickly. So I do think the long-term strategies will be different. The next 12-month strategy will be the most aggressive because we don’t know what Covid is going to do this fall and even next spring; and therefore, we’re going to plan for the worst case scenario, hoping that it actually ends up better than expected.
Gamble: Right. You mentioned the challenges in getting telehealth off the ground, one being that physician practices have different systems. Can you talk about how your team is managing that?
Hart: I’ve spoken with many organizations as we’ve gone through these last few months, and it seems there are different thoughts from different organizations in terms of what they’ve experienced; it depends on who you speak with. But when you get down to the people who have actually worked in the support of these environments, I hear a lot of the same thing: it’s a little bit messy. There are technologies that are doing decently well for organizations that are using them in certain ways.
In our organization, as with others, there’s a lot of diversity in how things are managed from clinic to clinic. There’s a lot of diversity of thought, a lot of different workflows, and a lot of different needs from one clinic to the next. If you have that type of organization where there are different technology requirements in creating a telehealth program, we’ve found that there isn’t a single entity that does it all and does it all well. And so you end up with this piecemeal environment with scenarios that this provider doesn’t offer and another one does, and you have to use that other solution for that scenario.
In terms of integration with the EMR, we’re working with telehealth vendors that provide integration with our Epic platform. And the same time, Epic is creating its own built-in solution, so we’re also looking at that as well. We’re looking at multiple third-party vendors that integrate with Epic, and we’re also looking at Epic itself. The more integration you have, the better the experience for the provider and family. When you’re using a patient portal, it makes it easier. It makes it easier to document and easier to access, and it makes it more seamless. That’s definitely something that’s important to our organization, as well as to others I’ve spoken with.