Q&A with CIO Aaron Miri, Part 2: “You Have to Make Sure Your Team Is on Their Game.”

For the past few years, we’ve seen a significant evolution in the role of the CIO. And although it isn’t always obvious, there are times when it couldn’t be clearer just how much has changed. Case in point: Aaron Miri, who has held the role at Dell Medical School at the University of Texas at Austin for the past two years.

During a recent interview about his team’s efforts in response to Covid, he expressed the same passion while discussing the human aspect of leadership as he did while talking about the groundbreaking 3D-printing face shield imitative. When it comes to managing people, Miri believes the need to “tough it out and soldier on” can hinder relationships, and that during difficult times, it’s important to “be vulnerable” and “talk to your team in a way they understand.”

He also talks about how the innovative culture at UT Health Austin has enabled his team to flourish, their strategy when it comes to contact tracing, the enormous potential telemedicine offers in terms of health equity, and why he feels like two years has “flown by.”

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Key Takeaways

• After partnering with a Seattle-based company to roll out a contact tracing initiative, UT Health Austin went back and revamped processes to incorporate analytics an algorithms to more effectively identify potential Covid cases.
• One of the most critical aspects of a successful contact tracing program is in building trust, which UT Health Austin was able to do by offering multilingual options. “We took the time to make sure they felt safe.”
• IT leaders have a responsibility to ensure staff feel safe and comfortable, especially those who are on site, and let them know they have leadership’s support.
• Although reimbursement has been a key component in telehealth’s rapid growth, increasing users’ “comfort factor” has been just as important.

Q&A with Aaron Miri, Part 2 (Click here to read Part 1)

Gamble:  Let’s talk about the contact tracing initiative. How did that come about?

Miri:  It was interesting. We have some of the brightest physicians, clinicians, and researchers I’ve ever had a chance to work alongside of; I’m constantly in awe of them and learning from them. It was the beginning of March when Covid first broke out here in Austin. By the second week of March, I received a phone call from one of our chiefs of family medicine, who said, ‘We really need to do home temperature monitoring for patients,’ specifically those who have through UT Health Austin that we suspect are positive or are awaiting rest results. He said, ‘We need to see what their temperature is so that we can intervene quickly, and we can dispatch people proactively to keep them out of the ER.’ The thought process in those early days was, if you can catch a temperature spike early, you may be able to intervene with various medications before they potentially present to the ER in really bad shape.

We partnered with a company out of Seattle to do exactly that. They had been doing hypertension monitoring, and they pivoted to COVID-19 monitoring because they already had a platform built for it. It made a lot of sense. It was quick and easy. There was an iOS app and an Andriod app, and developed a web app shortly thereafter. We put out apps in Spanish, which was very important to the city of Austin.

But right on the heels of that — not two weeks after we went live with home monitoring, which was around the beginning of April — we realized we needed to do contact tracing. The people we’re sending home are in contact with their families and loved ones. We need to know who they’ve been around and who those people have been around, and so on. That’s what contact tracing is. It’s basically the lineage of who you’ve been around and who you’ve been in contact with, and trying to get ahead of it so we can stem the source of transmission, especially from inadvertent exposure if someone’s asymptomatic.

And so we built a contact tracing system in partnership with that company to do exactly that, which was great. As we took on the public health response, in partnership with APH [Austin Public Health], we were able to contact-trace a large swath of the city of Austin and help incalculable numbers of people make sure they weren’t getting infected, inadvertently or otherwise.

Then, because we did such a great job with the city and with the public health response, and assisting the hospitals and physician practices, we were called on to help put in a plan for students returning to campus. In June, we received a request from UT Austin to help make sure students can return to campus safely, successfully, and as with as many protocols as possible to prevent infection — which means contact tracing — and the data analysis that has to occur on the fly to determine who is at risk and who is not. And so we stood up Version 2 of contact tracing with a completely revamped process using data analytics and algorithms of what we learned across the city of Austin, especially in terms of populations that are more predisposed to be exposed to virus.

And so in August, we had tens of thousands of students move back into the dorms. Our contact tracing platform is alive and kicking and has done a phenomenal job of bringing students back. It’s been a wonderful example of teamwork and collaboration across all of UT Austin — not just Dell Medical School and UT Health Austin. It’s also been a phenomenal response by the physician community rallying together to make sure that not only are we taking care of the patients that need us and whatnot, but also our students and our student body. Typically on the healthcare side, you don’t see them unless you absolutely have to. In this it’s been proactive, which is a good thing.

 

Gamble:  Is there an awareness or education component to this? I know it’s been an issue in some states — including New Jersey — with people being unwilling to participate in contact tracing because of privacy concerns. How have you managed that aspect?

Miri:  In a couple of ways. There’s a term called health equity, which means that you recognize in terms of a technology stack people of all shapes, all sizes, all colors, and all demographics will be potentially interacting with you in a didactic manner. You need to walk them through what you’re doing in a very transparent and safe manner that makes them feel comfortable. In our case, it’s having multilingual, multispecialty conforming to all 88 compliant types of messaging and communication — even the contact tracers on the phone, who are speaking with patients or people who were potentially exposed to Covid in their native language, in their native format, and in a manner that they feel comfortable with. This is why it was important that when we put out a smart app to the city, we also had a web app, because we found that the socioeconomically challenged population had smartphones. They may not have access to the App store or the Google Play store, but they could get to an internet browser on free Wi-Fi.

And so, as we interacted with what we call the disconnected population, utilizing those types of modalities and interacting with them in a manner that they’re comfortable with helped build a level of trust. For example, they might see that I went to a barber shop yesterday, and ask, ‘Who was there with you? Who sat next to you?’ In order to ask those questions and not be invasive, folks have to feel a sense of comfort that you really do have their back. I give a lot of credit to our mental health professionals here at UT Austin who cracked that shell day one and started working with our contact tracing team to help them understand that and make it a very safe conversation.

Now, it takes a little bit more time when you’re talking with somebody on the phone to make them feel at ease, but it’s been well worth it. We’ve had a tremendous success rate in terms of reaching out to people and getting them to call us back because, we take the time to make sure they feel safe and understand that we’re doing this to help them. We’re not doing it to spy, or for any other reason but to make sure that we stem this COVID-19 pandemic.

 

Gamble:  What are some of the other initiatives that are really leveraging innovation?

Miri:  There are a few different dimensions we don’t hear enough about. First, let’s talk about the mental health of clinicians, your staff, you as a healthcare IT leader, and your fellow peers in the C-suite. I spent a lot of time with my team, especially during the early days when the news was very dire; we were hearing about places like New York City where they had 18 wheelers with refrigerators to carry out the bodies of the people who has passed in the hospitals. It was a very traumatic time.

In fact, The Wall Street Journal ran a great article featuring Charles Nemeroff, chair of the department of psychiatry at Dell Medical School, who spoke about the PTSD-like effect that COVID-19 has had on this country as a whole. And so one of the first things we did early on that’s been recognized and awarded was to stand up a mental health hotline for our workers. It’s staffed by our social workers and mental health therapists for anybody that’s working the COVID-19 response to call in and talk. That initiative has paid tremendous dividends, especially now that we’re six months into the pandemic, because these are the same clinicians who are on the frontlines day in and day out, being exposed to everything and going home to their loved ones. It’s inevitable that the mental toll Covid-19 takes is going to be tremendous, and so you need to have these outlets and outreach efforts to make sure people feel good.

Let’s speak about IT. A component of my team is here every single day. I can’t exactly have people servicing devices from home; it’s almost impossible. And so a large portion of my team is home, but I’m here. My personal philosophy is, if any of my team is here, I’m here, regardless. I’ve been here every day.

For the people going to hospitals and clinics every day, there’s a natural fear factor. There’s a natural understanding. As an IT leader, you can spend time with them and say, ‘I’ve got your back. Let’s run a ticket together. Let’s run an issue together. Let’s go talk to the clinicians.’ You can let them know it’s going to be safe and secure. We can trust our EVS team and whatnot, that everything is clean as best we can possibly do it.

Those are the types of activities you have to do — not just from a macro perspective in your health system, but also in terms understanding what is the ethos of your IT team, and how they’re doing. Because when UT Austin come and ask us to set up a contact tracing system and processes and whatnot to facilitate tens of thousands of students coming back to campus and the return of Longhorn football, which in Texas is a big deal, then you have to make sure your team is on their game and they’re feeling confident and feeling good. It’s incumbent on all of us to do that.

The other thing I would say that’s important in terms of innovative factor is not just putting telemedicine out there for telemedicine’s sake, but allowing your physicians and your clinicians to experiment and innovate leveraging telemedicine tools. If you talk to some of your top clinical leaders in your health system, they’re constantly trying to figure out, ‘how can I do this better on the EMR? How can I do this better in the physical practice? Can I move my chairs in the waiting room here? Can I do this better?’ That’s just the nature of clinicians; they want to see patients better, faster, cheaper, and smarter.

However, a lot of legacy telemedicine platforms are cumbersome, and it can be very difficult to innovate on them. But you can give them telemedicine-type tools — maybe some consumer-type tools — and let them play. Let them innovate. In our case, we’re big believers in an integrated practice unit model where we have IPUs for our musculoskeletal team. They leveraged our telemedicine product to figure out how to create a virtual care team model to create waiting rooms; this way people could see a multidisciplinary care team virtually. That wasn’t something that came out of the box with instructions. They figured it out. Our physicians figured it out. Our surgeons figured it out — that’s awesome. Let’s adopt it. It’s fantastic. Great job.’ It makes them feel bought in. Telemedicine isn’t just a tool to help people chat; it’s a tool that can be shaped and molded like a piece of clay.

 

Gamble:  It’s been so interesting to see care providers really take ownership of this; even a year ago, I don’t think we could’ve predicted that.

Miri:  That’s true.  And a lot of folks say it’s about reimbursement and a lot of those types of things that shape the behaviors of users. I can appreciate that and I actually agree with that to a large extent. But I also think its comfort factor. When you’re so comfortable doing something every single day, to suddenly move someone’s cheese is a very difficult proposition — until you’re absolutely forced to for your life and death purposes.

I’ll give you a specific example. We measure the Net Promoter Score of every single patient who goes in and out of our facilities. Now of course, HCAHPS and other scores are important, but NPS gives us a quick way to read, ‘What’s your bugaboo? What’s going on? What’s good? What’s bad? Would you recommend a friend come here to UT of Austin?’ And the feedback we get is fantastic; we were constantly getting NPS scores in the mid to high 80s before Covid. We’re still doing Net Promoter Score sampling on every single encounter we do through telemedicine and virtualization, and the NPS is now in the 90s.

Why? Because people no longer have to worry about fighting for parking in downtown Austin. People don’t have to worry about traffic. People don’t have to worry about running five minutes late because there was an accident on the interstate. All those issues have gone by the wayside. Consumer adoption has been fantastic because now they realize it works, and they say, ‘why wasn’t I doing this before?’

Eventually we’re going to shift back to a model at some point in between. You’ll never put the genie back in the bottle. We will definitely revert back to some of the old behaviors, but I don’t think you’re ever going to put aside the consumer adoption or the uptick of telemedicine or remote patient monitoring.

Part 3