Don’t lose sight of the ultimate goal.
For CIOs, who have spent the past six months scrambling to implement tools that enable providers to practice care, all while establishing a remote workforce and ensuring the lights are kept on, keeping an eye toward the future may seem impossible. Or at the very least, counterintuitive. But if the organization is to thrive — and not just survive — it’s precisely what needs to happen, according to Robert Eardley, CIO at University Hospitals.
Taking inspiration from author Jim Collins, Eardley believes leaders who are focused mainly on completing the next project on-time and under budget are at risk of missing the big picture. On the other hand, those focused on making “a series of good decisions build on top of each other” can help their teams achieve success.
During a recent interview, Eardley spoke with healthsystemCIO about why it’s so critical to think long-term, what he considers to be the top qualities in future leaders, and the keys to successful change management. He also talked about the evolution of consumer engagement (and the role IT plays), how UH is working to keep healthy patients at home, and his thoughts on the power of ‘need.’
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- By implementing video-based temperature scanning, University Hospitals was able to “fill the gap” using technology when nurses returned to the bedside.
- One of the key components in improving patient access (specifically, computerizing physician directories) is in getting operational practice design and IT systems to align with each other.
- Sometimes the best strategy is to identify the end goal, then work backwards.
- The biggest challenge in migrating from phone-based discussions to online scheduling isn’t the technology itself, but the “comfort level” of users.
- Remote-monitoring tools can play a critical role in helping patients recover at home while still under the care of physicians.
Q&A with Robert Eardley, Part 2 [Click here for Part 1]
Gamble: One of the initiatives I read about was the use of AI and facial recognition. Can you talk about what you’ve done there?
Eardley: We have a partnership with a company called TensorMark in which we supply COVID test results to them. They use facial recognition to marry up who the person is, and then query whether there is a negative or positive value in the recent past.
On their side, they owned the conversion of sports venues and restaurants where they were going to try to implement this tool. We were party to this because if we had the consumers’ approval — which is its item to focus on — we could release the lab results out to this company to be able to give someone a negative COVID test result in the last 14 days. We’ve been working on that together; most of the facial recognition was on TensorMark’s side.
However, we did move forward with video-based temperature scanning at our front entrances. For instance, now when I walk into our building, I stand in front of a video camera, pull my face mask down, and the camera takes about 1 or 2 seconds to analyze the heat of my forehead and cheeks. It will ding positively if I’m under the threshold (about 97.8) and will make a different sound if I’m over the threshold (somewhere around 100 degrees).
The security guard themselves would be able to have a pretty quick visual so they know everybody who’s walked into the administrative building. For patients, they receive a temperature check upon entry, which is more efficient than requiring a nurse to sit there for the whole time the building was open and do temperature checks. That’s what we did early on, and I think we can all acknowledge that’s not exactly why they went to nursing school. But they were happy for the work because our patient activity was down so much. Now that it has returned, the nursing division is rightfully going back to the bedside, caring for our patients. We were able to find technology to fill that gap of taking temperature screens upon entrance to some of our buildings.
Gamble: That’s an interesting point. In our interviews, we’ve heard examples of both clinical and IT workers who were put into different roles, which required a lot of flexibility.
Eardley: That’s right. I think people inherently understood that it was a unique situation. First and foremost, our goal is to deliver upon the organization’s mission to take care of our community. When people had to live outside either their comfort zone or their normal situation, I think they quickly understood it was part of that goal of trying to set up these processes on something that was relatively unchartered. I’ve heard generally just positive feedback from people that were asked to do creative or unique things.
Gamble: Is there anything else that comes to mind in terms of strategic goals?
Eardley: Sure. We have a big focus on patient access, and while that’s a common focus, it really is a mix of getting our operational practice design, as well as our IT systems, in alignment with each other.
There are two parts to this access initiative. One part is simply exposing the availability of our physicians to a wider audience, either for a consult, a follow-up visit, or an initial referral. For a long time, we’ve been a phone-based culture. People would call the practice and talk to somebody to get information on who does what.
As we computerize this operation and bring it online, it really forces the discussion that we need to have a directory in the IT systems with which orthopedists provide which type of care. That way, when a patient is looking to complete a referral order for orthopedics, they can go to the right foot doctor for their toe pain or they can go to the right shoulder physician to investigate a torn ligament.
These all fall into orthopedics, and so there’s a lot of work to try to get an accurate physician directory of who does what in which specialties, and then within that, an understanding of the practice patterns — how long do they see patients and on which days? Some days they’re in surgery. Some days they’re in clinic, and in order to put what used to be a phone-based discussion into an online access, it starts with understanding how the physician practices, and then creating IT systems so that we have a discrete, subspecialty-based directory which can feed into our website search engine. For example, if you’re looking for an orthopod, we can expose enough availability in our registration and scheduling system so that somebody online can have a good collection of orthopods available on the day they need it.
That’s one side of it; understanding how the practices work and then exposing that online, while respecting their desire to have some level of control of the practice. The second is executing referral orders efficiently. If you go to a primary care physician and get a referral order to a cardiologist or an orthopod, you might get that referral order. We’re putting a lot of processes — both work processes and IT system processes — in place so that it can be exceptionally easy to get that appointment booked for the orthopod or the cardiologist. That’s one of our key 2020 initiatives.
Gamble: It’s encouraging to see that emphasis on patient experience and engagement. It hasn’t really always been a top priority and I think that it’s really a big step to see the industry moving closer to that.
Eardley: It’s an evolution, much like maybe the travel industry went through. If you go back 25 or 30 years, you had to go to a travel agent to book a trip. The travel agent had to work inside an archaic computer system to try to find flights and dates and times. It wasn’t self-service. For the past 10 or 15 years, we’ve expected to have online availability to flights.
We’re going through that same evolution in healthcare. I’m sure each health system will have a variation of this theme, but we all know the end game is for patients to go online, using either a phone or computer, and be able to scroll through and find the cardiologist or orthopod you want, and be able to book an appointment on a day and time that meets your convenience.
We know that’s the endgame, and so we’re working backwards to put in the steps in. Fundamentally, it’s migrating from what has long been a phone-based culture where you call the practice and they know which physicians do what; they hold a lot of institutional knowledge in being able to listen to an explanation on where the pain is, and point you to a particular physician.
It’s trying to take the simplicity of a 30-second statement on what your pain is, and pointing you to the right orthopod based on his or her area of sub-specialization. We’re trying to put that onto a computer system, so it can expose what’s been populated.
To do that, we need to have much more granular directories about who does the hand surgery, who does the back spine consult, who does shoulder, and who does feet. That’s one example where we’re going through that migration now. Part of it is, how do you run your practice and what do you do, because we’re trying to get it into the computer system. The other part is comfort level; we’re going to expose openings on Tuesday, Wednesday, Thursday to consumers. Admittedly, it’s always been exposed. But instead of calling to get appointments, we’re asking everybody to go online.
Gamble: I like the way you word; it really is an evolution.
Eardley: We already have the technology to be able to do online booking and online scheduling. That’s not the hardest part. The hardest part is understanding the subspecialties — what days they practice, what days they’re in surgery, when is the clinic open, and if not, does someone cover for that physician. If the person you want to see for a cardiology consult is on leave or on vacation, you need to know who the next best provider is. And so we’re really trying to get an accurate directory populated so we can expose online the appropriate physician for your needs.
Another item we’ve moved forward with across a large domain is virtual care. That’s a strategic initiative in a very broad sense. It takes a number of different elements; one of those that came out of the response to COVID is remote patient-monitoring.
Now, if you present to one of our EDs with a mild case, you’re not warranted for an inpatient admission, but we also know that this thing can go south quickly. We now have a tool we can send you home with that will remotely connect you to a physician who can monitor your care. We may send people home for a week of observation. If their O2 levels go south precipitously, we can contact the patient and check on them. If they’re having trouble breathing and the like, we can advise them to go to the ED or arrange for them to see the appropriate provider. That’s one initiative that we put in really as a response to the Covid pandemic itself, but we were already headed in the direction of having people be remotely connected, even if they’re in the home, to the appropriate caregivers within our system.
Gamble: And it’s a device that they get sent home with?
Eardley: Yes. It’s a device with a cellular option. You can plug into the wall and wear it on your wrist, and it takes enough of biometrics and vitals that we feel we have enough of a look to be able to check in on you, should the conditions warrant it. In one case, a patient went home with mild conditions that then turned worse; the provider who was monitoring the patient remotely from central command was able to get in touch with that patient. It was deemed critical enough to request an ED visit and admission. That’s where patients that are left to their own devices may not always know enough to take the appropriate action. We want to make sure that they are appropriately educated and that they have somebody at UH who’s making sure that they’re fully recovered without just sending them away from the ED and losing track of them.
Gamble: It goes along with what you mentioned before as far as the move toward population health and leveraging technology to keep patients out of the hospital.
Eardley: We have a motto that we try to live by; we want folks healthy at home rather than recovering in our hospitals, wherever possible and wherever clinically appropriate. Many people recover best in a comfortable home environment. It’s just that in years past, we didn’t have really a linkage into the home environment to be able to feel that we could appropriately observe their ongoing clinical situation. We have new tool sets that enable us to send our patients home and be able to clinically observe them so that they can recover and be healthy at home rather than recover in a hospital bed.
Another item that we moved forward with is a remote-monitored intensive care unit (which is also called an e-ICU). With a number of outlying facilities in our more rural areas of northeast Ohio, we might have an ICU, but we can effectively monitor those patients with an intensivist or two intensivists back in a central command post. We’ve moved forward on an e-ICU effort to be able to bring the knowledge and expertise of some of those physicians and intensivists who work at a central location. They can monitor some of our smaller remote locations that might otherwise be challenged with keeping an intensivist on the team full time.