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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- The ability to access an ICU staffed by an intensivist from a remote location has been a game changer for University Hospitals during the pandemic.
- One of the key lessons learned during Covid-19? “People are really apt to embrace change and absorb technology when it meets their needs, and when it’s simple and intuitive.”
- Going forward, consumers and health system leaders will have to “figure out together” the equilibrium when it comes to which appointments can remain virtual, and which require a physical component.
- IT shouldn’t be viewed as a division, but rather, a computerization of clinical and work processes, where the goal is to “bring simplification” to the patient chart.
- Knowledge of the basic mechanics are critical, but what’s more important in team members is having “a vision of what’s possible” and how it can be tied together to create better outcomes.
Gamble: Let’s talk a little more about the e-ICU initiative. Is that already in the works?
Eardley: That’s in the works. Some of our remote hospitals have ICUs physically; they have patients on telemetry monitoring. They have local nursing and local staff there to take care of their needs, but they might not always be staffed at a level where they would have a physician monitoring their care all the time. And so now, we’d be able to run monitoring from another location of an ICU that sits geographically disparate by 50 or 60 miles.
That is something that has occurred since the Covid pandemic. In the past, if you ran an ICU, you needed a physician on staff. We were preparing so that if there wasn’t the time or desire to drive 30 miles in some of our outlying areas, we could set up an ICU in a remote location and we’d still have the expertise of a physician intensivist overseeing the care. Before, we wouldn’t have been able to set up an ICU structure if it wasn’t staffed 24/7 by an intensivist. This allows consumers to stay closer to home – which, in many cases, is their preference – while still receiving the care of an intensive care specialist.
Another interesting thing we’re doing is we’re running what we call our Virtual Office. At one point about a third of our visits were through a virtual appointment rather than in person. As you may know, there was a virtual care option before Covid, but it was probably only a small percentage of appointments.
With the pandemic, we started to see upwards of 30 percent becoming virtualized and we’ve done that through a mix of technologies. For our virtual office appointments where we see the patient remotely with a video conference, we register that person in the same registration system we use for the rest of our enterprise, which is Cerner’s Soarian product. And then we document that care in our EMR, which is Allscripts’ TouchWorks. The only thing that we have to connect in the middle is the visual communication channel — either Doxy.me, a Zoom, or FaceTime. CMS offered a lot of discretion about what technology could handle that visual communication channel, and so as long as you can see and hear the person; as long as there’s a video and audio feed, Medicare had stated that you could bill the same rate as if it were an in-practice home visit with a special modifier.
And so we went in that direction. We’ve been seeing a lot of patients that way; it’s independent from on-demand care, which has its own process. We’ve partnered with a technology company called MDLive to create the infrastructure to support on-demand care, where patients can wait in line for the next provider of care in the next 7 to 10 minutes. That’s a different use case than if you’re scheduling Thursday’s appointment at 3 p.m. with a provider you already know, even if it’s going to be virtual.
Gamble: It’s really amazing how quickly this has taken off.
Eardley: It is. One thing I found to be a lesson is that people really are apt to embrace change and absorb technology when it meets their needs and when it’s simple and intuitive. I think the reason we’ve come so far is because it was an actual need people had. We weren’t trying to convince them through change management concepts and theories. They knew they didn’t want to drive in the office — why not do it over the phone? We’d hear, ‘I Zoomed with my grandchildren the other day, why can’t we do it that way?’ I think it’s a compliment to all of us as consumers of technology that we were willing to change so fast, and the health systems basically have adopted the speed of what the consumers have been comfortable with. That’s one way to think about it.
Gamble: Do you foresee it staying this way? We’re hearing people say there’s no going back — do you agree with that?
Eardley: I agree with high-level statement that things aren’t going back to the way they were. I think the nuance is going to be in two parts. First, on the regulatory side, if this moves forward, Medicare and insurance payers likely are not going to be as liberal with the video visits as they have during these past few months. They may prorate it at 75 percent of what they pay for an inpatient visit; that’s still unknown.
That’s one variable, and it’s an important one because before this shift, nobody paid for video visits. For health systems that were supporting it, there was usually a charge on the front end to your credit card. I guess we’ll learn together what the future holds as far as adjustments to the payment scheme.
Right now, it’s reimbursement equivalent to an inpatient visit. That’s important. During Covid, there was probably an excessive level of adoption of virtual care given the reasons we just stated, but if it went to 30 or 40 percent at its peak, it won’t go back to 2 percent like we were seeing before. But is it realistic to expect we’re going to equalize at around 10 or 15 percent? I think it will settle around that range.
Gamble: That makes sense; those numbers are more practical.
Eardley: It will probably split again, based off need. If you need to go in and give a blood specimen or urine sample or have pathology tissue taken, some of that is just physical by nature. If you have a video visit, to then be told you need to come to our office to drop off or have a blood specimen taken, you’d prefer to do it in one fell swoop if you didn’t have this virus concern.
And so those might be physical because you want it all in one; you want it to be convenient and be able to do everything at one time, including possibly the weight scale and other physical attributes such as looking at your skin for any lesions. Some of that is practical.
What will stay virtual is the surgical follow up, which in many cases is, we did the surgery a week or three weeks ago — how are you feeling? Do you have any infections? Any redness, itchiness, or any concerns from the surgery? If it’s, ‘no, I feel better every day. I don’t have any undue infection concern that I can distinguish,’ it’s a whole lot of wasted time for you to drive in to the orthopod’s office to say, ‘I’m feeling fine, thank you.’ That’s where we get into equilibrium of what’s the need, and if the need is to just to get a prescription for pink eye, that’s probably going to stay virtual. That’s what I think we’ll have to kind of figure out together; as consumers and health system leaders, which of these are more physical visits in some capacity, and which can be very efficiently run virtually.
Gamble: Right. So let’s switch gears a bit and talk about your career. You have been at University Hospitals for a little more than two years, and before that you were with Houston Methodist for a while. When you look back on the experience of going to a different organization and then coming back, how did that change your perspective?
Eardley: It affected me greatly. I was in consulting prior to joining University Hospitals back in 2006, then I was with the University Hospitals from 2006 to 2011, most of that time as associate CIO. At that point, UH was in a large growth spurt as part of Vision 2019, with many service lines and physical locations growing. Then in the summer of 2011, I took the role of senior VP, CIO, and CISO with Houston Methodist.
Houston Methodist is a first-class organization that does things right. I learned the power of focus and the power of knowing what one’s organization is about. During the seven years I was there, we had some big milestones: opening a data center, redesigning our website, making a push for population health, and doing a business case and migrating to an integrated EHR with Epic. There was an intensity and focus on what needed to be done, and we executed well on that.
When I returned to UH in 2011, I was committed to bring that same focus and intensity on our work here on behalf of our providers, patients and community because there are some critical needs that we have within IT. We are that infrastructure; we are the fundamental way organizations work, not IT as a division, but IT as a computerization of clinical and work processes. And so we really need to take a hard look at how we bring simplification to the patient’s chart, the EHR Enterprise. We have to really look at what the future would be around the personalized consumer experience.
The third is analytics; really tapping into the full toolset of some of the cloud providers and analytics providers is pretty compelling. Once you get into this data scientist community and that statistical side of analytics, that’s really important.
Those are three key items, along with a fundamental understanding that the engine of the success is having a quality team. You need to invest in the team first, which is built around trust, everything else stems from that, and so I want that to be one of our key focuses here at University Hospitals.
Gamble: When you look at the direction in which the industry is headed, what qualities do you feel are more important in future leaders? What do you value most in team members?
Eardley: To me, it’s the vision of what’s possible, the vision of tying it all together and making sense of the portfolio — not as one product that needs to be maintained, a version upgrade, a security update; those are critical mechanics. But it’s knowing what’s possible. It’s that awareness of what’s happening in both the healthcare and technology industries around popular trends and design thinking in a creative mindset. It’s choosing to do things first class.
Ultimately, I’ll defer back to a quote that I include as a footer to every one of my IT strategic plan slides. It’s a great quote from the Jim Collins book, Good to Great, Degree, where he talks about the flywheel model and how good successes start to build on each other and you get positive momentum. He says that “breakthrough results come about by a series of good decisions diligently executed and accumulated one on top of another.”
That quote is my inspiration to challenge ourselves as leaders — are we making good decisions now that can sit on top of a good decision later, and on top of another good decision? If you make a series of mostly good decisions that build on top of each other, you can really go places. If you’re just working on getting the next done project on time, on budget, and it’s not in context of this breakthrough result flywheel model, I think we’re all at risk of missing the bigger picture.
Gamble: I like that quote. I’m going to have to read some of this his material.
Eardley: That’s a good one. It’s fairly modest, right? It was his thoughtful analysis of a lot of what end up being public company, and the stock prices that have had the biggest results over time. It’s a series of good decisions built on top of each other; they execute well and they accumulate. Amazon is a common example.
If we work backwards from the vision, it’s putting steps in place to get there with a modest recognition that any of these decisions are really just going to be in the camp of a good decision. And when you make a number of those, that’s when you really start to differentiate yourself.
Gamble: Right. Well, I apologize — I’ve held you for a while. I really appreciate your time. This has been a great discussion. I want to thank you so much.
Eardley: Sure. Thanks for reaching out.