Q&A with CIO Jamie Nelson, Part 2: “It Almost Feels Like Another Industrial Revolution.”

Change doesn’t happen overnight.

We’ve heard it numerous times, and for good reason. In the past year, however, some have learned that the old adage doesn’t always hold up.

For example, at the Hospital for Special Surgery, which is located in the heart of Manhattan, there was a request to implement a color-coding system within Epic to identify whether a patient had tested positive or negative for Covid, or was awaiting test results. “That was on a Sunday; it was in production Monday evening,” said Jamie Nelson. “It literally happened overnight.”

Despite everything that was going on — or perhaps, because of it — her team was able to make quick decisions and implement solutions almost immediately, and as CIO, she couldn’t be more proud. During a recent interview, Nelson reflected on how the entire organization was able to come together and respond to an unprecedented situation, and shared some of the key lessons learned. She also talked about her team’s plans for 2021, much of which focuses on digital health, and the important work they’re doing to promote diversity and inclusion.

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Key Takeaways

• During the pandemic, it wasn’t just clinicians, but also IT workers who “stepped out of their roles” through tasks such as staffing the incident command center.
• One of the upsides of Covid? The “ability to focus on what happens and get things done,” and to work on “purpose-driven initiatives.”
• Although capital is limited as a result of cancelled surgeries, HSS is still moving forward with its digital health strategy.
• Regardless of how many accolades an organization has compiled, “we have to earn every single patient and make their digital experience more customer-friendly.”
• When it comes to promoting diversity and inclusion, Nelson believes the key is in building a stronger pipeline, which HSS hopes to accomplish through “winterships.”

Q&A with Jamie Nelson, Part 2 [Click here to view part 1]

Gamble:  Is that something you saw with IT, in terms of a willingness to take on different roles and step out of what they had become accustomed to?

Nelson:  Yes. We had people who had to be onsite during the pandemic when it was very frightening. As a leader, I was there. We have people on our desktop team who deal with Epic to make sure the patient boards were correct, and so we had a lot of brave IT people who came into the hospital during this very scary time. We run the hospital’s incident command center, so we helped staff that seven days a week; they wanted IT representatives there so in case something wasn’t working. I was part of the executive leadership team managing this whole crisis, and I can tell you that people definitely stepped out of their roles.

The interesting thing is how quickly decisions were made and how quickly we were able to implement things. One of my favorite stories happened when I was at the hospital on a Sunday. One of our surgeons came up to me said, we need to have some sort of color coding in Epic to determine whether a patient is Covid positive, Covid pending, or Covid negative. That was a Sunday afternoon; it was in production Monday evening. If you’ve ever worked in a hospital IT department, you know that this isn’t typical. You have committee A, committee B, etc. You have to test it, and if somebody likes it, someone else isn’t going to like it.

But this happened literally overnight. Our team enjoyed the immediacy and the ability to really focus on what had to happen and get things done — in a safe and effective way, but without a lot of the noise. That ability to focus and work on purpose-driven initiatives was a challenge that people rose to and really enjoyed in the end.

In fact, when things started heating up again, one of my directors email me asking if we’ll have to staff the command center again. And I said, ‘I think so. Why do you ask?’ They said, ‘It was such a great thing to do last time.’ It really gave a sense of meaning and purpose and attachment to the hospital. Our team really wants to help in any way it can, and this was very helpful.

 

Gamble:  I would think the ability to pivot and the willingness to do something different are things you really value as a leader.

Nelson:  Yes, but again, when everybody is aligned around something and has to face it together, it makes a big difference. In our case, I saw the hospital really come together. Politics went away. The normal day-to-day life in a working environment fell to the side; people just worked together, and I see that continuing. Barriers were moved and relationships were strengthened — those are the positives of working through a crisis. It really strengthens you as a team and has a lot of long-lasting benefits.

 

Gamble:  Right. As you look back on 2020, obviously things didn’t exactly happen as planned. What do you consider to be your primary objectives in 2021, all things considered?

Nelson:  Our budgets have been cut, obviously, like so many other organizations. But for us the financial fallout was twofold. We didn’t have our normal business stream for about two months; 90 percent of what we do is elective, so, that was tough. With Covid, it’s a whole different reimbursement model, and on top of that, you have the expense of having to care for Covid patients. We are being very fiscally cautious right now because we want to make up for those lost revenues, which really are what fuels our ability to grow this organization. Capital has been cut. Operating has been cut. And so from an IT perspective, things are going to be a little slower and more targeted on really important things.

But from an overall hospital perspective, there is a big focus on digital. We are pushing forward in terms of having a digital presence for our patients, which is an omni-channel, more updated app, and really trying to collect interesting data linking to Internet of Things and wearables. This is an area we’re continuing to focus on, spend money on, and build around. That’s pretty exciting.

We have new hospital building we anticipate we’ll be moving forward with. We got a nice gift from a donor this year to continue that, and so there are some pretty major things going on. But at this point, I think we’re taking a one-dollar step at a time; really watching that storm that’s coming and figuring out how it is going to impact us.

 

Gamble:  When we spoke last year, one of the topics that came up was the shift to digital, and everyone you’re doing to get there. I guess the upside of Covid is that we’ve had a sea change, which has been good in some ways from a digital health perspective.

Nelson:  If you look at telehealth, that is digital. That’s been a huge acceleration. Our CEO, Louis Shapiro, believes we should keep focusing on cutting-edge digital health around app development and wearables, because the world obviously is accelerating in terms of technology. This almost feels like another industrial revolution, or internet revolution, in terms of the arc of change here. He’s very determined, and I think wise, to say that we still need to put money into digital, because that’s our future. Having a much more frictionless customer experience, almost like a retail experience in terms of digital, is really important. We are continuing to move forward, because we know that’s going to be an important component as patients choose where they have their healthcare. Again, even though we are number one in the country for 11 straight years in orthopedic medicine, patients still have a choice. They’re going to pass many other very good orthopedic surgery departments on their way to get here. We have to earn every single patient and make their digital experience, and the experience of accessing us, much more customer-friendly. That’s one of the things we’re working on.

 

Gamble:  Very interesting. One more topic I wanted to touch on is the challenge leaders have faced in navigating so much challenges in 2020, including racial injustice. I want to get your thoughts on what it takes to promote diversity and inclusion, especially in fields and industries where it hasn’t been brought to the table.

Nelson:  When everything happened, HSS immediately looked inside of ourselves and said, we have work to do here. We need to put together a diversity and inclusion initiative. And really, the beginning part is education — really taking a look at ourselves and asking, where do we need to improve? It’s about listening to staff and listening to clinicians. That’s where we are right now. It was very important for HSS to take a look at ourselves — everything from how patients are treated based on race, color, creed, and sexuality, to how the staff are treated.

We looked at all different vantages. And the information was very insightful and has helped us figure out where we have work to do and where we don’t. But our CEO and our surgeon-in-chief — Brian Kelly, MD — both feel this is not going to be a flash in the pan that we can forget about. This is something we had to do. Again, the whole Black Lives Matter Movement, and the disparities uncovered by Covid, have really helped us say that this is a major focus; it’s not going away.

Within IT, we have done a couple of very purposeful things in terms of internships with young people from diverse backgrounds. We’ve been involved for quite a while with an organization that takes people from various backgrounds, trains them on technology, gets them internships with all sorts of amazing companies, and these young people wind up getting full-time jobs. That’s been great.

And this is our fourth or fifth year of sponsoring winterships. These are winter internships to young women, mostly of color, or first-generation women attending the City University of New York (CUNY) system, which includes more than 20 schools. They’re at the top of their class and they’re interested in technology. They come here for five weeks in the winter and we put them on very interesting projects, and they do a presentation based on what they learned.

In the past, we’ve thought about how to increase the pipeline with diverse, qualified candidates, because the problem is the pipeline. I’ve often said why don’t we have women in server technology? Because we don’t have women in the pipeline. Why don’t we have women in the pipeline? Because women aren’t going into those fields. That’s where a lot of the change needs to happen. If we can make a difference in the pre-college or the college level, I think that’s going to help push things forward in a much more positive way.

 

Gamble:  I agree. And I think that’s an appropriate response, because there’s no quick solution. A lot of it is realized that this is going to take a long time.

Nelson:  Yes. But you have to start somewhere. If you don’t have goals and put resources around it, it’s not going to happen. And so we are very focused on it.