When it comes to providing the best possible care experience for patients, “technology can get in the way.” The good news is it doesn’t have to be that way. In fact, technology can be leveraged to provide physicians with background information about the person being treated, so that both parties feel more comfortable. For WellSpan Health, achieving this has become a major priority, according to Hal Baker, MD, SVP and Chief Digital and Information Officer. “We all experience times where we need our problem taken care of and times where we need ourselves taken care of and sometimes, those are different,” he said.
During an interview, Baker talked about the ‘Know Me’ initiative that is changing the nature of care at WellSpan, an 8-hospital integrated system based in Pennsylvania, and what IT leaders can do to offer patients “a different emotional experience.”
He also discussed the unique perspective he offers as a physician, how his team was able to successfully deploy Epic across the organization, why standardization is an essential component of any implementation, and why he is optimistic about the future of the industry.
Focus on Innovation
Gamble: Let’s start by talking about innovation. It’s always been a priority, but it seems to be a higher one now given some of the restructuring that has happened.
Baker: It is. We’re becoming more dedicated when it comes to innovation. In my role, I oversee IT, innovation and analytics. All of these areas, along with things like adaptive analytics and robotic process automation, are becoming more important in healthcare. We’re starting to work in a more deliberate, consistent fashion, versus some of the ad hoc pockets of light we’ve had in the past. It’s really exciting.
Implementing Epic Across the System
Gamble: WellSpan went live with Epic a few years ago. We’re seeing more organizations migrate to a single EHR system, particularly in light of the increase in M&A activity. What do you think are the keys to a successful EHR implementation?
Baker: We had a very good governance process with core principles and guiding directives. We worked with a strong, experienced team that helped us set that up. We built a team that was fully devoted to Epic from the moment they were hired. Once you started the Epic project, if you were in another IT role, your fulltime job now was to get certified and get up and going.
We combined operational leaders and IT leaders in a very deliberate way. We went to our operational leaders and said, ‘We need your best and brightest to lead this.’ But when we started giving names, people would say, ‘Oh no, we can’t possibly do without that person.’ We stated explicitly — and this was coming from our operational leaders — that if it isn’t horribly painful to think about giving them up, they’re not the right person.’ And because of that, we had a very strongly clinically and operationally led go-live with solid leaders.
A nurse from one of our ORs, one of the most senior nurses in our office practice, led our inpatient and outpatient settings, and one of our best directors in the finance department led the revenue cycle implementation. They led that under a very experienced senior director of IT, and that combination of people coming together made a big difference. We had very, very low attrition during our go-live. We went live and had achieved HIMSS Stage 7 inpatient/outpatient in a year. We came in about $10 million under budget and our revenue cycle afterwards exceeded our expectations in getting on target.
Gamble: By having leaders from nursing and finance involved, did that help insure it wasn’t IT-driven?
Baker: Absolutely. If you ask people who was the chief executive over the Epic implementation, they would have said Tom McGann, our executive vice president for Patient Services, because we made a very deliberate decision that he was the front for this, not me. We didn’t want anyone mistaking this as an IT project.
Everybody was coming from a different record and we were all going live on something brand new together. So, it was also a remarkably unifying thing for all of us as an organization who had gone through a lot of affiliations recently, because everybody was moving to a brand-new place that we’re all moving into.
Gamble: One of the challenges we hear about with this type initiative ensuring standardization across the implementation. How did your team approach that?
Baker: It starts with communication. It was a deliberate discussion that we were going to have one best way to do it. There would be one set of order sets across all organizations. We had a unified team that did that. We were clear that if you were the imaging department manager at one hospital and you were the lead physician/radiologist in another hospital, you dropped your regional representation and you were representing the system as a whole — people did that really well. It was great to see.
We also said that you had to have a very legitimate necessary reason why there is any variation between our builds. If people said, ‘We’re used to doing it this way’ or ‘we’re used to doing it that way,’ we’d say, ‘Let’s do it the best way.’ That was a core principle that we talked about upfront.
Leveraging Tech to ‘Know’ Patients
Gamble: Back in 2019, you gave a talk at the CHIME Fall Forum about the ‘Know Me’ initiative at WellSpan. I thought that was really interesting. Can you talk about how that came about and what it hopes to achieve?
Baker: Sure. ‘Know Me’ is part of our guiding objective to try to get the full picture of our patients and learn their preferred name. For example, my name is Richard Henry Baker. My chart clearly indicates that Hal is my preferred name, and so that’s how a physician would address me. Those little things build trust. We’re working now with a company called PatientWisdom to bring in more of those stories of who I am as a person, versus who I am as a patient.
We’ve all experienced times where we need our condition taken care of, and times where we need ourselves taken care of, and sometimes those are different. We also know that our providers feel better when they’re treating people who they understand, than they do when they’re just treating a condition. That’s been a big push for us to try to leverage technology in a way that isn’t just easy to use, but also makes people feel like they don’t have to start over every time they come to us.
Gamble: Where does technology come into play?
Baker: If used appropriately, it can tell you whether, for example Susan Levine pronounces her name as Leh-veen or Leh-vine, and that can make a difference when you say somebody’s name right. But technology alone won’t do it. Technology can enable caring human beings to do it, and so you need both.
Technology can get in the way too easily. We’re trying to be deliberate and looking at things like ambient clinical intelligence to help keep the conversation between people and keep the fingers off the keyboard and the hands off the mouse, so that people can look each other in the eye and be fully present.
Gamble: And something as simple as knowing a patient’s preferred name can make a big impact?
Baker: It absolutely can. It’s the difference of walking in the room and saying, ‘I see that since we last saw each other, you saw XYZ and did this,’ and saying, ‘how was that cruise you were planning to take.’ Those little things make those of us who provide care feel more connected; but they also offer a different emotional experience to a patient. If I’m just getting my cholesterol drawn, it may not matter as much, but if I’m in for my breast cancer follow up, those things matter.
Addressing Physician Burnout
Gamble: As a physician, what are your thoughts around burnout and what can be done to ease it?
Baker: Burnout is a real risk. Even in my limited clinical practice, I can get as easily frustrated as anybody else with five extra clicks, or the distraction of a pop-up. I think what I can bring that perhaps compensates for my lack of deep technical knowledge is the ability to translate purpose and meaning and give context to a fantastic group of technical people, who mostly view themselves as healthcare workers in the IT department and not technologists at a hospital.
Gamble: Do you have any advice for CIOs who don’t have clinical experience on how they can better understand the issue on a deeper level?
Baker: You don’t have to be a clinician to understand it. You have to be able to distinguish when you’re having a personal experience from when you’re having a representative one. One thing about a general internist is that I don’t know more about a condition than a specialist, and so I’m used to asking others for help. I think that’s important. I’ve seen some wonderful CIOs who are paired with very strong and helpful clinicians in mutually respectful relationships, whether it’s the CNO, CMO or CMIO. Those partnerships are power. I know that I couldn’t do a darn thing here if I didn’t have a great technology team and a fantastic chief technology officer.
Gamble: Having been with WellSpan in different capacities over a long period of time, I imagine it has given you an interesting perspective.
Baker: I’ve been with WellSpan for more than 25 years. After I left my medical education fellowship, this is the first place I went. I still see patients at the same office where I saw my first patient as a private doctor. So I’ve been here a long time.
I came here because of the value system of the organization which has persevered through the last quarter-century. That’s important part. From an IT standpoint, my predecessor got us to the point where computerizing records wasn’t even a question. There was a role for me to play in helping us to figure out how to leverage IT and make it work with clinicians, for clinicians.
What I find exciting is the ability to make healthcare better; to make the experience better, safer, and more reliable. The EHR has done a lot to improve communication. It also has some downsides, and we need to continue to optimize, but I don’t think any of us would like to practice care without it.
The Future of Health IT
Gamble: When you look at where the industry is headed in terms of that progress, are you encouraged? What’s your take?
Baker: For most of us who lead IT, everything always feels like it’s moving too slowly in the next week and month. It isn’t until you look back over the last five years and think about where you were and where you are, that you appreciate how quickly things have changed. I think there is an inherent dissatisfaction with the status quo that’s part of what draws people to healthcare technology, and the thought that if we can do this right, we can make it better.
It’s a very dynamic time. Lines are blurring. You can pick up a genetic testing kit at Walmart, and that’s going to tie into your future healthcare direction with genomics and big data and machine learning. It’s breathtaking to think about what might be coming.
Gamble: What about the CIO’s role — how do you see that evolving?
Baker: We’re all increasingly going to be dealing with sophistication that’s beyond any of us to fully understand. It comes down to having open, collaborative discussions, and constantly asking ‘why, why, why’ to understand and help your teams figure out how to solve toward a purpose. The creativity of our shared efforts is more powerful than any one person can ever be.