Q&A with CIO Ray Lowe, Part 2: “It’s a lot of Communication, Training and Support.”

“It’s a great time to be a CIO.”

Since March of 2020, healthcare has gone through arguably the most dramatic period of change in the history of modern medicine. Care was reinvented as alternate sites were rapidly created to accommodate surges of patients, and digital technology adoption rates soared to new heights. And behind the scenes, IT teams worked around the clock to provide much-needed support for frontline care providers and patients.

And yet, in spite of all that — or perhaps because of it — there’s nowhere else Ray Lowe wants to be. “With our thought leadership and partnerships, we can think through how to solve many complex problems,” he said during a recent interview.

Part of that is a willingness to honestly assess strategies, and pivot if necessary — something his team did in the early days of Covid-19 when it became clear that web-based training for telehealth wasn’t the best method for all physicians. And so Epic training teams were sent out to provide hands-on instruction, and centers of excellence were created to help extend these best practices across the organization.

During the discussion, Lowe talked about the challenges AltaMed has faced in rolling out virtual visits — particularly for those in underserved communities; the “modernization effort” the organization has been going through since 2018; why collaborating with other C-suite leaders is so critical; and what he expects to see in the next few years.

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Key Takeaways

• One of the early lessons learned in training physicians on video visits? Distance learning doesn’t always work, which means other avenues must be explored. “It’s a lot of communication, training, and support.”
• AltaMed is about 70 percent finished with a “very broad technology uplift” that started in 2018 with modernizing the EHR.
• An Epic customer since 2018, AltaMed is the first US-based healthcare organization to go live with its social care platform, and is leveraging Epic’s translation tools to provide “a much richer experience” for multilingual patients.
• For today’s CIO, it’s essential to know which technologies are being adopted across different industries and how to incorporate them into healthcare. “That’s what we’re expected to do and what we should know how to do.”

Q&A with Ray Lowe [Click here to view Part 1]

Gamble:  As far as the providers, and all the changes they’re going through, how was your team able to stay on top of that and provide the assistance they needed? I can’t imagine it was simple.

Lowe:  I’ll give you one example. As we’re talking about a patient-centric mobile first strategy, originally we were doing more Web-based type training for providers. We were asking them to use their admin time to learn what we’re doing from a tele-visit perspective with things like the Covid-19 fast lane. But we weren’t as effective as we needed to be.

And so I had my Epic training team go out and work with providers in the clinics so that they had more hands-on training, because distance training and distance learning doesn’t always work. As we introduced more disruptive technology like telehealth video visits, we selected two locations as centers of excellence.

Tele-video is not as easy as it sounds. It should work like magic, but with any video meeting, you hear, ‘Where do I click,’ ‘What do I do,’ ‘What does the experience look like,’ or ‘I have the wrong monitor or the camera isn’t working.’ And so we actually built out two centers of excellences in clinics that primarily do tele-video so we can identify best practices and propagate that across the broader organization. It’s a lot of communication, training, and support.

 

Gamble:  Right. And you also have to have the right processes in place so that things are filtered to the right people. Do you feel like the right processes or structure were in place?

Lowe:  Yes. Again, everything was very dynamic. It was all hands on deck in terms of how we were adjusting and how we were modifying things. And we certainly did make some workflow changes; we’re still tuning them. But I think we’re getting better at understanding how we want tele-video visits to work. We now have the ability to send out the link through our MyChart for a patient to join, which is much more of a satisfier versus having the patient get dropped into a waiting room. It actually tells the patient when the provider is ready, and directs them right into the room. We’re looking at how we can continue to not only make it easier for the patient, but also the provider, so that it’s as seamless as a face-to-face visit.

 

Gamble:  Were there initiatives or projects you had to put on hold because of Covid?

Lowe:  No doubt. We were going to do a unified communications program, which was slowed down. We actually launched a CRM product in the first quarter that was slowed down a bit as well. We were looking at some other system replacements, and those analyses stopped as we focused on care delivery. Video integration is a lot of work. It’s hard work. And that’s part of our patient engagement strategy; this is what people are expecting. It needs to be incorporated with Epic so you have the whole care record.

We also had a slow down with provider productivity. We deployed HIPAA-compliant texting as a core text, but then we also slowed down our Imprivata tap-and-go. So we did prioritization around where and how we need to help providers, and we’re going to pick some of that up in 2021, as well as doing more ambient voice type of activities.

 

Gamble:  You mentioned mobile-first. It seems like that’s a core part of the strategy going forward.

Lowe:  Absolutely. Patient-centric care — where the patient wants the care.

 

Gamble:  Backing up a little bit, I’d like to talk about some of the work that’s been done to modernize IS and how you approached that.

Lowe:  From a technology perspective, we had a data center and our corporate offices in here, and it was a little bit messy. We needed to really clean it up and harden what we were doing from an enterprise perspective. AltaMed went through really explosive growth before. In 10 years, they’ve doubled in size. I came in to really bring an enterprise approach. So we actually did a wholesale replacement of not only the whole network with network switch routing, but also in the data centers. We had acquired another facility in which we did a build out, and are now doing active/active HA load balancing between our two centers. They’re about 40 miles apart from each other, and so that gives us that additional redundancy resiliency out there.

We were actually doing a firewall migration when the pandemic hit. Through our partners, we were able to accelerate that firewall to accommodate all of the virtual remote workers, or else we would have been shut down in terms of the activity around there. From a compute perspective, we went to a hyper-converged infrastructure. We primarily use Cisco, and we have a little bit of Palo Alto in our framework as well.

In another division of our company that I oversee, we implemented a managed care solution on Amazon Web Services. So we did a very broad technology uplift. We’re not finished; we’re probably about 70 percent of the way there, but we’ll keep moving on that through 2021.

 

Gamble:  So when you came in, it wasn’t necessarily that something was broken; it was more of a need to prepare the organization for the future.

Lowe:  I would say that I was brought in with the organization wanting to move toward a more modern EHR. I came here in January of 2018; I met with the COO in early February and she said, ‘Ray, we need to evaluate our current EMR solution and get it through the Board in May.’ That was a big ask, but we did it. We did an analysis where we looked at Epic, Cerner and athenahealth.

We went through a physician-led analysis, presented it to our executive governance committee, and had Board approval in the middle of May. We completed negotiations with Epic in two and a half months. After that was wrapped up, we went to Epic UGM in August, and we went live the following August.

There were some big wins for us there. We’re a community health center and were fortunately able to have our own instance of Epic, so we’re pretty blessed. But we were actually the first US healthcare company that went live with their social care platform, which is used within PACE (a Program of All-Inclusive Care for the Elderly). That was a big win.

Another win we’ve had with Epic is in the area of language translation in tele-video visits. A lot of folks were calling the language translation line and putting two phones next to each other so that they cloud all hear each other. We’re actually able to invite the language translation person to participate in that meeting so that the patient can see the interpreter and the provider at the same time, which makes it a richer experience. We’re also able to text out the video link, which is a new development we’ve been doing with Epic.

So we’ve had a lot of firsts. Moving ahead, Epic has the PRAPARE portion on the social determinants of health, and so we’re looking at how we can leverage that with other offerings to address how to best serve our patient populations that may need some assistance on the SDoH side.

 

Gamble:  With some of these initiatives, you’re early adopters. Is that something you’ve done in the past? Do you like to go that route, or does it depend on circumstances?

Lowe:  It depends, to be honest. My dyad partner, Dr. Eric Lee, and I did an interview with Ed Marx on the CIO-CMIO dyad partnership. I think our joint thought leadership that helped us, but that path has been defined by many other folks before us.

Kaiser and Stanford have done a phenomenal job. If you go to Epic UGM, they show you the art of the possible around it — but they don’t necessarily tell you how to get there and in what order. At the 2018 Epic UGM, they said, ‘this is where your digital roadmap should be.’ So they tell you what you need to do, but they don’t tell you how to get there, or in what order it should be done. Fortunately, we followed their lead and we’ve checked off about 9 of the 12 steps in our digital transformation. We still need to incorporate Symptom Checker, we need to do more analytics work, and we need to get Open Scheduling, but that’s coming.

There are other communities out there; the CHIME network is great. I also belong to a group of CIOs that includes Joel Vengco at Baystate, Aaron Miri at UT Health Austin, and Patrick Anderson at City of Hope, along with some other folks. In that group, I’m able to ideate with them and ask, how do you approach this? What are you doing around this? It helps make some of the decisions easier.

 

Gamble:  As far as digital technology, it’s a road you need to go down anyway, so I’m sure that’s a factor.

Lowe:  These are business-defined outcomes. I think for the modern CIO, knowing what technologies are being adopted across different industries and how to incorporate them into healthcare is really what consumers is expecting; that’s what we’re expected to do and what we should know how to do.

There absolutely is some risk involved in innovating, and we’ve innovated very quickly over the last year. Again, we went live with Epic in 2019; since then, a breathtaking amount of technology innovation was actually pushed out. But it’s a calculated risk in how we’re approaching it, making sure not to launch too early and having adopters in the organization that we can work with to build in the right support.

 

Gamble:  Right. So finally, how do you think the CIO role will evolve in the years ahead?

Lowe:  I think it’s a great time to be a CIO. With our thought leadership and partnerships, we can think through how to solve many complex problems, because we understand systems. But we also need to understand the trends, and what and how things can be utilized and how do we need to optimize around there.

Again, I’m very fortunate. As part of the senior leadership team working with the COO and the CAO, I’m able to transform how we communicate to patients. I’m able to communicate how our providers are doing with remote work. We hear about gaps in care or how we need to transform operations; if you’re able to change the role from being an order taker to a solution provider, that’s where it gets very interesting. And then as you move past that solution provider and you start getting to work with the vendor space, and the vendor community is seeing how you’re adopting and implementing them, they get pretty excited, because you’re transforming healthcare. The operational folks are really focused on operations, and so when you try to do something new and add more things for them to do, someone has to have that ability to take a step back and provide options, recommendations and outcomes.

I think that’s where the modern CIO should be. They should look at what is the business led initiative, what is the art of the possible, and what do we need to incorporate for our patients? Again, we want to deliver quality care that’s value-based, cost-effective, and easy to use.

 

Gamble:  Alright, well, I really enjoyed this. It’s been great to hear from you about what you guys are doing, so thank you. We really appreciate your time.

Lowe:  You’re welcome.