When faced with a major crisis, leaders have two choices. The first is to concentrate all resources on survival, doing whatever it takes to stay afloat. The second is to focus on surviving, while simultaneously figuring how to apply lessons learned going forward.
Edmondo Robinson, MD, falls into the latter category. Thanks to the solid foundation that had been established at Moffitt Cancer Center, the Covid-19 pandemic served as “an impetus for change and innovation,” and led to reimagining of the strategy in many areas, including patient-centric care.
Recently, Dr. Robinson spoke with Kate Gamble, Managing Director at healthsystemCIO, about how they’re restructuring to bring three core components — IT, data, and innovation — under one umbrella to ensure digital enables, accelerates and drive the strategy forward. He also discussed the vision Moffitt has to bake AI into “everything we do in cancer care,” the mission that drew him to the organization two years ago, and why being a CDO can feel “daunting.”
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- Staying true to Moffitt’s core mission of preventing and curing cancer “is what drives our strategic decisions. It’s what motivates us.”
- One of the challenges in pivoting quickly to remote work and virtual visits was keeping data safe — not just patient data, but research and team member data — without “hindering our ability to collaborate.”
- Prior to the pandemic, Moffitt had begun a strategic refresh to determine what changes were needed to support the rapidly growing organization and ensure the infrastructure was strong enough.
- When disaster strikes, leaders have two choices: focus only on survival, or focusing on growing from change and leveraging those lessons to come out “smarter, stronger, and further along.”
- The Center for Digital Health is “the physical or operational embodiment of the concept of digital accelerating and enabling the strategy.”
Q&A with Edmondo Robinson, MD, Part 1
Gamble: Hi Dr. Robinson, I look forward to talking about everything your team is doing, especially with the Center for Digital Health. But first, can you give a high-level overview of Moffitt Cancer Center?
Robinson: At a high level, it’s really all about our mission. Our mission is pretty straightforward; it’s the prevention and cure of cancer. It’s daunting, but that’s what we’re really about. Healthcare organizations always say they’re mission-driven, and they try to be, but it’s tangible. It’s what we are; it’s who we are. Especially when it comes to the Center for Digital Health and what we do on the digital side, staying true to that mission is what drives our strategic decisions. That’s what motivates us, and what we’re focused on. Everything we do should be aligned toward that mission of preventing and curing cancer.
Gamble: Right. So, you started with the organization pretty quickly after Covid-19 hit, correct?
Robinson: Yes. I started December of 2019, so I only had a few months before we were thrown into the deep end of the pool.
Gamble: Can you talk about how the team was able to pivot and try to find a way to meet patients’ needs?
Robinson: ‘Pivot’ is putting it nicely in terms of how we had to respond to the pandemic. I was brand new, and we were building our IT shop, which is part of the Center for Digital Health. The Center includes the IT team, as well as health data services and digital innovation. The digital innovation department didn’t exist then. IT was in the beginning of a rebuild, and then Covid hit. But it goes back to our mission, which is to prevent and cure cancer. We had to figure that out in the midst of a pandemic, as our team is going through a restructure, and I’m new to the organization.
Figuring out remote work “on the fly”
And so, we quickly did two things that were critical to our ability to continue to meet the tenets of our mission. One, we had to get as many of our team members as possible working from home. Obviously, our bedside nurses, doctors, surgeons and others in similar roles had to be onsite. But we also have a good portion of our people, including those on the research side (we do a lot of research at Moffitt), who didn’t have to be onsite, and so we worked to get them working from home, which was not a small feat. We had to figure all that out on the fly. My team really helped support a lot of that, along with HR and some other folks. We had to the support the technology; the laptops, computers, and things like Zoom, which we weren’t even using before Covid.
Keeping patients safe
At the same time, we had to figure out how to take care of patients and keep them safe. Our patients are at higher risk than the rest of the population in terms of infectious diseases like coronavirus. And so we shifted quickly. It was a heavy lift, but we worked with our virtual health team to support and enable Moffitt to increase virtual visits by 7500 percent. We did that over a period of weeks, not months. That’s how we were able to continue to provide care in the immediate aftermath of the realization that, ‘this is a pandemic, and it’s really hurting people.’
Gamble: In terms of getting the remote workforce up and running, I imagine that was a big lift, particularly when you have a big research component. Not just in getting them set up, but also the security aspects.
Robinson: Absolutely. What are the best collaboration platforms and how secure are they? Cybersecurity was huge, and it continues to be. We had to invest quite a bit of our resources toward making sure we’re keeping our patient data safe, our research data safe, and our team members’ data safe, and doing so without hindering our ability to collaborate in ways that are necessary to drive forward our mission to prevent and cure cancer. That was a big part of this. We had to turn this around very quickly — both from a patient care perspective and a remote work perspective — and do it in a way that’s safe and secure for our patients and our team members.
Virtual care algorithm
Gamble: Talk about the increase in virtual visits. Are there different considerations when you’re talking about patients with cancer? How did you navigate that?
Robinson: What some people don’t necessarily realize is that the vast majority of cancer care is ambulatory. Most cancer care does not take place in the hospital. But even within that outpatient realm, we had some really smart virtual health team leaders as well as clinicians and faculty members who had to decide, what types of visits are most amenable to virtual care, and which ones really require a patient to be physically seen? We actually had to go through that process and make sure we were optimizing our virtual visits so that, at the height of it, we were only seeing people physically who we absolutely had to be seen that way.
We went through a process and built an algorithm to determine which patients needed in-person care, such as those who need to undergo a chemotherapy infusion or radiation therapy. Obviously if someone needs a procedure, they need to come in.
We offered drive-through services so that people could get testing without even getting out of their car — and not just for Covid, but other conditions as well. We set up a drive-through lab to keep patients as safe as possible.
“A reset of IT”
Gamble: Very interesting. You mentioned earlier that IT was going through a rebuilt when Covid hit. Can you talk more about that?
Robinson: It was really a reset of IT. It wasn’t EHR-specific, it was a reset to acknowledge how exceptionally quickly Moffitt has grown. It’s only 35 years old, so to become an NCI-designated cancer center — the only one in Florida — during that time period is remarkable. It was an acknowledgement that the growth trajectory is not slowing down. Therefore, we had to rethink what the best IT structure would be to support our ongoing growth and promote excellence in achieving our mission. We did, and then we restructured our investment in those services and in our infrastructure so that we can support our growth moving forward. That’s what did; it was one of the first things I did when I got here. Again, we were just getting started when the pandemic hit.
Gamble: Nothing like a pandemic to change up your plans, right?
Robinson: That’s absolutely true. What’s interesting is that as a digital leader, I will say the pandemic required us to advance our innovation in digital probably about five years, in about five months. That’s how fast we moved.
Gamble: I guess the big question is, what has to happen going forward to help keep Moffitt on that digital track?
Robinson: Strategy refresh is critical. In the beginning of a crisis, you’re focused on keeping people safe and taking care of people as much as possible. At some point, though, you start to settle in. You’re still in the middle of a pandemic, but you’ve developed a routine and you’re moving through it. And you realize that the strategy you had pre-pandemic may not be the strategy you should continue to have across the enterprise going forward. If that’s true, then what’s your approach?
Learning, not just surviving
There are a few ways you can think about it. One is to say, ‘let me just survive this pandemic, and if we can get to the other side, then we’re good.’ That’s one approach: survive. Another approach is, what did we learn? What are we learning from our response? The pandemic is an impetus for that change and for innovation; what have we learned, and how should that learning influence our strategy moving forward so that when we come out of this pandemic — and we will get out of it at some point — we come out smarter, stronger, and further along than when we went in. If that’s going to be your approach, you have to be strategic about it.
Gamble: Can you talk more about the approach your team has taken, especially in terms of which initiatives to move forward?
Robinson: We did a pretty comprehensive strategy refresh, which was led by our chief strategy officer. We took a thorough look at Impact 2028, our 10-year plan that was launched in 2018. Our CEO was also new — he came in right before I did — so that helped with our strategy refresh work. We looked at where we should be focusing our energy, our attention, and our resources. We’re a not-for-profit cancer center, and so we have limited resources — where do we focus that? We really rethought that.
What we found is that digital, and the way we think about digital, powers our strategy. It enables our strategy. It’s part of the infrastructure. It drives that strategy forward. It accelerates that strategy. It enables that strategy. It’s built into all aspects and parts of the strategy. Before it was one of our pillars; now, we bake it into everything.
That’s one of the changes we made, because we realized just how critical it was for us to function through the pandemic. And so we said, ‘we should probably really think about it as a core component of our infrastructure, not this thing that’s often cast aside in some windowless room somewhere, but a core part of our overall strategy.’ That’s what we’ve done.
Gamble: Is that how the Center for Digital Health came about?
Robinson: We had been flirting with the idea before we did the strategy refresh. I think the way all of this came together — the pandemic, myself coming on the board, the new CEO coming on board, and the creation of a digital innovation department (and naming a VP of digital for that department). All of that came together and we said, this is the right way to build digital as the enabler and accelerator of our overall strategy by having these three departments: IT, data, and innovation. IT includes the core functions, and data includes cancer registry, data science, artificial intelligence, and other components. And then you have the innovation function, which is cutting edge, build-new, and leveraging tools from data and IT to really drive forward to the next stage our innovation and evolution.
It’s bringing those three together so that they work together tightly and not redundantly, but really work in concert to accelerate and enable our overall strategy, that’s what the Center for Digital Health does. That structure is almost the physical or operational embodiment of that concept of digital accelerating and enabling our strategy.