For someone who has been in health IT leadership roles since the 1990s, as Mike Minear has, it takes much more than a shiny toy to impress them. “I don’t get excited about whiz-bang technology,” said Minear, who has held the CIO role at Lehigh Valley Health Network for six years. “I get excited about what it can do for patients and clinicians.”
Not only should it help make the clinician’s job easier – and the patient experience better – but they should feel “it was the right thing to do,” and should have input into what’s being implemented. It’s that philosophy that has created a “deep partnership” at the 10-hospital organization, and what he hopes will propel them going forward.
During a recent interview with Kate Gamble, Managing Editor at healthsystemCIO, Minear offered perspectives on how LVHN is expanding to better serve patients in eastern and central Pennsylvania — especially those in rural areas; why finding the right vendor partner is critical; and the tremendous benefits he has gained from teaching graduate courses.
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- By implementing Vocera’s Ease app — which helps keep family members updated on a patient’s progress — LVHN has increased satisfaction scores while also removing some of the burden on busy clinicians. “If we can use tools to communicate outward, it’s so valuable.”
- For CIOs, the exciting part isn’t the “whiz-bang technology,” but what it can do for patients and clinicians.
- Before any initiative is implemented, it’s critical to have representation from different areas at the table. According to Minear, that “deep partnership across the organization” has been instrumental in LVHN’s success.
- As organizations move further into “the digital age,” it’s becoming just as important to seek input from patients about technology as it is from clinicians.
Q&A with CIO Mike Minear, Part 2 [Click here to view Part 1]
Gamble: Can you talk about your experience working with Vocera on the EASE app?
Minear: Ease is very different; we’re excited about it. What’s unique is that it’s not interacting with our patients, it’s interacting with their families, loved ones and friends.
When we started with Ease years ago, it was really only serving the surgery population. At that point, it wasn’t used for a 15-minute ambulatory surgery; it was more for longer surgeries where the patient’s loved ones were wondering what was going on. We offer Ease for the bulk of our inpatient surgeries, and the bulk of patients choose it. When they go into surgery, they give us a list of the family members and friends they want us to connect with and their contact information. We then send messages to them during the surgery and after the patient is out of surgery.
We’ve seen some of the highest satisfaction rates we’ve ever received, but not from the patient. It was their family and friends stating their satisfaction levels; we heard it from the patients secondhand.
And so, we expanded it into some inpatient procedure areas like cardiology—but for procedures, not surgeries. We have some long-term inpatients who are in units for several days due to their diagnosis; we offered it to them so their friends and families could track their status.
Expanding to the ED
Late last year, we brought it up in the ED. This was the first time the Ease app interfaced with an Epic EHR. Before, it had all been done outside of Epic. With the Ease app, it was important that we didn’t burden the ED clinicians with having to go in a do a lot of status updates. If you have one patient in the surgery suite, the circulating nurse would usually do that. They would be documenting in the EHR, so it made sense.
But for a busy ED, especially on a Friday or Saturday night, it just wasn’t practical for the care team to send messages. That’s all done automatically in Epic and so we know the status of the patient which is key. When you use Epic’s ED module (ASAP), the patient’s status is updated throughout the stay — for example, if they’re waiting for a test. That’s how an ED is managed. That data is already in Epic. We interfaced that to Ease, which triggers the messages to the patient’s friends and family.
We deployed it to our busiest EDs. In fact, during the holiday surge of Covid in late 2020, we opened a massive ED with about 120 beds. We’re very excited about adding Ease to that, because if a family member goes to the ED — especially if it’s a serious condition and they’re there for a while — it’s really helpful to have this communication.
Gamble: I would imagine it’s helpful not just for communicating with loved ones, but also helping to manage call volumes.
Minear: Yes. If we can use these tools to communicate outward, it’s so valuable. We want to do that for patients and families, but we don’t always have time. The Ease technology really filled a gap that a lot of people probably didn’t think about, but it’s there. And it’s been very helpful to fill that with communication.
Gamble: Is it typical of your organization to be on the bleeding edge, or at least be more willing to move forward with newer technologies or functions?
Minear: We don’t to like buy shiny objects. Even though I’m a CIO, I don’t get excited about whiz-bang technology. I get excited about what it can do for patients and clinicians. We don’t just buy technology because it’s neat; we look at our needs and find the right technology to fill those requirements.
I emphasize this a lot because it’s so important. Once we find the technology that matches a requirement, we do our cybersecurity reviews and all of our diligence. If it’s an interface or we’re deploying something new, that’s what we do. I believe we can manage risks well, but we’re very cautious. We wouldn’t interface with a new technology that we didn’t think was secure.
Gamble: That makes sense. Looking back at everything that’s been done to push some of the digital initiatives forward, having that Epic foundation was obviously key, but I would think you also had to have some strong partnerships in place.
Minear: Absolutely. I’m a CIO but I feel very strongly that you’re not successful with technology because of the technology per se. It’s really a people issue. We don’t do anything of substance without partnerships with clinicians, with operational staff, and financial staff. Everything we do of any substance has a big team behind it. With Ease, for example, we had ED clinicians and operational people at the table, and they had to feel comfortable that it worked and it was the right thing to do, and that they agreed with the message we’re sending. We take that viewpoint with every project we do. That’s really why we’ve been successful; it’s that deep partnership across the whole organization.
Gamble: You touched on something really important with the idea of trust. What are the keys to establishing trust?
Minear: I think you have to do things together. If we just said, ‘we’re going to turn on this technology,’ it’s never going to work. At the beginning of any of these projects or initiatives, we have everyone at the table. We try very hard to include everybody and we try to listen. Sometimes we don’t agree; sometimes a partner will say, ‘I heard about this technology and I want to deploy it.’ We might say, ‘we already have it’ or ‘Epic already does that.’
We don’t always agree, but once we proceed with something that we’re going to bring live, we make sure we have consensus and work together on it. And we can’t do it without their input, and they can’t do it without ours. It has to be a team effort; I don’t know how else you’d be successful.
Gamble: You’ve held IT leadership roles for many years. How do you think the CIO role will continue to evolve going forward?
Minear: In terms of the CIO role today, I think that has organizations grow, you have to be able to manage scale: both people scale and location scale. In addition to our 10 hospitals, we’ve got well over 250 geographic locations. There are all types of ways to measure scale. The complexity of what we do is pretty dramatic. In every place where we provide clinical care across the continuum, we have Epic supporting it. And not just the clinical part of Epic, it’s also revenue cycle. When we do homecare in Epic, there are a lot of unique federal and regulatory requirements with billing. Video visits have areas of complexity both in terms of how we get paid and how to integrate video technology with the EHR.
LVHN’s Patient-driven Vision
I think the reason for our success is that we have a patient-driven vision. We listen to technology folks and clinicians, but we’re also focused on the patient and family, especially as we move further into the digital age. What is it they need?
To give you an example, we’ve managed all of our COVID vaccinations in Epic. We’ve had edicts from the state and feds as to how to do the vaccine and who is eligible, and we’ve struggled to put that into menus that our patients can understand. When we added the second booster shot, we deployed it in Epic. Initially we heard a lot of feedback from patients that the menus were confusing, and so, we went back and rebuilt them. The patient voice has to be listened to. With anything you do, you may think it’s slick and digital, but if it doesn’t work for the patient, it’s really not going to work at all.
Gamble: Right. The last thing I want to talk about is teaching, which you’ve done for a while. I can imagine it has helped shape you as a leader. How have you benefited most from having faculty roles?
Minear: That’s a great question. I was first asked to teach at Hopkins about 20 years ago. I was interested. I was kind of curious, but I really never dreamed of teaching. I found that I really liked it. It pushes me to stay current and update my lectures. I have 13 lectures in my graduate courses; I usually take about 25 percent to a third of those and update them to keep current. Basically, I rebuild them from scratch.
All of the lectures are done online, so it has to be recorded and set up. Hopkins has done an amazing job helping faculty do their lectures in this recording environment. But it has to be current and relevant, and that’s been even harder during the pandemic.
At the height of the pandemic in 2020, I actually was asked to teach a couple of classes because we had a large cohort from China with a lot of clinicians. It was fascinating to hear what they were going through and what they were doing to combat the vaccine.
I’ve had students from 26 countries, which blows my mind, and they interact online. I learn a lot from students from different countries. It’s fascinating how healthcare can be so different, but yet, some of it’s the same. It has helped me grow and it’s helped me stay current. It’s been as useful for me as it has been for any students.
Gamble: When you first started, did you think you’d still be doing it 20 years later?
Minear: No, not at all. It has enriched my life in a lot of ways and given me a lot of different world views and perspectives. That’s what education is supposed to do, both for students and the people teaching it.