MedStar Health does things a little bit differently. In addition to the chief information officer — a role Scott MacLean has held since 2018 — the 10-hospital system also has a chief innovation officer, chief digital transformation officer, and a VP of performance improvement and analytics. And MacLean wouldn’t have it any other way.
“I like the way it’s organized because our technology infrastructure is what runs all of these things and enables programs to be able to thrive,” he said during a podcast interview with Kate Gamble, Managing Editor at healthsystemCIO. It has also enabled a focus on digital transformation “that’s more than just technology.”
It’s a philosophy that he believes will serve MedStar well as the organization surges ahead with plans that were altered due to the pandemic and moves toward the ultimate goal of “systemness.” In the interview, MacLean talks about how his team is dealing with the myriad challenges brought on by Covid; the enormous step he took when he first came to MedStar; what he hopes to accomplish with the CHIME Board; and how volunteering in Baltimore has helped him became part of the community.
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- MedStar Health has a “full swath of projects across informatics, application, infrastructure, and security spaces,” with the biggest focused on converting to Cerner’s capacity management system.
- When MedStar’s final hospital went live on Cerner in late 2021, the staff leveraged a combination of onsite and remote at-the-elbow support to train users.
- Ensuring devices and systems are upgraded and patched “is a never-ending battle,” said MacLean. “All of these things need to be in working order.”
- Having a digital platform is about much more than portals; it’s about “getting ourselves and our physicians to a place where it’s easy for patients to interact with us and get the care they need.”
Q&A with Scott MacLean, CIO, Medstar Health, Part 1
Gamble: The last time I spoke to you, it was just before the pandemic. I’d like to focus on what the recovery process has been like at MedStar, and how you’ve been able to move forward with some of the projects that were delayed. First, what do you consider to be some of your top priorities right now?
MacLean: Sure. We’re still focused on taking care of the people in this region and whatever dangers are there stemming from the Covid pandemic and public health issues. We have a full swath of projects going on across the informatics application, infrastructure, and security spaces.
Probably the biggest one we’re focused on now is capacity management, bed management, transport, and environmental services within the Cerner environment. We’re converting our myriad systems used for bed management to the Cerner capacity management system. That’s an enterprise endeavor, just like doing implementations of our EHR in the enterprise model, which we completed at the beginning of 2021 when we went live with our tenth hospital. We’ll continue to build out the EHR platform that we call MedConnect using the Cerner capabilities.
We also have a big project with acute case management that we’re working on and will finish later this year. We’re doing positive patient ID for blood and breast milk which I think will put us in a better place for applying for HIMSS Stage 6 and 7 ratings. We’re also doing projects around anatomic pathology, ordering and tracking using bar coding technology. Those are just a few of the highlight projects we’re doing in the application space.
In the infrastructure space, we’re in the process of putting in a new voiceover IP telephony system; that’s a multi-year project that of course involves network upgrading and equipment as well as licensing end-user devices. We’ll complete a big part of that this year with call centers and with ambulatory sites, and we’ll finish up with our hospitals in the next couple of years as we go through ageing equipment and capital cycles.
A combination of onsite & remote support
Gamble: You said the tenth hospital went live on Cerner in 2021 and that had to be moved back because of Covid. Did you experience any challenges with that?
MacLean: We were well prepared. We had gotten the project ready, and we made the decision as Covid-19 hit in late February or early March of 2020 to pause that project, so it was just about a year a later that we restarted it. We did have to go through some additional cycles of testing because we had upgraded the EHR during that year that we delayed.
But we were well prepared with a combination of both onsite and remote at-the-elbow support. I think everyone learned how to do these things with less people in the hospitals, but it was also being able to help our end users.
That hospital, by the way, was on its own Cerner instance. It wasn’t that they were unfamiliar with EHRs or with Cerner, frankly; it just converted to the enterprise version of Cerner.
Striving toward systemness
Gamble: You mentioned bed management capacity as an area of focus. Has your approach to that changed because of what happened during Covid?
MacLean: Well, it was on our road map already. We’ve been striving toward one MedStar and systemness for over a decade. As we added our tenth hospital and built our distributor care delivery network with the ambulatory sites, we were able to manage as one facility in the pandemic — albeit with putting together data from various systems around bed management.
One of our priorities, as we look at this fiscal year (which starts in July 2022), we want to get onto a single instance of capacity management using our Cerner tools that are integrated with the EHR. That will enable us to better manage all of our facilities together and be able to move patients as appropriate to the best site of care, or admit them to the right care site of care.
Painting the Golden Gate Bridge
Gamble: I read in an interview you did about how MedStar was able to continue to refresh and upgrade the infrastructure despite everything that was happening. It’s so important to be able to focus on that.
MacLean: It is, for all of us. I was talking on how we can have the greatest applications and the best enabling technology for our end users, but if we don’t have the right network connectivity — whether that’s wired, WiFI or cellular — and we don’t have the right end-user devices — whether it’s desktops, laptops, smart phones, or smart shared clinical devices — it doesn’t do much good. All of those things need to be in working order. They need to be upgraded and patched, obviously, for the best performance and security.
We went about that throughout the pandemic. We probably had a little bit of more space to direct some of it in the first wave since some of the ambulatory sites were closed down, but it’s a never-ending battle for everyone. My former boss Jim Noga at Mass General Brigham always said, ‘It’s like painting the Golden Gate Bridge; as soon as you get done one way, you have to go back the other way and keep refreshing it.’ We continue to do that.
Gamble: That’s a good way to put it. What about digital capabilities? What are you looking at in that area?
MacLean: The way we’re organized here MedStar Health, I’m the Chief Information Officer, and I report up through the Chief Administrative Officer. We have a Chief Digital Transformation Officer, John Locke, who reports to the CEO. John is experienced in various technology ventures; he came to MedStar to help us with our transformation.
As you know, it’s not just about technology. It’s about how we pivot and change as an organization. We saw some of that during the pandemic with our conversion to tele-health appointments and the ability to deploy technology rapidly and make it usable for both clinicians and patients.
“More than just a portal”
And so, we conceived what we call the Integrated Digital Health Platform. It’s more than just a portal. We have a portal, of course, but this is a space where people who aren’t feeling well can come to us; there are different channels where they can interact depending on what they need. It might be a tele-health visit. It might be a referral to urgent care or primary care, or the ability to schedule appointments online.
The best and first application of this was when we used it for our Covid vaccination program. In December of 2020 when the vaccine became available, we were able to look at our patient population, determine which patients where eligible, and send them invites, making it easy for them to schedule an appointment. For those who weren’t eligible, we kept records and were able to reach out to them. Even if they weren’t MedStar patients, if they came in through our website or portal, we could reach out to them once they became eligible and help them schedule an appointment.
That’s an example of how it’s not just portal, but a platform where people can interact, and eventually get reminders and prompts.
Gamble: That’s an important distinction between the traditional portal and what we have now, which has a lot more capabilities. That’s a big difference maker for patients and families.
MacLean: It is. As part of our strategy going forward, we’re very interested in making things accessible to people. The digital platform is another way of access that’s really important, and so, from an operational standpoint, we’re getting ourselves and our physicians and other clinicians to a place where it’s easy for patients to interact with us and get access to the type of care they need. The digital front door, our Integrated Digital Health Platform, is an enabler of that.
Gamble: In terms of your geographic footprint, are MedStar’s hospitals pretty spread out? And are they diverse in terms of the patient population served?
MacLean: They are. Seven are located in Maryland — four in Baltimore, one in central Maryland, and two in Southern Maryland, and three are in Washington, DC: MedStar Georgetown University Hospital, MedStar Washington Hospital Center, and MedStar National Rehabilitation Hospital.
Gamble: Can you talk about some of the challenges MedStar encountered in terms of getting telehealth up and running and meeting the needs of patients during Covid?
MacLean: Sure. I should also point out that we have a Chief Innovation Officer, Bill Sheahan, who is vice president of MedStar Institute for Innovation (MI2), which also houses the MedStar Telehealth Innovation Center. The team worked very hard in conjunction with me and with John Locke and our teams around constructing a telehealth platform that was one click and easy to use for patients and providers. It has worked really well.
We also developed a tool that enabled patients to test out their system for camera and volume and those in connectivity reliability before they go on a tele-health call with their provider. That seemed to be very helpful and satisfying to them.
We also used the technology for consults in the inpatient units and for patient families and visitors to be able to connect with patients when the hospitals were closed to visitors. In Baltimore, we provide a mobile care unit that goes out into some of the communities that have less access to care. That unit was also able to go out and administer vaccines.