Sometimes a simple change can have a big impact. Case in point: when Ed Kopetsky started his tenure as CIO at Stanford Children’s Health/Lucile Packard Children’s Hospital Stanford, his first priority was to rename the IT department to the ‘Information Services’ (IS) department. In doing so, he helped promote a culture of service at the Bay Area-based organization, and encouraged team members to come forward with ideas and collaborate with others to deliver outstanding results.
That spirit — which has helped establish Stanford as one of the top children’s hospitals in the United States (according to US News & World Report) — was alive and well during the height of the Covid-19 pandemic, as the team rapidly rolled out tools to enable providers to deliver complex care in a safe manner.
“We modified our inpatient rounding with care teams using telehealth. It was a real hit with caregivers,” said Kopetsky, who praised the creativity and urgency demonstrated by the IS and clinical staffs. However, although he was impressed by their ability to tackle a “brand new problem” in such an innovative way, he wasn’t surprised. “People just acted. That’s at the root of who we are.”
Recently, Kopetsky spoke with Kate Gamble, Managing Editor of healthsystemCIO, about how Stanford has been able to create and sustain a strong culture; its “multidisciplinary approach” to digital transformation; and why the CIO role is far from “over.” He also discussed the unique considerations for pediatric organizations (especially relating to Covid-10), and his plans for the near future.
Q&A with Ed Kopetsky, CIO, Stanford Children’s Health/Lucile Packard Children’s Hospital Stanford
On Stanford Children’s Covid-19 response
When Covid-19 hit, there was a great windfall and a very high adoption of telehealth. In fact, within two weeks, we had gone from doing 20 visits a day through telehealth to 800, which is a 40-fold increase. It demonstrated that not only was it feasible, but it was also desirable in many instances. It has improved access; patients are getting in faster and they’re getting the same high-quality treatment.
We’ve integrated it with Epic MyChart so that patients (and families) can schedule appointments and log in through their MyChart account, which makes it more convenient.
What’s really incredible is that the number of escalations we’ve had has actually improved throughout the pandemic. I have to believe it’s because of our responsiveness to the problems and the challenges.
On telehealth & equitability
One of the challenges with telehealth is making sure it’s equitable. We’ve enabled Spanish and other languages and integrated interpreter services into the telehealth platform. And so now, we can offer the same support for virtual visits as we do in our inpatient setting, where we have interpreters with the care teams.
We’re also looking to provide laptops or mobile devices to those who need them through the Lucile Packard Foundation. We’re sensitive to the fact that not everybody has access to current technology or knows how to use it, especially first-generation families. Those are issues we’re addressing proactively.
On telehealth’s positive impact
The other side of telehealth is that it has helped improve access for patients whose parents were unable to bring them to in-person appointments. And so, in some ways, it has opened up a new channel for us.
We’ve also seen a drop in cancelled appointments. With the telehealth option, it’s easier for families to connect with us and schedule appointments without having to miss work.
The other factor is that a lot of our patients have complex conditions, and as a result, have more than one provider. Telehealth has also allowed us to have interactive sessions with multiple providers. And while that’s challenging right now, we’re trying to improve that space so that care teams can conduct telehealth visits with families, as opposed to an individual provider.
On ensuring provider safety
We’re the highest acuity children’s hospital in the country, and more than a third of our inpatient capacity is ICU-level. When Covid hit, cross-exposure and PPE use became serious issues. To address this, we outfitted our computers on wheels (COWs) with telehealth capabilities; that way, when we did clinical rounds on patients with Covid, only one provider entered the room, which helped keep our staff safe and preserved PPE, which was very scarce.
We definitely had our struggles in the early stages of Covid. By modifying inpatient rounding and enabling telehealth through mobile computers, we were able to provide our caregivers with some peace of mind. Importantly, we sustained the level of quality that we had established before the pandemic. We saw no increase in safety issues and there were no reported incidents of cross contamination between patients and providers during those two years.
It was very creative on the part of our caregivers and our IS team to say, ‘We can do things differently’ even though this was a new problem that we hadn’t thought about before. I thought that was really cool.
On building a ‘culture of service’
When we made changes during Covid, it didn’t come from me — people just acted. That’s the root of who we are. We have a culture of service. In fact, when I came here 13 years ago, I renamed the department ‘Information Services’ to promote that.
All our IS employees go on clinical rounds. Every area of the business has a defined IS leader who works with their counterparts in other departments to continuously tune and optimize our systems.
Prior to Covid, leaders went on Gemba walks twice a week, which helped establish great partnerships. They’re joined at the hip with the frontline to create solutions when a need arises. That carried over, and it’s been great for key area leaders to have trusted partnerships and a single point of accountability from IS.
On bringing the infrastructure in-house
After our most recent hospital expansion (Lucile Packard Children’s Hospital Stanford) was completed in 2017, we started the process of insourcing our infrastructure. Back in the early 2000s, before I arrived, it was almost impossible to keep technical people in Silicon Valley because of the rapid growth. Health systems couldn’t compete. And so, although some things changed, we continued to outsource the infrastructure.
When we expanded in 2017, we tripled the size of our existing hospital and built a modern data center. We started to bring everything back in-house except for a few select services. We still have some things hosted — our EHR is hosted through Epic, for example — but the majority of systems are now in-house or cloud supported, including shared systems with Stanford Health Care. The enterprise PACS for Stanford Medical Center is actually hosted at Stanford Children’s. The benefit is that when you’re on-prem, we can maximize the bandwidth which is especially important for imaging. That’s critical for us, as we’re one of the leading institutions in the world when it comes to using AI and image archiving for development and discovery.
On data analytics
Discovery is a big part of our mission; that’s one of the reasons why Lucile Packard Children’s Hospital resides on the Stanford campus. We’re tightly partnered with the Stanford School of Medicine, and we’re involved in the research piece. Using data and analytics is core to that. Whether it’s new or historical data, we’re always looking for patterns and outcomes that allow us to cohort practically on the fly and look at the history of similar patients to try to predict outcomes.
It’s really fascinating. It’s a great place to be, and I’m really honored to be the CIO here.
On creating true partnerships
A while back, our CMIO [Natalie Pageler, MD] and I did a presentation to the board about IS’ role in the organization’s success. It’s a major role. First, you have the EHR, which enables us to treat patients on a longitudinal and cross-enterprise level — an ability we didn’t have 7 years ago. That was a significant achievement.
Second is our world class analytics program. We did some things creatively. We treated it as a partnership with quality, finance, and research, and we used a federated structure as opposed to centralized. We train people throughout the business on analytic tools and capabilities, rather than doing it for them. That way, they can do it on their own, because they know their business better than we ever will.
On governance and transparency
Our governance structure brings everything together so that there’s full transparency into our systems development and analytics work, including what’s transferable to other areas in the organization. This way, we’re not reinventing the wheel every time a new need comes up. We can look at these capabilities and tools across the enterprise. That was a major strategic initiative to keep advancing toward our triple mission of patient quality, safety and discovery of new care for patients.
On the digital health steering committee
To give you a little history, I was asked by our CEO to chair the digital health steering committee when we first conceived it and I actually declined. I didn’t think it should be led from IS; I thought it should be led from the clinical side. And so, the compromise was that the Chief Medical Officer [Dennis Lund, MD], the Chief Administrative Officer of Ambulatory and I would co-chair it. It was brilliant because it had the medical side advancing, the ambulatory side adopting, and the IT side enabling.
That was five years ago. Now, the CMIO, CAO and I sit on the committee and others are chairing it. But the same concept applies — it’s a multi-disciplinary approach with leadership from clinical, ambulatory care, and Information Services. I’m really proud of that.
As a leader, it’s not always effective to be the point person. Sometimes it’s better to be partnered with others. I’m glad I made that decision. It was a little uncomfortable at that time, but it clearly worked out.
On the 5 domains of digital transformation
As we moved down that path, it became apparent that there are five domains of digital transformation. The first one is patients and families, because when you have a pediatric patient, the whole family is involved. The second is providers; and by that, I mean not just physicians but nurses, advanced practitioners, etc.
The third domain is business operations. How can we make it easier to do things more efficiently and effectively, and remove variance from the process? The fourth is the market and our ability to grow and predict trends with our patients and increase awareness. That includes our consumer portal and any community outreach. The fifth domain is research. That’s our other mission; it’s why we’re part of Stanford Medicine.
The IS executive committee oversees all IS services and digital transformation; that’s part of the governance I put in when I came here. We have the Chair of Pediatrics from the School of Medicine on that executive committee, along with the CEO, COO, CFO, and others. We meet bimonthly to track our achievements in digital transformation by domain.
On sharing within the pediatric community
A lot of good things have come from that collaboration, and not just telehealth. We’ve developed predictive analytic tools for bilirubin, diabetes, and congenital heart disease that enable us to continuously monitor patients and see when they need to come in for a visit, instead of having to bring recorded data to appointments. And we’re sharing all of these tools with other children’s organizations — our apps are available in the Apple store as well as the Epic Orchard. That’s our mission here: discovery and sharing innovation. I’m really honored to be part of that.
Sharing data with our colleagues around the nation is a big part of what we do. We share every discovery freely and we participate in data consortiums. One of the unique things about pediatrics is we’re looking at maybe 6 or 8 percent of the population, and only a small percentage of those patients who are really sick.
Our big data needs are dependent on sharing with other children’s organizations nationally.
On moving forward with ERP and RPM
Our ERP system which will go through a conversion to the cloud — most business will in the next 3 years. We’re looking to reinvent some of our key processes and make them more reliable, efficient, and transparent, so that we know where things are in the queue.
We’re also advancing RPA work. We’ve got multiple pilots that have been extremely successful and seeing significant improvements in performance. It’s amazing; when things are done manually on paper and between people, there’s basically no measurement. When you automate, it’s very clear. They’re either working or they’re not.
There are some other great advancements in that space. We’re redeveloping our consumer portal for the community — that will be done in October. We’re investing a lot of resources to reinvent that. We know that in our market (Silicon Valley), people want automated ways to discover us, to research us and to make appointments, and so we’re responding to that.
On knowing the business of healthcare
As the industry goes through a workforce restructuring, it’s critical that people really know the business. Someone might come from banking and think a system can be shut down for 5 minutes, much like they do with ATMs. Well, you can’t do that in healthcare. This is life support.
People who don’t understand that are bound to make technical mistakes and errors that put patients at risk. And so, we really emphasize the need to know the business first.
On the evolving CIO role
To have such a strong focus on digital transformation really speaks to what IT has become. We’re not just the computer geeks anymore; we’re on the front line changing the way healthcare is delivered and the way the business is run.
The CIO is really transformative. Anyone who thinks the role is going away just isn’t looking at it right. It isn’t going away; it’s changing. We have to have 100 percent reliability. We have to have high performance. If that isn’t there, everything else falls down. But that’s what got us here.
Now, the question is how are we going to innovate for the future? That’s where we are now. Most hospitals have EHRs; the question is, what are you doing with it? Stanford Children’s is pushing the needle and we’ll continue to do that.