The word ‘digital’ can take on different meanings, particularly in health care. And while some believe digital transformation is what health systems have been doing since passage of the HITECH Act, others see it another way. Bill Hudson, Chief Information Officer at INTEGRIS Health, falls into the latter category.
Although he acknowledges that IT’s role in automating processes has been significant, making the jump to digital seems premature. “To me, it’s truly connecting to our patients; truly connecting to our communities and launching digital-first initiatives that enable those workflows,” he said in a recent conversation with Kate Gamble, Managing Editor at healthsystemCIO. “That’s what digital is really about. It’s not technology. It’s technology working with the clinical side, working with the physicians, with the medical staff, and with analytics to make sure we’re reaching out to our populations and closing the loop.”
During the interview, Hudson discussed how he has applied this philosophy in practice — both at INTEGRIS Health and past organizations, and how his teams are leveraging digital tools to “meeting our communities where they are.” He also talks about why he returned to the provider side, the “opportunity” he couldn’t pass up, and what he believes should be the first steps for a new leader.
Q&A with Bill Hudson, Chief Information Officer, INTEGRIS Health
Gamble: Hi Bill, thanks so much for joining us. I want to talk about the work your team is doing and get into some of your career experience as well. Just for some background, INTEGRIS Health is a large health system based in Oklahoma, and you joined the organization in December of 2021 as CIO. Does the organization have a chief digital officer? How is that structured?
Hudson: The digital work is split up. We have a chief transformation officer, Brian Jones, who is responsible for the employed medical group as well as driving transformation and helping to manage population health. He and I work extremely closely on our digital initiatives; the responsibility is shared between the two of us.
At my previous organization (John Muir Health), digital fell under me. I worked with the CHIO, Chief Health Informatics Officer, to drive some of those changes. Here, it’s just structured differently.
On the evolution of digital leadership
Gamble: So for many organizations, I would imagine it’s still a work in progress.
Hudson: Frankly, I think this is one of those things that’s going to continue to evolve. There are aspects of it that fit under IT. There are aspects of it that fit under the role of strategy, and there are aspects of it that fit under the role of transformation and population health. I think it’s ultimately going to depend on a number of things.
One is how people get things done within an organization. It’s also going to depend on the CIOs themselves — are they aligned with clinical and business operations? Is the CIO aligned with public health initiatives? I think that for those organizations in which they are aligned, CIOs are going to take on this responsibility. In organizations where that’s a weakness or where strengths lie in operations, we’re going to see more of a shared alignment.
On having a digital mindset
Gamble: Interesting. In our interviews, we’ve heard some people say that digital transformation is something CIOs have been doing all along. What are your thoughts there?
Hudson: Yes, and no. It’s easy to look at everything we’ve been doing for a long time and attach ‘digital’ to your title. And to a certain extent, IT has been automating things.
But to me, it’s truly connecting to our patients; truly connecting to our communities and launching digital-first initiatives that enable those workflows in a very different mindset than simply deploying say, MyChart. It’s reinforcing the use of that application.
And it’s not just about the technology. It’s about how the technology is used and integrated. I was talking to the CEO recently about how digital is a thread in everything we do. Sometimes the thread is wider and thicker, and sometimes it’s narrower. But as we start thinking about the core issues moving forward, digital is certainly one of them.
I look at digital not just as technical enablement, but also the ability to reach out, communicate, educate, and connect. Those operational, workflow-type tasks that embed technology in someone’s day-to-day life — to me, that’s digital.
On taking a digital-first approach with Covid vaccines
When I was at John Muir Health in January of 2021, I was one of a few folks responsible for coordinating our vaccination efforts. As part of that, we looked at how we could use digital and work with the community to allocate vaccinations.
Once we knew we were going to get vaccinations, people started saying, ‘We have to set up a call center — how are we going to take those calls?’ I sat down with my leadership team and said, ‘we’re not.’ And they looked at me like I had two heads. I said, ‘Trust me. We’ve been using Epic and digitally engaging with our patients throughout Covid. We’ve integrated that workflow into our clinics, into our hospitals, and into our care processes and back-office business processes. Our patients are ready.’ They trusted me and said, ‘okay, let’s take a digital first approach.’
The next Saturday, I had seven people on the phone with me. My team sat together and placed all of the eligible people in our community into a cohort and broke them up by letter. We weren’t sure how fast people could register, and we wanted to make sure everyone got a fair shot. And so, we randomly released letter blocks over the course of about six hours; when that happened, everyone in that cohort received a text message, a MyChart message, and an email saying, ‘you’re eligible to register for a Covid vaccination. Click here.’ or, ‘go to MyChart and sign up.’
We continued to release letters; no one got off the phone for six hours. We sent 26,000 invitations that day, and we filled 6,000 digital appointments in the first 24 hours. We opened up 2,000 more patient appointments the next day, and we filled those in the next 24 hours. We had the first four weeks scheduled a week before we had vaccinations, and so, we were ready to roll.
We also saved 10 percent of the appointments for equity to ensure people who didn’t have digital access were able to make an appointment. We worked with physicians to identify folks at high risk, reaching out to some people directly to help schedule vaccines.
Because we applied a digital approach, when patients showed up for their vaccinations, 80 percent had already completed the pre-registration steps in MyChart, which allowed us to save time and staff more appropriately.
On ensuring equity
Gamble. Can you talk a little bit about the equity piece and how you did that?
Hudson: Of course. To me, the coolest part was that around the third or fourth week, our [then] associate CMIO, Dr. Priti Patel, and a few other folks used the slice-and-dicer tool in Epic to make sure we were meeting the needs of our community and distributing the vaccination equitably. They looked at our five zip codes responsible for the majority of our critical inpatient Covid admits, to make sure that we were distributing the vaccination evenly, and that all races were represented equally.
As it turned out, they weren’t. And so, we were able to look at the data and put together a program to help educate and communicate to these populations to make sure they were getting vaccinated. Within a few weeks, we had shifted the numbers. Instead of certain demographics being wildly underrepresented, we had a vaccine distribution that was more equitable and was meeting the needs of our community.
On digital as a team sport
That’s what digital is really about. It’s not technology. It’s technology working with the clinical side, working with the physicians, with the medical staff, and with analytics to make sure we’re reaching out to our populations and closing the loop. To me, that’s what it means, and that’s why it’s so hard. Because that’s not a one-person job. It’s three, four or five people coming together across the system to have that vision and drive it. It wasn’t my idea to look at the demographics. I did drive us towards digital; I said, ‘let’s push out digital.’ But it wasn’t my idea to look at the demographics and ask, ‘are we doing this the right way? How do we make sure we’re being equitable?’
That team approach has really made a difference for our community. I think the opportunity for digital to drive change in health care is in patient engagement.
On “meeting communities where they are”
Gamble: It goes back to what you said about digital being part of the thread. Is that part of the approach at your organization?
Hudson: It is. We look at digital as an element of what we’re doing. We’re not digital first; we’re patient first. We’re trying to care for the community first. Digital is a tool and a way of thinking that enables us to expand the scope and capability of our organization to reach the community. It’s a tool to make sure we’re not leaving anybody behind. If we’ve learned anything throughout the last 24 months, it’s that our communities are ready to engage with providers in a meaningful way through the use of digital technology.
And of course, it’s not appropriate for every use case. You can’t get a vaccine remotely. But those digital threads — those digital workflows — enable providers to get patients back in and make sure they’re getting the well care they need. For example, if you’re over 50, you might get a reminder to schedule a colonoscopy. It’s an opportunity for patients to do it on their own time, versus getting a call when you’re in the middle of three tasks and you say, ‘I’ll call you back later.’
This way, patients can schedule it on their own time. It gives them the power. It also cuts out the middleman, and I think that’s really important.
If you think about it, that’s how we interact in other facets of life. If I have a problem with my iPhone, I don’t call Apple. I go to Apple’s website and start messaging someone for help. I get it taken care of on my time, and at my pace. Before I know it, there’s a new phone on the way. If we make it possible for people manage their health, and asynchronously stay in contact with providers and schedule appointments, they’re more likely to do those things.
Digital is about meeting our communities where they are. Sometimes that requires a high degree of digital integration, and sometimes it’s low tech. But it’s about making sure it’s an element of what we’re working on.
On returning to the provider side
Gamble: Looking at your career background, you were John Muir for about five and a half years, and before that you were with VMWare. I would imagine that gave you an interesting background. How have you been able to draw from that experience?
Hudson: I was chief health care strategist at VMWare, and before that, chief technology officer at Kettering Health Network. I really enjoyed both of those roles. It was neat to be able to help a technology company make sure they were focused on the provider market in a very specific way. It was also amazing to work with CIOs, CFOs, CMOs, and CMIOs across the country and see all of the cool things they were doing and be able to share those best practices. That was the best part; being able to share those ideas and incorporate them.
But as much as I loved doing that at VMware, every single time I sat down with one of those guys, I was jealous of all the cool things they were doing and thought, ‘I really miss being on the provider side.’ And so, when I had an opportunity to work at John Muir, I jumped on it.
On INTEGRIS Health’s appeal
Gamble: What was it that drew you to INTEGRIS Health specifically?
Hudson: It’s very much aligned with the community. The CEO’s vision of building partnerships and enabling those to be able to expand access and connect to our community was something that really struck me.
It’s a strong organization with a good technology foundation that had an opportunity to push to the next level, and an opportunity for technology to be a part of caring for the community. That was really exciting, and I wanted to be part of it.
The other factor is that I’m from the Midwest, and so it was also an opportunity to move back to that area.
On being the ‘new’ leader
Gamble: When you arrived there and started the new role, what was your approach in getting to know the organization and determining immediate priorities?
Hudson: When I look at an organization, I like to understand what we’re working with. What are the big commitments we’ve made and things we want to get done? Number one thing is, don’t mess anything up.
Number two is to get out and meet folks in the organizations. Meet the clinicians. Understand what’s working well and where their concerns are. To me, IT is something that happens with folks, not to them.
It’s a strong partnership. It’s about communication and alignment. My focus since I arrived here has been getting the IT team to focus on becoming aligned with the operational, business, and clinical needs of the organization. It’s bringing that information back into IT and using it to prioritize — and being very transparent about those priorities so that the organization doesn’t see IT as a black box where they have no idea what’s happening on the inside. It’s making sure they know what we’re doing. They’re part of it. They’re connected to it. That helps ensure IT is aligned to the needs of the organization and the community, and that we’re focusing on the right things.