Michael Elley is no stranger to change. He has spent time with six different healthcare systems — holding executive roles in all but one — and faced unique challenges with each organization. His approach as leader, however, hasn’t wavered. Each time he has taken on a new role, his first priority is the same: getting to know the people (even if that means meeting with every member of the IT staff).
“It’s about building relationships with your colleagues and other leaders and understanding the culture, understanding what they’re focused on, and understanding the gaps.” It’s a strategy that has worked well, Elley said during a recent conversation with Kate Gamble, Managing Editor at healthsystemCIO.
Having that foundation in place is critical, particularly given the burden IT teams face in having to do so much with limited resources. It’s one of the key reasons Baptist Health was able to pivot quickly when Covid hit and transition to Google, which resulted in “a much more collaborative and efficient” work environment.
And that’s just one example.
During the interview, Elley talked about how his team is leveraging technology to improve care — and efficiency — for patients at the 11-hospital system based in Little Rock, Arkansas. He also shared insights on how cybersecurity (and the CIO’s involvement in it) has evolved; why long-term plans are becoming obsolete; and what he hopes to gain by transitioning to the cloud.
We believe driving toward consumerism and making it more efficient and effective for the patient could have multiple avenues in terms of how they engage with us and do business.
Prior to the pandemic, the expectation for a lot of healthcare systems was for patients to come to us and navigate based on our definition of how that should happen. Now, the expectations are different. We need to engage patients in a digital way.
If you told me a year ago that we would’ve been this focused around bots and AI, that wouldn’t have been on my radar. But it is now. People still do 3-year and 5-year plans, but I think honestly a lot of it is wasted.
Before, health systems were like a bunker. There was one way in, one way out. Now, that’s not the case. Now, it’s like you’re a skyscraper with all these windows and doors. It’s totally different.
It’s building those relationships with your colleagues and other leaders and understanding the culture, understanding what they’re focused on, and understanding the gaps. That’s how I’ve approached it, and it has been successful.
Gamble: Hi Michael, thank you as always for your time. What are some of the key areas of focus for your team?
Elley: I don’t think we’re dissimilar to any other organizations. Everything from a cyber perspective is always hot. We’re getting more and more into AI and automation and are really focused on efficiency right now. Coming out of the pandemic, we weren’t as efficient as we were prior to it. I think a lot of that is attributed to contract labor, which is still more pervasive than what we want. That’s impacting us from a bottom-line perspective, along with increasing supply costs.
A lot of parts of the organization are looking at efficiency measures and how we can improve on those; of course, that all relies upon IT. At the same time, we’re focused on Leapfrog and patient safety and implementing new systems there. We’re focused on patient satisfaction. We believe driving toward consumerism and making it more efficient and effective for the patient could have multiple avenues in terms of how they engage with us and do business.
And then there are the core initiatives: implementing a new oncology service line (Epic’s Beacon) and implementing Beaker as our laboratory IS. We just put in a new radiology system. We’re moving more to the cloud and leveraging Google in different ways.
There’s a whole lot.
Gamble: It sounds like it. Can you talk more about what you’re doing in terms of automation?
Elley: Right now, one of our big areas of focus is implementing a revenue cycle management product from AKASA. We’ve created a command center, or access center, to better move patients around and take on transfers, those types of things. We’re going to start pulling data from Kronos on clinicians’ schedules and availability and tie that in with patient data in Epic so that we can understand our staffing needs and optimize our staffing ratios to increase efficiency. That’s something we’re kicking off. We’re also interested in robots that we can implement to help with deliveries and things like that.
But our big priorities now are revenue cycle management and clinical efficiency.
“We lost people”
Gamble: You mentioned staffing and efficiency. I’m guessing that Baptist, like most organizations, has been hit hard by resignations and clinician burnout.
Elley: Yes. Within IT, we have former clinicians; some of them felt compelled to go back to the bedside because their purpose in life had changed. And so, we lost some people to that, and we lost people to remote work.
We had people who wanted to get out of the healthcare industry because they were dealing with different strains of Covid, PPE shortages, and the political nature of the environment. It ratcheted up to the point where there are more physical altercations taking place. Consequently, a lot of people started evaluating or reevaluating their career path. It takes a special breed.
“Ahead of the curve” with patient flow
Gamble: Definitely. Can you talk more about the command center for patient flow? That’s an interesting concept.
Elley: We have 11 hospitals at Baptist. Earlier this year, we stood up an offsite command center with large monitors showing what’s happening in terms of transfers in, transfers out. They also show the status of patients who are being discharged, and what needs to be done, such as a lab or imaging, and what are the instructions, so we can be more proactive about discharging patients at the expected dates and times.
We’re looking at this for all 9 of our acute hospitals. We want to try to get ahead of the curve in terms of patient flow.
Gamble: And there’s a big IT component in having all those systems in place and being able to interoperate with each other.
Elley: It’s ever-growing. We looked at some vendors for help with this, but doing it externally is pretty expensive, and so we started building out dashboards within Epic to help manage that. We implemented an Epic module to help with that as well. We’re also looking at Hospital IQ, an analytics platform that pulls in both Kronos and Epic data.
“Need for improvement” within IT
Gamble: Looking back to when you started with Baptist, was there a three or five-year strategic plan in place? How did you approach that?
Elley: It’s interesting; the position had been vacated for some time when I got here. There was a strategic plan, but it was fairly rudimentary. Some of the executives at that time had pulled in an outside firm to do an assessment, which found a lack of IT governance, and a need for improvement around data and analytics and cybersecurity. That was pretty evident when I got here.
Another factor is that the IT department wasn’t right-sized compared with other Epic organizations. There was a staffing component that we needed to address in order to improve our posture around security and around data and analytics.
The “full-on effort” of integrating hospitals
Shortly after I arrived, we purchased two hospitals totaling between 600 to 700 beds and 44 clinics. And so, even though we had strategic initiatives and goals we wanted to accomplish at that point — this was late in 2018 and throughout 2019 — the focus was on integrating those hospitals and clinics into our Baptist Health environment, which is a full-on effort. And then we were going to start focusing on everything else.
Then, 2020 happened and plans changed for everybody. The focus was on remote work and telehealth and setting up all of these different locations throughout your health system to take on more patients, do testing, etc.
Covid’s impact – “Interesting, fun, maddening and scary”
It was interesting and fun and maddening and scary, all mixed into one. It was a huge change, and it was definitely interesting, but we came out of it with some great things. Early on we moved to Google, and now I think we’re much more collaborative and efficient in how we work. We have remote work capabilities, which allow us to recruit people from outside of the state — that’s definitely helpful in Arkansas. We’ve made a pretty hefty investment in telehealth and some other technologies; that has sustained itself.
“The expectations are different”
The digital component is also an advantage that came out of it. Prior to the pandemic, the expectation for a lot of healthcare systems was for patients to come to us and navigate based on our definition of how that should happen. Now, the expectations are different. We need to engage patients in a digital way. All of those streams were built out and are still sustained today.
Long-term plans & “wasted” efforts
Gamble: Given everything that’s happened in recent years, have you altered the way you view long-term strategic planning?
Elley: When I look back at my time with BJC Healthcare (from 2005 to 2010), 5-year and even 10-year plans were pretty standard. When you think about it now it’s silly because things changed so rapidly. But that’s what we did.
Now, I don’t have a 3-year plan. The organization has a 3-year plan, which we tie some initiatives to, especially when it comes to improving access and patient care. In reality, we’re planning 12 to 18 months at a time because everything changes so quickly. If you told me a year ago that we would’ve been this focused around bots and AI, that wouldn’t have been on my radar. But it is now. People still do 3-year and 5-year plans, but I think honestly a lot of it is wasted.
Gamble: It makes sense. You need to be aligned with the organizational strategy, but you also have to be able to pivot.
Elley: We’re a large health system; we have 12,000 employees and $2 billion in revenue. But we’re not huge. As a result, we’re able to move, change direction, and shift pretty quickly. I’ve been part of some organizations that can do that; Ohio Health was one of them. For others, however, it’s much more challenging because there’s a lot of bureaucracy.
But we’re able to move quickly.
Gamble: You mentioned cyber earlier. Do you have a designated CISO?
Elley: I do. The CISO — and this was in place prior to my arrival — reports to the Chief Compliance Officer, which some might view as a ‘fox in the hen house’ situation. The CISO sets the policy and can keep IT honest, if you will.
But I have a strong belief everything we do must be done in a very secure manner. And so that was moved under me, and it’s been going well. We’ve been able to move the needle quicker and get more done by having the CISO report to me.
It’s funny; when I was in a different CIO role about 6-7 years ago, I remember we had one meeting per month to talk about security. It would last about an hour. Now, we meet 4 to 5 times a week. It’s such a hot topic and will continue to be in the future.
No more “bunker”
Gamble: With everything happening so quickly to enable remote work, the cybersecurity risks multiplied. I would imagine you had to be in constant contact with security.
Elley: Yes. Before, health systems were like a bunker. There was one way in, one way out. Now, that’s not the case. Now, it’s like you’re a skyscraper with all these windows and doors. It’s totally different. We’re investing quite a bit in this technology, and I think our partners are adjusting their philosophies and their technology stacks to help support this new way of working from a cloud perspective or a remove perspective.
Eying the cloud
Gamble: Are you doing some work with cloud at this point?
Elley: We’re moving as much as I can. When I came here, maybe 1 to 2 percent of our environment was in the cloud. At the end of this year, it will be around 30 to 40 percent. We’re in the middle of moving our ERP into the cloud. I like to say we’re a Google shop, which is cloud-based, obviously. Any time we’re looking at new technology or we need a refresher, we look at their cloud offerings first.
We refreshed our Epic environment on-prem a few years ago. Our plan in late 2023 or early 2024 is to start looking at moving to the cloud. There was an announcement a while back with Epic and Google. A few health systems, including Hackensack Meridian, are planning to move their Epic environments to the Google Cloud. We’re going to start evaluating that. We’re putting immutable backups into the cloud and moving more and more out there.
Predicting costs with cloud
Gamble: We’ve had some interesting conversations about cloud migration lately, and one theme that keeps surfacing is that it can’t be rushed. It needs to be slow and steady, and you can’t expect instant results. Do you agree with that?
Elley: I do. The main goal of moving to the cloud is the financial aspect. In the past when we purchased a new system, we’d have these peaks and valleys with capital spend. It wasn’t always projectable. We know that every 4 to 6 years we’re going to have to go replace the system and it’s going to cost X dollars. But then the vendor would introduce new technology, and we’d have to upgrade. And so, we didn’t know with pinpoint accuracy what the spend would be.
When we move to the cloud, we’ll know month over month what our spend is going to be based on how much space we’re consuming or processing. There are calculations that go into that. Our finance folks, including our CFO, really like that flat nature of spend when it comes to the cloud. He’s a huge proponent and supporter of moving there.
Gamble: Right. I want to switch gears a bit and talk about your career path. You’ve been with Baptist for about 5 years and have held CIO roles at different organizations. Based on what you’ve learned and your experience, did you approach this role differently?
Elley: I don’t think so. I’ve been with 6 different healthcare systems, 5 of them as an executive. For me, it always starts with the individuals, the people in IT. You have to build those relationships. At nearly every organization, I’ve made it a point to meet with every member of IT. It’s building those relationships with your colleagues and other leaders and understanding the culture, understanding what they’re focused on, and understanding the gaps. That’s how I’ve approached it, and it has been successful. By making small changes, you start building some street cred and building support. That has worked well for me here.
Back in 2020, I was tasked with reengineering patient access across our system. It was unheard of for a CIO to focus on that. But I love it. I love the operational side of the house.
Coming to Baptist
Gamble: What was it that drew you to Baptist?
Elley: Before this I was doing consulting work. I thought I’d really enjoy traveling around to different places. But it got to be a lot. My kids were in middle school, and I was missing out on their activities because I was always on the road. I was living in Columbus, Ohio, traveling to Boston every week working with Lahey Health.
And I missed being the CIO. I had three opportunities in three different states; this one aligned most with my interests. And I really enjoyed the people I met when I came here. It was an easy decision; I like being in the South. I like the culture.
Gamble: I imagine it’s hard to get a feel for what an organization is like in such a short amount of time.
Elley: It can be. One factor was Epic. Some of them with customers of Epic, which was advantageous because I had been using Epic for the past 10 years. There’s definitely a level of comfort there. Also, I’m originally from Missouri, and this is much closer.
There are also financial considerations. You have to look at not just what’s best for your career, but the best fit for your family and where you’ll be happiest. That helps drive the decision
Gamble: Were there lessons learned from that experience? It has to be very different from a full-time gig.
Elley: I only did it for about a year. I was with the same organization for a while. It was a consulting gig, but I acted more as chief technology officer. And so, it wasn’t too different. One thing I learned is the people aspect and how important that is. These people are away from home; they’re doing a lot to support your organization, and so, it’s really important to treat them like permanent staff.