“This Takes Time”: How CIOs Are Navigating the Road to Integration and Automation

There never seems to be a quiet moment in healthcare. Artificial intelligence and machine learning are a constant buzz, and the merger and acquisition wave never really slows down.

For CIOs and other leaders, however, the core objectives remain the same. “Everyone is focused on improving patient experience and lowering costs,” said John Henderson, CIO at CHOC Children’s. “Automation and doing things more effectively is the way to do that.”

But before that can happen, organizations need to reach a level of integration that has become increasingly challenging.

“Healthcare is one of the most highly regulated industries. There’s a lot of documents and a lot of patient information, and as much as we want to just focus on patient experience, it’s not that simple,” said Grace Nam (Strategic Solutions Manager, Healthcare, Laserfiche). During a panel discussion, Henderson and Nam spoke along with Shafiq Rab, MD (Chief Digital Officer & System CIO, Tufts Medicine) about the obstacles that stand in the way of achieving systemness and how organizations can position themselves to reap the benefits of integration and automation.

Tufts’ massive integration

When Rab arrived four years ago, Tufts was a holding company with 28 EMR systems and more than 100 patient portals. After a great deal of upheaval — which happened during the pandemic — the organization has whittled down to one EMR and one portal.

But it hasn’t been an easy road, Rab noted. “We’re still understanding how to do things one way. We’re working toward that.” Not surprisingly, the technology piece is the easiest part. “Workflow, processes, and operations are more important. They need to govern the technology.”

And as with any major initiative, change management is a critical piece; Rab’s approach started with building a case. “We have to understand what’s the value,” he said. “For us, the value is that we need information to serve our communities. Let’s use technology to work together as a system.”

Changing processes, however, means changing the workflow, which can be a hard sell, and needs to be approached carefully. In some cases, IT can bring immersion teams or rely on the vendor to help ease the transition. Another option is to “cash in on political capital” and utilize super users to spread knowledge. And of course, there are governance committees and subcommittees focused on easing the process.

Regardless of methodology, what’s important is that users feel supported, noted Rab. “It’s not about ‘pushback.’ It’s educating people on how to do things. That’s why this takes time.”

Selling automation

Another important factor, according to the panelists, is demonstrating the need for change. “We have to document the workflow. We have to document the processes, and then the a-ha moment comes when they see that the workflow is not that smart,” said Rab. “From there, we can start to automate.”

Henderson agreed, noting that CHOC Children’s conducts discovery sessions with business and operations, during which they discuss potential opportunities for automation. In order to drive change, however, it’s imperative that workflows are thoroughly documented — which unfortunately isn’t the case much of the time. “The expectation is that we’re just going to come in and automate it very quickly,” he said. Instead, his team walks through it step by step. “We say, ‘Here’s what needs to happen and here’s what we need from you. We have to understand exactly what you’re doing. Because if we develop a bot or robotic process automation, it’s going to mirror everything you’re doing manually today. And so, we need that documented. You can’t just tell us what it is.’ We need to go through that process.”

The better teams understand the process — and the way behind it — the more likely they are to become actively engaged. “If you build trust, they’re going to work for you,” said Henderson.

CHOC’s unique EMR setup

The road hasn’t been an easy one for CHOC Children’s, which has two hospitals — one of which utilizes an EMR from a large health system (Providence), while the other’s EMR is managed in-house. “It’s important for us to make sure we have the same level of clinical decision making, order sets, and all of those things across two different EMR systems,” said Henderson. That means working closely with Providence to ensure the EMR matches the one at CHOC’s main campus, which takes a great deal of collaboration.

“It takes our physician community, physician champions, administrators, and nursing teams to really make sure we’re keeping those things in sync,” he noted. “We don’t want to be in position where we have different levels of care between those facilities because the EMRs are being managed differently.”

And that’s just the beginning. Once the EMRs are ironed out, the focus must turn to workflow standardization, which is no simple task. “Everyone’s workflows and systems were designed for them, for those practices specifically. And they’re not going to necessarily get exactly what they had before,” he said. “They have to accept and make those decisions so then we can enable and implement that standard across.” And that has to happen before the technology piece is put in place.

For Henderson’s team, one of the advantages in having an integrated system is the ability to implement a standardized scheduling system. “We said, if we’re going to support staff scheduling for our nursing community, we need to do something different,” he said. And so, “we got our two groups together and decided to get on the same solution.” The key driver was the ability to offer opportunities in shifts across locations, which isn’t possible with disparate applications. The other upside, in addition to increased efficiency and staff satisfaction, is lower costs.

None of that, however, is possible without constant communication between IT and the business, noted the panelists. And it needs to be a two-way street. “Sometimes we bring the conversation to the business, and that’s part of developing and cultivating relationships with your peers,” said Henderson. That way, “it’s not always about them having to come to us and ask for help.”

As IT leaders, part of the role is understanding what’s happening on the business side — particularly where challenges might exist — and offering solutions. “It’s going to them and saying, ‘You’re leveraging three or four different applications to provide this service. We think there’s a better way. Maybe we can reduce the applications that you’re using, make it more efficient for you, and give you back capacity,’” he said. “Our role is also to help them see where they can shrink their portfolio of applications.”

Low-hanging fruit

Having that foundation is important for CHOC Children’s, which has several initiatives in the works designed to enhance the customer experience. In addition to creating a standardized call center, the organization is also leveraging automation to enable mobile check-in.

It’s an area that’s ripe for innovation, according to Nam. “End user activity is so important. Engaging them at the front end of implementation does matter.” She believes one of the most important use cases for automation is removing cumbersome steps from access points. “We need to look at where we’re spending time fixing errors within the process and focus on the low-hanging fruit that’s more results-driven,” and therefore, more impactful for end users.

That’s where she believes LaserFiche’s global enterprise content management system can play a key role in driving process automation. “With our intelligent data capture process, we are supporting organizations and helping them streamline processes.”

What’s more, by becoming more efficient, organizations can move toward the ultimate goal of achieving the quadruple aim of physician satisfaction, staff satisfaction, patient experience, and value, said Rab. “Whatever we do, we have to include those four aims. If we can do that, it will help us propel the mission,” he added. “Because we have to make money, we have to decrease cost, we have to reduce burnout, and we have to come through for our colleagues. This is the time to do that.”

To view the archive of this webinar — Leveraging Integration & Automation to Drive Towards Systemness (Sponsored by Laserfiche) — please click here.