Scott Smiser, CTO, Emory Healthcare
Laura Fultz, VP of Applications & Digital Experience, Emory Healthcare
In this interview, Editor-in-Chief Anthony Guerra speaks with Emory Healthcare’s Chief Technology Officer Scott Smiser; and VP of Applications and Digital Experience Laura Fultz, about their transformative digital health initiatives. They share how Emory is integrating cutting-edge technology to enhance both clinical and operational efficiency, most notably by pioneering Epic Hyperspace on Apple MacBook devices. This project, rooted in user-centered design, reflects Emory’s commitment to improving clinician experience by aligning technology with their needs, ultimately enhancing patient care.
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Anthony: Welcome to healthsystem CIOs interview with Emory Health Care Chief Technology Officer, Scott Smiser and VP of Applications and Digital Experience, Laura Fultz. I’m Anthony Guerra, Founder and Editor-in-Chief. Scott and Laura, thanks for joining me.
Scott: Thanks for having us.
Laura: Thanks for having us.
Anthony: Very good. You want to start off by telling me a little bit about your organization and your role. I won’t make both of you tell me about your organization, but let’s put that on you, Scott. Tell me about your organization and your role, please.
Scott: Scott Smiser, Chief Technology Officer at Emory Healthcare. Emory Healthcare is based out of Atlanta, Georgia. We have 11 hospitals and over 320 clinic sites across the metro Atlanta area. And we’re looking at expanding outside Georgia. Emory has a footprint, obviously, nationally, but also internationally. I think at one point I was told we touch or influence 160 different countries around the world with research.
Anthony: And your role, you want to tell me a little bit about your duties?
Scott: As chief technology officer, I’ve got responsibility for the complete technology stack. So anything from servers, hardware, integration, enterprise, desktop management, et cetera is all within my purview.
Anthony: Excellent. Laura, you want to tell me a little bit about your role?
Laura: I’m the Vice President of Applications and Digital Experience. What that means is I manage the entire Epic stack. We’re a relatively new convert into Epic where we just hit our two-year mark and also other third-party systems like pharmacy and imaging, heart and vascular. We also have the user experience team under my purview, which is something we’re really excited about. They help in two different facets. They can help us before we put something in production and get a gauge of are we hitting the design, are we doing what we intended to do with different testing labs and pulling in end users and making sure that we’re doing the right things. They also provide another service, which is creating a digital health score for our end users. It starts with something that we call trickle feedback. We throw out 40 randomized to 40 different machines across the enterprise every day. We ask them two questions on a scale of 1 to 10, how’s your Epic experience? And then there’s a free text box and that allows folks to give some more feedback.
We collect that every day. And then that is paired in with information from Epic, like on our signal data from ServiceNow, our service management system, and all of that data together puts together a digital health score. We know who’s happy and who’s not. Then we have a team of folks that go and look at who’s not happy and we reach out to them. Then it’s not sort of the black hole of you asked me for my feedback and then I never heard from you again. We’re going to follow up and say, “hey, I understand you’re really frustrated about X, how can I help you?” We know who to provide extra training to, who maybe has something wrong with their workstation or their system. We’re super excited about that program and I’m thrilled to have that within my area.
Anthony: Sounds like a great program. One of the things that’s come up recently is the idea of don’t just check a box and say we rolled out X and so therefore we’re good. You need to find out if your users are happy. Do you know this is being done at other health systems in different ways or you feel like maybe you got something unique going on there, Laura?
Laura: I don’t know. I think that we are doing it really well. I’ll put it that way. I don’t want to speak to what others are or not doing, but I’ll say right now we’re actually hosting a user experience summit. We’ve got people, healthcare leaders that have flown into Atlanta to meet with our director of user experience. Epic is down here. We’ve shared a lot of what we’re doing. Chris Holland is the director of the area and he’s been speaking nationally about what we’re doing here. We’re very excited and you’ll actually see a part of that of the data that that team generated in our presentation that we’re delivering at CHIME with Apple and Epic. We were able to leverage that team to give us data and insights onto what was the user experience, what was the net promoter score, and are people really happy with what we’ve done.
Anthony: We’ll get into that in a second, but I just want a little bit more on what we’re talking about. It’s very interesting. The way you’re doing it helped you figure out if this is a one-off issue, if you get a negative complaint or somebody says something’s not working, you can delve deeper and find out is this a one-off issue or are we seeing something systemic where we need a larger solution? Is it affecting a lot of people?
Laura: That’s right. Departmental-wide, is it something…this type of user, this type of location, and it’s all actionable data that we can drill down to, and we’re just super excited.
Anthony: And then you go to the training, right? So is this an issue a lot of people are having, do they not know you can click on this one button and it’ll solve all your problems? Okay, if that’s the situation, how do we weave this back into the training people are getting, right? Like root cause type thing.
Laura: That’s it. And so the team that reviews those digital health scores, it’s a hybrid team made up of analysts, our education and readiness team, which is our trainers and then informaticians. We have a real blend, and they meet weekly to see what came in for the last week. And then they start to divide and conquer. And so training things go to the training team, app issues go to the app teams. And if it’s a design or workflow issue that can go over to our informatics colleagues.
Anthony: I like it. It sounds really good. You mentioned the session you’re doing at the CHIME fall forum, which is kind of what we want to focus in on a little bit and learn a little more about that. The title of the session is – Take a Byte, spelled B-Y-T-E, very clever, out of the Apple. Emory Healthcare’s Epic Leap onto Apple MacBook Devices, so you got a little play on words with Epic. You got a lot going on there in the title. Tell me about this. Tell me sort of what it’s all about, why you decided to put together a session for this at CHIME. Obviously, that’s something you want to highlight, feel like you’ve done some interesting work here. So Scott, why don’t we go to you? You want to give me the overview?
Scott: Yeah, absolutely. As an avid Mac user for over 20 years, I’m really excited about what we’re doing. This all started last year when we were rolling out our ambient listening project at Bridge, and we were rolling that out on iOS devices on iPhones, but there was a desire by our CIO, Dr. Erskine, to look at potentially doing a MacBook Airs as an endpoint for that delivery of the ambient listening. So we were in the process of standing up a testing lab. We’ve got an innovation lab there in Atlanta that has all the different Apple products that we’ve bought so we can do regression testing and any kind of testing within enterprise applications or use cases. But we bought a contingent of MacBook Airs initially knowing that we were going to use ambient listening. But we also knew that Epic, and we’re a new Epic customer as Laura alluded to. I mean, we’ve only been alive with Epic for two years. We got a 10-star designation, so our team is very proud of that designation. It’s right above her head. Very proud of our 10-star designation. But you know, Epic is a very strategic partner with us. We’ve got great relationships with them. They were in the process of looking at putting Epic Hyperspace on a Mac. So we were part of the braintrust dialogue. And really it was the convergence of an appetite for looking at Apple products in a different way in healthcare, but also being on the forefront of putting Epic on that local chip set and that local endpoint experience.
We started that last fall and we actually got the first round of code in December in our lab. So my team and Laura’s team did all the regression testing with Epic engineers. The Epic engineers and Apple engineers were on site, and we really started with a phase zero of rolling this out to a contingent of doctors that were very, shall we say, excited that Emory was going down the road of deploying Emory-managed MacBooks and Mac devices. And that’s really where it started, last fall and the holidays. So, for the past 10 months or so, Laura and I have been really adamant in rolling out continually at scale of what’s going on with Epic on those MacBooks. And the experience data that she’s alluding to that’ll be shown in the session is very compelling.
There’s so much to say about these devices, Anthony, to be honest with you, but the way our clinicians, in my opinion, are interacting with the device, the way they feel about interacting with the device, because they use these devices at home or they grew up with those devices in school, they never thought the day would come where really convergence of EMR and clinical care and a MacBook could happen in a local endpoint like that. And I feel like the way they are interacting with those devices, and they feel, that’s going to translate into patient care for us and the patients that we’re serving in our community.
So that’s how it all started. I don’t want to give everything away, but I’m happy to answer whatever questions you have about what we’re doing in Atlanta.
Anthony: I’m going to give Laura an opportunity. Anything you want to add to that before I go into more questions?
Laura: I’m a recent Mac convert, and so Scott and I have been the best pair. I think he saw me looking at his laptop, and he was the one that pushed me onto this. Scott, maybe a week later, because he said, “don’t worry, you can keep your Windows, laptop, it’ll be fine.” I think that lasted a week. And it was like, “I’m done, I’m all in.” And so for me, this has been super exciting to learn something new and then to see the excitement from our end users. And what Scott and I like to say is that we weren’t doing an IT project to them, we were doing something for them. And it’s so much easier to work on a project where your end users are engaged and so happy to participate. And it has just been a joy to work on this project.
Anthony: Okay, great. So let’s get in. You’re talking to the right guy because five years ago I converted and I’m like an apostle for Apple. I love it. Don’t tell my wife and kids, but converting to a Mac is the best thing that ever happened to me. Once I got it, there is a learning curve, right? It’s not that big, but there’s a learning curve. There’s that intimidation of the initial switch. Like, I don’t know what this thing is, things aren’t where they used to be, but man, it’s like from driving an old clunker to a Ferrari. In my opinion, maybe I’m overstating things.
So, a couple of questions there. Number one is, is the idea behind this that it’s fundamentally a better piece of equipment? Meaning, let’s see if we can get our users on this because this is a better machine. These are better. And, therefore, if we get them on the better thing, they’ll be happier. Is that an underlying idea here?
Scott: Absolutely. I mean, just from a technology stack, Apple from software chipset, a complete integration of the device is all under their roof. They stem to stern design these devices. And I think there’s this stigma in the industry that Laura and I are trying to help combat with peers is that these are just consumer-based products, that these aren’t industry-leading products. But to what you’re saying, Anthony, I mean, from a device standpoint, there’s tons of Forrester research and others out there that have done analysis on the total cost of ownership over time. I’ve got a 10-year-old MacBook that’s downstairs in the kitchen island that I can flip open and look up a recipe if I want to, and it’s 10 years old. I couldn’t do that with all these devices.
And then you look at what the joint commission’s wanting to do with healthcare and going carbon neutral and we’ve done power studies to back up what Apple’s done with these silicon chips. These devices are using 50 percent less power. At some point we’ll probably talk about here that we’ve done a complete nursing unit of nothing but Apple and the carts themselves are running iMacs and the nurses love them, but then they don’t realize the technology behind it. They’re like, “you know, I don’t have to plug these things in every shift.” And I’ll ask them, how many times a day or 24 hours? They say, I don’t think this one’s been charged for 24 hours. Let’s see what the power is. Because the silicon chips use so much less power. So that’s appealing to us from a cost standpoint. And I feel like these devices are going to require less support tickets, the users are happier with them, and they’re going to last longer.
Anthony: Yeah, I mean, you’re probably going to get people to convert in their personal lives once they have to use one at work.
Scott: Yes, Laura is a convert. Laura was a quick sell (laughing). We were at a retreat, and she was sitting next to me, and I was using the trackpad to flip between desktops on the trackpad. And on break, she goes, “how are you doing that?” Because she was seeing the different wallpapers and the different applications pop up. And I’m like, “oh, you can have multiple desktops on a Mac, and you just swipe through them.” And it’s just little things like that, that as an avid 20-year user of a product, I’m taking for granted, but Laura’s like, “that’s kind of cool.” And I feel like Santa Claus. I’m like, “do you want a MacBook? Let’s get you a MacBook and see what you think.” And the training wheels were off within seven days. She’s like, “yeah, you can have the Windows unit back, I’m good.”
Anthony: I did mention that learning curve. How did you deal with that for your users who are PC people and have always been PC people? I would imagine there was, nobody likes change. Everybody will give you a little pushback. So how did you work through that?
Scott: The first thing we had to do, Anthony, is really prepare a team, both internal to Emory digital with Laura and I looking at individuals that we wanted to get those devices into that would be supporting Epic and the other applications. We actually ran through some classes where we moved everybody through our North Lake campus as far as people that would touch these devices out and field service tech operations help desk, et cetera, where they went through a 2-day boot camp of just all the commands of how to support Mac OS. Now, the surprise gift to them after graduating from the course was they got a MacBook Air, and they were excited about that. So they got a MacBook device themselves. They were able to take that back to their work area and work with it.
We were preparing the group from that vantage point. But Apple did a really good job with giving us free content, little snippets, little webinars of how to use your Mac. They’ve got custom free classes on how to go from Windows to a Mac in a meaningful way. So I thought the learning curve would be farther than what it was. I have found that people run in there pretty quickly. Once they get their feet wet with it, it just starts to come naturally. And I really attribute that to Apple’s design, the OS and the feature set, and just how intuitive the product is long-term. So, that was a ramp-up, but we have not run into the hurdles. As Laura and I talked to some of our peers, they’re asked, “how did you get your users to use it? I mean, did you have to staff up a whole other team to do this?” And the answer to that was no. We just gave our existing team the training and the tools to be successful. But a lot of the users are self-sufficient once they get the device.
Anthony: Laura, anything you want to add.
Laura: From an Epic perspective, it’s not that different. Epic is Epic. Epic is the same and feels the same on a Mac that it did on their Windows machine, except it’s a little bit faster and a little bit easier on the eyes. So from that aspect, that was just a plus for us. And Scott mentioned this, but our team at first, there could have been fear of, “oh, I got to now test Epic on an Apple product or an Apple OS and Windows but the appeal of, oh by the way, did you realize you get a MacBook now to use as your work computer?” People were signing up without hesitation of, “I will do that. I will do that. I would love to do that.”
That was a big lesson learned that we thought that could be a larger thing to scale, but it ended up really not being much at all.
Anthony: Scott, you mentioned that people never thought that this would be possible, that they could be used for this, maybe an enterprise situation. Why is that? Give me a little more information about why people never thought the Apple products would work in an organization like yours and what changed?
Scott: It’s a fair question, Anthony. I think that there’s two misconceptions 0n Apple products and in business. One is the thought that they’re only geared towards consumer experience, because they’re very good at selling products to consumers. They’re very good at getting that consumer what they want and getting them in their ecosystem. So I think a lot of people are like, well, that’s a consumer-based product. Why would you put that in a business? That’s the first misconception that I’ve been trying to dispel.
The other is, I’ve dealt with this internally, that there’s this perception that Apple devices are twice as much as the regular devices, and I’ve had to dispel the cost structure on that as well, but they’re not. If anything, for us on an Intel chip Windows machine, a business-level machine, the MacBook Air is $100 cheaper just out of the gate on face value. Now, if I wanted to do a MacBook Pro fully loaded up, et cetera, but I mean, these silicon chips, these MacBook Air M2, M3s with 16 gb of RAM, I mean, they are peppy little machines. Laura and I will tell you that, people that are using Epic on those machines are like, this is so much faster. Now we’ve got to do the comparative of, are they that much faster than an Intel? But it just, that experience for them feels faster.
So I think the two misconceptions are Apple’s only for consumer products and they’re more expensive, which both are untrue.
Anthony: All right, very good. I think I’ll give you guys one final question and let you each respond. People in your positions have a million things to do. There are a million projects on the million requests. Everyone’s got governance, trying to make sure things are lining up, spending money on the right things. This bubbled up to the top. You said Dr. Erskine was like, ‘hey, I want you to look into this.’ What would you say to your colleagues at other organizations of comparable size about why this is something they might want to think about doing? I’m going to start with you, Scott, and then I’ll go to Laura, and we’ll wrap it there. What are your thoughts, Scott?
Scott: Thirty-two years in the business, I’ve had to sell a lot of things. I’ve had to sell the concept of some technology. To what Laura was saying, I’ve not had to sell this. I didn’t realize when we ventured on this just to dabble into it, what this would mean to our users, how they feel about how they’re interacting with the EMR and different technical assets. And it’s something that, if anything, I’ve had to put guardrails around to control the growth of where we go with this in a meaningful way. So I can tell you that we started out one-to-one, right? We were going to do one-to-one. And then the concept came up. We had a chief nursing officer at one of our facilities say, “hey, can we do something more with this?” And I’m like, “what do you want to do? Could we do a whole nursing unit?” I’m like, “hmm, okay, that’s interesting. Let’s explore that.” And we did it this summer. So we did an entire unit of nothing but Apple products.
But I think at the end of the day, the big misconception is the cost. And when I talk to my peers, they feel like it’s more expensive. I will tell you without doubt, we were affected with the CrowdStrike event, like a lot of people in the industry. Laura and I saw firsthand that these Mac devices weren’t affected by CrowdStrike. So we had MacBook Airs that were in surgical suites. We had that whole nursing unit that I just talked about was fully operational. They did not know what this blue screen of death thing was about, to the point where ICU across the hall came and borrowed their carts and actually used it. So it made me from a technology office think of that diversification of endpoints and OS could come in handy.
Now I will also tell you that there’s a concern that it’s going to be twice as much to try to manage two different types of ecosystems. That’s not really come into fruition. Obviously, we’ve added an FTE to focus just on the Apple OS. But I don’t know, I mean, the CrowdStrike event alone made me think, “okay, well, what if our fleet was 30 or 50 percent Apple and not just a smaller percentage that it is today?” Because it took us a good 72 hours. Luckily, we had a great team that got us back online, nearly 30,000 devices in 72 hours. But that was an eye-opening experience for me.
Anthony: That’s an excellent, excellent point. Really interesting. Laura, any final thought?
Laura: I think the question would not be why would you do this, but why not? I mean, what we have seen from the financial benefits, from the user experience alone and being able to deliver something to our end users that brings back that joy of practice that we hear about a lot, something that they’ve been asking for for a long time. And it was just sort of the fear factor, I think, in the past of, well, we can’t do that. We can’t support that. We can’t pay for that. And when we started asking, why not? And just jumped right in and then saw that huge benefit. Why would you not do this? Scott hit on everything, what we saw at CrowdStrike, how happy our end users are, the financial benefits. Our analysts are happy to be able to do this. It’s just, there’s so many wins, we can’t wait to see what’s next.
Anthony: Well, that’s wonderful. And I’m fully supportive of this because I am a happy, happy MacBook user and I’ll never go back. I want to thank both of you for your time today. This was a wonderful topic, very unique topic, really great. And I think it’d be useful certainly to our users. I’ll be at the CHIME forum, so I look forward to seeing you in the hall and at your session and saying hi. So, thank you both so much for your time.
Laura: Thank you very much. We’ll see you in San Diego.
Scott: See you in San Diego.
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