Sanjog Aul [00:00:08]:
Hello everyone. Welcome to CTN Virtual Roundtable. And the topic for today is Optimizing Healthcare IT for Enhanced Patient Care and Efficiency. And this virtual roundtable is made possible with generous support by Zones. My name is Sanjog Aul. I will be your moderator today. I’m from CIO Talk Network.

Sanjog Aul [00:00:31]:
So what is this topic all about? If you notice, healthcare is going through a lot of transformation. On one hand, you’re trying to use all these emerging technologies, the digital solutions, to bring the latest and greatest innovation in an area where we want to innovate for them and give them some value. But at the same time, there is the business side of healthcare, which also needs attention because costs are going out of control in some cases. And then also there are some inefficiencies which we have to work on so that we can give a good overall experience. But then all at the same time, since we are bringing more and more digital into healthcare, the EMR and the EHR aspects are getting even more critical. And on top of it, we are having things like artificial intelligence somehow getting introduced, and the security aspects are becoming paramount. So there is no dearth of challenges. And we are trying to figure out how to make the best use of the opportunity that we have in hand and actually do a noble job of taking care of the patients.

Sanjog Aul [00:01:44]:
So, to discuss this, we have a great panel here today. We have Chris Paravate, who is the Chief Information Officer with Northeast Georgia Health System. We’ve got Matt Reich, CIO and Senior Vice President with McLeod Health. Jeremy Meller, Chief Information Officer, Children’s Healthcare of Atlanta. Tara Eckert, Assistant Vice President, Digital Transformation for Kennedy Krieger Institute. Ryan Blackwell, Vice President, Chief Digital Modernization and Cloud Officer with Tufts Medicine. Adrienne Woods, Director of Digital Engagement with Hackensack Meridian Health. Surya Kant Khale, Chief Technology Officer, Vice President, Information Services, Technology and Infrastructure for Albany Medical Center. Balavignesh Thirumalainambi, Executive Director of IT, Care New England. Keyven Lewis, Director of Healthcare Services with Zones. And Guy Shepperd, Director of Infrastructure Platform Services from Vanderbilt University Medical Center. Well, we have a full house, very, very experienced people.

Sanjog Aul [00:02:37]:
You guys have all paid dues. So we would like to start with one simple approach. Pick your top challenge which holds you back from fulfilling the agenda that business has in your role as a healthcare IT leader. And as you share your challenge, I also want you to answer this another question. Given healthcare, it is kind of tough to manage. Imagine you were a superhero and you had a specific superpower to manage healthcare the way it should be managed, in your view. Who would you be as a superhero, and which specific superpower will you use? And please answer this question along with the challenge that you’re going to share. So I’m going to start with you, Chris.

Chris Paravate [00:03:26]:
I know. My apologies. I was enjoying your superhero question. Our challenge, particularly, is around our growth. We’ve grown in the North Georgia region by 10 to 12% year over year. We’ve gone from one hospital to five hospitals in the course of about six years. And as we’ve grown, we’ve really continued to manage those businesses in separate, distinct entities.

Chris Paravate [00:03:55]:
And so continuity of care across the patients from ambulatory into hospital imaging and treatment is very fragmented, particularly in scheduling and access. So that’s my topic. Superpower, I don’t know if this is a superpower, but I’m going with Jedi mind tricks. I think I’d want to be a Jedi. And Jeremy is a good friend of mine. He’ll probably laugh, but you will use this tool. It will provide great patient care.

Sanjog Aul [00:04:31]:
You will. That would be an incredible power. What do you think, Jeremy? All right, very nice. So, Matt, you’re next.

Matt Reich [00:04:38]:
So I think the challenge that I’m interested in hearing others contribute on is around workforce development, particularly in our IT realm, understanding that over the last four or five years, our folks have been through a lot. And so today we’re faced with challenges of how to recruit strong talent. And then, of course, there’s challenges about how you manage a hybrid workforce as well. So a superhero power. The best I could say might be that maybe I have the power of patience.

Sanjog Aul [00:05:14]:
Well, I did not know there was a superpower, but I’ll take that. So this is good. This is good. So let’s go with you, Jeremy. You’ve got a Jedi friend here.

Jeremy Meller [00:05:28]:
Well, I would say some of the biggest challenges we are facing are dynamics, I would say, with standardizing processes within an organization where, like a lot of organizations, healthcare is a segment of the industry that there’s a lot of autonomy, and there’s a lot of autonomy especially when you’re in an academic setting. Your physicians have actually a great deal of autonomy, and whether that’s driven by being part of, let’s say, a university healthcare or university system, whether it’s from the fact that physicians themselves can be pretty independent. And so for us to make meaningful impact, for example, on patient experience, and to really develop a real digital front door, it requires deep standardization and improvements in our internal operations to meet those needs of being more healthcare consumer centric. And sometimes those run at odds with other forces, whether it be what I just named or in some cases even regulatory or other types of things. We really want to be a leader in pediatric behavioral mental health, for example, in the entire state of Georgia. And there are just a litany of regulatory and other barriers that exist, for example, in helping us or impeding us from getting to the impact we want to make.

Jeremy Meller [00:07:08]:
Our teams are performing great. We’ve had record low turnover. We had 140,000 applicants to Children’s Healthcare of Atlanta last year. I think what we found is, post pandemic, that a lot of people really want to work for a mission driven organization. A lot of our challenges are not in some of those areas, but they’re more in just how do we cut through and get momentum. And so I guess, to follow Chris, it would be certainly a Darth Vader like power to dictate whatever needs to be done in order to make progress. But we’re working through things.

Sanjog Aul [00:07:54]:
So we’ve got Jedi and the Darth Vader. We’re bringing the Star Wars, huh? Okay, nice. Tara.

Tara Eckert [00:08:02]:
Hello. Yes. So, Tara Eckert here, AVP digital transformation at Kennedy Krieger Institute. So what I found to be the most challenging, and I’ll talk about my superhero power in a minute related to that, is sort of the adversarial dynamic between IT, EMR, like all the IT or technology, I guess you could say, versus operations and clinical. While I think that there is a desire to collaborate and sort of be in harmony with one another, I think there’s always this expectation that the other group is not trying to help you. So I think everybody really trusting each other’s expertise and that we actually all do really want the same thing would really help overcome some of the challenges that we have with really just not listening to each other. So my superpower would be, I would help promote synergy, help people with humility, and walking into rooms with the expectation that they might learn something and they might gain something from the partnership.

Sanjog Aul [00:09:11]:
All right, Ryan.

Ryan Blackwell [00:09:14]:
Nice to meet you all. Thanks for the intro. I’m at Tufts Medicine, and three years ago, we had a strategy to go big bang all at once, Epic, and we chose to host that in a public cloud. In addition to that, our strategy was to exit all of our data centers. And the value proposition has been great. Knock on wood. 100% availability, no downtimes, all the power of the cloud with cost optimization and security are all built in. So that’s great.

Ryan Blackwell [00:09:48]:
What’s bad is what’s left in the physical data centers. So we’re left with a series of applications that, for technical reasons, resistance to organizational change management, are getting difficult to exit out. I almost liken it to a barge sinking in a river, and the silt creates a suction that’s disproportionately hard to get it out of its stuck place. So that’s the problem we’re looking to solve. These apps are mostly legacy EHRs and our PACS systems. From a superpower perspective, I love Captain America, but I didn’t know what his actual superpower was, so I had to go to ChatGPT and say, what is Captain America’s superpowers, and indomitable will and moral compass. I think that’s why I like him the most.

Sanjog Aul [00:10:43]:
Adrienne.

Adrienne Woods [00:10:46]:
Hey, everybody. Thank you. Adrienne Woods, director of digital at Hackensack Meridian Health. And one of the things that is a pain point for me right now and my team is working through the online scheduling process. So while we have been doing online scheduling for physicians for about a year and a half, we’re still trying to streamline it and make it easy for the digital folks, the clinicians, the physicians, and the IT partners. So looking at how to streamline that process, everything from patient education to physician education to working with IT partners to make sure that everyone knows the benefits of this. And the ultimate benefit, of course, is putting patients first, because patients should be able to schedule their appointments online. But we want to make it a win win for everybody.

Adrienne Woods [00:11:36]:
And tied to that, my superpower would be time travel. Because for everything we’ve learned over the last year and a half, if I could time travel back a year and a half ago, I would have set it up differently. You live and learn, so that would be mine.

Balavignesh Thirumalainambi [00:11:44]:
Hello, all. I’m Bala from Care New England health system. My challenge is very specific to where we are in our timeline for our Epic enterprise rollout. So we just started the journey. It’s going to be a one and a half, two years long path. And the challenge that we are faced with, we have multiple hospital systems, with one of the largest behavioral health hospitals in the Rhode Island state. The challenge we’re faced with is even though we have sort of kickstarted our Epic implementation, we are still getting project requests from all of our operating units.

Balavignesh Thirumalainambi [00:12:26]:
So we’ve set up an IT governance, and we have set up a communication committee that’s focusing on messaging our team members on being very cautious about taking on new projects while we take on this large project. So that’s the challenge we have that I would love to hear solutions related to, based on your experience. In terms of superpowers, I took Ryan’s advice. I went on to ChatGPT. The superpower I wanted was to be at multiple places at the same time, because all the projects that are coming in come in with good intent. So I wish I could be at ten different places trying to explain how we can do it, when we can do it. So there is a superhero called Multiple Man, if you guys have heard of. So I would want to be Multiple Man, and I also want to be Iron Man so that I have an unlimited budget to fund everything.

Sanjog Aul [00:13:26]:
Very nice. Very nice, Keyven. Now, you have an interesting perspective because you talk to a whole lot of healthcare leaders, work with a whole lot of them. What do you see as the top pet peeve there?

Keyven Lewis [00:13:42]:
I don’t have one, but what I do hear is very common across what I’m hearing from everyone today on the call. My top three, it’s my triangle. We always use triangles for everything, but I do have a triangle. Of the triangles, one of them would definitely be, let’s make sure that we’re getting everything that we want on our wish list that we can afford. So that’s a cost type driver. The other one is really, there was mention of processes, and there’s mention of making sure internally we’re in a position to be successful, whether that’s our staff, our clinicians, our physicians, our nurses. That’s a top driver, especially with us recovering from COVID. And then the next one is really, how do we make sure that our end users, our clients, the patients are still being served and that they have a good experience as well. So with all of those in mind, one of the common things that resonates, that we have to make sure that we’re addressing, and the word that comes up always is organizational change management. But the key is it’s not just me pushing information on to, this is the way we’re going to do it. If I had the Jedi power, I would say, this is the way we’re going to do it. And everyone would say, okay. But it’s really making sure that there’s buy in. We need to make sure that we’re facilitating a win win scenario when we’re doing these type of things.

Keyven Lewis [00:15:12]:
So those are some of the things that are common. I have a million other ideas from experience of how we tackle those things, but just welcome to continue to deep dive in each and every one of these particular challenges that everyone is sharing today. So I’m going to stick with the theme. Since we were going with Marvel characters, and because I’m a movie buff, I didn’t have to use ChatGPT, I would be Doctor Strange. So I have the wisdom to understand what needs to happen, but I also can pull up my different crafts and do my little hand signals to make it happen. So that’s what I would be.

Guy Shepperd [00:15:55]:
I am Guy Shepperd. I am the director of infrastructure platform services at Vanderbilt University Medical Center. Thanks. Really enjoying hearing everybody’s problems today because it makes me feel good that we’re all in the same boat. My problem is more of a business problem. The business problem we have, our staffing problem, is we are too short on nurses. We have to get travel nurses, which causes a budgetary problem. And the business came to us and asked, how do we solve it? And a group of us said, well, let’s look at this virtual nursing.

Guy Shepperd [00:16:31]:
Let’s do it. And we did a proof of concept, and we did it. And it went really well. We were able to get a good patient to nurse ratio and give good care. And they loved it so much. They said, do it. And this is one of those times when they had an open checkbook and they’re like, go ahead and do it. We want to do it for this department, this department, this department.

Guy Shepperd [00:16:51]:
And all of a sudden now, we are in a supply chain problem where we can’t get the parts that we need, so we’re having to move. When you start thinking about what is involved, you have cameras, you have devices, you have all these things that have to be on a wireless access point, and then you have to have bandwidth to go with it so that you can have all this quick information that you need to have readily available. Well, that means you got to have dense wireless access points, you got to have dense network connectivity. And that’s the part where we hit a supply chain problem where all of a sudden we cannot get medical grade wireless access points. We can’t get the infrastructure we need. So my question is, how are you as a group still trying to innovate and move things forward, but also deal with the supply chain problem that everybody says doesn’t exist but actually really does? And I love the superhero question. I’m lucky I got to be the one to think about it the longest, but I am like Keyven, I am a Marvel fan.

Guy Shepperd [00:18:09]:
But I’m going to go with a DC character, not a Marvel character. I’m going to go with Flash, because the problem is, I never have enough time to get stuff done. I can’t be everywhere at once. But if I could do it really fast and get it done, I think it’d be much better.

Sanjog Aul [00:18:24]:
So I’ve not heard so many analogies of superpower in the healthcare setting. I tell you, this is the best takeaway. So, okay, so we’re coming back now with this second round of essentially going through the same sequence in terms of the challenges. But now what we’ll do is we’ll request each of the leaders to, in a crisp manner, just articulate their challenge in a sentence. And what is it that they would like to hear or get inputs on from the rest of the group? And please raise your hand virtually so that we can go one at a time. And let’s keep these solutions you share to be very crisp, very pointed, very actionable. So, with that said, Chris, reiterate your challenge in a sentence or two, and what is it that you could get as inputs and advice from the group, which they can then go ahead and provide.

Chris Paravate [00:19:20]:
The problem I’m working on is the consistency of our patient experience as they move across the care continuum, whether that’s ambulatory, acute, outpatient hospital. We don’t look across that continuum the way that patients are receiving access. So what are you trying to look for? I mean, a recipe to be able to do that seamlessly. I think if I was to pick on one group, let’s say our ambulatory group, they do a great job of scheduling in primary care. They’ve opened up online scheduling. We got some of the challenges that Adrienne mentioned, and I’ve got some suggestions for you, but that’s a separate scheduling column.

Chris Paravate [00:20:10]:
And then if you say, okay, I’m seen in neurology, and the neurologist says, I need an EEG, that’s a hospital based service and that’s scheduled by hospital based services. And so I’m curious how people tackled call centers, centralized scheduling, and how they’ve articulated that business case to their organization.

Sanjog Aul [00:20:35]:
Anyone? All right, Ryan, let’s start with you.

Ryan Blackwell [00:20:39]:
I’ll start with the simpler, which is just the infrastructure to consolidate disparate call centers into a single telephony platform. We found good success with AWS Connect. So the mechanics of call trees, call routing, call queues, failover numbers, when you’re not quite ready to take on the untangling of the Christmas lights on how you actually do open scheduling, the first place I chose to start was just get them on a single platform, and then you can incrementally control the customer experience as they navigate, from a telephony standpoint. That’s where we started, AWS Connect for the consolidation of our call centers from a telephony standpoint.

Chris Paravate [00:21:28]:
And we are a mixed bag. We’ve got Avaya and the call center tools implemented, but only in our high volume clinics. And so I only have part of the data to really articulate, okay, we have call abandonment, we have people on the phone too long, we have too many voicemails. I’m aggregating that, but I have some clinics that do it and some clinics that don’t. And I don’t think we have a nimble enough platform. So I’m going to be evaluating that.

Sanjog Aul [00:22:04]:
Sure. So, Guy, you have a thought, a suggestion?

Guy Shepperd [00:22:11]:
Yeah, I’m going to go along with Ryan here. He went with the telephone. What we did is we went with the infrastructure, the actual devices. We had a problem where they were different devices, different areas, different types, so they didn’t have the same look and feel when they were using it. So from a customer perspective, a patient perspective, we now have a specific tablet that looks identical. Whether you go into our ambulatory or the ER, wherever you’re going to check in, everything is consistent. And the screens are being monitored by Intune, so we have that consistency and scalability on that infrastructure so that we can keep things all in one place and together.

Sanjog Aul [00:22:56]:
Adrienne.

Adrienne Woods [00:22:57]:
Thank you, Chris. One of the things, even before you said the access center or the call center, I was thinking patient access center and investing some time and education with the patient access center. We actually combined all our patient access centers into one. Not all our providers and not all our medical schedulers do use it, but a lot do. And I would say that the more that we can drive both hospital departments and our primary care practices and our specialists to our patient access center, the more seamless that experience is for the patients. And as you said, just showing those departments the decrease in call abandonment rate and that one call appointment made and so forth would be great.

Tara Eckert [00:23:40]:
This order works out perfectly because what I have to say is sort of a supplement for what Adrienne said to hopefully support those types of activities. So, in the interest of brevity, one of the things I didn’t share earlier is that I have a dual role. And my other role is that I’m also the co lead of an initiative called Access Transformation at my organization. And my advice when it comes to things where you’re really trying to promote consistency and things that are supportive of the patient experience, having a formal sort of umbrella that’s very intentional and has executive and board kind of support behind it, like an initiative or a department or whatever, I think is really key to get people to change what their appetite is for harmonizing from what it’s been in the past. And that’s the experience that we’ve had because we had similar issues. We have one platform, but just trying to get everybody to be consistent, what they were using, what the experience is with the patients. It really took that really executive level supported initiative to get people to agree with it and say, can we all just agree that the patient comes first? Okay, we’ve agreed on that. Let’s talk about what we can do now. So I don’t know how helpful advice that is, because it’s hard with the level of authority that people typically have in IT to push for that sort of change. But I just wanted to say that if you can formalize an effort like that, it can be really helpful.

Sanjog Aul [00:25:11]:
Jeremy?

Jeremy Meller [00:25:14]:
Yeah, I like that, Tara. That’s really good. And I think our approach is similar, but we started really, I would say, kind of at the top, and we really looked at our organization and our leadership. We organized across the care continuum a little bit better, so we didn’t have quite as many of those silos. We hired somebody who had really good operational knowledge and really good data analytics capability. We paired that with some folks on our side who really wanted to go deep and develop a real strategic data asset around analytics for access to really help us see and visualize what was happening. And I think all of those things have really helped, and it has really driven the ability to operate a little bit more off of a single playbook.

Sanjog Aul [00:26:06]:
All right, Bala. And then we have Matt, and then we’ll move on to our next challenge.

Balavignesh Thirumalainambi [00:26:11]:
Yeah. So, to Chris’s question, we face a similar issue in terms of bringing enterprise level patient experience uniformity and conformance. So what we did, or are in the process of doing, is to come up with the digital health strategy with patient experience in mind. I don’t know if I heard, Chris, if you’re an Epic shop. The Epic roadmap page under care companion had a lot of components of what our end users were interested in.

Balavignesh Thirumalainambi [00:26:44]:
So we went through a process of taking stock of what we have today and then mapping our path in different phases. And we plugged in what we wanted as part of our review, and then we also placed a flag on when exactly we want two or three of the functionalities in the future. So we sort of came up with that digital health strategy, that care continuum.

Sanjog Aul [00:27:21]:
All right, Matt.

Matt Reich [00:27:23]:
Yeah, and I’ll be brief. I don’t want to be so repetitive, but here I think I’m really aligned. You said it really well, and basically understand the organization’s role in supporting change. That has been probably one of the biggest learning points I’ve had over the last several years, is understanding this idea that projects can’t be IT led. They have to be organizational led, and that’s really started to hit home. It’s not that I don’t want to pull my team together and let’s go do these big things, but without the organization’s support, they unravel too quickly. And so I’d say that the successes we’ve seen, I absolutely have to give lots of credit to our organizational teams that helped put the solution together and then hold it together until it became muscle memory.

Sanjog Aul [00:28:17]:
All right, so, Matt, now you’re the one who is next in the sequence in terms of sharing your challenge in one line and get some advice from others.

Matt Reich [00:28:24]:
Well, I hope everybody can share on this one, but I am just anxious to learn where people are with workforce development. We’ve been through a lot of changes. We’ve been through an ERP change. We’ve been through an EHR change. It wasn’t just about swapping software. It’s really moved us to a whole new level of how we leverage these systems to help drive business. So if it’s patient centered or if it’s on the back office side, it’s taking more resources to do that. I think it’s also about understanding what’s IT’s place.

Matt Reich [00:29:01]:
And then what part does operations have to own to make sure that these things, kind of my previous point, that the initiatives are successful. And of course there’s been challenges, obviously COVID, the shift to a lot of remote workers and then what that’s done in teams. So a lot of different facets to that, but anxious to see what you guys have learned.

Sanjog Aul [00:29:30]:
All right, Chris.

Chris Paravate [00:29:31]:
So we focus very heavily on the IT culture and connection with the business. And so as we approach virtual work and we’re challenged to really address that, we said we don’t want you in the office just to be in the office, but when you connect with your customer, we need you to be where your customer is and really understand not just what the customer was telling you, but really immerse yourself in the business and understand that work environment. And so as you think about all the disciplines within IT, nursing informatics is on prem. They’re on site. Business reporting and analytics, not so much. We might have some people who are engaged in that and that’s enabled some flexibility.

Chris Paravate [00:30:25]:
I am seeing some change. People are kind of coming back to the workplace and see the value of that and the connection. But that’s been our strategy. Additionally, within IT, really focusing on what are the core values that we really embrace, what’s the environment that we’re creating for people to get stuff done and removing those things that are unproductive and that create challenges.

Matt Reich [00:30:58]:
Do you find you’re trying to grow your talent, or are you recruiting your talent?

Chris Paravate [00:31:03]:
It’s a mixed model. We do grow pretty heavily. Our help desk and our training teams are our farm teams. We hire the very best and brightest, unskilled, unexperienced resources and we groom them in. Our help desk is the very best.

Chris Paravate [00:31:32]:
And then those individuals, we have about 85% turnover on our help desk within one year. And they move on to other roles. And so they quickly learn the breadth of the organization, and then we focus them and hone their skills.

Sanjog Aul [00:31:40]:
All right, Guy.

Guy Shepperd [00:31:43]:
One of the things that we did when we were going through these huge transformations is we made sure that one, we let the people that stayed with us know where their future was. So we got rid of the fear, uncertainty, doubt for the people that we had so that we could retain them, because that’s a problem you don’t want to have in the middle of transformation, is losing somebody and then bringing somebody in. So we not only showed them where they’re going, but we gave them education along the way so that they could see that they’re progressing with the transformation of what we were doing to where we were going. But then we also, when we did have the turnover, we took the mindset of let’s hire for where we’re going and bring them backwards instead of bring them where we’re at and bring them forward. So we actually had to do some recruiting.

Guy Shepperd [00:32:35]:
We took some chances on some people that we hoped they were where we were going to end up in six to twelve months. And they were able to help us along the way. So that’s the two ways we did it. But the big thing was keeping the current staff away from that fear, uncertainty and doubt of what they’re going to do, if they’re going to be employed, and to keep them. That was the big major thing that we saw.

Sanjog Aul [00:32:56]:
Tara.

Tara Eckert [00:32:58]:
Yeah, so in my organization, our IT department has grown, I think, about 25ish percent in the last four and a half years, which is when we went live with Epic, and I’m talking about after go live. So not just adding Epic staff, but the IT department as a whole. And a lot of that, most of it has been within my digital transformation program because that’s the thing that’s changed the most. And so what we’ve done, it’s usually you can’t really talk about recruitment without retention or retention without recruitment. And I think from a retention perspective, you can actually use some of your retention strategies to help with your recruitment. So I think that there’s a well established body of knowledge and best practices when it comes to engagement, that IT departments have historically not been very good about adopting or prioritizing because a lot of us are nerds and we want to be the chief nerd and not necessarily also the change leader and the person who really promotes growth and positive change and engagement in our groups. So I think we’re starting to see the need to change that direction a little bit.

Tara Eckert [00:34:06]:
And then specifically, there’s a lot of engagement strategies. Someone mentioned mission, vision, values, linking it back to the organization, helping people continue to understand why they do what they do. But one of them is, and can be, remote work. There are some roles that are appropriate for remote work and there are some roles that aren’t. My program, I’m biased because my program is literally entirely remote. I have two people that like to come in and I let them come in and I gave them offices, but nobody else wants to come in but me. And that’s fine with me because of what they do. And I think that to tie that all back into the engagement piece, engagement is just more important when you have remote workers.

Tara Eckert [00:34:47]:
Someone mentioned earlier, remote work comes with its own challenges. And I think that you just have to work harder to address those challenges because in today’s market, you cannot be like, we’re in Baltimore. I have somebody that lives in Connecticut, and he’s like my best data architect. So I just think that we really have to change the way we think and really be scrappy and really partner with HR, work with your HR business partner, drive them up the wall, have monthly touch bases with them. Learn to be an HR manager and not just an IT manager. That’s kind of my general advice.

Sanjog Aul [00:35:25]:
I’ll take one last comment on this one because we’ve got quite a few people to get their challenges, and anyone who’s raised their hands, please feel free to over chat, provide inputs to Matt and for any other future comments we will take, because we have to go through quite a bit. So with that said, Jeremy, I’ll take yours as the last one. And then we keep moving.

Jeremy Meller [00:35:43]:
Oh, sure, I’ll be quick. We increased our retention from about 87, 88% to 95.7% last year. We were ranked number 22 among all large organizations, Computerworld Best Places to Work. And so we’ve really focused on this a lot. We focused on things like making sure we’re paying well. We pay at the 75th percentile. Really emphasizing our mission, because that’s what we really have to sell, is the mission of taking care of the kids.

Jeremy Meller [00:36:10]:
We, of course, support the flexibility and work from home, but we couple that with agile so that there would be better work planning, so people would see the impact of their work. And one last thing I’ll mention is we banned the word customer. We will not use the word customer. They’re not customers. They’re not directly paying for the service that we’re providing, at least a lot of them, most of them, anybody internal. Instead, we think of it as a deeper relationship. We think of it as business partnering.

Jeremy Meller [00:36:42]:
We are partnering with you. We are internal consultants. We are subject matter experts, and we really set that expectation that you’re not just an IT guy or gal, you’re really a consultant for our organization, coming alongside to help them with the best decision that’s going to help the business. And I think that that’s added a lot of fulfillment and enjoyment to the jobs.

Sanjog Aul [00:37:02]:
All right, so, Jeremy, over to you for your challenge, crisply stated, and then ask what you need from the team.

Jeremy Meller [00:37:10]:
Yeah, so I think I was focusing on change management. So my question for everybody would be, how are you managing the pace of change, of which, of course, technology and all the innovation in technology is only accelerating? We have this great opportunity, but we also have a lot of burden. One of our sister healthcare organizations, Lurie Children’s, you may have heard of them, they’re going on four weeks of being locked up with ransomware, of not having access to their systems. It’s just absolutely tragic. And so you have all of these pressures, but how are you all managing that pace of change?

Sanjog Aul [00:37:52]:
All right, who’s going to take this? All right, so we have Ryan, I guess.

Ryan Blackwell [00:37:58]:
Jeremy, one of the things that we need to figure out as leaders is how do we take things off of our plate that don’t directly contribute to the advancement of the business? Not to be a big advocate of the cloud, but when you put infrastructure in the cloud, the inherited benefits cut your work in half. You don’t have to maintain a physical data center. You have less unplanned work. Your cybersecurity gets more rich. So you want to free up time and have less unplanned work. Don’t be in the business of things that can fail. Put that to someone else. So by going to the cloud we recovered half of our engineering time, we have less unplanned work as a result of outages.

Ryan Blackwell [00:38:42]:
And the math is working out with variable operational costs versus upfront capital. So that gives us more financial autonomy to make decisions based off of what goes right and what goes wrong. I never thought in my IT career I’d be able to actually have time blocked out for experimentation, what works, what doesn’t work, and to ideate through technical solutions what they might be. Going to the cloud has recovered back that time, if you will, and then also the cloud is meant to consume without having a PhD. So the biggest Michael Jordan brains I have, I’m able to recover them from unplanned long term technical debt outages and apply them to the true problems of the day. So just a thought.

Sanjog Aul [00:39:32]:
Sure thing, Adrienne.

Adrienne Woods [00:39:35]:
Yes, great question, by the way. I think that what I would say is we work hard on picking, similar to what Ryan said, what are we working on that will most influence our goal? And then we go as fast as possible with the change management on that one instance and everything else becomes secondary. So we work in terms of sprints and our sprint right now is if it doesn’t help a patient click, call or text us, then it’s secondary. And so anything we need to do to speed up the change management for that goal, we do. Everything else, it sometimes moves slow.

Chris Paravate [00:40:08]:
Yeah, at a strategic level, certainly leaning on my peers and retool the IT governance to really make sure we’re working on those major projects within our capacity. And if capacity needs to be increased, then they’re part of that decision. On the enhancements, in a day to day work we’re doing sprints partnered with our customers in that aspect, but demand is exploding. I mean, 274 active project requests, I got 89 projects in flight, got 347 FTEs in IT working to cover that. So it’s a great problem to have. And all the technology, frankly, I’ve also had to make some tough decisions about resources that couldn’t make the transition as technology has changed and the organization has changed, cloud and AI and all those things. What does that leader look like? And frankly, technology is the table stakes that invite you to be part of the operations. And so I’ve had to make some tough decisions about some of my team and really kind of retool for the future.

Sanjog Aul [00:41:23]:
Matt. Matt, you are speaking on mute, I believe.

Matt Reich [00:41:30]:
Put my hand down, but it didn’t unmute. So I guess Ryan hit on something that I feel a lot, and that’s about where you’re trying to get rid of the non value add. And we’ve not taken on one initiative that has actually cut staff, but what it’s done is freed them up to focus on other things. So what that tells me is more about looking down the road and how can elimination of that waste basically be cost avoidance for the future, not necessarily looking to cut costs today.

Sanjog Aul [00:42:05]:
Okay, Tara, your challenge, crisply defined. Tell us what you’d like to hear from the team.

Tara Eckert [00:42:12]:
To ensure I wasn’t too verbose, I wrote down lack of partnership between IT and clinical and operations. So hoping to hear about establishing an informatics program or something that’s more formal to facilitate partnership.

Sanjog Aul [00:42:29]:
Adrienne?

Adrienne Woods [00:42:32]:
Yes, Tara. We’ve had some great feedback and experience from our IT teams that have really put a group together that not only do analytics for the clinical areas of the departments, but also like business translators. And I can’t remember the exact word they use for them, but they’re liaisons to the business side that speak both the technical, the clinical, and the business goals. And their need to still see a profit, those kind of things. And that group does very well and seems to align those teams where they haven’t been before.

Sanjog Aul [00:43:04]:
All right, Guy.

Guy Shepperd [00:43:06]:
Tara, we saw this problem last year, and we actually are in the middle of what we did to solve it, and it’s actually working out really well. Is we took the executives, say directors from the IT side and the directors from the health IT and business side, and we have a meeting for 30 minutes every other week so that we can bring any questions we have, so we can have direct connection versus trying to do it over email, text, and all these other things. And it’s amazing that we now see projects and ideas that they have at the beginning and we can help them out and then we solve their problems. And we’ve actually, in the last six months, we’ve received acknowledgement from the health IT side that it’s a better system just by having this 30 minutes meeting every Tuesday. It was actually this morning, and I think it lasted 28 minutes, but people got all their problems out on the table and we’re seeing a whole lot more streamlined.

Tara Eckert [00:44:05]:
Quick win solution. I love it. Keep it coming.

Chris Paravate [00:44:09]:
Yeah. I’ve employed this concept of first team. My first team is my peers, and my office is actually not in IT, it’s in administration. I make sure that there’s clear alignment at the very top level. So if the CFO and I are sitting down and we’re talking about a Workday implementation, we get everything out on the table. And if he and I are completely aligned, and there’s no ambiguity between what I expect and he expects, that removes so many issues that create these chasms in the way that teams react.

Chris Paravate [00:44:52]:
We can finish each other’s sentences about what we hope to accomplish and we work out any differences. It makes it a lot simpler. And that’s a big part of my role, is to make sure that that alignment is there.

Sanjog Aul [00:45:05]:
All right. Ryan, you had a thought.

Ryan Blackwell [00:45:08]:
Yeah. Depending on where the disconnect is, I find rounding is a pretty effective means. Just if you have people that are going to be on site or traditionally remote, scheduling one day for them, just round the hospital, round up those leaders, hear the voice of the customer, relay what sponsorship I need with them, and it’s not an overly fancy way to approach it, but it’s a good place to start.

Sanjog Aul [00:45:32]:
All right, so, Keyven, I see you almost have taken 20 pages of notes as everyone is sharing ideas. Any thoughts that you have?

Keyven Lewis [00:45:40]:
Actually, the suggestions are right in line. So I don’t want to mention something that’s totally different. I agree with all of these approaches. It’s what I’ve seen, experienced. I always use this adage and it falls right in line with what everyone is saying, getting people together, making sure that you’re in alignment. I always say that if you have to send two or three emails and now you start having these email chains firing across, pick up the phone, in this case, get together, get in a room and hash things out. I think it goes much better than, there’s so much lost interpretation from sending emails. But to just sit down face to face, even if it’s, in the world that we live today, even if it’s a Teams call, it’s pick up the phone and just have a candid discussion. The one thing that I will always add is everything we do should be outcome based.

Keyven Lewis [00:46:32]:
So if I’m going to have a meeting with you, there’s a desired outcome for that meeting. Let’s make sure that we stay focused on that, because so many meetings, you have a meeting and things start coming up, and that’s great dialogue, but that really wasn’t the decision or the outcome that we wanted out of this meeting. So being crystal clear, focused on what the outcomes are is a great thing.

Sanjog Aul [00:46:55]:
All right, now with that said, we have Ryan. So, Ryan, you’re next. Share your crisp challenge and let’s get to hear what the leaders are saying.

Ryan Blackwell [00:47:08]:
We’re 90% complete with a full physical, on premise data center migration into a public cloud. And we have applications that are being stubborn in their movement. So here’s the choice. Should I spend the sweat equity and chop through the jungle and trying to refactor them into a cloud native app, or should I bring them over in their Citrix footprint, which then dilutes the value statement of the cloud? So should I refactor and rebuild and do all of those political fights, or seamlessly bring it over with a vMotion, but then it’s more expensive, less fault tolerant, things like that? That’s the question I’m asking myself today.

Guy Shepperd [00:47:57]:
Those are great questions, Ryan, but my question to you is this. I have found as we’re moving things to the cloud, it’s not whether they should move to the cloud or we should go from app native to just Citrix, but are they really needed? Because I’m going to use an example. I have a server that was owned by a department that had six users. I showed the infrastructure that it took to run that server, and all of a sudden, oh, but we can do it in this Epic module. We can do it in this other thing. And all of a sudden, when I showed the cost back, it was the chief financial officer who came back and said, do we really need this? And I think that’s where I would start. Is there infrastructure behind it, especially in the data center, because you have all that heating, cooling, people, all that stuff that has to be involved. That’s the first thing. If you show the cost, it’s amazing, the business says, we really don’t need this much. We can do 80% of it in this module and we don’t need the software.

Sanjog Aul [00:49:06]:
All right, Adrienne, now your challenge.

Adrienne Woods [00:49:10]:
Sure. Okay, I’ll be quick. My challenge is we want to move faster and more efficiently with happy physicians and happy patients through the online scheduling process.

Sanjog Aul [00:49:21]:
That’s the outcome that you’re looking for. Is that a challenge that you would like these people to…

Adrienne Woods [00:49:26]:
The challenge is we’re being asked to do that. No, the challenge is that we’re a year and a half into online scheduling and don’t seem to be moving at the speed that we want to. We just keep, in some ways, kind of reinventing the wheel each time we bring new people on to online scheduling.

Sanjog Aul [00:49:43]:
All right, Chris?

Chris Paravate [00:49:45]:
Yeah, so this is a sister problem to my challenge. We’re using Epic’s physician capacity dashboard, which Epic recently rolled out. When you look at ours at the highest level, it’s 72% utilization, and that turned everybody beet red in the room. And then you start drilling into it and you say, okay, your no show rate is 10%. Now you’re down to 82%. You still have 18% capacity.

Chris Paravate [00:50:19]:
And how is that being used? And then being able to show all the things you talked about earlier. No one’s going to schedule a new patient visit tomorrow, but we are similar. I’m trying to pull some of the autonomy that each clinic has somewhat away. I was on a call with another health system a while ago, and one of the things that I took away was that they were focused on creating patient relationships with their brand and not with their physicians, which we tend to connect to our physicians. What’s interesting about that is, then you start getting to a consistency model. It’s like, okay, if I saw Doctor Smith or I saw Doctor Johnny, it should be the same encounter. We’re not there.

Chris Paravate [00:51:12]:
That’s a little Pollyanna. But that dashboard where I’m drilling in, because people, when they see it, they want to argue with it, but then you can start drilling down into that and see where the problems lie.

Sanjog Aul [00:51:28]:
You are muted, Jeremy. Are you going to be able to unmute?

Jeremy Meller [00:51:34]:
Yep. Sorry. Yeah, I would say first thing we’ve done is try to set expectations around online appointment scheduling. When you look at, we just got the Epic report card and our online scheduling percentage is pretty low. But when I look at what the top 10% is, it’s only 10 to 12%. And so the uptake on it isn’t overly large anyway. And there’s some natural reasons for that.

Jeremy Meller [00:51:56]:
Think about, like, when you go to a specialist and let’s say you go to an ENT doc. I don’t know, usually when I go, if I’m going to be a long term patient or not. I may just go there, may get checked out, may get discharged, may be on my way, and I’m not going to go through the hassle of registering so I can do all this. I’m just going to call them up. Now, if I become an active patient, an established patient, then everything changes. We have less than 1% of our appointments scheduled online, and we have 70% of our patients who’ve been seen three or more times are actively engaged in our portal, actively using our digital front door tools, actively using e check in, and some of those things where we’re getting the most benefits. So I think that’s part of what we’re trying to do. Then we’re really focusing on three areas, templates, standardization of schedule and decision trees, which tend to be the things you have to get nailed in order for you to have a good online digital front door presence.

Jeremy Meller [00:52:56]:
As we know, healthcare is just inherently variable, so even between specialties, there’ll be massive differences in how patients are managed. But if we can get these decision trees worked out properly, then hopefully we can send the right patient to the right kind of care provider. Can they see an APP instead of going to the specialist who has a three or four month wait time? So that’s where we’re focusing.

Sanjog Aul [00:53:29]:
All right, Bala, your challenge. And so we can have the team respond.

Balavignesh Thirumalainambi [00:53:37]:
My challenge for you, Chris, is during our enterprise EHR rollout, there’s a need to control and prioritize new project requests that are coming in. Love to hear best practices around project prioritization during this enterprise rollout.

Ryan Blackwell [00:53:57]:
I think I’m probably speaking to the choir, but as leaders, we’re faced with a project list of 400, 500, 600 projects. What do we fit in and what we don’t? You kind of never get through that chunk, if you will. One thing I’ll say is you have a limited amount of resources available to you to get the organization to say, I am only going to consider what is my work in progress limit and I can’t even think about the rest. So if a certain number of users say, okay, here are the ten projects that have to go on, and then from a Kanban perspective, you release them out. So you’re not necessarily committing to schedules or even doing deep discovery on the 300th or the 400th project. You’re more narrowing. I can do this in a month, let me know what the 30 day, 60 or 90 day priority is.

Ryan Blackwell [00:54:52]:
And then when you get closer to that iterative cycle, then you bring it back in. But it’s a beast to try to figure out, what do you want me to do with 600? So I just narrow it down to a work in progress capacity limit.

Guy Shepperd [00:55:08]:
Well, we did, when we had these issues and we still have them, is we decided that we would only take two big rocks projects and then we’d fill in five or six small rock projects. So we keep things moving. But the big projects that take time, effort and money, those will get done, like an Epic rollout or any of the big rollouts, like the CRM and those type of things that you roll out. Those are big projects and they take a long time. It takes 18 to 24 months. But what about that project that only takes six weeks or twelve weeks? Those are the small projects. We do two big rocks or one big rock, two medium rocks. We try to keep it so that we keep things moving that way. That’s the way we prioritize it. You bring a big rock, don’t expect that you’re going to get it in the front of the line anytime soon.

Sanjog Aul [00:56:04]:
All right, now, turning around the table there, Guy, you got to share your challenge in a crisp manner so that the rest of the team can give you input.

Guy Shepperd [00:56:15]:
My challenge, and this is a couple people actually hit on this, is how do you keep innovating and keep moving forward in the current environment that we live in, whether it be the supply chain people? How do you keep innovating and moving forward?

Ryan Blackwell [00:56:31]:
I think as an IT leader, we are expected to have a certain amount of infrastructure in place when we’re generally asked to do generative AI, so there’s a lead time. So as you’re making your architectural decisions, if you can concurrently put yourself in a posture to serve an IT request need that’s six months late or six months in the future, that’s how I know to do it. The creation of a data lake or large language models or AI automation isn’t something that I can fit the lead time, infrastructure, technical debt pay down as when the need comes, then the lead time is like nine months, twelve months, 16 months. So my strategy is every time we build a new third party application, we refactor off of some other parts of technical stack. I’m figuring out how can I additionally put myself in the posture to serve a future need while I’m implementing this part of the tech stack. So it might be domain consolidations, it might be cloud, it might be data lakes.

Ryan Blackwell [00:57:44]:
And you kind of do it in secret on the backend. But I think that it’s near impossible to say suddenly I want generative AI and supply chain without incrementally starting to do it kind of on the backend, without telling people. It’s just part of your reference architecture for anything new you do.

Matt Reich [00:58:08]:
So we do this well in some areas and not as well in others. But I think if I had to pick one thread, it has to do with the relationship to the operations side. And I tell my team, the way I measure it, if we’ve got a strong relationship, they sit around the table and they start brainstorming on solving a problem and applying technology, they’ll stop and say, we can’t have this conversation because so and so is not here. That’s sort of my measuring stick. Are we doing well of being good business partners? Because the alternative is that they will still go out there and they’ll do their own discoveries, and then they come back with the solution already, and then nobody’s happy because they feel like they’re reacting and then they’re having to rework the analysis. So if I had to pick one thing, I’d say focusing on those business relationships.

Sanjog Aul [00:59:06]:
Great. So we went through the list, and Keyven, coming to you, since you took the most notes, I believe, and you were very intently listening, how about you give us your take in terms of what happened in this room, some key takeaways that you feel we should iterate and highlight here?

Keyven Lewis [00:59:23]:
I want to first just congratulate the team. I think this forum, and I look at it as like a think tank. Everyone, share your challenges, give advice. I think the forum was exceptional, and I think not only should it be, don’t treat it as a one time event. I invite everyone to continue to connect and collaborate. My triangle is the same.

Keyven Lewis [00:59:48]:
One of the things that I need to want to articulate is that making sure that we’re addressing those three points of the triangle. I’ll focus more, we have a lot of internal things that we’re trying to work on, whether that’s the technology we’re using, the people and the processes. All of those are internal facing challenges that we want to make sure that we address. And everyone’s issues, even though they sound common, they’re going to be unique to your environment. And then the other one is really making sure that the end user has the same experience. No matter where I’m going, no matter who I’m talking to, my experience is consistent, because at the end of the day, they do have a choice of where they’re going to go for their care. I think all of those things are very, very important.

Keyven Lewis [01:00:33]:
And it seems like everyone has a grasp. There’s no magical formula for everyone. One of the things that I will say in closing is to make sure that we have a plan in place. I kept hearing some people saying, how do you do this? How do you do this? It’s massive. My favorite saying is, how do you move a mountain? Some people say, how do you eat an elephant? But I like the mountain instead.

Keyven Lewis [01:00:57]:
One rock at a time. But you got to move that one rock. Another analogy that I tie into it, if we talk about things like, if you talk to anybody in financial debt, they always say, map out all your debt, and then map them out highest to lowest. And then there’s always a question, are we going to eliminate them based on which one is larger, or are we going to remove the one based on which one has the highest interest rate? Same concept here.

Keyven Lewis [01:01:24]:
So we have to make sure that we’re continuing to move it forward. But if we’re going to have a million projects or 300 projects, let’s make sure they’re prioritized. Make sure that we’re getting input from those that are asking, okay, how important is this to you? And give them a criteria. Based on these criteria, how would you rank them? And then at the end of the day, what we want is we want buy in.

Keyven Lewis [01:01:45]:
We want everyone to feel that their voice was heard. That’s typically where your challenges come from, because you didn’t hear what I had to say. So get buy in where it’s a win win solution, and then we’re providing them solutions. I know Ryan specifically mentioned when he talked about cloud, but there was a couple of consistent tones that I heard about. Get that low hanging fruit off your plate so that you can provide more thought leadership, so you can be more strategic in the things you’re asking to do. But you got to get that low hanging fruit off your plate, whether that’s internally or externally. And if you want to do it externally, it’s got to be someone that has your interest in mind, which means it’s not a vendor, it’s a partner.

Keyven Lewis [01:02:24]:
Somebody that I trust that really has the mindset that your wins, your internal wins, are their wins. It’s not about a paycheck. It’s about making sure that they’re successful.

Sanjog Aul [01:02:34]:
What a great conversation today. Thank you so much, all, for contributing. Chris Paravate, Matt Reich, Jeremy Meller, Tara Eckert, Ryan Blackwell, Adrienne Woods, Balavignesh Thirumalainambi, Keyven Lewis, and Guy Shepperd. Thank you so much again for helping us out with this forum. Hopefully you got a bunch of nuggets.

Sanjog Aul [01:02:52]:
And I can’t thank enough Zones for being our sponsor for this beautiful series that we’ve been running all year long. Thank you so much again, folks, and have a lovely day ahead. Thanks, everyone.