The C-suite executives who have successfully made it through the grueling last 12 months have come out on the other side with plenty of lessons they have learned and are now applying to make their healthcare provider organizations better.

Cut down on bureaucracy. Push healthcare faster. Jump a higher bar for patient experience. Follow the data to new answers. Satiate curiosity about artificial intelligence and digital health. Bolster data governance. Apply lessons to get back to normalcy. These are the lessons highlighted in this fifth feature story in Healthcare IT News' lessons learned series. (Click here to access the portal with all the stories in the series.)

This time around, three health system CIOs and one CMIO share their experiences from the past year. They are:

• Matt Kull, CIO at the Cleveland Clinic in Cleveland. (@ClevelandClinic)
• Tara Matthews, CIO and CISO at Einstein Healthcare, based in Philadelphia. (@EinsteinHealth)
• Dr. Brett A. Oliver, chief medical information officer at Baptist Health, based in Louisville, Kentucky. (@GeorgetownBrett)
• Richard Temple, vice president and CIO at Deborah Heart and Lung Center in Philadelphia. (@DemandDeborah)

Cutting down on bureaucracy

For Kull at the prestigious Cleveland Clinic, one big takeaway from the past year has been how efficient and capable the IT team can be once they get out of their own way.

"To meet the urgency of COVID-19, we adapted our governance processes to responsibly and rapidly provide the speed, focus and resources the situation demanded," he explained. "By cutting down on bureaucracy and making the way our initiatives are prioritized and sponsored more agile, we made incredible strides in mere weeks, on projects that would normally take months, if not years."

The team now is far ahead of schedule in its development of remote patient monitoring, virtual health, technology resiliency, communications and home workforce.

"By cutting down on bureaucracy and making the way our initiatives are prioritized and sponsored more agile, we made incredible strides in mere weeks, on projects that would normally take months, if not years."

Matt Kull, Cleveland Clinic

"The past year has given us a once-in-a-lifetime opportunity to reassess our governance processes," said Kull. "We learned that crystal-clear focus and priorities are key, and governance processes adapted to center them increased our efficiency and capacity astronomically.

"We look forward to continuing these governance updates beyond the pandemic," he said, "such as simplifying our reporting architecture to become more nimble; driving value from existing partnerships; accelerating the adoption of new relationships; establishing clearly defined organizational goals; following an agile implementation model for all work; and engaging enterprise steering, where we let all stakeholders weigh in from the start."

Moving fast with technology

As Kull and team rapidly adapted, Temple, of Deborah Heart and Lung Center, and his team discovered something else about speed: Contrary to common knowledge, healthcare IT can indeed move fast.

"Healthcare has historically been seen as somewhat of a laggard as it relates to its embrace of technologies that may be much more commonplace in other industries," he said. 

"Being able to rapidly change paradigms is not something that healthcare has generally been known for. However, with the onset of COVID-19, we providers proved that, despite the perceptions surrounding us, we really could turn on a dime when the circumstances necessitated it."

"With the onset of COVID-19, we providers proved that, despite the perceptions surrounding us, we really could turn on a dime when the circumstances necessitated it."

Richard Temple, Deborah Heart and Lung Center

In the middle of March of 2020, when shutdowns were beginning, Deborah Heart and Lung Center was able to pivot almost instantaneously to supporting a largely mobile workforce and introducing a care model centered on telehealth, neither of which were previously very prevalent in the industry, he said.

Contracts were signed, VPN bandwidth was scaled up, and new modes of operation launched in a surprisingly efficient manner, he added.

The quick and nimble response

"One can't help but note the contrast between the quickness and – dare I say – nimbleness of providers' response to the COVID-19 disruption," Temple said. "In a more normal circumstance, scaling up initiatives of this magnitude would require a mountain of paperwork, endless committee huddles, an established budgetary funding source, and many different sign-offs on the road to fruition."

With regard to preparations for COVID-19, the train started leaving the station in March 2020. Within a couple of weeks, providers began to attempt to make the best of the new reality on the ground, moving programs that had generally been much more at the periphery of the providers' vision right into the center stage of their attempts to survive and thrive in this very challenging new environment, he said.

"Moving forward, I plan to think bigger and think broader in terms of defining what is possible for our hospital to accomplish," he said. "We, as a hospital, have demonstrated that we can move quickly, effectively and with uniformity of vision when a challenge presents itself that we rise up to with all due speed."

In the case of COVID-19, it was abundantly clear what was at stake if the hospital was not able to rise to the occasion.

"Other initiatives, such as digital patient engagement and artificial intelligence, offer great transformational potential, but we as leaders need to articulate the value proposition for technologies like these across the entirety of the hospital community with the same type of clarity that we did for our successful pivot to COVID-19," he said.

Raising the bar for patient experience

During the past 12 months, Oliver of Baptist Health has learned that the bar has been raised substantially for the patient experience and the desire for virtual care.

"No longer can a health system think that simply standing up a portal as a simple repository of information is satisfactory," he stated. "While the patient experience has always seemed a soft endpoint to me with my clinical background, I historically would concern myself more with quality metrics testifying to great patient care rather than the patient's experience. That has changed with COVID-19."

"The digital journey needs to have high-quality outcomes and deliver care in the most appropriate manner and location."

Dr. Brett A. Oliver, Baptist Health

While touchless check-in, two-way texting, wayfinding and limiting time in waiting rooms was started with COVID-19, new expectations have been raised as the industry emerges out of the pandemic and finds the new normal for medical care, he added. Healthcare providers and patients alike now understand the potential and what is possible, he said.

"With nontraditional players flooding the industry with billions in venture capital, and with experience from other industries with great customer interfaces, the stakes are high for medical practices and health systems to make it a priority," he noted. "The digital journey needs to have high-quality outcomes and deliver care in the most appropriate manner and location."

A patient-friendly platform

Now providers must also deliver it in a more patient-friendly platform. If they do not, another provider – in-person or virtual – is ready to step in and fill the void, he added.

"In addition, the foundation for all great patient experience is communication," he observed. "Early on, we could not communicate enough with our patients and communities about COVID-19. It reminded me how important communication is to the patient relationship. Data has shown that with better communication comes better adherence to medication and other treatments."

All of healthcare's digital solutions for a great patient experience should emphasize good communication in a clear and empathetic manner, Oliver said.

"I've learned that digital tools can be a new way to allow for that," he said. "For instance, digital tools can give patients a platform to ask questions on their time and without the pressure of being in front of the clinician to get a more thorough answering of questions to ensure they understood things correctly.

As noted in a recent Accenture report, those that adapt to these new delivery methods and exceed patient engagement expectations stand to grow market share as patients look for a more secure and convenient experience."

It appears patients are more than willing to switch care providers if their experience expectations are not met.

"I've learned that the patient experience, enhanced and expanded with our digital toolbox, is a business imperative and is no longer optional, and that communication is at the center of it, whether in person or using a digital tool," he said.

Following the data

On another note from Oliver, with prolonged exposure to new technologies and ways of accomplishing patient care, both patients and providers have begun to find new use cases to deliver high-quality and convenient care.

"There are many different use-cases we could look at and focus on," he noted. "I've learned more than ever to follow the data. For example, we've seen an exponential growth in our behavioral health virtual care hub. This is a centralized team of clinicians that provide outpatient behavioral health patient care as well as ED coverage for consults across our system."

Baptist Health had an established program before, but when COVID-19 hit it expanded quickly, like many of the health system's care offerings.

"However, unlike other areas that fell back, our behavioral health team saw very little drop," Oliver said. "Following that data point, we looked to open a virtual option for behavioral health in all of our primary care offices. It has been extremely successful.

"Rather than IT driving a digital solution, we looked at the data to see what was already working and looked to serve those operational leaders to enhance what they were already doing."

Baptist Health could only have done this through digital solutions, he said.

"It is difficult to recruit providers to certain areas of our system," he said. "This digital hub approach allows those providers to live where they want to – and provide care for a much greater service area than one could in a traditional manner. The tools that enabled this hub could be used by any specialty. The key was focusing on what was already working well."

Fostering curiosity about AI

Another lesson Kull says he learned this past year at the Cleveland Clinic is that there is genuine and pervasive curiosity from all constituents across healthcare about artificial intelligence, machine learning and other digital tools.

"A physician recently asked me to discuss deep-reinforcement learning," he noted. "It's truly exciting that complex data science concepts are becoming accessible to medicine, and that people are conceptualizing the use of such methods in healthcare."

Healthcare must put the building blocks in place now for the platforms needed in the future, Kull said.

"But equally important is ensuring our workforces will have the skills to both build and utilize these platforms," he noted. "Solutions cannot come from IT fast enough: We need to empower our entire enterprise staff broadly to build the digital tools of the future."

The Cleveland Clinic is establishing an enterprise digital university to train and educate its caregivers on digital tools. With this university, it is creating a framework for innovation at the edge and ensuring its workforce is ready for the jobs of tomorrow, Kull explained.

"It is also imperative to create internal consultants specializing in digital tools and processes," he added. "These are the experts who can mentor and guide the less experienced, share digital competencies, repurpose localized innovations, and implement radical changes across our enterprise."

Ultimately, the clinic wants to create an enterprise of "digital transformers" – empowered caregivers at the forefront of AI and app development.

"By offering a curated approach and toolset, we enable caregivers to access information in safe and secure ways, empowering them to make the needed advancements to deliver on our promise of providing the highest quality digital health and individualized healthcare," he said.

Shoring up data governance

This past year certainly represented a new threshold of change and obstacles, said Matthews of Einstein Healthcare.

"As we began to flex and adapt, we realized the underpinnings of our metrics, reports and other analytic measurements were very disparate and inconsistent," she recalled. "When we sought out the cause, we found at the very root of this was minimal data controls and standards. In a word, we lacked good data governance."

"As we continue this journey, we are applying one major lesson learned, which is ensuring both our analytics and security teams are involved in any new initiatives, projects, vendor selections or otherwise."

Tara Matthews, Einstein Healthcare

Although over the past few years, Einstein Healthcare began building out an analytics team that included many different areas of the network, staff realized the need to pivot from producing dashboards to mapping data points. In addition, staff looked at current policies and standards used to control the data, as well as the security robustness of those systems.

"As we continue this journey, we are applying one major lesson learned, which is ensuring both our analytics and security teams are involved in any new initiatives, projects, vendor selections or otherwise," she noted. "We know now that only a continuous data management approach will ensure the data is accurate, safe, consistent and trustworthy."

Another takeaway from the past year for Matthews was in regard to her organization's cybersecurity posture of its Internet of Things devices.

"We know this is nothing new, especially demonstrated by the Mirai botnet attack back in 2016, and have been securing our posture each year," she said. 

"However, this past year we were inundated with connected devices from all areas inside and outside of the organization. It's no surprise the use cases for these devices exploded during the past year, and, in order to enable the business, it was difficult to keep up with securing the demand."

Boosting organizational readiness

Matthews looks at these lessons learned as holistic opportunities to boost organizational readiness.

"In regard to the IOT explosion, we first needed to understand the 'where, who, why' and the respective connected device environment," she said. "This task has prompted a deep dive into our IT asset management program. We have allocated investment dollars into building out this program with automated tools and inventory software."

Additionally, Einstein Healthcare's IT department is partnering more closely with their clinical engineering department counterpart to ensure security of medical devices is a shared responsibility.

"Not only with our internal teams, but that includes the vendors who support them," she noted. "To that end, we are only engaging with vendors who have a security-first posture and have discovery tools with automated mitigation techniques built in."

Finally, she added, as the organization deploys all these devices coming from a multitude of vendors, the IT team has taken a harder look at the vendor management program and third-party vendor risk.

"As such, we have bumped up [the] priority of establishing a vendor-risk-management framework within our current road map," she said. "This includes putting in measures to continuously identify and manage risk, as well as providing metrics around key performance indicators, which will enable business leaders to make decisions based on appropriate risk factors.

"As we look back on the prior year," she continued, "it was certainly not without challenges, but has brought many opportunities. We hope that our current initiatives based on these lessons will provide positive impacts for the organization moving forward."

Applying lessons learned toward the new normal

For Temple, of Deborah Heart and Lung Center, if lesson No. 1 is that healthcare provider organizations have the capability of pivoting quickly when required, lesson No. 2 is that organizations can internalize and apply the lessons learned during the pandemic as the world begins its journey back to normalcy.

"Lesson No. 2 really grounds itself in the concept that IT is always important for all manner of initiatives at the hospital. But sometimes IT needs to step back and play a more supporting role in execution," he explained. "Our coming through in the clutch during COVID was no fluke, and this lesson is exemplified by the absolutely remarkably smooth rollout of our vaccine program here at our hospital."

In much the same way, there was a mad scramble right before COVID-19 hit. There was a similar scramble with some disconnects in terms of real-time information when vaccines were first granted emergency use authorization, Temple said.

"I have to give unabashed props to our vaccine committee, led by pharmacy, infection control and employee health, with IT in more of a supporting role, for an outstanding and seemingly seamless rollout of our vaccine administration program," he concluded.

"We all know it wasn't easy, but careful thought, collaboration and overall calmness ruled the day – and it just seemed so natural in the auditorium where the vaccine administration program was set up."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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