Oklahoma Heart Hospital was founded in 2002 with the idea of being something truly different – an all-digital hospital with a heavy focus on the patient experience and the latest automation that would change the way healthcare is delivered.

It has succeeded. Patients are happy. Patients' families are happy. Doctors and nurses are happy. And accolades and awards keep coming in.

David Miles is chief information officer at Oklahoma Heart Hospital. And CIO at an all-digital facility is a big job. Healthcare IT News spoke with him for a big two-part interview about what he's focused on with his IT investments and innovations.

Today we focus on the hospital, its operations, and what an all-digital approach means to patients, providers and outcomes. Tomorrow we'll focus on a major digital project at the hospital – switching over from a Cerner electronic health record to Epic.

Q. Oklahoma Heart Hospital is a rather unique two-hospital health system in that it opened an "all-digital" hospital in 2002. Please describe the health system and the all-digital hospital.

A. Oklahoma Heart Hospital is a physician-owned cardiovascular specialty hospital. We have two campuses here in Oklahoma City, one on the north side, one on the south side. We have about 70 outpatient clinic locations spread all across the state. We have practices as far away as several hundred miles.

It's a little bit unique in that hub-and-spoke model. But we have around 80 or so employed physicians and a ton of wonderful partner physicians who practice here in the Oklahoma City area. We serve the entire state of Oklahoma with our outreach program. We send our physicians to those locations at different times during the week, different amounts during the month. The goal is to provide access to critical specialty care in the communities our patients live and work in.

We're a five-star CMS quality award winner for as long as I can remember. Q3 of this year we were voted by Newsweek as one of America's greatest places to work for parents and families, as well as one of Newsweek's top 175 cardiac hospitals in the nation. U.S. News & World Report lists eight service lines of ours as high performers for 2024; Forbes has named OHH one of America's best in-state employers for a third consecutive year. So, lots of accolades.

Again, a testament to the vision our founders had and the work that continues today through our staff and caregivers.

So, the all-digital concept. Again, when OHH was founded back in 2002, there were many electronic medical records at the time, but they were not coordinated, meaning hospital-side and clinic-side weren't necessarily tied together. The work being done in the clinic wasn't always available for viewing to the work that was being done in the hospital.

Basically, unifying the care continuum and working toward a patient-centered experience was very important to our physicians. They were all coming from different organizations around the city. They all felt very strongly about patient care and the patient experience and what wasn't being offered at the places they were coming from.

Again, providing a better patient experience was very center to the values placed on the organization. The focus from 22 years ago is still at the center of all the decision making we have here. We want to be different intentionally. We believe we are. And the awards and the accolades and the patient experience feedback we receive definitely support the hard work and focus for our providers and caregivers. And that spirit carries on to this very day.

So, being digital, again, what does that mean? If you were to ask, what does being a digital healthcare provider mean, basically, that means that back in 2002, we were focusing on workflows, not paper shuffling. We didn't want to spend an incredible amount of time searching for patient histories and past results so we could ensure the quality of care we were providing was at the top of the spectrum.

We also really valued physician time so they could prioritize spending it with the patient, their families, listening and working to solve the many complications that come with having critical heart care.

Q. From an IT perspective, what impacts does all-digital have on patients, clinicians and care?

A. For our founding physicians, that was a central concept to why OHH was founded. Again, pretty visionary work. From my perspective, patients have evolved over time, as has their desire for healthcare that's convenient, transparent, personalized and coordinated, and to feel like a valued member of the care team. It's not just the doctors, nurses, caregivers. The patient, too, is a member of that care team.

So, I think those elements go into the patient experience that providers and health systems are looking for. Convenience, transparency, personalization and coordination, and to feel like you have a say in your care. For us, when we talk about convenient, all-digital allows easy scheduling. It allows the patient to look for appointments convenient for them, that work with their family, work with their work schedule.

It also offers self-service tools, tools we know patients are asking for. It offers the ability to send clinical data electronically; for example, if you're on a home monitoring device, it allows that clinical data to be sent seamlessly back and forth to your care team.

Those convenience factors are part of what we would consider the digital platform. From a transparency perspective, it allows patients to find and access their own health information; for example, through their patient portals. It also allows for proactive pricing for procedures.

So, when you come in and you ask, "Well, how much is it going to cost?" We don't have to make phone calls or send faxes back and forth anymore. We can quickly estimate how much your cost of care is going to be without having to go through different layers of approvals.

It also offers real-time communication about procedures and results. For example, my family member's having surgery, how's it going, where are you at in the surgery, how long is it going to be? Those types of updates can be sent electronically during the procedure. And you'll see test results, lab results, radiology imaging results, those types of things, very quickly.

From a personalized perspective, all-digital means we can offer customized and tailored care plans that accommodate changes in the patient's health situation. We can look at clinical data variables from all kinds of disease management states and other things, which allows us to provide better, more closely coordinated care.

It also allows a much more personalized approach to preventative care. For example, how do I stay healthier and stay out of the hospital, which is much safer for the patients and certainly more appealing for their personal life and for the ability to coordinate care.

All-digital from a care coordination perspective, the biggest benefit there is the ability to deliver massive amounts of information and education to the patient at intervals that make sense during their care journey.

For example, please don't inundate me when I'm discharged. I just left surgery, I'm not sure what I'm doing. I don't even know how to take the medications you gave me. The last thing I want to talk about is my rehab that's two weeks away.

This all-digital platform allows care coordination that allows you to just-in-time feed information to the patient that they can digest, follow and understand. Understanding what the patient is experiencing mentally, emotionally and physically allows us to provide that information at the right time. I know you're scared now. What can I provide you that will help make you feel better?

A couple other things for care coordination that all-digital allows would be monitoring adherence. It's with post-discharge instructions. We can ask you to log in and tell us when you're taking your medication. With digital monitoring tools that might come from wearable technology.

And lastly, what all-digital allows is for the patient to feel valued. Do I have a voice in medical decision making or am I being told what's best for me? All that information is available in our clinical medical record. We want to work toward building patient loyalty through honesty, and that honesty comes in documentation, it comes in the education we provide to the patient, and it comes with a collaboration with clear instruction.

They know what they need to do for their own health when they leave our organization. While all-digital may not help the compassionate side of healthcare, it certainly will go a long way toward allowing the staff to have enough time to comfort and be engaged in the moment with the patient.

All of those benefits are really what we're after when we talk about making all-digital work for us and what it brings to the care continuum.

Q. What are some of the outcomes your all-digital hospital has achieved over the years?

A. If you go back to the very beginning, just an incredible amount of automation in our revenue charge capture and billing functions. From going from paper documentation into automated submittals. From a 10,000-foot level, the ability to electronically drop claims and have claims adjudicated without manual interference or manual interpretation. A huge time-saver for both the insurance side and our side.

Here are a couple of real-life outcomes examples. We use some clinical data in consolidation of our medical device choices. We consolidated down to one implantable device in our OR. We approached our physicians with some data we were able to pull. We showed them what that was worth. They asked about clinical efficacy of the device, so we were able then to pull trial study data for the device we were suggesting. We also were able to pull our own patient outcomes using the device we were suggesting.

All of that wouldn't have been possible if we hadn't been able to pull the right population set and use those clinical indicators to build a case for why clinically it was safe and an appropriate decision.

A couple of other things. We evaluate all of our CAF [coronary artery fistula] PCI [percutaneous coronary intervention] cases here at OHH. We're looking for appropriate decision making regarding whether the case was necessary or not. We use that digital information in the clinical documentation to do peer reviews.

We have other cardiac specialists who review each other's cases and say, "Yeah, everything here would suggest it was an appropriate decision to have that surgery." So, identifying the right population set and reviewing the documentation to support medical decision making has been a huge win for us.

And then lastly, the value of digital records for success in our informatics and data science departments. We use our data warehouse every day to identify trends in disease state management or trends in clinical outcomes so we can create best practice models for our caregivers, both on the nursing side and on the physician side.

We're using an incredible amount of data to define what helped the patient get better, quicker, what provided the patient with more comfort. We definitely use this digital information for us to consider those successes in our outcomes.

Click here to read part two of this interview.

Click here to watch the video of this interview that contains bonus content not found in this story.

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