Welcome back to Optimum Healthcare IT’s “4 Questions with…” series, where we interview top executives in the Healthcare IT space. We search for the leaders with track records of service excellence, who are passionate about their work and make patient safety their top priority. In this installment, we have five questions for Andy Crowder, Corporate SVP, and CIO at Scripps Health
OHIT: What are the top 5 challenges facing IT organizations as we move towards 2019? What are the top 5 opportunities?
Andy Crowder: Not surprising to my colleagues within the HIT industry; however, our challenges also serve as our greatest sources for innovation & transformation.
Challenges:
Managing Health Care Costs – IT investments must improve the total healthcare cost equation. It is no longer enough to simply have a positive net present value or return on investment to offset the capital. IT investments must deliver year-over-year reductions in expense, improve the customer and caregiver experience, and help grow the market. In every other industry, technology has lowered the overall cost of delivering goods and services and as a result, garnered new customers. We must deliver the same outcomes in healthcare. At Scripps Health, our entire executive team gets up every day with a mission to transform the way we deliver care, reduce the total cost and give customers the convenience and experience they desire. Scripps Health President and CEO Chris Van Gorder, newly appointed Chief Operations Officer Shiraz Fagan, Chief Growth Officer Rick Neale and Chief Experience Officer Dr. Ghazal Sharieff are challenging the organization and each of us, senior leaders, to get outside of our silos and disrupt our way of thinking. It is an exciting time to be at Scripps Health, as we are truly poised to meet the needs of our community and the healthcare industry.
Implementing & Nurturing Effective IS Governance Structures – It is impossible to achieve breakthrough transformation in cost, quality and experience – let alone safely implement technologies – without effective governance structures. These structures are the key to ensuring total alignment on organizational strategic imperatives and engagement of clinical, operational and physician leaders to guide the way forward. Furthermore, the governance structures must have active change management and communications processes to keep frontline staff at all levels abreast of the changes. We have some of the most amazing caregivers at Scripps Health and, if we put them at the center of everything we do in IS first, last and always, we can’t help but win. We are not always perfect in our execution, but our point of reference and focus are perfectly centered, thanks to great leadership from our physician informatics duo of Dr. Joseph Stein and Dr. David Wetherhold. Their philosophy to make our solutions so easy to use the customer can’t help but leverage the tools we serve as a constant true north for all of our analysts and our Epic partners.
Balancing Optimization Efforts in the Midst of Deploying New Functionality – At Scripps Health, we have been aggressively deploying Epic across our health system. Also, we have been deploying Community Connect to the independent providers who joined our Scripps Accountable Care Organization and deploying Healthy Planet to support not only our value-based contracts but also all of our population health efforts. Regardless of how fast we deploy new capabilities, healthcare delivery and healthcare processes are changing faster. Our customers and caregivers want efficiency and convenience, which requires great clinical informatics leadership and the ability to be agile. At times, this pushes us to the very edge of our capabilities, and we don’t always hit the mark, but together we learn and improve. Providing enhancements to workflow must happen within a reasonable timeframe, or our caregivers will lose trust in our capabilities and focus. Measurable results in reasonable timeframes are essential, along with communication, communication, and communication.
Workflow – We must take the time to adequately design and vet technology solutions that enhance the caregiver and consumer experience simultaneously. This ties directly to the items mentioned above and is an area we have focused on and will continue to focus significant portions of our teams and efforts. I have worked for two other health systems, Maine Health and Florida Hospital, part of Advent Health. In all of these organizations, we knew that having clinicians driving the design at all levels was critical; however, at Scripps Health I think we have something truly wonderful at work. We have phenomenal clinical leadership with Scripps Medical Foundation, Scripps Clinic, and Scripps Coastal, plus the strength of our independent providers who have joined us in our Scripps Accountable Care Organization and all of our clinically integrated networks. Their insights regarding the healthcare ecosystem and what each of them requires to take care of our customer needs are invaluable. They are all truly in it together. These design drivers from our engaged providers, supported by our clinical informatics analysts, ensure we have intelligent design by caregivers hardwired into all of our products and offerings. We don’t always get it perfect out of the gate, but due to their engagement, we get it right together as the feedback loops never stop.
Enterprise Reporting, Business Intelligence, and Advanced Analytics – AI, Machine Learning – Scripps Health President and CEO Chris Van Gorder, or CVG as we all refer to him, and our Scripps Health Board of Trustees are relentless in the pursuit of improvements. Improve everything always, and you are never done. That culture and call to action cannot be realized without a viable improvement and management system, and actionable information/insights. At a recent corporate leadership retreat, the call to action was phrased in the form of a question: “Have we harnessed our data, and are we leveraging it to make the right decisions for the right reasons at the right time?”You might think that’s a lofty goal, but it’s truly important to enabling our caregivers so they can look through the windshield of what is about to be, instead of looking in the rear view mirror of what could have been. Based on our recent investments in Epic, data warehousing, cloud computing, and interoperability technologies, we are adequately poised to respond to the call as long as we keep these efforts crisply aligned to our organizational strategies. Our future state business intelligence and advanced analytics capabilities are even more important as we shift to more toward value and risk-bearing contracts. I’m currently working with a key group of stakeholders to evaluate our roadmap, processes, and structure. Our deliverable is to recast our team’s focus and assets in this important area to support our organizational plans and tactics.
Opportunities & Areas of Focus:
Our opportunities lie in digital health and our digital roadmap. We will complete our enterprise deployment of Epic in October and quickly pivot our team’s focus on our Digital Health initiatives:
Virtual Care Our customer base is very engaged, and they are digitally savvy consumers. They want access to information, care and support regarding their health in a variety of options, such as:
Targeted smartphone applications for specific conditions
Personal health tracking and wellness coaching, leveraging wearable technology
Digital home monitoring for chronic conditions and at-risk patients
E-visits for low acuity everyday problems or video visits as an alternative to a conventional office visit. Nothing will ever replace the in-person direct provider-to-consumer experience; however, these new digital health tools give our customer choice, access and convenience. With Epic fully deployed, we will begin a multi-year initiative to make virtual care available to all of our customers in the post-acute and ambulatory care settings.
Web & Mobile Our web presence today, with the exception of our MyScripps patient portal and MyScripps mobile application powered by Epic MyChart, has predominately been static information about our providers, locations, services, and health and wellness content. New web and mobile offerings will provide existing and new customers the ability to:
View average wait times in our emergency departments, urgent care facilities and express care clinics
Engage with care teams and concierge services via real-time online chat
Leverage virtual care offerings. If customers are unclear about the right care venue or offer for their needs, they can contact our concierge services or enter an online pathway that – based on a few questions – directs them to the appropriate, convenient care setting. Depending on the information they provide, the best option may be a form of virtual care with a video visit, a quick trip to one of our conveniently located express clinics or simply messaging our provider and care teams. Regardless of the need or concern, all of our services need to be accessible via the web and mobile device.
Epic Optimization It has been 1.5 years since we first launched Epic in the ambulatory and post-acute care venues, and while we have made significant improvements, we have pent-up demand for additional changes to improve caregiver and provider efficiency, implement new specialty content, and enable new capabilities for improved access and customer experience.
Our opportunities lie in digital health and our digital roadmap. We will complete our enterprise deployment of Epic in October and quickly pivot our team’s focus on our Digital Health initiatives.
OHIT: How do you ensure that IT line managers are involved in strategic IT planning?
Andy Crowder: I am so excited about our IT managers and leaders. Spending time with them on our current challenges, successes, and opportunities to improve is a constant source of inspiration. Even just a few hours a week with these passionate, thoughtful and intelligent leaders affirms for me we as a team can make the improvements to healthcare that our customers and nation require.
IT managers and departmental leads attend our annual IT strategic planning retreat, where we take the organizational strategies and link them to our efforts. They are center stage in not only aligning organizational strategy but also selecting the projects and activities we will embark on as a team.
OHIT: How do you strike a balance between information sharing and information security?
Andy Crowder: This is a hard balance and one that requires a deliberate focus on due process, corporate expertise outside of IS, attention to regulatory compliance, and leveraging great supporting resources within CHIME and other industry bodies. We are required to share information with everyone for the purposes of providing care, improved customer access, and drive improvements in cost and quality. I subscribe to the saying, “A wise person has many advisors.” Chief Information Security Officer (CISO) Powell Hamilton, the audit and compliance team led by Gerry Soderstrom, the legal team with Brad Ellis and Richard Sheridan, the Board of Trustees and the great Scripps Health technology leaders serve as wonderful advisors, ensuring we achieve balance in information sharing and security, as well as all of our corporate endeavors.
OHIT: Do you have an IT governance program in your current organization? If so, can you provide a high-level overview?
Andy Crowder: Scripps Health has an IS steering committee called IS Executive Oversight Committee (ISEOC) that reports to the executive cabinet, led by President and CEO Chris Van Gorder. The steering group meets quarterly and oversees all of the strategic IT initiatives and the annual capital and operating budgets to ensure we are meeting our targets, achieving the desired outcomes and making modifications if we need a change in direction. Underneath ISEOC is a series of leadership councils that tie partially to our organizational structure or primary verticals. The leadership councils are chaired by key organizational executive stakeholders and normally meet monthly. These councils are accountable for ensuring the execution of the strategies approved by ISEOC.
