Nov 15 2022

CHIME22: 3 Takeaways on How Culture Impacts Change and Digital Strategies in Healthcare

Experts from three health systems shared perspectives on the people and processes driving transformation.

More than 90 percent of healthcare organizations are in some phase of accomplishing their digital strategies, according to the Digital Health Most Wired Survey National Trends Report released during the 2022 CHIME Fall Forum.

The report highlights the perspectives of organizations that have undertaken a digital transformation journey: for example, 23 percent of survey respondents said involving all departments in developing a digital strategy was a critical step toward successful change. Some 19 percent named assigning a board or C-level sponsor to the project as an important measure.

In citing the biggest challenges to realizing a successful transformation, 20 percent named lack of dedicated budget, 15 percent said cultural resistance, 12 percent said tendency for short-term over long-term planning and 11 percent said an over-reliance on legacy technology.

 

Experts from Tufts Medicine, Seattle Children’s and University of Utah Health shared their insights on transformation and digital strategies during the CHIME22 in-person conference in San Antonio. Here’s what they had to say about making changes to improve the healthcare experience for clinicians and patients, without sacrificing one or the other.

1. Tufts Medicine’s Cloud Migration Saves ‘Lives Instead of Drives’

Tufts Medicine announced in May that it had successfully deployed its digital health ecosystem in the cloud through Amazon Web Services. During November’s CHIME Fall Forum session, Chief of Digital Modernization Jeremy Marut said that bringing the healthcare IT ecosystem to the cloud was a foundational step for the organization’s digital transformation.

“Our guiding principles are based on frictionless experience,” Marut said. “This perfectly lined up with the vision of not just dipping our toe in and just doing a little POC [point of care] or test or training, but to bring the entire ecosystem that makes that experience into the same location to create that consistent medical experience.”

In 14 months, Tufts Medicine consolidated six disparate electronic health record systems into the full suite of Epic, Marut said, and “cloud-ified” 42 mission-critical, third-party applications integrated into Epic. “We wanted a consistent resiliency and latency for all these apps together,” he added.

A major lesson learned, Marut shared, was to start off with a solid, finalized architecture so you don’t have to go back to rebuild systems, which his team ended up doing. He also discussed the importance of upskilling staff, not just in house with on-premises team members but also with newly hired cloud engineers who don’t have healthcare IT experience.

CHIME22 Slide

A slide showing Tufts Medicine’s timeline for their cloud journey.

It was also critical for Tufts Medicine to work with its third-party vendors during its move to the cloud, pushing them to improve standards of resiliency for their apps.

Marut also outlined the areas where he found the cloud brought the most value to health systems. First on his list was improved availability and resiliency: “This way, we consistently provide the same, unified experience to our clinicians and patients.”

Next was reduced costs with on-demand consumption-based budgets, which he said were monitored and tweaked in real time.

Another benefit he described was dynamic capacity: “Never run out of space again. Why are we sitting there worrying about how much space is left in the data center, and we’re forsaking our business and our healthcare decisions based on that infrastructure?”

Marut shared a story of when the system’s breast health center opened its doors on a weekend during an October for Breast Cancer Awareness Month and offered free mammograms —without telling Marut’s team. At the time, the event impacted the system’s storage for weeks, but now that they’re in the cloud, he hopes something like that won’t be a problem in future.

Last, Marut named healthcare data as an area where the cloud brought major value: “By integrating this entire ecosystem into a platform surrounded by modern services, we’re actually able to enable life-saving innovations,” such as tools using artificial intelligence and machine learning.

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Marut added that the cloud helped improve Tufts Medicine security posture because the start of the project prompted a security review. Moving to the public cloud also exposed the fact that many of the apps in the data center didn’t have the ability to encrypt in transit. If potential threats such as internal actors are to be taken seriously, then it didn’t make sense for the data center to be clear text, he said: 

“You want to start with a zero-trust mindset and methodology. And then by building your infrastructure as code, you’re able to encapsulate all those rules and all that security, and replicate it time and again every time you want to implement a new environment.”

Now, instead of Marut’s team being worried about “a stupid drive going out,” staff members can move their attention to projects that directly improve the patient experience and digital access.

“We’re now saving lives instead drives,” Marut said. “Infrastructure is not sexy. You shouldn’t get into any type of project like this just to refinance your technical debt.”

2. Real-Time Data Cultivates Urgency Around Health Equity

Seattle Children’s continues to take steps to address health equity and organizational diversity and inclusion after the resignation of a clinic’s medical director citing institutional racism in 2020 and the release of a detailed report on persisting racial disparities last year.

Tracking real-time data about the treatment of patients has been one step in capturing specific areas where unconscious bias needs to be addressed, said Dr. Zafar Chaudry, chief digital and information officer at Seattle Children’s. For example, when used in the emergency room, the data-tracking tool can see how soon pain medication is administered based on race and gender. An analysis found that white, male patients were able to get pain medication much sooner compared with Black patients or female patients of any race.  

CHIME22 Speaker

Dr. Zafar Chaudry, Chief Digital and Information Officer at Seattle Children’s, stands in front of the audience during his presentation, “Identifying and Addressing Health Equity with Real-World Data.”

Armed with this data, Chaudry said protocols should change to ensure every patient has access to pain medication within a certain time frame, and providers can be monitored to see if they’re compliant. 

Being able to collect, record and report on clear measures has helped influence changes to Seattle Children’s strategic objectives and other diversity, equity and inclusion targets. The organization will continue to make changes, Chaudry added.

“You can use your data to effect change,” he said. “It’s been driven by the clinical staff, many of whom didn’t know that they were facing this on a daily basis.”

3. University of Utah Health Boosts Experiences with a Strong Team

University of Utah Health CIO Donna Roach spoke at last year’s CHIME Fall Forum about the academic medical system’s digital health improvements. This year, she returned with her colleagues to talk about the collaboration and processes that helped drive change.   

Roach stressed the importance of a cohesive experience across the health system. Digital transformation couldn’t just be contained to the hospitals and clinics, which is why the health system’s Digital Enablement Committee (DEC) also included department chairs, the head of innovation, the head of research, some operational leaders and health sciences members.

The health system’s digital transformation roadmap contained “swim lanes” that addressed specific areas, and the “total experience” was important enough to have its own lane instead of being interwoven into other goals. 

“When we think about experience, we don’t just think about patient experience. What I wanted to emphasize is patient, consumer, physician, clinician and employee – it’s total experience,” Roach said. “You can’t do patient experience on the backs of your clinicians, on the backs of your employees. It all has to fit together.”

She emphasized the need for feedback loops to better inform digital strategy. When the health system was testing more online nurse rounding tools through Microsoft Teams and Office 365, nurses were directly involved in the design and process.

 

Roach chaired the DEC along with Dr. Michael Strong, chief medical information officer, to ensure the digital strategy benefited from a heavy clinical perspective. In his nearly 30 years with the organization, Strong said, as competition arose around the traditional system, the shift to offer an exceptional patient experience has been palpable. But leaders must take charge.

“It has to be a deliberate decision from the top. Culture is never going to change organically. It’s too easy to just continue with the status quo,” he said.

The patient experience officer works with the DEC so that they’re designing programs with patients, not just for them. Senior Director of Digital Transformation Laura Marquez added that continuous learning, whether it garners success or failure, is key.

“As we bring agile into healthcare, which is completely new and unknown to our teammates and colleagues, we recognize that it’s OK to take these risks and create a culture of safety where failing is OK,” she said. “It’s really not failing; it’s learning from those mistakes and trying again.”

Keep this page bookmarked for our coverage of the CHIME22 Fall Forum, which took place Nov. 7-10 in San Antonio. Follow us on Twitter at @HealthTechMag and join the conversation at #CHIME22Fall.

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