The Integration of Digital and Healthcare IT with a CIO-CDO

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Bill Russell / Tom Barnett

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January 15, 2021: What does a hybrid CIO-CDO role entail? Digital definitions can sometimes elude us. Tom Barnett of Baptist Memorial defines it as meeting the patient where they’re at and allowing them to digitally engage for their care in the easiest fashion possible. From the CIO perspective, it’s keeping the core systems, roadmap and strategic direction of the healthcare system in place. How can a leader effectively engage with their remote workforce? How can we further reduce the amount of burden on medical staff? How do we reduce touch points during the pandemic whilst still maintaining a high level of care? And are healthcare system’s just responding to COVID? Or are they able to field other projects?

Key Points:

  • What kinds of digital projects have come to the forefront during a pandemic? [00:07:30] 
  • The rise of inpatient telehealth [00:12:13] 
  • As we recategorize rooms, in order to adjust to the changing patient volumes, the Epic team needs to be able to jump in and reconfigure them to make sure operations are in real-time. [00:16:00] 
  • Learn how to manage a drive-through COVID testing site using tricks from the fast food industry [00:13:25] 
  • It’s important to focus on optimization areas for physicians [00:16:50] 
  • https://www.baptistonline.org

The Integration of Digital and Healthcare IT with CIO-CDO Tom Barnett

Episode 352: Transcript – January 15, 2021

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[00:00:00] Bill Russell: [00:00:00] Thanks for joining us on This Week in Health IT influence. My name is Bill Russell, former healthcare CIO for 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged. Today we have Tom Barnett, the CIO and CDO for Baptist Memorial Healthcare. 

[00:00:22]Special thanks to our influence show sponsors Sirius Healthcare and Health Lyrics for choosing to invest in our mission to develop the next generation of health [00:00:30] IT leaders. If you want to be a part of our mission, you can become a show sponsor. The first step is to send an email to [email protected]

[00:00:39] A quick note, we launched a new podcast Today in Health IT. You’re not going to find it on This Week in Health IT podcast feed. It’s a new channel. It’s its own show. We look at one story every weekday morning. Check it out. We, you know, it’s roughly about six to eight minutes long. It’s an easy way to stay current on what’s [00:01:00] going on in the health IT space. Subscribe wherever you listen to podcasts or you can hit our website this weekhealth.com, hit the subscribe button and it’ll show you how to find the podcast. 

[00:01:11] If you’re new to this show or returning after a while, we now do three shows on this channel on This Week in Health IT. On Monday we cover the news and I do that now with a round robin group of about six to eight people. So it’s a back and forth on the news and what’s going on. On Wednesday we have an influence or a solution showcase episode, [00:01:30] and every Friday we’re going to do an influence episode just like this one. Be sure to check back for more great content and now onto today’s show.

[00:01:38]Today we have Tom Barnett, the CIO and CDO for Baptist Memorial Healthcare out of Memphis with us good morning time and welcome to the show. 

[00:01:48] Tom Barnett: [00:01:48] Glad to be here. 

[00:01:49] Bill Russell: [00:01:49] Yeah. I’m looking forward to this conversation. So, before we get started, this is the second time you’ve been on the show, but, you’re now with, with a new organization.

[00:01:57] So, talk to us a little bit about the [00:02:00] move, how, how do you like Memphis so far? 

[00:02:03] Tom Barnett: [00:02:03] Oh, I love Memphis. I love the weather, especially, especially this time of year, so, 

[00:02:07] Bill Russell: [00:02:07] yeah. And you came from upstate New York, right? 

[00:02:11] Tom Barnett: [00:02:11] Absolutely. great area, great folks. but it also has 104 inches, roughly average snow fall for you.

[00:02:20] Bill Russell: [00:02:20] Oh man. So w when did you make the move? How long have you been down there? 

[00:02:25] Tom Barnett: [00:02:25] I’ve been down here since the last week of May. 

[00:02:28] Bill Russell: [00:02:28] Did you have a favorite restaurant [00:02:30] yet? This, one of the things Memphis is known for is restaurants. 

[00:02:33] Tom Barnett: [00:02:33] Oh, it’s for me, it’s barbecue. I’ve been working my way through the, through the barbecue restaurants here. I love it. 

[00:02:40] Bill Russell: [00:02:40] That’s fantastic. So we’re going to talk a lot about the digital side. We’ll we’ll talk a little bit about, COVID and what’s going on. Excuse me. Cause you, as we were talking earlier, you experienced COVID in New York. Having made the transition in May. And then you experienced a couple of peaks in Memphis when you got down there.

[00:02:59] So [00:03:00] you, you seem to be, hitting the peaks in these various locations. So we’ll touch on that a little bit, but before we get there, tell us a little bit about Baptist Memorial. 

[00:03:11] Tom Barnett: [00:03:11] Sure. Well, Baptist Memorial is a, Baptist Memorial Healthcare Corporation, is a 22 hospital health system, based out of Memphis, Tennessee. So, but their markets are pretty much Western Tennessee Northern basically meant to Northern Mississippi as well as Northeast [00:03:30] Arkansas. get bought a 4,000 member physician network, and associated ambulatory clinic network as well. 

[00:03:37] Bill Russell: [00:03:37] Wow. So, so you are, so Mississippi, you are hitting some places that have some escalated levels of COVID even right now, I would assume.

[00:03:47] Tom Barnett: [00:03:47] Yes we’re seeing our second spike that we’re kind of going through right now, which has actually eclipsed the COVID spike that, their first one that they have, which really peaked kind of in the late June timeframe. 

[00:03:57] Bill Russell: [00:03:57] Wow. all right, [00:04:00] well, here’s what I’d like to do with you. You have one of those interesting roles. And I wanna sort of talk about that. So there’s the CIO CDO role. what does that entail? What is the combination of those two things at your health system? 

[00:04:13] Tom Barnett: [00:04:13] They’re actually very related. So from the CIO perspective, obviously keeping the core systems and roadmap for the health system and their strategic direction for the future in place.

[00:04:23] But digital in order to now begin that, and digital means, you could probably ask five different health [00:04:30] systems. You might get six different descriptions. From our perspective, it’s primarily from the patient engagement perspective. So making sure that encompasses everything such as, I know a lot of terms, different organizations use include digital front door, but in all of those patient engagement technologies and how health systems interact with their patients, as well as providing that care, digitally.

[00:04:55] But it also has a secondary focus as well, which I think has come to the forest [00:05:00] part of the pandemic this year and that’s digitally engaging our workforce as well, for new ways that they’re working. So I think it encompasses both hats to them. Yeah. 

[00:05:09]Bill Russell: [00:05:09] It’s interesting. You talked about that digital definition is something that eludes us, but it is at that intersection of how people interact with our health system, either the care, the caregivers, the care providers or the patients, and enabling that with all sorts of technologies where they can, do visits, they can [00:05:30] send, they can pay bills, they can do inquiries, all the things that they used to do.

[00:05:36] You know, face-to-face in person, send a mail, send an email, now are becoming, tools that, that are tightly integrated into the operation. And it’s interesting to watch because you’re right. It is very, it’s very different. The reason I point that out is that the CIO CDO role is still [00:06:00] interesting in the, in the IT world.

[00:06:02]There’s some organizations that are going with both. There’s some organizations that are going with combined and there’s some organizations that just call it a CIO, but they also have taken on the, really the digital, digital roles. So that’s why I highlight that. DOes your digital group have sort of an objective statement or a mission statement around the digital initiatives?

[00:06:25] Tom Barnett: [00:06:25] In a sense, we have an informal one. We’re working through what those digital roadmaps look like [00:06:30] as I’m getting into this role. In kind of defining what this space means for us. overall, I would say it’s meeting the patient where they’re at and allowing them to digitally engage with us for their care in the easiest of fashion, easiest fashion possible.

[00:06:45] Bill Russell: [00:06:45] So do you have, do you have a team? Do you have a, like a, I mean, clearly you have a CIO has a lot of teams around, around the operations and informatics and those kinds of things, but, do you have a team that’s dedicated to digital [00:07:00] by itself? 

[00:07:01] Tom Barnett: [00:07:01] We’re in the process of building that team out. So a lot of those skills and those disciplines are within the existing IT team that we have today.

[00:07:11] So we’re very much around assembling teams around initiatives to be able to move forward on different aspects that we need to work with as we need to build out additional, skill sets internally, we’ll look to figure out how we come up with a more dedicated team for the areas that need them.

[00:07:29] Bill Russell: [00:07:29] So, so [00:07:30] let’s just talk generically. And maybe even across your previous, also some in this one, what kind of projects have come to the fore, during a pandemic? What kind of things are we doing to reduce the touch points and those kinds of things? 

[00:07:46] Tom Barnett: [00:07:46] I think it’s reducing the touch points, it’s a lot to your earlier statement about things that patients did with us in-person previously that they know want to do, digitally. and the pandemic really became a [00:08:00] catalyst for that. So from our perspective, it’s definitely working through, and I think this is similar with a lot of health systems, as the pandemic began its onset earlier this spring, video visits which may have been a curious technology before or telehealth suddenly took a spike.

[00:08:17] And, suddenly became a very fast growing area. So you’re either ready for it or you weren’t. And I think that’s consistent with both health systems that I’ve been with this year. They were both poised to be able to take advantage of [00:08:30] that, to be able to help those patients who necessarily maybe did not want to come into a healthcare setting for risk aversion reasons. But now we’re able to engage with that physician digitally through video visits. 

[00:08:43] Bill Russell: [00:08:43] What areas? So we saw the spike in terms of, telehealth. I mean the numbers were just staggering and amazing, but we also saw it come back down. Are there areas where telehealth is really taking hold and you see that it’s, [00:09:00] the future is really clear and other areas where you’re like, “Okay, we may have some work to do here. We still have to figure some things out.” 

[00:09:08] Tom Barnett: [00:09:08] I think it’s going to depend on the individual use cases. So obviously things that will lend themselves to a video visit followups, potentially certain dermatology types of visits, certain sub medical specialties, possibly. But that becomes a big convenience factor, not only for the provider, but for the patients [00:09:30] specifically. In order to be able to quickly get that diagnosis or that follow up that you’re looking for in terms of ongoing patient monitoring and so forth as well. I think if you’ve looked toward keeping those touch points lighter, in this post pandemic world that we’re in, Any of those types of transactions that can be made frictionless or a quick speed, if you will from that interaction definitely lends itself to digital.

[00:09:59] And we’re looking at [00:10:00] those as we look at our use cases to figure out which ones are the best candidates to become digitized. 

[00:10:06] Bill Russell: [00:10:06] So as Baptist Memorial and gotten rid of all clipboards and pens, are we at that point yet? 

[00:10:11] Tom Barnett: [00:10:11] Well, I think we have 15, that are left here, but we share them. 

[00:10:17] Bill Russell: [00:10:17] The, no, the reason I asked that question, so CVS just announced, they’re taking PayPal, they’re taking Venmo, they’re taking all those things. And part of that is the retail nature of their business. They’re trying to reduce [00:10:30] touchpoints. Right. So even touching that pen or using the card, the credit card reader and that kind of stuff. They’re finding that people are more amenable to solutions that, they’re educated now, right?

[00:10:43] So they know how germs move, not at the level that a doctor would understand the difference between a virus  and other types and how things move. But they’re more educated on, hygiene and cleanliness, and they’re more willing to touch their phone than they are [00:11:00] the things that people are handed to them. Have you seen like a higher demand for those types of projects or is that one of those, if you didn’t have it before COVID, there’s, hasn’t really been enough time to put anything in place?

[00:11:15] Tom Barnett: [00:11:15] I think that level of distancing and doing a lot of those forums online prior to getting to the office visit for example, anywhere that we can minimize those types of physical touch points were already in place. And I think they’ve been [00:11:30] refined since COVID is taking root. So we’re looking at where can we optimize those?

[00:11:35] Where can we reduce those touch points wherever possible. And even, but it’s always a combination right. Of not only digital technologies, but it’s people process and tools. So making sure that that the social distancing is in place, how we’re scheduling those clinics to make sure that we avoid a lot of folks being in the same waiting room at the same time.

[00:11:57] Anytime you can push that. And that can be a couple of different [00:12:00] things that can be alerts going to a phone to let patients who are waiting in their car and knowing that they can come in for their appointment. I think we’re looking at all of those different strategies as things that can be employed to make life easier for everyone.

[00:12:13] Bill Russell: [00:12:13] Are you guys doing a lot with, for lack of a better term, inpatient telehealth, between the clinician and the patient, but also the physician to physician communication. Are you using telehealth in your inpatient settings? 

[00:12:27] Tom Barnett: [00:12:27] Absolutely. So I think with, with [00:12:30] consults happening across state lines and so forth, again, particularly within this post COVID world that we’re in, we’re doing a lot of those through, through video visits and consults.

[00:12:42] Even small things like, in order to help reduce the level of PPE equipment that we’re going through as a health system. In some cases, particularly in higher touch ICU settings, we’re putting tablets out there so that patients can engage with nurses directly through these kinds of digital [00:13:00] communication channels.

[00:13:02] All of it allows a constant monitoring, real-time interaction with the patient. But can also be a sensitive to some of the, environments and circumstances that we’re in as well. Another area that we’re looking at, that was actually optimized and it was processed, but some technology as well, we have a drive-through COVID testing lines in our main Baptist Memphis hospital.

[00:13:28] And, it, it gets a fair [00:13:30] amount of activity, as you can imagine. So figuring out ways that we can almost emulate, if you will, certain fast food restaurants in terms of how they manage clients. So working with our in-house process improvement team, they came up with some great strategies that allowed us to extend wifi coverage across a larger parking lot area, and then deploy tablets, to allow staff to be able to register and check in patients who are waiting in their cars, in these testing minds, [00:14:00] but all focused on increasing throughput and increasing the, or decreasing the amount of time it takes for folks to get a test. I think those are all aspects of where we’re utilizing, process improvements combined with technology to, to really drive strong results.

[00:14:17] Bill Russell: [00:14:17] Yeah. So you’ve been there since May. I don’t think there’s been a normal day since you’ve been there. But I’m gonna, I’m going to press in to some of these questions might be unfair, but I’m gonna press in any anyway, but what’s so from a data perspective, from a [00:14:30] real-time analytics dashboard, those kinds of things, what kind of projects have you been fielding since you’ve been there?

[00:14:37] Tom Barnett: [00:14:37] So mostly they’ve been, around responding to our COVID situation that, that we have not, again, not unlike a lot of health systems right now. but real time dashboards in terms of bed utilization, levels of care, acuity levels, 

[00:14:53] Bill Russell: [00:14:53] Are these things you already had or were there things you had to develop?

[00:14:58] Tom Barnett: [00:14:58] I think these were things that were already [00:15:00] in place. So again, this perspective, there’s a lot of fantastic tools that come out from the Epic platform and Baptist was the first site. So if you’re familiar with the stars rating, in terms of implementing Epic functionality, Baptist Memorial was the first health system in the world. They had 10 stars in 2017 and we were just recertified again this year, 2020 as a 10 star site. And as such, we have access to a lot of tools, a lot of dashboards, and a lot of, enabling [00:15:30] technologies, if you will. That can definitely be just some refinements, in some cases, in terms of how I’m speaking specifically to, but utilization and, and throughputs and acuity levels that can definitely allow our team to make adjustments.

[00:15:45] We’re also responding from a surge level, as we do readiness around us, we’re all watching, infection cases rise. What that means for our team. Yes, we are on Epic. Yes. We have been doing that for a while here, [00:16:00] but when it also means is that as we recategorize rooms, in order to adjust to the changing patient volumes, that requires the Epic team as well, to be able to, be able to jump in and reconfigure some of those rooms to make sure that we’re working real time with operations. That those changes are reflected both in those daily dashboards, as well as any reports, we need to be able to stay on top of what the overall, activity level of the health system is. 

[00:16:27]Bill Russell: [00:16:27] Do you guys participate in the arch collaborative at [00:16:30] all? Just out of curiosity. So are you doing a lot of things around the physician experience and that the EHR interaction?

[00:16:38] Tom Barnett: [00:16:38] And, absolutely. And I’m working very close partnership with our CMIO, Dr. Jake Lancaster, who I know was on the program earlier this year. We are definitely focusing on optimization areas within physicians. So some of the things we’re looking at is kind of getting and refining some of the standardized templates [00:17:00] around physician documentation.

[00:17:02] We’re also taking a look at other metrics that are available such as time spent in the EMR outside of normal working hours and how we can set those as benchmarks to work with our in-house training team, as well as our process improvement team to focus on how we reduce the amount of burden that’s on those positions to make sure that we’re flowing that work through for a provider and in a real-time fashion and with as many [00:17:30] optimization points as we can put for them and keep them out of that record churning out downtime. 

[00:17:35] Bill Russell: [00:17:35] Yeah. I’m looking at this video and you, they really haven’t given you much time to like unpack boxes or put anything up on the wall or so you’ve been fairly busy since you got there.

[00:17:47] Tom Barnett: [00:17:47] Absolutely. So it’s, learning a new organization, learning a tremendous amount of, talented people that I’m working with as well as doing a lot of it, quite frankly, through this camera. [00:18:00] So, a lot of what we’re doing our video visits right now. So a lot of our management staff and leaders are still on site while our staff is, working in various modes of working remotely, depending on the team.

[00:18:13] But a lot of our meetings are all done through actually almost exclusively through video right now. So, while it is very beneficial to get from one meeting to the next, through a click very quickly, it does allow a lot of times to, unpack boxes. You’re right. 

[00:18:30] [00:18:29] Bill Russell: [00:18:29] Yeah.  Was talking to somebody they’re like, which kind of doctor makes the best CIO and I’m like, that’s easy. It’s needy doc. I just because you can’t possibly do everything they put on your plate, so you’re constantly prioritizing, triaging. Yeah. I mean, you’re just there’s some things you look at and go, that’s important. I’m going to put that in a holding pattern because this is critical and you just, you you’re making those kinds of decisions pretty often.

[00:18:57] I think I’m going to close with a pretty big [00:19:00] question and I’ve been asking the other CIO this question, because it’s interesting, you guys go in different directions. What do you think that the lasting impact on health it is going to be as a result of the pandemic?

[00:19:20] Tom Barnett: [00:19:20] The lasting impact? So I think a couple of the comments that I’ve heard, in a few of the different health systems that I’ve been with this year, is [00:19:30] operations has been very impressed with how quickly it has been able to turn around solutions very quickly, whether it’s suddenly, within a few days, let’s move, a thousand or 2000 people to work remotely, and clear out offices and as a result of what we’ve all been dealing with. Or drive through COVID lanes or dealing with, video solutions to be able to engage with patients, what it means for it is. We’d [00:20:00] been able to focus on things because there’s been a priority and an urgency put on it. I think a lot of the other work, has kind of gone to the side.

[00:20:07] So the lasting impact, I think we’re all going to be looking at new ways to work, embracing digital tools on a level that probably hasn’t been done in health IT before just in general, because healthcare in general is always, a step or two behind maybe other industries, for example. But I think as we all look at how well the remote or [00:20:30] the WebEx or the video world has worked for everybody, I think there’s going to be an opening up of how do we do this type of focused teaming and being able to rally teams around kind of what these new strategies are and being able to implement them in a lot shorter timeframes. So, whether you call that, dev-ops or any of the other, trendy words that are out there, I think there will be a clarity that comes out of this.

[00:20:58] Digitization, [00:21:00] learning how to work remotely, and focusing on all of the work and only the necessary work needed to drive a result or bring a solution into fruition. I think that clarification, as well as the catalyst that the pandemic has done, is really going to leave its imprint on our industry going forward.

[00:21:21] Bill Russell: [00:21:21] Yeah. I love that. And actually I lied, I have another question, which is how big is your staff at this point? 

[00:21:27] Tom Barnett: [00:21:27] The IT staff. so the corporate [00:21:30] staff were about between 350, 375. 

[00:21:33] Bill Russell: [00:21:33] So is that spread out or is that mostly in Memphis? 

[00:21:36] Tom Barnett: [00:21:36] That group is mostly with them now supporting a lot of our enterprise it systems. We also have a desktop support and a number of IT personnel embedded in each one of our hospitals. So collectively we’re probably up in the 800 FTE 

[00:21:53] Bill Russell: [00:21:53] And, it’s just the reason I wanted to go down this path. It just dawned on me. I mean, you’re new in the, into the role. There’s probably [00:22:00] people that you’ve literally only met this way is my guess.

[00:22:04] Tom Barnett: [00:22:04] Absolutely. MIght see them in the parking lot after work and not recognize them when they’re not on video. It’s literally been like that. 

[00:22:13] Bill Russell: [00:22:13] And w what’s the most number of squares you’ve had on a screen as you’re trying to have a meeting? 

[00:22:19] Tom Barnett: [00:22:19] Probably, I think 20, 

[00:22:26] Bill Russell: [00:22:26] To a certain extent, I’ve heard the same thing. That it’s been a really [00:22:30] interesting to be able to connect to people in this way. very freeing for some people. Some people have long commutes, maybe not as much in Memphis, but in other markets, people have long commutes and those kinds of things they’ve now been given part of their life pack. A lot of them are, are wondering like what the future, and I’m not gonna put you on the spot.

[00:22:47] You haven’t been there long enough to put you on the spot here, but a lot of health systems are trying to figure out what the future of work is. And, it’ll be interesting. We’ve really had to adapt it. So I’m going to assume you’re going to have the next time we talk to you. I [00:23:00] have a few more books on that show.

[00:23:01] Tom Barnett: [00:23:01] I think I will. And, and one of them I’m reading through right now is, is that Mark’s new book on digital? 

[00:23:08] Bill Russell: [00:23:08] Yeah. Well, you’ll have to listen to the interview as well. I, he sent me the book on like a Tuesday. And I was interviewing them on Wednesday. So I stayed up all night. I crammed the whole book in and had him and Paddy on the show. Yeah, I love those. Those two guys are doing great work and I love the books. So I look forward to hearing [00:23:30] your thoughts on it when you get that, Tom. Thanks. Thanks again for coming on the show. 

[00:23:35] Tom Barnett: [00:23:35] My pleasure. 

[00:23:36]Bill Russell: [00:23:36] What a great discussion. If you know someone that might benefit from our channel from these kinds of discussions, please forward them a note. They can subscribe on our website thisweekhealth.com or you can go to wherever you listen to podcasts, Apple, Google, Overcast, that’s what I use. Spotify, Stitcher. We’re out there. You can find us. Go ahead, subscribe today or send a note to someone and have them subscribe. We want to thank our channel sponsors who are [00:24:00] investing in our mission to develop the next generation of health IT leaders. Those are VMware, Hill-Rom and Starbridge Advisors. Thanks for listening. That’s all for now.