Ninety percent of hospitals now have an AI strategy in place, a survey by advisory firm Sage Growth Partners found. With 100 million users within a week of its launch in November 2022, Open AI’s ChatGPT has also fueled AI’s adoption in the healthcare sector.
More broadly, the global healthcare technology market is expected to grow 18.3% to $439 billion in 2023 from $371 billion in 2022, and projections indicate the market will have nearly doubled to $852 billion by 2027, according to ResearchAndMarkets.com’s Healthcare Technology Global Market Report 2023.
Though these numbers paint an impressive picture of healthcare IT, organizations don’t really need them to know how fast healthcare digital technology is moving. They experience it in the influx of product introductions and upgrades vying for their attention every day.
Learn From Past Misses
Digital technology’s potential to improve quality, streamline processes and democratize care is breathtaking, but the velocity of the change can unnerve even the most intrepid. Indeed, “figuring out how to develop systems to use a growing quantity and variety of digital information is perhaps the most important, and formidable, health care mission of our time,” leaders of the National Committee for Quality Assurance write in Harvard Business Review.
A potential pitfall is becoming confused and distracted by all the newness. To chart a clear path for a smooth system rollout, experts encourage providers to look back and revisit lessons learned from past implementation as an integral part of the process. Learning from earlier mistakes—and successes—can be a powerful antidote to the market’s flood of shiny new objects and an anchor for smart planning rooted in problem-solving.
“Adding a lot of gadgets to an existing clinic that already has its fair share of existing tech only complicates the ‘system’ rather than making it simpler,” writes business adviser Heath Gascoigne, London.
It behooves providers to understand where they’ve erred previously so they can avoid repeating the same mistakes down the road.
Don’t Be Afraid
“It’s about a balance between staying in touch with the market and understanding where things are going on the one hand, and ‘keeping the lights on’ and maintaining what we already have on the other, all while thinking about innovation that will move the needle in terms of quality and efficiency,” says Jeffrey Sturman, senior vice president and chief digital officer at Memorial Healthcare System, Hollywood, Fla. Sturman is an ACHE Member.
That balancing act incorporates reflection on past successes and misses, he notes. When the COVID-19 pandemic hit, Memorial Healthcare System quickly deployed an electronic solution to monitor hand-washing compliance due to heightened infection control concerns. But “because we moved so quickly, we implemented a technology that wasn’t ready for broad deployment, and we eventually had to remove it. We were dealing with the here and now of the pandemic, so our due diligence wasn’t what it should’ve been,” he says. Lessons learned from that experience, including the importance of evaluating all the options, even during a crisis, will inform the system’s next implementation of a hand-washing compliance tool.
Still, considering how rapidly digital technology is progressing, Sturman contends that “it’s important not to be afraid to try things. There’s no harm if you have a culture of acceptance, and the organization knows you’re doing it because you’re passionate about improving patient care.”
He advises organizations that might be in the earlier phases of digital transformation to “build relationships with people who can help you learn, borrow some of their successful ideas and push those agendas forward. If your digital ecosystem is not working for you, don’t be afraid to change it. Change is hard, but if you’re in IT and you’re not a change agent, you’re in the wrong business.”
We spoke with three providers featured in past IT issues of Healthcare Executive to probe how looking back and learning has helped them to move forward.
CentraState Healthcare System and Atlantic Health System: Partnering for Innovation
When Healthcare Executive profiled CentraState Healthcare System in a 2015 article on IT innovation, the Freehold, N.J.-based organization had recently been named a “Most Wired” hospital by Hospitals & Health Networks. CentraState was considered a trailblazer back then, but a lot more has happened in eight years.
Pivotally, in 2021, the system entered into a co-ownership agreement with Atlantic Health System, Morristown, N.J. Their combined strength and economies of scale have expanded the scope, reach and efficiency of healthcare services across key regions and synergized digital transformation for both partners, according to Sunil Dadlani, executive vice president and chief information and digital officer for Atlantic Health, and an ACHE Member.
A maelstrom of healthcare disruptors, including consumerization, the pandemic, workforce shortages, changes in reimbursement models and supply chain issues mandated a strategic realignment as CentraState faced the current healthcare environment, he says.
By 2021, Atlantic Health had already made strategic investments in a scalable and agile digital infrastructure. CentraState was able to expand its digital profile exponentially by leveraging this foundation, working as part of a centralized IT organization that caters to the needs of each system while minimizing redundancy. The IT organization has a joint business governance framework that brings clinical and nonclinical leaders and IT team members together to discuss business needs and use cases. Dadlani says this structure helps ensure a standardized-but-flexible systems approach to IT.
A go-live for CentraState on Atlantic Health’s system was achieved within a record-setting six months, making it the fastest implementation on this platform worldwide. The IT leadership’s guiding principles for both organizations helped expedite the timeline, according to Dadlani. They included an agreement by CentraState to adopt Atlantic Health’s IT processes and policies organizationwide.
Within four months, quality improvements at CentraState included an increase from 80% to 98% in computerized physician order entry rates, a significant reduction in hospital-acquired pressure injuries, and revenue cycle performance in the 75th percentile or higher in 10 of 11 core metrics.
Despite this progress, Dadlani believes a lot could go wrong if the organizations did not incorporate healthy doses of honest reflection and evaluation into their IT initiatives. “You can’t design your IT road map in isolation. You have to look in the rearview mirror and connect the dots between past, present and future,” he says.
Dadlani stresses the importance of having the organization’s strategic plan as the digital road map’s driver. Initiatives can go awry without clear goals and alignments to business needs and priorities, effective communication around change management, and buy-in from and collaboration with stakeholders. “We’ve needed to become more prudent and methodical about making sure we’ve learned these lessons by aligning tightly with the business strategy across both organizations,” he says.
Other lessons learned include setting a goal to further develop the strategic value of digital technology. “The key is learning how to invest judiciously and systematically in a way that will help create competitive advantage,” Dadlani says.
Experience has also taught the system the need for a scalable and flexible IT infrastructure designed with interoperability in mind. The need for that interoperability became glaringly clear during the pandemic when CentraState ran into problems around data-sharing with patients, providers, and state and federal agencies. “Proof of concepts and proof of value mean little without the ability to scale at the enterprise level and seamlessly share data,” Dadlani says.
He also stresses another ingredient to CentraState/Atlantic’s success: an emphasis on diversity and gender balance that has brought depth and richness to the IT team and strengthened performance. “We are always experimenting,” he notes, “but we learn fast. We pivot, adapt and recalibrate to keep pace with our organizations’ business needs and where the industry is heading.”
UCLA Health: Seeking Digital Solutions to Issues of Access
Profiled in Healthcare Executive in 2019, Ronald Reagan UCLA Medical Center, UCLA Health’s flagship hospital, was one of the first institutions in the United States to use telemedicine in the perioperative space. Patients who are triaged by the anesthesiologists to receive a virtual preoperative assessment are able to log in at home from a personal device that is connected to their EHR. These patients undergo a remote comprehensive evaluation by a member of the anesthesia team. Photos of the airway taken during the exam are embedded in the EHR.
The remote technology’s strong convenience factor helps reduce no-show rates across surgical specialties, demonstrating telemedicine’s effectiveness as a tool for improving access in one of the country’s most traffic-congested areas. The technology’s benefits became evident even before the pandemic jump-started telehealth’s large-scale adoption nationwide.
What a difference a crisis makes. In the year before the pandemic, UCLA Health’s remote visits totaled roughly 3,000, and the perioperative telemedicine program saw about 180 patients. Since then, remote services have expanded by several orders of magnitude, states Chidinma Chima-Melton, MD, FCCP, medical director of quality and telehealth at UCLA Health. Telehealth visits for ambulatory care reached their zenith during the height of the crisis, when physicians conducted 500,000 in a single year.
The system’s less than 1% telehealth rate before the pandemic soared to 85% after March 2020 and has normalized at 18% of ambulatory visits, she adds, noting that the specialties have settled into their individual comfort zones with the technology.
Because removing barriers to access remains one of the system’s key strategic priorities, telehealth continues to figure prominently in the system’s digital road map, says Chima-Melton. The cardiac and thoracic surgery program provides an example.
The program sends patients who have undergone coronary artery bypass grafting, lung resections and other surgeries home early with remote monitoring devices. Two levels of nursing care support patients, including a call center that proactively checks in with patients for signs of potentially concerning symptoms. The program garners high patient and clinician satisfaction ratings while increasing access and revenue by freeing valuable bed space. Notably, the program has led to a 48% reduction in readmissions, Chima-Melton reports.
During the pandemic, the system discovered, not without difficulty, its capacity for being nimble as well as strategic in the face of ferocious change. After a period of merely reacting and adapting to the system’s huge influx of patients and increase in telehealth visits, “we started thinking about how to leverage the opportunities for innovation that the rapid shift to telehealth had opened,” Chima-Melton says. That led to revisiting the goals for telehealth and developing new use cases.
UCLA Health has since piloted, with a small number of clinicians, asynchronous e-visits for conjunctivitis, gastroesophageal reflux disease and urinary tract infections, and it plans to expand the program to 10 conditions involving more providers. The “store and forward” approach of e-visits enables patients to report symptoms through a portal and for physicians to review and manage these requests later. This allows patients with more straightforward conditions to receive prompt care without an on-site visit, opening appointment spaces for more complex patients.
Chima-Melton says that UCLA Health has learned to prioritize technology initiatives in a way that provides a built-in buffer against the digital market’s frenetic activity. “It’s easy to get swept up by the next fad,” she says. “We avoid that by making sure our IT goals are aligned with our institutional priorities.”
The institutional priority of population health, for example, translates to an emphasis on projects that are going to affect as many patients as possible. “Does it serve our patients and clinicians well, improve access for vulnerable patients and improve quality? The projects for which we can answer ‘yes’ to those questions tend to move forward,” Chima-Melton says. In keeping with that emphasis, efforts are currently underway to create targeted population health virtual care pathways and implement AI-based “triage” for patient messages, ensuring that busy clinicians prioritize those with high-risk features.
The blending of telehealth and quality through Chima-Melton’s dual roles as medical director for both was fortuitous. “There’s so much synergy between them,” she says. “We identify care gaps and create programs around them, with telehealth oversight to help make them more efficient. I think it’s something more institutions should consider.”
Circle Health and Tufts Medicine: A Data Lakehouse in the Cloud
Circle Health, an integrated community healthcare system headquartered in Lowell, Mass., was already immersed in leading-edge work around interoperability when Healthcare Executive profiled it in 2018. A part of Tufts Medicine, the principal teaching affiliate for Tufts University Medical School since 2014, the system has remained something of a pioneer in digital transformation.
In April 2023, all members of Tufts Medicine, including Tufts Medical Center and Lowell General Hospital, Circle Health’s flagship institution, went live under one EHR (from a total of 28 different platforms, all of which were working well on their own). In doing so, Tufts became the first health system in the country to move its digital ecosystem completely to the cloud, reports Angel Santana, Tufts Medicine’s IT executive director.
The fact that the IT teams across Tufts Medicine’s member institutions now operate under a single IT organization parallels the high level of connectedness that characterizes the digital ecosystem itself, Santana says.
As of August 2023, Tufts Medicine’s IT function began operating without data centers, thanks to an architecture known as a data “lakehouse” that offers economical storage for all types of data, including clinical data, while supporting machine learning and predictive analytics. “We are a platform company that is totally cloud-first and AI-first,” says Shafiq Rab, Tufts Medicine’s chief digital officer and system CIO. Rab credits that cloud-first, AI-first philosophy for much of the system’s cost savings. The increasing use of application software as well as data in the cloud has reduced not only hardware costs but also the number of applications requiring maintenance from 900 to about 150.
This strong digital foundation frees the IT organization to focus on its mission of serving as “enablers who work to improve efficiency, decrease costs and bring joy through digital innovation to the lives of the caregivers, employees and patients who are our customers,” he says.
According to Rab, the ongoing process of cultural transformation required to achieve those connectivity goals has been the most challenging aspect of the IT team’s work—proof that a digital transformation is about human factors and change management as much as it is about technology.
A key element of that cultural transformation was creating a sense of urgency around digital technology by involving all stakeholders, including physicians, patients and staff, in the development of the system’s digital front door.
The digital front door “is successful because we didn’t build it for ourselves, we built it for our caregivers, patients and physicians,” Rab says. “That’s how we have a clinically integrated network of 2,000 private doctors in our group.”
A digital governance committee works to achieve consensus and unite stakeholders around a common mission. “The biggest lesson we’ve learned is to make sure that all stakeholders have a voice in decision-making,” says Santana. “Since they are going to be the people using the system, it’s imperative that they feel free to share ideas and be part of the process.”
Of course, the risk is having too many voices, but governance helps cut through the cacophony. “It’s not that we don’t have differences, but we talk them out,” says Rab. “And we have a North Star to become the most trusted place for people to come to receive their care. Connectivity across settings is a big part of that. We haven’t reached nirvana, but our leaders, staff and physicians are committed to this transformation.”
Susan Birk is a Chicago-based freelance writer specializing in healthcare.