Big Healthcare IT Transitions Deliver ROI and Physician Satisfaction

Sobol: Welcome to the CereCore podcast where we focus on the intersection of healthcare and IT, from practical conversations to strategic thought leadership. Let's unpack the decisions, challenges, and journey of those whose purpose is to deliver technology that improves healthcare in their communities. 

Sobol: Today, we have Rick Keller joining us as a guest for the podcast. Rick is the senior vice president and chief information officer at Ardent Health Services based in Nashville, Tennessee. 

Welcome Rick, it's been wonderful knowing and working with you for now a number of years and really look forward to our conversation. So, thanks for joining the podcast. 

Keller: Thanks Phil, appreciate it.  

Sobol: Let's start off with a little bit about yourself. I know that you've been in healthcare for a few years now, won't really get into the exact number of decades. If you would just maybe take us through a little bit about your career and then touch a little bit on Ardent Health itself and your role there. 

Keller: Thank you. Yes, I've been in IT, for a little while you might say. Thinking back, I think, really deciding on a career in computers and technology, while in college, where I changed from an engineering and architecture start was really, I think pivotal, where I sit today as you can imagine. The first half of my career was really spent with the financial services industry in IT. And so, learned a lot of valuable lessons in that area that I think I really brought forward to healthcare IT.  

The watershed moment for me really is when I joined Ardent over 14 years ago. It has been very challenging in different ways than the first half of my career, but it's been very rewarding. As we work in healthcare, it just really gives you a sense of purpose and when you're helping others care for patients. I've really enjoyed the time that I've been in this role and at Ardent in particular. 

Sobol: That's excellent. You certainly make mention of the fact that everything that we do in IT, it has a direct correlation to that patient care. And I think back to when we first started working together back in 2016, Ardent was going through a large Epic implementation and was looking for an organization to help them with legacy support so you could sort of transition some of those people over to the Epic project.  

In thinking about those sorts of large investments really that an organization makes—so many times, you have to wonder why are you doing it? Right, why are we making that investment? What do we hope to gain out of that? And I think you touched on a little bit, right? 

Ultimately, it's that efficiency, satisfaction for physicians, nurses, clinicians, and ultimately better patient care from an outcomes perspective. 

Maybe talk a little bit about what your approach has been to quantify that process and measuring it on a go forward basis as an organization. 

Keller: Sure, we all know or most of us find out measuring ROI for an EHR implementation in particular when you are replacing legacy systems in our case. In 2016, we had to make a decision because one of our core applications, and EMRs we were using had a sunset date that was set upon us. So, we needed to make a decision, and it was really pivotal for the organization, because we had to get it right. 

And we did a little bit of due diligence when we looked at a cost model that we were putting together. Epic really seemed to fit what our needs were and what our growth and strategy was. Aside from reductions and maintenance of legacy systems that can get displaced, and in our case, we were able to reduce our application portfolio by over 100 applications. 

We were able to pick up a return in the net of our new Epic maintenance, versus all the maintenance from four to five different EMRs that were in use in the enterprise. 

Those are some hard types of returns that do have a limited lifespan because once all of that run out is accomplished. Then we started to look in other areas that were not as hard dollar savings in a sense. But we found physician recruitment increased because most of the medical schools in their education— physicians are educated on Epic. 

They would look to go to organizations that were deploying or using Epic. So, we've really been able to maintain a high caliber, highly efficient physician and clinician workforce. I think the other area that we've looked at is our ability to collect cash more quickly. The days to collect really increased with our use of Epic and the EMR.  

Also, an area that we measure is our clinic throughput, and physicians how quickly can they see patients, how quickly can they move throughout their day, and the efficiency of having one patient one record that you can see between the clinic and a hospital setting.  

Over the last two to three years, we've really started to invest in some of the technology around MyChart for patients. We've had an initiative over the last 12 months that came from our CEO. It is called: we need to ban the clipboard. We need to get rid of paper forms for registration and problem list and other things. So, we've had significant improvement in that where we have gone year over year in the last two years is an increase of well over 500,000 submissions of online questionnaires previous the appointment.  

We're almost 30% now of online payments via MyChart application or mobile application. We're seeing the elimination of some of that in the registration setting—use of paper where it really, as we all know, as we are patients at some point in time—you feel like you fill out the same information. Allergic to sulfa. I tell you every time. 

Sobol: Exactly. 

Keller: That's some of the ways that we're beginning to measure some real efficiencies and hard dollar savings and elimination of expense. 

Sobol: That's fantastic. I think you hit the nail on the head when it comes to just all the different areas that go into those. All the different measurements: from hard measurements, from an ROI perspective to soft measurements, to workflow to satisfaction, because it all plays a part in those decisions, whether it be a large EMR roll out or other projects. That makes great sense. 

We certainly do a lot of work with you in and around the help desk and so I wanted to ask you a little bit about that. When you partner with an organization to provide support, it could be a daunting proposition for IT leaders and organizations. 

Certainly, there's a lot of factors that go into that decision. If you would just share with our audience a little bit about it, how did the timing was right? How did you come to the conclusion that the partnership was right? 

Keller: Certainly, thinking back to 2016 timeframe happens to coincide with the Epic implementation that we were starting to embark on. And, we had our own in-house help desk. It had averaged from 10 to 18 to 20 help desk analysts. We really stepped back and looked at the cost of managing your own helpdesk.  

Once you set aside one of the biggest obstacles, which is a loss of control. Once you can resolve yourself to—well, let's put a partnership together where we still have equal control. A help desk is not a core competency of our IT organization. We realized it was hard to recruit, it was hard to retain, and our service wasn't stellar to begin with as we started to grow.  

So, that was a key point for us is to first acknowledge—this isn't what we do best. Let's find someone who does. Having the advantage of being in Nashville and such a deep knowledge base of services and companies. We looked at and were working with you guys already doing, as you mentioned, some of our legacy support. 

Then, we looked at—why don't we try to build something together around help desk and Epic and different things. I think that's key to look for a partnership that you can grow together with, that you look for someone who helps improve your services, not just deliver it. And that's where I think our partnership has been so successful. 

We've been able to add in more than just answering the phone and pushing the ticket somewhere. Over this time, we have grown to where we share in the first call resolution metrics and satisfaction for our clinicians and users. So, I think once you decide that it's something you really don't do that good at find somebody who really does and then just work together. 

Sobol: You threw out a term that a lot of organizations use. Right? And that's this concept of partnership. Sometimes it gets overused, and I've talked to a lot of CIOs that are very jaded when it comes to that word.  

However, I do think when it actually is a true partnership, as you mentioned, it's a shared responsibility and that lack of control doesn't exist. It's not that you're just pitching something over the fence and saying good luck. 

It truly is we're going to bring together two organizations and work together for that common goal and need. If that's the mindset, like you mentioned, then success will follow. When we partnered with you, we certainly have worked through the years, added a lot of metrics and things along those lines. 

When you see it from a help desk perspective, you see a lot. Right? And as that gets documented and the teams work together, there is a lot of analysis that comes out of that.  

Can you think back over the past couple of years—have there been any of those “aha” moments where suddenly all of the data that came out of that relationship went, “Ooh, yeah,” maybe there is an area of focus here that we need to have. Maybe there's something else that we can be doing as an organization to increase the level of knowledge or understanding, whether it be in a physician group or clinicians or whatever. 

Keller: I mentioned first call resolution and really our partnership as we work together to minimize and reduce the number of password resets. Those things that are blocking and tackling, they are almost the same thing every time. How do we not just handle it very quickly but how do we eliminate the need for it.  

Working with some of the metrics, we've been able to track, and we've been able to see as we work together to implement things. As we've matured, we now have our passwords expire after 12 months. It is a more complex password. But when the password is used over and over, you remember it, it is complex, it may not be compromised, but that has reduced the number of calls that come to our service desk that need a password reset.  

Implementing newer technology as we measured, for example, in our UT East Texas market, where we had hundreds and thousands of calls when the user's ID or password had a lock, and it was locked out. Well, it was due to aging hardware.  

So, working with CereCore helped us measure how many they were getting of these. We have been able to measure implementing newer PC technology due to Epic and our workstations and endpoints. We eliminated these ghosts in the machines that kept locking out a user. 

So, it's the ability, I think, to measure the impact and look for root cause, and then measure the improvements that we couldn't do on our own. And wouldn't have the ability to invest in those types of tools that show those metrics and measurements. 

Sobol: Great example. I want to pivot for the last couple of topics more to some industry trends. Before pandemic, Ardent was already taking advantage of telemedicine and you've made mention of the work that you all were doing with the Epic MyChart and the patient portal.  

I'd love to get your take and perspective on the future. We did telemedicine. It was really important during the pandemic. What does it look like now? What's that patient engagement going to start looking like now, from a patient portal standpoint—whether it be Epic MyChart, or another patient portal? Whatever it might be for organizations, where do you see that consumerism drive or that whole concept of leveraging that portal in more meaningful ways, going over the next, say, three to five years?  

Keller: Certainly, certainly. I will give you a little bit of our journey and our path. Pre- pandemic we were doing a lot of planning for telemedicine. We were stuck in the planning. Will they really use it? Will we get reimbursed? Will it be a true service? And so, we were able to leverage that planning, though, right when the pandemic hit, and we stood up the ability for televisits and video visits in what felt like overnight. And that has continued to mature. 

And again, whenever I start to talk about these things, Epic is such a great platform to build on because you do have offerings embedded within it as you all know having support some of the Epic hospitals in your ecosystem. You can just build upon that. It's seamless through the different tools. So, it doesn't feel like you're jumping out and adding into something else. And that leads me into really where our organization along with others are.  

There's a lot of disruptors that want to get into healthcare and start to provide what they really have very sophisticated consumer type applications or offerings, but what's really difficult is how hard and complex healthcare is.  

We've got that part down. We've been doing that. We're now looking at trying to meet the patient where and how they want and need care. So many things you can do on your cell phone, your iPad, at your home computer, laptop, if you will. People don't want to make a call to the office of their primary care physician and be told in three weeks we can get you in.  

Life just doesn't move that way. 

We're trying to move as fast as life for our patients and create the connection to them long term by providing ways to schedule online. As I mentioned, fill out questionnaires online, find a care setting that meets what they need—if it be an urgent care before having to go to the hospital. 

We're really trying to create an environment to where they can find a provider that they trust, find their locations that are easy. Get in and out and not have to navigate through a myriad of processes and just streamline the experience as quickly as we can. And then build the affinity with our patients. So, when they come back—we know that they've been with us before, and we can then have a lot of information that we tell them about. 

And then they're going “oh, you remember me.” So, it's really simply creating a way for the patients to be seen, where they want to be seen, and how they want to be seen, because somebody's going to do it. 

Sobol: You're absolutely right. That whole concept of being known is comforting. Particularly as you're going through, whether it be chronic or just individual episodes. So, it's important and I love hearing and your perspective. You made mention of it—healthcare is complex. It is crazy and rapidly evolving, ever changing. The past few years have really shed light on that, and it's one of those industries that passion of helping others and solving problems is just their day in and day out. But it is a rapid pace. 

So, what I'd love to hear from you is just a little perspective, how do you keep up with that pace? How do you keep up with all the things that are happening? Staying in tune so that you as the IT leader of Ardent can be there from a strategic standpoint, helping the organization kind of see what's on the horizon and how they might leverage technology to address those needs, not only today, but also of the future. So, maybe there are some publications, things that you look at or things that you subscribe to, or things that you do that to grow that knowledge base, not only personally or professionally, but the audience would also be interested in tapping into. 

Keller: Certainly, I don't think I have really anything that novel from sources if you will. But what I think, we sometimes lose sight of or don't carve out is building that margin of time in your day to read and just research. Our profession, our career is constantly changing as you mentioned. You have to be a life learner. I try to look at CIO information that's online, whether it be in Modern Healthcare or other places.  

But also, bringing it closer—the last couple of years, I joined Inspire CIO, a Tennessee CIO-based network of my peers that is cross industry. And that's what I think is so important about this one. I have a CIO friend now and colleague who is CIO Nissan, here in Nashville. 

We have some core infrastructure things that are very similar. I meet and go to lunch with other CIOs here in town and we commiserate. There's no competitive advantage that we could share. Otherwise, somebody may think, what are those three doing together? Somebody going to buy somebody? But we just really share the struggles and challenges and successes that we have. CHIME is another place—the Fall Forums and things where even partners like yourselves meet up at. 

I think sharing cross industry as well as things that are working for us within healthcare helps me stay abreast and try to keep pace. And then not only are going to our user group meetings in and around Epic and other major partners in technology where we tell them our problems and they go off and build solutions or directions that we can hopefully meet up with and marry up with at some point.  

Sobol: That’s a great point. I think what we've been hearing from a lot of leaders like yourselves over the past couple of years is kind of that move away from everything operations—into wait a minute, I need to be that strategic leader. 

At the same point, how do I get there? I get there through that taking that time to learn, taking that time to network, taking that time. I think this is something that's now beginning to gain momentum is that I'm going to look outside of the industry. 

I love that. You've brought that up and made mention of it because there are things that other industries have done. For a couple of years, those have been relatively new concepts in the healthcare market. Whether it be, it's just a different progression, different needs structure—whatever it might be. I think you're spot on with that. You've got to take the time; you've got to have that discipline and then it's got to be comprehensive in nature. I certainly love that approach. 

I'd love to wrap up with—and this is something that we've been really focusing on with healthcare leaders. Not only in the IT side of things, but also from the board level down through the CEOs, COOs, CMIOs, but also CFOs—and that's that whole concept of just team. Right? So, in the concept of you as a leadership group, buying into the same strategy. I'd love to hear just a little bit about how you see that playing out in your everyday life. 

How do you get on the same page with your clinical leadership? How do you get on the same page and communicate effectively with a CFO? They speak a completely different language than IT and sometimes that translation is a little bit of a challenge. But it's critical when you're all trying to achieve that strategic initiative. I'd love to hear just a little bit about how you do that. How do you have that balancing act? What does a successful relationship between all those entities look like for you? 

Keller: For us and some of your listeners may know, we've gone through an executive leadership change over the last two and a half years. As part of that, we've had to establish those new relationships and working relationships and we really just have tried to focus on communication and alignment.  

For me, everyone is my customer. When I approach it that way, I have to manage and communicate out. Because up is one way. But really, managing and communicating out is more successful. In that we need full transparency of what is going on in the IT&S organization—from our budgets, from our strategic direction, from the normal things that help keep operations running that then create margin for us to try to do innovative things that hopefully will move us towards those goals that we talked about earlier.  

I think just creating lists of things that we're working on and pairing them up to the executive owners and stakeholders. So, they know. That also helps all of the senior leaders in the organization know what they're working on and how it fits into somebody else's. And if it's slowing down, understand well, it's because we had to focus on this objective over here, then we'll get to that piece of it. 

I think that's just an approach that we've taken, trying to communicate and meet monthly as a senior leadership team across the entire enterprise with over 24 people coming together, monthly to share information and as well as just update each other on how the organization is working. I think you measure success by the lack of surprises. You don't want to surprise any of our executive leadership teams or others. 

Sobol: Right. 

Keller: Especially in our world, if we're pushing something out into the enterprise for security reasons, or for other reasons. The last thing we want is to generate a bunch of calls to our service desk or a bunch of information or a “what is that?” So, communicating ahead of time. No surprises is one of our key measurements of success. 

Sobol: I think that's brilliant. I love your concept of communicating and managing out. So many times, people talk about managing up and down. 

I think you are the first one that I've heard mention managing out and I love that. That's a great takeaway and perspective. Rick, we really appreciate it. So, as we wrap up, certainly appreciate your time today, appreciate the partnership that we've had.  

Are there any last thoughts that have kind of come to mind as we've been having this conversation that you would love to share with your colleagues who may be listening to this podcast? 

Keller: One of the things that just quickly comes to mind is: you can imitate to innovate. I didn't come up with that on my own. This is something Epic and their team share with us. If you're going back to that life learner, you're looking at things—you don't have to come up with “It's never been done before.” Because it's new to our organization, but somebody else did it, it's still innovative for us.  

Sobol: That's a great point. Rick, again, thank you so much appreciate your insights and look forward to many more years to come.  

Keller: Thank you. And thank you for thinking of me to do this. I appreciate it.  

Sobol: Thanks for listening to the CereCore podcast. If you like this conversation, check out our other episodes visit us at CereCore.net to learn more about our IT services and connect with us on LinkedIn.  

At CereCore, we are healthcare operators at heart and know the difference that the right IT partner can make in delivering quality patient care 24/7. Let’s help make IT better. Here’s to the journey.