Fostering a Culture of Innovation and Growth

Phil Sobol: Today, Shahzad Fakhar joins us on the CereCore Podcast. Shahzad is a healthcare technology and executive operations leader with HCA Healthcare and serves as vice president of field operations within the information technology group.

Well, Shahzad, thank you so much for agreeing to participate in our CereCore podcast. We look forward to learning a little bit from you today, to hear all about your journey, and some of your insights. So, thank you for being here with us today.

Shahzad Fakhar: Hey Phil, thank you for inviting me and I look forward to the conversation.

Sobol: Wonderful, well, we always like to start out with just a little bit about you and your journey as a healthcare leader. So, you have witnessed tremendous change in the industry over the tenure of your career. And I know you have really seen some dramatic changes in growth at HCA as well. And so, if you could maybe just share a little bit about what that journey's been like for you.

Fakhar: Sure, exactly right tremendous journey of 33 years in healthcare IT. And when I stepped into it, I did not know how much change was in front of us. Over the years, I have had the opportunity to work at a 90-bed hospital, to a 700-bed hospital, and serving multiple divisions in five different marketplaces.

So, needless to say I have seen healthcare from a small, rural 90 bed facility, and the influx of technology which has impacted the 90-bed facility to a transition into the 700-bed facility, specialty care, more metropolitan market driven. Then also fortunate to experience how healthcare gets delivered in the communities itself and how the technology has impacted the collaboration between the community healthcare settings, and more of an enterprise setting across the nation.

So, yes, it definitely has been an evolution in some cases and some bar has been ready to evolutionary also to bring the healthcare together.

Sobol: That perspective of being so close to the community and then working your way up to a corporate role really gives you a fantastic perspective on what we all try to achieve on a day in and day out basis. Which is where the rubber meets the road with healthcare, which is not always at the corporate level, but in many instances, it is at that bedside community level. So, you bring that wonderful perspective. Throughout your tenure, I am sure you have seen just a tremendous amount of innovation that is taking place in the marketplace, and just in healthcare in general.

So, maybe share with our audience a little bit about your philosophy on innovation. What encourages you or others around you to bring that innovation forward in the health care setting.

Fakhar: So first, and foremost, healthcare IT is always evolving. And there is a definite need of constantly defining the new normal, as you say, is majority of it in the past has been that we have been driving it internally, but there's a lot of external pressures now, which are driving to. So we have to balance that out. And I think the desire of innovation comes internally to make things better in the way we perform them, but externally to deliver better care for the care providers and for our patients also. 

So, there is a new normal we get defined based on a lot of circumstances that are not in our control and we have to adjust to that, and innovation plays a big part in us making those adjustments.

And if you are not continuously making the change and innovating, it is really difficult to keep up with the pace and the request. And some of that has to do with overarching consumerization in healthcare also.

So, the desire comes from multiple different factors: information, the way we process information, the way we look at the outcomes we deliver through health care, and also the impact we provide in our communities on the overall health of the community. All these things are pressuring us to innovate in all different areas, not just pure care, but the way we communicate that care also. And the way we collaborate within our own facilities, but external to our facilities at the same time.

So, we have to be cognizant of the fact that we have to always think about the way we did the work yesterday, it is not the way that we are going to perform the work tomorrow.

And if that is the case, what are the innovative ways of doing the work for tomorrow? And it typically addresses today's problems, but it should also extend into helping us or building on resolving tomorrow's problems which typically are not clear to us because the environment hasn't changed.

And if it changes, how should we react? It should build up on what we have learned during the work we did yesterday. So there's a lot of different ways of approaching, but it's a constant innovation which is needed to make sure we are looking at the work at all different levels. 

Sobol: You made some great points there Shazad, and I think you hit on a couple of things. One, is kind of laying that foundation for innovation and that consistent innovation that you can build off of regardless of where you must pivot.

So, there is a flip side to innovation and that is just being static. And there are certainly consequences that go along with that. And I think sometimes organizations get to that static state, because they are unsure of the future. And so, I appreciate what you said about laying that foundation so that it is always there so that you can take advantage.

Fakhar: Yeah, some of the innovation requires not just solving a problem, but also investing in being prepared to solve the problem. It could come from tooling, which is required to say what kind of innovation is required. Meaning, what type of effort is needed, then staff, and sometimes the bigger initiatives. Some challenges require some dedicated teams to focus on innovating because you have to really figure out where you start and how you can build up on it. And you have got to have people who have been involved and have done innovation at all various problem effort levels, who can think through that. So, sometimes the more mature your process becomes, the more dedicated you must get to the tooling and the staffing. 

Sobol: Right, that makes great sense. And you mentioned a little bit about some of the consumerism, certainly with caregivers, patients, and their expectations 10 years ago, 15 years ago are radically different than they are today.

And, as you mentioned, IT is continuing to change on a day-in- and day-out basis. Looking at the future, what are some of those big areas of opportunity for innovation that you see today and what organizations need to be paying attention to.

Fakhar: Definitely, a lot to be done in patient care documentation. I think that is front and center of accumulating information and then digesting it presenting it back to all different stakeholders in the mix. So, what does it mean to the caregiver and the documentation provide insights from one caregiver to another. So, it is very critical that we do an efficient job of documenting the care. So, it can carry the patient to different care settings, but also provide a lot more comprehensive longitudinal record of their care, which caregivers can look and compare to and make clinical decisions on.  

I think it is also the patient itself is a very well-educated patient within this new consumer world. So, what does it mean to them? For them, it is providing their care episode information in more meaningful and easy to digest way. Whether it could be providing them dashboards from their one visit to another, or whether it could be the detailed reporting that they can read through on their own. But the accessibility of information is critical also for them. So, the documentation leads into how you keep the consumer, or the patient informed of their journey in the mix also.

At HCA we are investing a lot on modernizing our EHR system to make this very efficient process in documenting. So we have invested in Meditech Expanse, and CereCore is our critical partner in this journey, and we will lead into our first markets going live in January. Which will take us through our next markets in North Florida going live by the end of the year. And hopefully by then, we have a desired schedule for the rest of the enterprise to move into the Expanse world and those are kind of investments.

But documentation takes it so far, and I think innovation also leads into the automation of these back-end processes. And some of these key processes, which require automation, we have done great, but we got a lot more to do. Leading into it, such as patient billing, scheduling patients efficiently in a timely basis from all different care settings. Patient communications -- how do we inform them and keep them connected to all their care episodes and scheduling. As I mentioned, we collect a lot of data in that patient care settings. How can we present that information and analytics around them back to the patients and the care providers. What are the key success criteria that we can present to make the efficient, timely, and impactful decisions in their care. I think all those things lead us to saying is, hey, prevention, what are we doing in the prevention? Because it is important to the care givers and then to the patients also. The AI applications, which we are leveraging these days, to just prevent medical errors, and then kind of demand forecasting for our own staffing really provide better care for our patients.

All these things lead into, or part of the big automation efforts and they really play together in their various areas very well. So, I think that leads to a lot of different areas of automation and innovation, kind of serving each other hand in hand.

Sobol: Yes, you have mentioned an awful lot and I certainly think people that are listening might not be part of large enterprise systems, even mid-sized systems, etcetera are going to go, holy cow, that is a lot, and there is only a handful of us, and only a handful of me. And so, you have heard that whole phrase saying that the whole is greater than the sum of the parts. And it is certainly not something that IT or a certain individual can tackle or do together.

You are in the unique position of being part of a large organization that spans, continents, including the United States and the UK.

Right? So maybe talk a little bit, maybe about just the kind of the collaboration that is required to execute on some of the things that you talked about, not only internally right because you have got many different stakeholders across the enterprise, but also externally with the partners, folks outside of the industry, that might even be bringing new ideas or fresh perspectives.

Fakhar: So, one of the first things you got to tackle in this collaboration is the silos, which are inherent, and they are non-intentional, but they do happen. So, how do you identify the silos and try to bring folks together to collaborate? 

Whether they are internal or external, you are going to run into both the types of silos in the mix. So, let's talk about internally -- the processes itself, the workflows -- require a lot of collaboration and sharing in the mix. So you got to first start internally figuring out where the silos are, and how you can approach them. And what are the values they provide by breaking the silos and working across. Service lines. I think another way of looking at the silos is the service lines get very narrow in the workflow, and the patient can need multiple service line help in their care journey. How do you make that seamless for them not to navigate, but facilitate navigating through better communication, better coordination of care in all different settings play a big role in that?

Let's talk about external. How can you leverage partnerships which typically don't are visible in healthcare settings, but can be leveraged across like big Google platforms? Can they leverage us in processing information and presenting information and the insight in a different way?

Partnership with Meditech on the platforms. I mean, as we are deploying Expanse, we are definitely looking at opportunities of creating insights for our own clinicians. How do they utilize the systems? And if they provide us the insights to help them most probably do things differently, organize workflows differently to be more efficient. Having those insights go a long way of most probably changing behaviors and breaking silos and reaching out and sharing a lot more information in care settings.

And then, you know, you always have to go and compare with external healthcare entities. I leverage quite a bit CHIME’s work effort. I am part of CHIME itself. HIMSS brings a lot of value in the mix also. And then, everybody's looking at healthcare from a technological perspective, their own way of delivering it. And there are some learnings to be done when you look at consumer space and say how healthcare is getting delivered. Needless to say, COVID has changed the paradigm, the way we think, the way we connect, and we talk about it a lot. Since COVID we are doing things differently and nobody wants to go back but go forward.

And what they go forward means is really thinking out of the box in the collaboration space, and finding partners, which typically have not been in healthcare. And we will see more and more of these partnerships.

But it all starts with having an open mind about doing things differently and having a good ear to listen to. What we are trying to solve upfront. And I think it is just how you approach different problems when you have different partners in the mix.

Sobol: I agree and I am glad you brought up COVID, we have heard time and time again, across the industry, and certainly, I believe HCA was no exception. It was a unique challenge for organizations, and it broke down a lot of silos, a lot of processes, very quickly as folks kind of reacted to this new normal.

I think, in some ways, it was a challenge but it allowed us to say, okay, how do we do things differently? How do we do things faster? How do we move things down the path?

And collaboration is key to that. So, you know, are there some of those areas where, you know, HCA took a look and took a different approach as a result of COVID from an innovation perspective that have now kind of become I don't know if I would call it the gold standard, but kind of the new norm as you described it? So whether it be in process or in ways that we, you know, that HCA kind of delivers care.

Fakhar: Well, just like everybody else we had to pivot and figure out what it means to us and where the needs are. So you are exactly right, everybody had to think on their feet and assess what information we had and where it's needed. So yeah, at HCA, we did pivot it in a lot of different areas based on the needs. First of the big adjustment, we have the information. Now, what is the need for the information? And how it could be presented.

So, NATE is a tool which was generated and was developed internally, and it all focuses on the analytics for the treatment and efficiency. That is what NATE stands for. We created different views based on the need from NATE itself. And we start doing analytics on the information and presenting it to the clinicians in a timely fashion to react on and really focusing on COVID itself, what COVID protocols were in the mix, and how the patients need to be treated based on the information we were collecting at a very fast pace. Every bed in the HCA Healthcare system was being assessed to say how it could be leveraged for COVID patients.

Sobol: Right.

Fakhar: So, we had to make all this information available to our clinical resources so we can optimize the resources and any other clinical protocols to be leveraged. Another example is the COVID ARDS, which is acute respiratory distress syndrome, that just the clinical protocol around that to make them accessible to all the intensivists, the therapists, nurses and ability to monitor these patients closely, who are going through these protocols.

It was like, how quickly you can analyze the information and present it back in a timely fashion. And then, it happened over and over again. The information is always there. And sometimes you just have to innovate the way you present the information itself and make it more relevant and make it more dynamic to be able to for the clinicians to respond to.

Sobol: Sure.

Fakhar: So, NATE served as a great tool, which has more demands coming for it to be responsive too and we changed views just to be more responsive in that, providing the information on a timely basis.

The vaccine management became a bigger initiative. I mean, we never had a different way of providing the vaccinations and tracking them, but the COVID vaccinations created its own challenge at the last minute. We used Pega as a tool to create the vaccine management across the enterprise and being able to deploy it in 60 days across all functional areas in the organization. And that was an iteration also, needless to say, week one was difficult, week two got better, week three got excellent, and week four it was a running machine across the enterprise.

So, you just work through the challenges and become very innovative and addressing those challenges in a short period of time and theInre is a lot of team members would need to be commended on responding in a very short timeline to address these needs

Sobol: Certainly, and I know HCA is no exception, and we saw it across our client base as well. IT organizations just really stepped up. And I think COVID re-emphasized the focus that we all know is there. Right?

That what we are doing is not just IT, but what we truly are doing is transformational in the delivery of health care. And I believe COVID was a refresher for some IT organizations to really bring it again to the forefront in a critical and urgent fashion. And I got to tell you seeing and hearing what you and your team have done and some of our clients have done -- it's been exceptional.

One of the reasons why I think so many of us have chosen healthcare IT is that chosen path because it is very different from IT in manufacturing or distribution or anywhere else where widgets are widgets, and this is people. And there is something different about that mission for sure.

Fakhar: Exactly, I think that one of the most exciting parts is that this is not a healthcare IT is not a boring space. There are plenty of challenges. And if you are the type who, likes to be involved in solving problems and dealing with a challenging environment then healthcare IT is for you. But it is a mission you sign up for. And it keeps you thinking on your feet to think through the next problem. 

What COVID did was we most probably were always trying to catch up with the next problem. What COVID has done is made us think about the next problem and trying to be prepared for it. So, it is making it a little bit more proactive thinking about what the next problem could be and getting ready for it. It's making us very adaptable also with the same or different constraints to be more responsive. Healthcare IT -- we never thought we could do it remotely. Right? So, we are doing a lot of this remotely by leveraging the technologies.

Telehealth is a great example of that innovation. I mean, needless to say it has been there, but the adoption of telehealth required some innovation. How do we make it happen on such a large scale in a short period of time? And that was pretty much determined from the pandemic nature of it. So, the post-pandemic, we are still looking at the next problems and we are still focusing on the next challenges ahead of us and trying to bring innovation front and center to help us tackle them. And I think that is what we need to keep moving forward. 

Sobol: Agreed. Well, I certainly appreciate your insights today. We always wrap up these sessions with almost just an open-ended question, and it is what advice do you have for others in IT, from a healthcare perspective? Any lessons learned or what are some of those top couple of items that we talk about such as innovation or what they should be looking at thinking at to set themselves up for success in the future? What are maybe a couple of those just golden nuggets that you might have to share with the rest of the viewing audience?

Fakhar: I think one thing I keep in front of me all the time is staying attuned to your customers, the clinicians, and the patients. They attribute their experiences with us to what they experience in their life with other conveniences and how can you be innovative in making sure you are delivering at the same level where they get other things done for example, banking and day-to-day activities. Healthcare needs to be a part of that fit into their normal routine of how things get done.

Second, I advice is think of what they will be asking for next. And it's all about an experience. A care setting experience is all about, can I take them from one setting to another without having them to struggle through it? Can I schedule something for them? Can I inform them? Can I fill the gap by getting their medications there before they get there? All these conveniences are critical for us to making the connections in our business. And third and most probably important is just always a constant change and be open to it and be receptive to it. And just mature through it. You don't get to the perfection or at least close to the perfection in the first attempt. It's a journey. And you have to go through it. But be open to it. That's a step one before you can mature through it. 

Sobol: Yes, great insights. Well, thank you so much for your time today and your perspective. And I know that it will be well received. And so, thank you again, and we appreciate it.

Fakhar: Well, thank you for the time.