Exciting things are happening these days in California healthcare, particularly in the integrated health systems connected to major University of California organizations—the University of California, San Francisco (UCSF), the University of California, Davis (UCD), the University of California, Los Angeles (UCLA), the University of California, Irvine (UCI), and the University of California, San Diego (UCSD).
As part of a broader initiative around strategic planning and strategic coordination among the CEOs and other senior executives at the University of California campuses, the CIOs of the five health systems connected to University of California organizations, have quietly been working together for nearly three years now, to harmonize health IT strategies, drive forward strategic organizational initiatives, and find operational savings where possible, across all five health systems, as they collaborate for the common good.
Recently, six CIOs involved in the initiative sat down for a videoconference interview with Healthcare Informatics Editor-in-Chief Mark Hagland. The six are: Tom Andriola, CIO of the University of California Office of the President, the group’s facilitator; Joe Bengfort, CIO at UCSF Health; Christopher Longhurst, M.D., CIO at UC San Diego Health; Mike Pfeffer, M.D., CIO at UCLA Health; Chuck Podesta, CIO at UC Irvine Health; and Will Showalter, CIO at UC Davis Health. The six healthcare IT leaders have been collaborating on a broad range of areas of effort, including sharing data centers, extending their instances of their common electronic health record solution (from the Verona, Wis.-based Epic Systems Corporation), and working to pool clinical data in a single warehouse, among others. Below are excerpts from the recent group interview.
Who would like to summarize some of the key elements of this important initiative?
Tom Andriola: in response to the challenges in the healthcare industry, we’ve created a coalition allowing five of us and myself to come together, to look at things both at a local level and an enterprise-wide level. We just had a very engaged discussion around data-driven use of analytics for strategy to help us compete at the local level and also at the enterprise level.
Was there a formal mechanism to begin to bring this together?
Andriola: It was our executive leadership that saw there was a lot of benefit to come together to deal with changes in the marketplace, and they launched the program in which we as CIOs could come together.
And what has the timeline been? When might you be able to say this began?
Andriola: We kicked this off in 2014.
Chuck Podesta: My second day here, I attended the first meeting around leveraging value.
Joe Bengfort: So we’re in our third year. Chuck was a new member when he started at UC-Irvine in 2014, Chris was new when he started at UCSD in the fall of 2015, and Will just came in, in the last four months. So we’ve had about 50-60 percent turnover of CIOs since then.
What can you do together, broadly speaking?
Bengfort: Very early on, we mapped opportunities on a two-by-two grid. What are the things that CIOs can do, versus major operational challenges? We mapped our opportunities against that, and said, let’s start on things in the easier, more-in-our-control category. So we started with major spend, and contract development, and consolidation of data centers. We can do that without changing things like formularies or clinical workflow. That’s where we started; now we’re doing things around clinical decision support and the VNA [vendor-neutral archive].
Chris Longhurst, can you share a few thoughts based on your experiences as a clinician leader and former CMIO?
Christopher Longhurst, M.D.: I just joined 18 months ago, and this is my first CIO role. Another tremendous value-add of this group is just sharing best practices. There are five health systems here, and most of these folks bring years of experience, so for me as a first-time CIO, that’s tremendously beneficial. We’re meeting face-to-face on a monthly basis. We’re meeting in Los Angeles right now. And that proximity and closeness generates opportunities. And that floats down; our CTOs are meeting today. Dr. Pfeffer sponsors our CMIO group,. I’m sponsoring our analytics team. So the best practices benefits are great. CISOs as well.
Bengfort: Also being able to trust each other. That’s probably the number-one thing here.
Dr. Pfeffer, could you also speak to your perspective on this with regard to your background as a former CMIO?
Mike Pfeffer, M.D.: Joe and Chris really said it well. And this kind of comes from teaching medical students and residents the importance of role-modeling. We all trust each other and hold each other in high regard. That role-modeling has really trickled down to all the people who work with us on our teams. As Chris has said, the CTOs are successfully meeting. You can’t force people to work together.
Bringing down the collective spend by working together, in other words?
Podesta: Initially, as Joe mentioned, some of the low-hanging fruit. We were able, from a hardware perspective to stratify things from highest to lowest, and we knew storage was a huge cost for us, so we got our CTOs together and our procurement people together, because we all had different contracts, for example with Cisco and IBM and HP, and we were able to move from five contracts to a single contract, and shifting the timing.
And that means working together to develop single contracts whenever possible, correct?
Podesta: Yes. We started right away in 2014, picking off some of our bigger-spend items, and continually go down the list, to see where we can make a difference.
Could you give some kind of metric on the savings?
Bengfort: We do have system-wide contracts. Because of the nature of state-sponsored organizations, those contracts sometimes aren’t the best. But we were able to take another 13 percent off from some of our vendor contracts. So it’s millions of dollars of contracts. And the savings were material to every heath system, not just the high level.
You’re also moving forward on VNA [vendor-neutral archive] development, correct?
Pfeffer: the VNA project is a great example of a pilot where we could try things out at one or two organizations first. The VNA has been a really amazing project; it’s been very collaborative across the sites, and has significant potential.
What has it involved, and can you give me a sense of the timeframe around that project?
Bengfort: We’re nearly a year and a half into that. And when you’re making a decision across five health systems, it takes a little bit of time. You’ve got to get people together and agree to certain parameters, and the implementation takes a little bit longer. But we’ve initiated an RFP, have awarded a contract, and will go live sometime in early 2018.
Did everyone already have a VNA within their individual organizations?
Podesta: At Irvine and San Diego, we had some semblance of it. But the other thing that’s important here is that we had to bring five radiology chairs and their teams together to collaborate on this.
Bengfort: We’ve had to think about areas where collaboration was more or less possible. Radiology was a good one.
Longhurst: And in terms of spend, there are shared data centers now. The two northern systems in one data center together, and the three southern systems in another. We’re also enabling strategic initiatives. And you’ve spoken with Chuck about leveraging their Epic instance. And beyond the cost avoidance, there’s the benefit of collaborating around pop health, and we’re all working towards a single data warehouse for the entire system.
Could you all speak to the challenges and opportunities for CIOs to show leadership, in settings like this one?
Podesta: For me, it’s balancing the local and system priorities, sometimes they’re not aligned.
Andriola: Having been here since the beginning, this group embodies what some have called the genius of the “and.” And having leadership capabilities to balance those things. Collins (Jim?) said that. And also understanding that, maybe this is not where my organization is going. So maybe we’ll let two of our systems come together on a particular initiative or not. That balance of the genius of the “and” is key.
Bengfort: And in Lean methodology, there’s also a saying that’s used: respect the past. We’re not going to force everybody to cut over to a new thingamabob. We have timelines we’re working on, but respect differences.
Pfeffer: Having a common purpose is also important. We’re all at academic medical centers, and we know that every dollar spent on IT potentially takes dollars away from patient care, education, and research—that’s a driving force for us.
How does that iteration of bringing things back to your respective organizations, for affirmation and consensus, work?
Longhurst: The fact that we’re creating a single data warehouse that will aggregate multiple visualizations, including claims data, employee location, etc., should help us to innovate in ways we couldn’t otherwise, and reduce duplicative initiatives.
Pfeffer: Yes, and cultural change is a big part of this. It’s now part of how we do business. The teams wouldn’t think about going out and buying a vendor solution without talking about it together first. And that takes time, but that’s been part of the success.
Joe: And we’ve seen great examples where our teams have been bringing things to us. So we’re having to prioritize all those opportunities.
Will Showalter: And it’s very collaborative among all the teams, and that’s very important.
Podesta: And our CIOs, for example, are collaborating on the NIST cybersecurity standards. So we’re actually lessening the risk across the UCs, in a coordinated fashion, that’s huge; you couldn’t put a dollar figure on that.
Chris: For the readers, takeaway, this is an example of five separate systems with five CIOs and five separate balance sheets, who have found a way to work together collaboratively for the benefit of all.
In the next year or two, could you name two or three things that you expect will be accomplished?
Longhurst: We have a single data warehouse now that’s aggregated some of the data from each site, and we’re using that to begin strategically evaluating our position in the marketplace. So certainly analytics is a huge opportunity in the next 12 months. And Chuck’s site goes live on a shared EMR instance, so we will all be using a single vendor platform.
Bengfort: And also, converging on the computing and storage side of things, there’s a lot of opportunity to converge platforms and that might be within our two-data-center strategy. Both on a purchasing and technology platform point of view. And some of that we may do in the cloud, and in terms of the VNA, we’re piloting some of that now. Also, affiliations and hosting of affiliates on our medical records, that’s very complex from a contractual standpoint, with lots of compliance work.
Could organizations not under a combined governance umbrella work together in this way?
Longhurst: We’re not a true system with a single P&L [profit-and-loss ledger], so this is like a “Star Alliance” kind of arrangement; each organization is still competing in its own local market. So I would say that this is a replicable strategy. But part of what’s been driving this is that our CEOs have been collaborating together, and you really need that to move forward.
Andriola: Yes, I agree. When you’re down at the deeper levels of infrastructure, looking a storage, we’re all looking to go to the cloud. And in those areas, even if you don’t have a legal entity partnership, you could still do things at scale. Things like VNA and EHR are going to be hard, because you have to align clinical processes; but at this technology infrastructure, I think are easy opportunities.
Is there anything anyone would like to add?
Longhurst: I just want to go on record as being humbled to work with this group, and by sharing best practices, and work together. The opportunity is unique. To me, it’s a special time at the University of California, and a pivotal moment.
Bengfort: We’re all overwhelmed with increasing demands and needs, but together, it’s like we coming together bringing special strengths.
Longhurst: It’s true, it’s like everyone at the table brings a special super-hero power.
Podesta: We also actually genuinely like each other, that helps a lot.
Bengfort: And you’ve got to be willing to talk the tough stuff, and we’ve been doing that.
Podesta: Chris calls it “being willing to throw fish on the table.”
Bengfort: If people aren’t willing to talk frankly with each other, you start to lose trust. So we just call each other out, in a respectful way. You’ve got to have that truth-telling, and that respect—and then it all works.