Chicagoan Tim Zoph has spent decades in healthcare executive leadership, including 21-plus years at Northwestern Memorial Hospital in downtown Chicago, between January 1994 and October 2015, where he served in a few different positions, including CIO and as the chief executive over facilities development for that organization. While he was at the organization, it grew to become a $5 billion academic medical center, and a recognized leader in quality, education and technology. In addition to his CIO role, Tim had management responsibility for the Facility Design and Construction team and Enterprise Project Management Office, where had oversight for designing, building and activating over $1 billion worth in new facility projects.
Zoph is particularly well known among the members of the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) as a long-term faculty member and program director for the CHIME Boot Camp program. He also was one of the CIOs whose insights provided material for Graham Weller's recent book The CIO Edge: Seven Leadership Skills You Need to Drive Results, from Harvard Business Press Books.
This spring, Zoph joined the Naperville, Ill.-based Impact Advisors consulting firm as client executive and strategist. At Impact Advisors, he splits his time almost evenly between working directly with client provider organizations on strategy, development work, new facilities planning, and cybersecurity, and on helping the consulting firm overall with its own strategy and client service direction. He spoke recently with HCI Editor-in-Chief Mark Hagland about his perspectives on where healthcare and healthcare IT are headed these days. Below are excerpts from their interview.
You seem to be enjoying the work you’re doing these days. Tell me a little bit about how you’re dividing your time between direct client consulting and strategizing with the firm.
I’m spending about half of my time working directly with clients, which is great. I’ve got clients in both New York and Seattle. It has to do with where my time can be most valuable in working with clients. It tends to be with larger, academic organizations—the more complex organizations that I’ve worked in, in the industry, capitalizing on that. And when you run big organizations as a senior executive, in some ways, it’s hard to be an individual contributor, because your time is so tight and is so tied into management priorities. So this is a great time for me to have the focus and the thoughtful time to really research and be more reflective about where we’re headed. So I feel like I’m a better individual contributor now than when I was a senior executive, simply because of the challenges of managing those roles.
Looking around at the overall landscape of the industry, it seems clear that U.S. healthcare is at something of an inflection point. I’ve often compared it to the moment during the building of the Transcontinental Railroad when people were having to break ground in the Rocky Mountains, literally in some cases with picks and shovels, to lay track. Does it feel to you as though there is an analogy there with what’s going on in the U.S. healthcare industry now?
Yes, I agree, I would use a lot of the same analogies. We’ve made significant investments in foundational systems in the industry. Yet I still think the industry is challenged to get the most value out of those systems and to make sure that we’re laying those foundations correctly and moving to the next steps. So having simplified, scalable, interoperable systems, is so important to get to the next level. And to me, that next level involves knowledge-based systems, and the population-based systems. How do I aggregate those systems and harvest the knowledge inside those systems? That’s so important. And interoperability involves a combination of challenges facing vendors, CIOs, and the industry as a whole; yet we’re not today still exchanging information at key points in transitions of care, and that’s holding us back. And patients today are still left fundamentally being the messengers. So we have to make the systems simpler, scalable, interoperable, and more easily manageable. So we have to turn the page on that foundational strategy, to get to begin to become knowledge-based.
We need to get to the next level in healthcare, and a lot of that will relate to how we better connect with patients—really engaging patients directly in their health, and engaging them so that they feel that they’re true members of the care team, and are contributing directly to their record. We talk about being patient-centric, but that still leaves us with a very small footprint overall in patients’ lives. And mobility, among other things, will be so important. So we have to take advantage of these foundational technologies, and layer up on them. So not only do we have to scale up, but also scale in, by allowing innovation to occur more organically. And part of that is about technology, but it’s also about collaboration and attitude. And we have to be prepared for that, because it will transform our system as we know it today.
Do you think that the leaders of inpatient organizations fully understand how much things will shift to outpatient over the next decade?
With CMS’s incentives and announcements [recent mandates from the federal Centers for Medicare and Medicaid Services], and the care being based more on outcomes than encounters, it’s clear that that’s a better way to manage health—for many leaders, it still feels like a very long way to get there. You have emerging ACO experience, but it hasn’t reached scale yet. So people see the transition coming, but you need to put the management and leadership structures together to build the systems that will help us move forward. And right now, most organizations just don’t have the information yet to go fully at risk. So you see an evolution. And in many ways, the incentive systems are still built around fee-for-service performance, so you’re seeing some very early evidence that this is going to happen.
And if you look at the Geisingers of the world and others that have had the structures in place already, where they’ve already blended the physician organizations and inpatient organizations together, they’ll move faster than others. In the shorter term, you overestimate the progress, but in the longer term, you underestimate the change. This is one of those where you may well soon get to a tipping point; it will come through changes in leadership and management; incentive models; and information. And those things really need to come together to make their way out of the traditional structures and fully embrace at-risk healthcare.
They’re having to build the care management processes and the data analytics systems at the same time, correct? That seems to be one of the heaviest lifts right now.
Yes, that’s right. And the other piece of this is the whole engagement of the patient. Patients need to become true members of the care team and their contributions and insights need to be valued. And we truly need to be managing with them, and not just managing them. And that is a cultural change.
So how do we get there, in terms of patient engagement, and the cultural change needed to make that engagement possible?
Let me talk about information and trust for a moment. One of the ways in which patients will feel like they’re part of the team is if you share information with them. OpenNotes is one element there. One of the ways you get them to feel like they’re a trusted member of the team is to share information with them more readily. And then they’ll begin to understand that they’re part of the team, because their information will be part of the record, and will travel with them. So you have to culturally be prepared to onboard patients in ways we haven’t done that before. We need to know things like, are patients taking their medications or not? What’s their blood pressure on a given day? And are they exercising as planned? We need to do know the day-to-day trends that occur outside the health system. So part of this is transforming the model of care to fully incorporate the patient and family as part of the care team, and have the trusted information-sharing both ways.
The vendor tools for data analytics and population health are just not there yet: that is what every single patient care executive I’ve interviewed has told me. Your thoughts?
In fairness, in some cases, some of these products are just plain old care coordination tools; and the vendors are trying to figure out how they can build and evolve their solutions. And I’ve been in the industry a long time. I think we feel as providers, and some of this is back on us, too, and perhaps we just haven’t been sophisticated enough consumers. I do think that providers need to be far more declarative about what they need, and the capabilities they need, and actually be directly engaged in the innovation. I don’t believe this is something where you simply sit around and wait for the products to arrive. You simply have to roll up your sleeves and get involved in the development itself. You’re only going to discover what you need by doing it; otherwise, it’s not going to happen.
As I wrote in a recent blog, commenting on a previous commentary that had appeared recently in The New England Journal of Medicine, there are provider organizations beginning to do that kind of development now.
With the consolidation of healthcare delivery in this country, you now have larger, more sophisticated organizations than ever before. Second, we’ve consumed this now ourselves, and paying attention to end-user-based design—we’ve learned some lessons. And we are going to be forced to be innovative, because we’re going to have to scale in, not just scale up. We’re going to have to take advantage of commercially-based technologies from other industries that have worked with their consumers. So I think that innovation is going to have to be a core competency; there’s no other way to get there. Sometimes, you have to fail rapidly to figure out what works and what doesn’t. And you’re going to have to have innovative cultures to develop technological innovation.
So I do think, per the inflection point that we’ve been discussing—that we needed to let the industry (vendors) bring solutions to us, and go through that beauty pageant phase around evaluating functions and features, to get to where we are now, which will demand that we become more declarative. And I think it doesn’t do us anybody any good to say, gee, I don’t like this, don’t like that. But what are we going to do this time around, if we were less than satisfied. So we’ve learned a lot about what works and doesn’t work. But fundamentally, it goes back to those who buy the technology, to make sure the market meets their needs.
Will the “big-box” clinical information systems vendors then respond? They’ve consolidated, too, acquiring smaller EHR and other vendors.
There’s always that fear that there won’t be a competitive edge in the industry. On the ambulatory side, though, we still have a lot of competitors. And if the systems won’t respond, some consolidation is actually healthy. But it’s incumbent on the industry to be far more declarative about what our needs are, and we’re getting to that point where we’ll need to be more demanding consumers, because if our clinicians aren’t satisfied, and if our patients aren’t having confidence about how they engage with us on their health, we’re failing them. So we need to make sure the solutions in the marketplace will enable this really, really important transition in the healthcare system to occur. So we need to be demanding and take on some of this ourselves. I just think we have to be better this time around; we’ve got to be better; and we’ve learned from this rapid deployment. We’ve got to learn and recalibrate.
What is your read of attitudes towards change right now among U.S. healthcare executives and clinicians?
Yes, I do think so. And the caring cultures that we have, and the work that goes on in these healthcare systems every day, despite the high level of regulation and the lack of the most advanced tools, I’m really impressed by the high quality of care they deliver. There’s a lot of stress around dealing with a concomitant set of changes happening at the same time, and it’s a very challenging time in the industry. I do think there’s greater awareness of the need for change. You do see variation. The more sophisticated organizations are way out ahead. I do worry about the organizations that aren’t fully aligned, especially among organizations in rural health. The pace of change is dividing the ends of the system quite rapidly. So part of this is making sure we can provide the quality of care, including specialty and emergency care, that’s going to be needed as we go through these changes. I’m not a health planner, but those with the best leadership and strategic planning, and others are falling behind.
You’re also very involved in consulting on facility development, of course, too.
Yes, and I think we have an amazing opportunity to build the next-generation health facilities that are really smart and adapted and really will give us a significant step up in the environments of care; and technology is a huge part of it, not only in the systems that will go inside it, but in the design itself—the biomedical systems, security systems, communications systems. And thinking about how all those systems integrate and adapt. And thinking about how patients will interact with these buildings; it’s a very interesting time. You can get some of those thoughts out of my blog (LINK). We’re getting much smarter in how we prototype these buildings, in terms of safety and efficiency. So it’s a really exciting time to think about smart buildings in healthcare. I’m working on some project work in Seattle, where we’re using some of these concepts, and some of these concepts, I’m weaving.