Short-Term Gain, Long-Term Success: Five Takeaways for CIOs from Industry Peers

This article was originally published in Becker’s Hospital Review.

Across the health IT industry, leaders are balancing pressing concerns like increasing call volume and the need to maximize revenue with limited resources. And nice-to-have initiatives just don’t cut it anymore, with those that don’t drive revenue left on the cutting room floor. So how do you balance building for the long term with the pressures you’re managing right now? 

In the webcast Digital Health: On Air, leaders in a variety of roles have shared the challenges they’re facing – and the strategies they use to achieve success in spite of them. Here are some of their takeaways: 

Take an incremental approach 

In healthcare, “change can be very, very challenging,” says Arz Raheem, Sr. Director of Digital Transformation at Montefiore Health System. “[But] I think, after many years, healthcare is open to the change that is needed. And even if that’s iterative, that’s fine.” 

Investing in a large-scale transformation project might be off the table for your organization right now. That’s okay, according to Raheem and Tarun Kapoor, MD, Chief Digital Transformation Officer at Virtua Health. And it can even be an asset. 

“In our hypercompetitive market, speed to impact is worth a lot,” says Kapoor. “And so you have to think about, ‘What is the problem that the consumer is facing in this specific situation? How can I make them successful?’” 

At Virtua Health, Kapoor’s iterative approach created real clinical impact. Realizing that some patients weren’t responding to colonoscopy reminder outreach, he took a step back. “Traditionally, we say, ‘you have a care gap. Come into the office so we can talk to you about this care gap.’ Instead, we said, ‘we know you might not have time to come in right now. Can you do a Cologuard® test at home?” After this more tailored outreach to a specific subset of patients, Virtua Health got thousands of home tests back and found nearly 300 patients with positive results. 

Instead of taking months to work toward a larger project and hit a number of defined milestones, Raheem says, he’s also seen results from an agile approach where projects are smaller-scale and can be expanded later, if they’re successful. An important caveat: “Be brave enough to kill it if there’s no value.” 

Bring varied stakeholders to the table 

So, what’s the most important ingredient in this iterative approach?

“We try and find people from operations; finance; security; compliance and legal; who are open to change, who can be our champions,” says Raheem. “[Then] we can take good ideas from ideation to implementation and make sure that we’re creating value,” he says. 

Gathering this multi-stakeholder group and approaching challenges from this lens requires a culture shift, says Raheem, from the traditional health IT implementation model. 

“Technology has had, in my opinion, a culture of more preservation and maintenance. I say, ‘I’m going to try small things. I think I’m onto something and want to show you what I’ve got.’ But if you don’t have the right support, great ideas will die on the vine.” 

At the same time, this “coalition of the willing” across different areas of expertise is especially important for Raheem, who serves one of the country’s leading academic medical centers, to avoid introducing risk with an agile approach. 

“We’re agile, but we have to be extremely careful about how we implement change and how we’re introducing new technologies because we’re in an environment that is heavily regulated,” he says. So, “if you don’t have that support, then speed to impact doesn’t really happen.” 

Pinpoint your pain points 

Another way to create outsize success? Pinpoint very specific use cases for new technology, like Main Line Health. 

First, Main Line Health identified that their call volume was too high for staff to handle. Having already successfully transitioned to a centralized call center and offloaded some calls to an external resource, they needed another lever to help patients get to the right place without waiting on hold. 

Next, they identified that a majority of incoming calls were to schedule mammograms and DEXA scans. “The largest service line supported by central scheduling is radiology and imaging,” said Noreen Friel, Director of Call Center Operations. “And we’ve been trying to increase access to our digital front door and enable patients to schedule themselves.” With a defined scope of the types of calls they wanted to assist with self-service, they were able to quickly add a call-to-self service workflow for patients that would allow scheduling for mammograms and DEXA scans by SMS if the patient desired. 

Since adding in the self-service option for these types of calls, Main Line Health has saved 900+ hours in a single year while still getting patients what they need. Pointing to the success of the project, Friel says: “We already had self-scheduling, and we kept it pretty simple. So it was implemented very fast.” 

Look for hidden barriers

As your health system is evaluating what’s necessary for the short-term and where to focus for the long term, Elizabeth Woodcock, DrPH, MBA, FACMPE, CPC, founder and executive director of the Patient Access Collaborative, encourages looking for hidden access barriers. 

Hidden barriers, says Woodcock, exist throughout the patient experience and can often be resolved to create more equitable and smooth access to care. These barriers could include:

• All patient outreach in English, at an organization where 20% of patients speak Spanish
• Confusing parking or lack of directions to the right office at a large health system
• Required information, such as address, that prevents patients without that information from completing new patient intake 
• Lack of accommodations such as free parking for patients who can’t afford a parking deck fee 

Better patient access or transformation of the experience doesn’t have to be out of reach if your health system is focused on containing costs through this year and next. Consider low-cost changes that could address these hidden barriers, such as: 

• Having your call center staff who speak Spanish accessible through a bilingual call center line 
• Providing detailed instructions for parking and locating their doctor’s office for patients coming to your facility for the first time 
• Making address or phone number fields optional on electronic new patient forms
• Asking patients if there are accommodations that would make getting in the door for their visits more accessible 

Woodcock says that the number one best tool leaders can have for transforming patient access is to “really, really listen.” And as part of this listening, understand that finding hidden barriers requires more creative thinking than simply consulting patient feedback surveys, as these are often a “biased sample” of only patients who have been reached in the right way and in the right language, Woodcock says. 

Ultimately, Woodcock points out, searching for and addressing hidden barriers is worth it. “Our most vulnerable patients’ voices are not being heard. And because of that, they’re fighting to get in our system.” 

Take a look at cybersecurity basics 

The rising threat of cyberattacks means it’s impossible to focus on iterative, impactful changes without a strong security infrastructure. And the very digital transformation that helps create these changes creates more risk, according to security expert Brent Williams. 

“Healthcare is a target-rich environment,” he says. “Think about the datasets that are out there – it’s really powerful in terms of stealing identities. In the last 10 years, malicious actors have definitely noticed that, as the digital aspect of the healthcare business continues to grow.”

A core component of a secure health system, according to Williams, is a company culture of security. “The term I use is ‘business as usual.’ Security, when it’s done well, should just be part of the fabric of your processes, your technology, your business,” he says. To enable this culture, he recommends: 

• Making secure processes as low-friction as possible so they’re followed consistently.
• Regular staff education 
• Ensuring that everyone knows about your information security and compliance team and brings them in for new vendor evaluations or new hardware 

“It’s the same weaknesses over and over,” like unprotected VPN endpoints or login pages, that lead to significant cyberattacks, says Williams. “So I keep coming back to the basics.” And over time, Williams says, “the team starts to get a bias toward, ‘oh, this is working well.’” 

While the added scrutiny needed for cybersecurity at today’s health systems can be stressful, says Williams, this basic hygiene can protect against costly and disruptive cyberattacks and allow your health system to focus on other impactful initiatives. 

Conclusions 

The CIO is at the center of a number of challenges, from serving more patients with fewer staff to remaining competitive without overspending on expensive digital tools. But amidst these challenges, you’re still responsible for directing your organization toward long-term success. 

The experts featured in season 1 of Digital Health: On Air are creating immediate impact with long-term potential with: 

• Iterative change that avoids devoting long-term resources to projects until they’re proven on a small scale. 
• Multi-department coalitions to ensure that initiatives have the right context and considerations needed to be successful. 
• Technology tweaks targeted at very specific pain points, like individual appointment types that create high call volume. 
• Process changes to solve hidden barriers that might be preventing access to care, driving up ED utilization, or causing frustration and callbacks. 
• Strong security basics to avoid dangerous, time-consuming, and expensive cybersecurity threats. 

If you’re interested in topics like these or would like to hear more from these speakers, follow Digital Health: On Air on Spotify or subscribe for a monthly episode digest.