The New Normal and the Healthcare IT Organization

The New Normal and the Healthcare IT Organization
John Glaser, PhD, Board Member, Scottsdale Institute
Chuck Appleby, Director of Publications & Communications, Scottsdale Institute

“This is not the end. It is not even the beginning of the end. But it is, perhaps, the
end of the beginning.” Winston Churchill

Even Winston Churchill’s famous quote at a turning point in World War II is likely too optimistic
for this moment in the COVID-19 pandemic. Given the lack of widespread testing, a resulting
lack of data on the virus’ prevalence and the prospect of at least a year before a vaccine or
treatment arrive, it’s difficult to locate ourselves in this crisis. Dr. Michael Olsterholm, director
of the University of Minnesota’s Center for Infectious Disease Research and Policy, may have
put it best in a recent PBS interview: “We’re in the second inning of a nine-inning game.”

Still, while its form is unclear, we can begin to visualize a post-COVID new normal for
healthcare, shaped by factors ranging from fear about the safety of care at hospitals to the
gradual recovery of a decimated economy.

The Scottsdale Institute1 recently convened chief information officers from nearly 20 SI-
member organizations2, all U.S. health systems advanced in information technology, to envision
this new normal3. The CIOs discussed their perceptions of the new normal for the information

1
  The Scottsdale Institute (SI) is a not-for-profit membership organization of prominent healthcare systems whose
goal is to support our members as they move forward to achieve clinical integration and transformation through
information technology. SI facilitates knowledge sharing by providing intimate and informal forums that embrace
SI’s three pillars of collaboration, education and networking.

SI members are 50 advanced, not-for-profit health systems and academic medical centers committed to sharing
best practices. Senior executives such as CEOs, CMOs, CIOs, CMIOs and CQOs cultivate relationships while their
organizations collaborate on IT-enabled performance improvement. Unlike many large-scale national
organizations, we keep SI activities at a scale that facilitates group interaction and collaboration.
2
 AdventHealth, Atrium Health, Baptist Health,Bon Secours Mercy Health, Bronson Healthcare, Centura Health,
CHRISTUS Health, Indiana University Health, Memorial Health System, Michigan Medicine, SCL Health, Sharp
HealthCare, Stanford Medicine, Stanford Children’s Hospital, Tampa General Hospital, The University of Texas
System, University Hospitals, Virginia Mason Medical Center.

3
  Whether the phases of the COVID-19 pandemic are called crisis, intermediate and new normal or response,
recovery and re-imagine, many observers view it in three logical phases, the final being the “new normal” marked
by new ways of communicating, working, transacting business and delivering care.

technology organization, portfolio and operating characteristics. How will COVID change
information technology in health systems?

The COVID-19 pandemic changes every day and so does health system planning and response.
However, based on the CIO discussion, we project eight characteristics will emerge as lasting
features in the post-COVID world. The following is a snapshot of that discussion highlighted by
quotes, which participants preferred kept anonymous.

Governance and decision making

Health system decision making is often complex and bureaucratic. These decision processes
usually leverage data but data literacy across the leadership team can be uneven. Consensus -
ensuring that everyone’s needs were addressed - was often a highly desirable attribute of
decision making.

The pandemic has introduced significant urgency into health system decisions on resource
allocation, new program introduction such as telehealth and measures to ensure patient and
staff safety.

This prolonged urgency is expected to change health system decision making (including
decisions regarding information technology). The new normal health system governance and
decision making:

Will have greater speed and less bureaucracy.
“Speed to value is critical. Most of our traditional bureaucratic hassles have disappeared [during
the pandemic]. So, to maintain those gains we’ll have to really challenge internal processes
going forward.”

“Less bureaucracy and more speed to action.”

Will be more data driven.
“It’s clear we must do a better job at infusing digital literacy throughout the health system – for
staff and also with patients.”

“It’s exciting to see data-driven decisions facilitated by [our center for outcomes research]. That
inserts CIOs into the conversation on strategy.”

Will be more decisive; greater comfort with saying no.
“We are making a relentless effort to say ‘No’ to things not relevant to the demand of
immediate clinical need.”

Organizational collaboration will increase; more of a “we’re in this together”
spirit

Health systems, like any complex organization, can be plagued by parochial interests and
fiefdoms. Crises have a way, if properly led, of galvanizing an organization. The organization’s
members put their self-interests to the side as they come together to engage a common,
threatening enemy.

This rejuvenated sense of collaboration permeates the entire organization from the c-suite to
the clinics.

Information technology projects can be difficult to manage. One major source of difficulty is
aligning the diverse interests of all impacted by the project and overcoming distrust among
participants. The strengthened spirit of collaboration should lead to more effective IT projects
and implementations.

Another silver lining in the COVID cloud: talent retention. “Our people have stepped up and
been so energized. Millennials are inspired. This will help with retention of IT teams.”

Health systems will become more data-driven organizations

The urgency and uncertainty that characterizes the pandemic has heightened health system
interest in being more data driven. Given the criticality of many decisions, quickly having access
to the right data by the right people becomes essential. Being more data driven will have
several ramifications

Data quality will receive heightened interest
“We’ve seen an exploding appetite for data and analytics and collaboration across the
enterprise.”

Academic medical centers are in “a rush for data to start clinical trials, which is causing privacy
and legal executives to loosen up. Also, how do we make data assets as frictionless as possible
for users?”

“For us the biggest analytics forces are on the predictive side. For example, who was on what
type of ventilator? Also, we identified different processes. We find that this moment is an
opportunity to standardize data processes. We’re now planning the revenue resurrection.
Historical rates of mask usage don’t match the high rate of mask usage today.”

Faster turnaround of analytics requests is required
“Analytics is key to real-time clinical decision-making with remote monitoring using a central
dashboard that can alert clinicians when a patient’s condition is deteriorating. Finally, agile
analytics using PowerBI, Tableau, ArcGIS mapping and other tools is becoming de rigueur. Once
you get hooked on these reporting and analytics tools you can’t do without them.”

“We are totally dependent on technology to create the speed we need to respond to this
situation. We’re advising which strategies to take based on how quickly we can support it with
the technology.”

Analyses must be broadly shared across the organization
“There’s a push toward data transparency. To share more, not less. To share more broadly.”

“Anyone can ask a question. We’re breaking down barriers. It’s opened up new awareness.”

Inconsistent processes that produce inconsistent data will be less tolerated
“Data quality has come front and center. We need to change the processes in how data is
collected, and we’ve taken initiatives to clean up our data, and to track in real-time.”

The IT organization will become more of a strategic partner

Most health systems regard information technology as an important enabler of the
organization’s strategies and plans. A high performing IT organization and CIO are viewed as
critical assets.

However, IT is still often seen as a necessary and expensive evil. Malware must be thwarted.
Electronic health records need to be more usable. IT projects need to go faster and cost less.

Those operational issues remain but the pandemic has elevated the importance of IT as an
organizational partner.

Input sought on operational and clinical tactics
The discussion highlighted, a CIO noted, “how important IT is to clinical. We’re working shoulder
to shoulder. IT is integral to care.”

“My IT team has daily COVID briefings with clinical operations. We’re making daily changes to
Epic, for example if clinical leaders want to change ICU beds to COVID beds and so on. We’re at
the table and able to provide IT solutions at a moment’s notice. A silver lining is that they
(clinicians) need us as much as we need them. We’ve created a crisis dashboard that gives
clinicians a single pane of glass on a single source of truth. The value is huge.”

Greater appreciation of the criticality of the technology
“IT has become more critical to clinical operations as a result of COVID. We’ve flattened the
curve, and now we are starting to figure out the next six months. We are using the ‘Now-Near-
Far’ framework to provide context around ‘What do we just need to get done now?’ What are
the people, processes and technology required to support that mindset?”

Emphasis place on anticipating organizational needs

“Our COO is very focused on the ‘now.’ We expect our surge to occur on April 29. We have calls
with him on Monday, Wednesday and Friday. We installed in-patient teleconsults this week.
Physicians are so busy planning the ‘now’ that they’re really looking to IT to ‘be ready for us
when we get there.’”

Increase in the CIO’s strategic and operational importance
A CIO said his working relationships have changed. “Prior to COVID, I didn’t find myself as
actively engaged with the CEO as I am now. Our conversations in the last three weeks have
surpassed those we had in the last year.”

Limited budgets will lead to constraints on IT investments

Heath system revenues have been materially reduced during the pandemic. The progressive
opening of the country, the reintroduction of elective care and the gradual near term reduction
in the COVID patient burden, will provide some revenue relief. However, health system
operating and capital budgets will be constrained for many months.

These constraints will impact health system decisions on IT investments in several ways.

Emphasis on leveraging existing investments
“We really need to maximize our investments. We have limited capital for new things, which
puts a premium on being innovative with existing resources.”

Improving yield of innovation projects
Given limited funds for new IT investments, pressure will be placed on existing innovation
projects to deliver tangible value in the near term.

Emphasis on minimal viable products
IT projects often strive to deliver the complete set of desired capabilities. Vendor selection is
often based on the ability of companies to provide everything desired.

Funding limitations have led to a shift in capabilities emphasis. Rather than providing
everything months from now, IT projects need to provide a necessary but smaller set much
faster, in order to obtain value now rather than months from now.

The health system’s workforce will be more virtual

The use of telehealth has exploded during the pandemic. Much of this use has focused on
supporting virtual care; patients interacting with their care team over Zoom rather than in the
practice.

The technology has also been applied to supporting staff who can work from home. These staff
can include clinicians who must self-quarantine but can take care of patients virtually.

When the pandemic subsides, many employees will want to continue having tele-work as an
option.

The introduction of virtual work has also led to discussions about workforce composition. What
staff will we need in the new normal?

“The digital workforce has emerged and will likely enable us to reduce and minimize the need
for humans at every step in clinical and operational workflow. We are supporting a very
widespread remote workforce now.”

“Many of our physicians ask, ‘Why would I want to go back to an office?’ And their office
support staff may not be needed anymore.”

“What does staff look like in the new normal? We’re also going to be a different kind of
business. We may also want to look at different business models.”

Telehealth will become core to care delivery; it will finally arrive

As has been described in many analyses of the impact of COVID, telehealth has gone from a
technology that has been confined to a niche for decades to a foundation for care delivery.

“We’re seeing our clinical model shaped by consumer expectations. That has resulted in a
stronger emphasis on prediction and prevention and far more telehealth, remote monitoring
and virtual care that are really changing our clinical models.”

“Are CIOs ready to support CISCO Jabber or Zoom video conferencing for doctors, who have
quickly become accustomed to those solutions?”

“We’re seeing greater innovation with our current [existing] portfolio. [Our organization] is
using telehealth, for example, with inpatients.” The innovation is that it doesn’t span vast
distances or heavily trafficked urban geography, but just a few feet as the caregivers stand just
outside the patient’s room. “We’re going to see bigger use of telehealth innovations like that.”

Providers also recognize that virtual care is more than telehealth. ‘We’re standing up new
chatbots every week to give guidance to patients, providers and the public.”

Consumer engagement will add “safety” to existing objectives of convenience
and quality

Engaging consumers is an important strategic goal for virtually all health systems. An engaged
consumer supports a health system’s efforts to maintain appropriate volume, deliver great care
and ensure that patients manage their health.

These efforts have traditionally focused on consumer interests in high quality, low cost and
accessible care. To this list of criteria, we must now add consumer interest in safety. While
safety, particularly medical error reduction, has been a long-standing focus in healthcare, safety
will come to be redefined as low risk of being infected.

Consumer-facing technologies include self-scheduling of appointments, remote monitoring of
health and information to support care decisions. To this list of technologies, we will need to
add capabilities and information that help ensure safety.

CONCLUSION

The COVID pandemic has changed our world. There will be a new normal that emerges in the
years ahead. While the new normal for healthcare is uncertain, the contours of that future are
beginning to emerge.

Health systems will become leaner, faster, more data-driven and more decisive. Collaboration
will increase and engagement of patients and providers will accelerate over a platform that is
enabled by telehealth, virtual care, remote monitoring and hospitals in the home.

Healthcare CIOs recognize the silver linings in the COVID cloud and are anxious to keep such
pandemic-driven advances in the new normal. “We’ve seen unprecedented collaboration,
communication and cooperation. I hope we don’t lose those gains on the other side of this
crisis,” said a CIO.

In the end, the CIO discussion offered a roadmap to the new normal with key mileposts such as
the partnership between IT and clinical, collaboration and speed to value. The question is how
do we cement the gains we’ve made in this crisis? We need active management and leadership
to also endure in order to make these gains permanent.