Q: What are the key challenges for the healthcare industry right now?
Probably the biggest thing, at least in the U.S., is the cost of healthcare. Everyone, I think, shares a desire to have the same or better quality of healthcare at lower costs and delivered more conveniently.
The way that people are interacting with healthcare has changed a lot. It used to be that the only cost of healthcare to many people was their copay and deductible, which were small. Now, when people are facing $1,000, $2,000, even $5,000 deductibles, their healthcare costs are much more visible and really important for them to manage. The idea of patient as consumer, where they're making choices around where they put their money and how they want to consume is real now. That's a good thing, but as a system we haven't yet figured out how to help them be good consumers and to make informed choices.
At the same time, there's still an enormous amount of work to be done just to improve basic health. People are still seeking breakthroughs in treatment of disease, illness, and extension of quality of life.
I think Mayo and others are working hard to try to live in this brave new world of changing reimbursement and changing consumer expectations while we continue the many centuries-long pursuit of how to let people live happier and healthier lives.
Q: Where do you see IT fitting into those big-picture issues?
The changes taking place nationally have led hospitals and doctors to think about moving technology from the back office into the front office.
I think there are two legs to it. One is finishing the work of automation. How do we take the manual burden out of healthcare? Think about things like barcoding of medications or the flow of materials and caregivers and patients through a complex delivery system. How do we make the operations of the delivery of care and the payment for care more efficient so we can match the kind of economies that you see in other industries that have been able to increase their product quality and breadth while reducing cost?
Second is delivering a new set of oftentimes digitally based products and services that allow people to consume healthcare in the ways that they consume things in other parts of their lives. Think about all we now take for granted around travel, entertainment, retail, hospitality, financial management, or banking, where physical materials have been significantly reduced or taken out of the environment altogether and replaced with virtual products and services.
What does that mean in healthcare? Can we interact with patients at a distance? Can we use remote monitoring to track someone's health, with their consent, when they're not at a doctor's office? Can we offer guidance to health seekers who want to live healthier, longer lives? It used to be perhaps you'd come in and talk to a doctor in a face-to-face conversation. Well, that can be replaced with a number of digital products and services. The opportunities are pretty staggering to improve delivery as well as create more health and convenience for patients.
Q: Are there areas where IT investments haven’t paid off yet?
There’s a long history of the productivity paradox, which is where investments in technologies don’t lift productivity. It's sometimes hard to see how an investment in some new technology results in a direct cost reduction or revenue increase.
There's also dead weight loss like the burden of cyber security. There is a lot still to be done to make these technologies fully secure. And many of us are investing a frustratingly large amount of time and money in that area.
And then finally, many health systems implemented EHR [electronic health record] systems over the last couple of years. A lot of that was driven by regulatory requirements under the HITECH [Health Information Technology for Economic and Clinical Health] Act that was passed in 2009 which more or less required implementation of electronic health record systems for individual providers and hospitals. For some, it was the very first time they had ever implemented any kind of similar technology beyond their billing system.
These technologies are not necessarily as user-friendly as they need to be. And they don't interoperate in the ways that we would've expected. There's a lot of noise in the trade press around, did we get our money's worth? I consider these to be first-generation growing pains that should not be a surprise to us. But that's not very satisfying to a clinician who's dealing with an EHR that they don't like and where they want to share information with a colleague and they can't.
The next horizon is to get all of these new investments to start working together within hospital systems and across healthcare systems.
Q: Mayo is revamping its EHR and revenue cycle systems. Can you describe that project?
In February 2015, we made a decision to convert three legacy systems to a single new EHR and revenue cycle system that will be used across all of our campuses and care settings. That project has a core team of about 500 people, but we're engaging thousands of other people across the organization who are offering viewpoints and helping us come to agreement on common standards and approaches. We should be done with all of our implementations by the end of 2018, which, for a system as large as ours, is fast. We're on track, but we're still in the early stages and have a lot of heavy lifting ahead.
This project is 10 to 20 times the size of anything else we are doing. It's enormous. Having an absolute first-class electronic health record system is necessary but not sufficient to be Mayo Clinic. So, at the same time, we’re working on a range of other projects that depend on the presence of that strong core system. The other projects might be smaller in dollars or people or time, but might have an even more profound impact on the organization.
For instance, we are investing pretty heavily in a Unified Data Platform, which will use a data-as-a-services approach with an associated API environment that allows innovators inside and outside Mayo to create new tools to support clinicians.
When we have our data platform in place, the payoff for us really will be to drive new and profound insights on patients, the progression of disease, and the lifecycle of wellness. It will allow us to unlock data that we've been maintaining at Mayo for decades. We think that we will be able to derive more powerful insights more quickly, that we can help smart doctors be even smarter, that we can take administrative burden off them so that they can focus on patient care and research and education.
Q: How much can IT play into using evidence-based medicine?
Out of the big data and machine learning space, we're finding that there's real power in being able to aggregate large sets of data and enrich that data in ways that it can be more profoundly understood.
For example, we have a project with our surgical teams that scours through a patient record and delivers not just a stream of discreet data but results, many of which have been machine derived, that notes that when a given data condition occurs, there's something of clinical importance. And we've found ways to bring that to the attention of our clinical teams to take action. We're in the early stages with this in our surgical practice, but we think it has a lot of potential.
We're evaluating a lot of other machine learning and, if you will, artificial intelligence technologies to speed up the pace at which we can derive meaning from masses of data to give insights to doctors. Of course, none of that is going to replace a traditional scientific method for discovery, translation, and application. But we think the computer tools can supplement.
Q: Mayo is known for its use of design thinking. Does that show up in the approach to IT as well?
I'll give you an example. Within the EHR consolidation we have a project that focuses just on user experience design, where a team that is not responsible for directly delivering the built environment has a role in observing user experience as part of the project. Some of the leadership from that team comes from our Center for Innovation, which has been one of the real drivers within Mayo for design-centered thinking.
There's a lot of ways in which projects like this force you to revisit how you do the various parts of care. We've already seen ways to make routine processes more standardized, which in turn allows us to focus on innovation, on new clinical approaches and breakthroughs.
Mayo is blessed with a more-than-hundred-year history of clinicians working together as a team. We have a well-defined and well-honed method for careful collaboration and discernment. Sometimes it takes a long time to get to decisions, but once we make them, they stick, and they tend to be really great designs.
Design thinking combined with the legacy of care teams working in a comprehensive, integrated way gives us some tremendous opportunities. Oftentimes, we can avoid the “everyone's wishes thrown in a pot” design that happens not just in healthcare but in large, complicated systems in many settings.
I find our clinicians are frustrated when there's two or three or a dozen systems that need to somehow interact with each other, but they've been built in a way where they can’t. Our focus has moved from best of breed but isolated technologies into technology that is more enterprise focused and more architecturally driven. We are working to go from point solutions to shared solutions that allow collaboration, not just across different portions of the care delivery team but also between the different disciplines like research, education, and practice.
Q: How does Mayo’s mission shape these efforts?
I have never worked in an organization that has had such a clear vision and adherence to that vision. It really infuses the whole organization. If you ask anyone from our CEO to a cafeteria worker what is Mayo's purpose, everyone will answer, "The needs of the patient come first."
Mayo has worked as an integrated care delivery system for a long time. It's a place where people come because of the vision and stay because of it. And all those interlocking pieces are really foundational to ensuring that the needs of the patient come first.