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May 7: Today on TownHall Sue Schade, Principal at StarBridge Advisors talks with Robert Eardley, SVP and Chief Information Officer at University Hospitals. They discuss EHR migrations, current focuses at UH, and future plans in healthcare technology. We delve into the major projects at University Hospitals, including application decommissioning and legacy data management, the move to Azure, and an impressive EPIC stabilization and benefit achievement stabilization initiative. Specifically, how is the hospital utilizing an interactive voice agent (IVA) system to enhance patient interactions? How are they overcoming workforce challenges in an increasingly digital world? Dive into these captivating topics and more in our enlightening discussion with Robert.

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Today on Town Hall

as humans, we don't like the call tree and pressing buttons and, feeling like, oh my gosh, I spend as much time trying to navigate The menus is I do trying to solve. So what this does is it really tries to ask the question right up front.

Why are you calling? How can we help you? And then either reply with the information or get you into the right call queue.

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health.

Where we are dedicated to transforming healthcare, one connection at a time. Our town hall show is designed to bring insights from practitioners and leaders. on the front lines of healthcare. Today's episode is sponsored by ARMIS, First Health Advisory, Meditech, Optimum Health IT, and uPerform. Alright, let's jump right into today's episode.

Hello, I'm Sue Shade, Principal at Starbridge Advisors and one of the hosts for the Town Hall Show at This Week Health. Today, my guest is Robert Eardley. He's the Chief Information Officer at University Hospitals in Cleveland, Ohio. He's been in this role since early 18 and recently completed a major EHR migration, which we'll be talking about.

I'm looking forward to talking with Robert today to hear about that success for sure and what else he and his team at UH are currently focusing on. So welcome, Robert.

Yeah, thank you, and thanks for the invitation.

Absolutely, it's good to see you again. So let's start by having you briefly introduce yourself and tell us a little bit about University Hospitals.

Yeah, so in brief, I've got a little bit of a unique history with University Hospitals. In total, I've been here about 11 years. And so, I was with Ernst Young for about 9 years, and then I joined University Hospitals in 2006. I was with University Hospitals for 5 years at that time, until 11. And most of that time as Associate CIO, and then I got the CIO role down at Houston Methodist.

So I was down at Houston Methodist for seven years 2011 to 2018, and then decided to return to university hospitals as CIO in 2018. So actually the second stint, I've been here for six years and that gives a little snapshot of my background.

Okay, great. And can you tell us a little bit about university hospitals for people who aren't familiar with the system?

Sure, University Hospitals is in Northeast Ohio, in Cleveland, Ohio area, across about nine counties here, and so just reference point, we're about a 6 billion net patient revenue organization. We have 16 hospitals from a tax ID perspective, but about 12 of those, are of significant size. We've got a couple that are critical access hospitals and a couple that are in the smaller bed count category.

We've got about 3, 000 employed physicians and many of those employed physicians are faculty professors at Case Western School of Medicine. So that's a snapshot of who we are.

Great. I'm gonna, I told you the questions that I want to ask, but I'm going to go out of order a little bit because you did mention the fact that you were at UH previously, then you left for the Houston Methodist Opportunity, and then you came back.

And maybe full disclosure I know something about UH because I served as the interim CIO for a year during that period when you weren't there in 16. So, great organization to work for. I loved it. So good people. I'm glad that you're back there. But what was it like coming back into the organization after having left?

Yeah, so, it was good to see people that I knew before, but from a kind of an IT situation at Houston Methodist, I was fortunate to be able to lead a business case, to move to an integrated health record. We looked at the major players there, decided on Epic, and really implemented Epic really from 14 to 17 at that time.

And so After I returned, it really was obvious how hard people work to try to plug all these systems together. There's kind of a common theory, it doesn't matter what EHR you're on. That is mistaken a bit, as long as it's an integrated system. Then, depending on the brand, a lot of the benefits of the integrated system.

But we were running, in our organization, about 14 major systems. For things that EPIC could do within the integrated system. So that was a big benefit.

Wait, I got a clarifying question. So when you said the organization you're referring to as Houston Methodist then, or now?

Oh yeah when I returned to UH to the spirit of your question of, what did I find when I returned in 18?

And I found that it's incredibly hard to keep up with the organizational initiatives when you're trying. data across so many different systems. Not impossible, but you work really hard to try to just get the workflow integrated across all these systems. So that stood out when I returned. wasn't inherently coming back to implement EPIC by any stretch.

So, for the first couple years was we worked hard to try to get the prior portfolio ready to go. Where we needed to be. We spent a lot of time on the relationships with those suppliers. And so, while they are good people, ultimately what Epic has built over the years does stand out for its integrated nature.

And so we uh, in the very tail end of 2019, early 2020, there was an official endorsement to take a look at our EHR situation, and so we worked a lot with three of the major players in the marketplace, couple of the incumbents that we had, which was. All scripts, various products, and Cerner various products.

And then with Epic. And so we looked at all three and the organization came to a conclusion that Epic would best serve our needs. And so that decision was made at the tail end of 20.

Okay, and I know that, again, from my experience there in 16, that was a long time in coming, and I know what you're talking about in terms of trying to get the then set of core systems out to those other hospitals and the challenges of maintaining and trying to make changes when there were so many different systems.

So, Robert, I've wanted to talk to you for a while to do one of these town hall interviews, but I kind of, Reminded you that I wanted to do that. After I saw the article in Becker's in January, it caught my attention. The headline was University Hospitals projects 100 million plus annual benefit from EHR install.

So that's impressive. It's not what you usually see as a post epic implementation story. So congrats to you and the team on such a huge financial success. So why don't you tell us. What you're doing, maybe a little bit more about the implementation, what you went through, I know it was just last fall you finished, and then how you're addressing really trying to value and realize that value for the EPIC implementation.

Yeah, so, in 2020, we had kind of an official endorsement to let's look at the HR marketplace. In 2019, we looked at just. The marketplace, so I'm backing up, 2019, the marketplace in general, is there going to be a new entrant to EHR, Microsoft and Google's, and so we had some outside support at that review, and the conclusion in 2019, there's not going to be a brand new player and so in 2020, we initiated a review of the larger EHR suppliers in the marketplace, so to the spirit of the question, it's In December of 2020 is when we made the formal business case to our board of directors.

And what really sold the business case was the fact that we put a payback period into the model. So how many years of benefit, once Epic is fully live, how many years of benefit do we need in order to pay back the investment? And that was five years on the conservative benefit, and then about 📍 two and a half years if we obtained the reach benefit, or think of those stretch goals.

So that changed the story. It wasn't just a cost additive. It was an engine to offer returns. And then the conversation was how fast can we get this started? How fast can we implement? So that payback period graph really helped change the tenor and tone of how we thought of it as executives. In that, to your question, the program budget was 623 million.

And that was a mix of. We had 588 million for our historical kind of core facilities. And at the same board meeting that we chose to move to Epic, we acquired a three hospital system here in Northeast Ohio. So we did one scope change during the project for 35 million to extend to Epic at that newly acquired health system.

That was, our new partner. So 623 is our total. From a benefit side the Becker's article largely got it correct but it was we do grow 📍 to over 100 million of benefit, that's across about 14 benefit categories and I can kind of walk through, give you a little flavor of what that looks like and we very conscientiously, we are tracking those benefits and in this fiscal year of 2024, our fiscal year is the calendar year, This fiscal year, we're targeted to achieve 60 million of benefits.

And that grows to over 100 million, really towards about 120 million in the subsequent years as we mature on the workflows inside EPIC. So, that part's

What are a couple examples of the 14 benefit categories, and who is leading that effort for benefits realization and really overseeing it?

How's that integrated with, maybe your standard governance? Thanks.

Yes. And so during 2020, if I can touch upon that first, during 2020, when we were doing the business case, we worked across multiple domains with the operating owners of those domains. So think our physician practices. Are we going to be able to achieve more clinic visits through the efficiency of Epic?

We work with our surgical leadership. Are we going to improve our. On time case starts are we going to reduce our OR cancellations? We work with our leaders of our pharmacy area. Will we be able to coordinate pharmacy fill better for our patients by fulfilling that out of our internal pharmacy making sure that those get filled?

And that has a positive benefit to the organization if we can do that. So those are three examples of increased volumes through efficiency and coordination increased revenue by decreasing case cancellations due to lack of information flow, and then increased revenue by trying to do the right thing for our patients by fulfilling Those medication scripts out of our MEDS program and in that world, the patients have a choice, as they should about the coordination and so we worked with them in 2012.

They each signed off on these benefits. That was three examples of the 14 📍 I mentioned . So now that we're in 2020, we are working with an internal department of university hospitals called the Department of Operational Effectiveness, DOE, think of it as a project management function for the organization.

They've had a recurring monthly forum called Value Improvement Program. Program. VIP.


And so a key focus for our VIP Structure value improvement program is obtaining the epic defined benefits in 2024. Okay? So they run the meetings, they call the operating leaders of these different areas, the operating leaders speak towards, this is what we expected to achieve and here's our actuals.

And so now we really only have one month behind us, January of 2024. We had a February meeting, and so we were tracking, are we achieving one month worth of benefit? And that's the structure that we bring to tracking these benefits over time.

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 Okay, that's impressive. Impressive. And I think it's a sign of a high functioning organization.

And again I think I'm very impressed with University Hospitals. I know you have new CEO in the last, what, year Majerian, he's quoted in this article and Becker is about the project and the, the future benefits expected. So, it sounds like you've got really strong support and buy in from the executive team, which is.

As we know, critical as CIOs. That's right. That's great. That's great. Can we pivot from there and talk about some other 24, priorities you may be working on?

Yeah. So in 2024 we in IT speak in terms of big boulders. What are those big boulder projects? These are more definable. And so, our first definable effort is what we call application decommissioning and legacy data management.

So, application decommissioning is part of the EPIC process. Business case, I, representing IT, was obligated to turn off the old systems and get that cost savings. And so, I list that first because I want to make it top of mind for the organization that's an obligation for us to go achieve those savings, turn off the old systems.

And as anybody who's been associated with work like this, we need a lot of operating partners to validate that data. That's one example. Another example is, maybe to state the obvious, But I'll state it anyways is Epic Stabilization and the Benefit Achievement Stabilization. We're not where we want to be.

We're live now about four months and so that's top of mind. We are extending medical device integration as a part of that. Project. And so we've got a partner there basically getting a lot of the vital signs out of many of these connected medical devices, making sure that gets electronically entered into the EHR.

That's a continuing project for anybody who's associated with things like that. And so that's a continuation. And then other more, a little bit IT centric items just to round it out is We've got we have a Microsoft 365 transition, so it's a little bit inside baseball, but we need to get the organization over there.

We are fully cloud enabled with Azure Analytics in Microsoft Azure. And so, we need to move a lot of our internal SharePoint sites over to the SharePoint Cloud as part of that project. And so I think the intranet or whatever equivalent phrasing we call it Community Digital Workplace here at we need to move to the Azure Cloud this year. And then lastly, we have an urgent care Business that we've worked with a joint venture operating partner to run Urgent Cares, and we have a lot of Urgent Cares across, and they're right now running on their independent EHR, and we want to move them to Epic in August of 2024.

So that's maybe a selection of some big projects. Those are definable projects. And, since it's 2024, no real IT story would be complete without really talking about, our approach to AI, organizing AI. And so that's more of a conceptual initiative. Now and so that is an area where we've got an AI policy setting committee.

We are reviewing inventory of new AI initiated or requests. And so, that committee will review how do we want to use AI, what's its purpose, is it making any human judgments on our behalf and so, that's an area where we've inventory and we're working this process and so, we can always dive into that further.

Okay, great. I wasn't going to specifically ask you about AI, but when I looked at the article again that I referenced this morning, it does reference AI and it successfully integrated AI into your IVR system to direct call center inquiries. Do you want to talk about that a little bit?

There's a quote in this article from Dr. Majerian about volume and what you've done.

Yeah, so we did implement, there's a tool that had been being used at another Northeast Ohio organization, Progressive Insurance, I think many people know Progressive, so I'll leave the name of the tool out for the purpose of the question, but it allows you to the caller to really speak what they are trying to solve for.

And so we're all familiar with the, press one, two, three, four, but this technology says, what are you calling for? And then it will interpret That human voice request and get you to the right agent. It has a very high success rate. And so, right, those calls come in everywhere from scheduling and billing, or I've got a concern with my clinical results.

And right, we've got procedures of how to handle all those. And so, in some cases, the interactive voice agent, so it's moved to this phrase called IVA, instead of interactive voice response, IVR, which all of us are familiar with IVR, right? You press 1, 2, 3, 4. So, as it moves to this concept of interactive voice agent, if there are repeatable questions that the computer could answer on behalf of the patient or the caller, then it will answer.

It will answer those questions. With the information that we already have on file that absolves some of even human interaction, gets the caller the answer they want but where it can't be answered with a response, then it's really targeting to try to get into the right agent queue, so that caller gets to who they need to talk to the first time without bouncing around across different agents.

I love it. We all have experienced IVR and listening carefully to the menu and press this, press that, and then getting bounced around. So, if you're using AI to improve that experience that's great, right?

Right. Yeah. And I don't, I don't offhand know all the what can it respond?

Some of the things like outstanding balance but I think we've tried to populate that with office hours, office locations, send a text of the location to my phone. We've expanded over time some of those where the computer could take the action that the caller. And the IVA has a human voice back.

That's pretty good. We all do not like, as humans, we don't like the call tree and pressing buttons and, feeling like, oh my gosh, I spend as much time trying to navigate right. The menus is I do trying to solve. So what this does is it really tries to ask the question right up front.

Why are you calling? How can we help you? And then either reply with the information or get you into the right call queue. Okay. All right. Great. Well, I, I'm watching the time here, and I want to get into one more question, and that's about workforce challenges. Every organization is facing challenges.

I know you probably compete at University Hospitals with Cleveland Clinic for IT talent. We're dealing with hybrid remote work. So what innovative approaches have you taken to retain staff to help develop the workforce of the future? And you mentioned earlier community and the digital workplace, which I recall is a broader effort across UH. so maybe talk about that as well as IT within that.

Yeah, I think if we go back we have a reasonably low turnover rate. So if that's one metric to monitor, it's under 7%. It's 6. 7, 6. 1 percent and that's in light of all the changes with implementing EHR, acquiring an IT group that came with that other health system that I mentioned earlier in my comments.

And so, how do we try to achieve that? We really try we try to be respectful to the individual, and let me move that beyond kind of a trite comment. So as we implemented EPIC, we already had good people here. And so a lot of the EPIC team was populated by people that has worked for you, University Hospitals.

for quite a long time. And so we gave them a role on the Epic team. While we separated it, it still was an IT Epic team. And we committed to getting that team credentialized, by Epic through the different functions that they have, knowing. Somebody could leave. Well, that's true, but they could leave at any time.

And so, so that's one thing that we did. We've had low turnover. And as we get into the go forward, we're committed to, if the software you support, whether it's Epic, whether it's Cisco Networking, whether it's Oracle, we'll get you the training that software needs. deserves, right? You're going to be credentialed at that item that you should be an expert in.

So that's on the, application and maybe the technology side. So that's a little bit on the training side. And on the hybrid work model side, we have been very flexible over these past three, four years. We've had a lot of in person kind of big group events that just really come along for the ride as you're implementing something like EPIC with EHR.

And so we've had a lot of times where we've brought people in. Hundreds of people into the office but they're purpose built. They have a reason why we're asking people to come in. Now that we're on the other side of implementation I happen to be sitting in the office today, but I have fully embraced coming into the office does not make you more productive.

try to embrace the hybrid or remote workforce. If we have an event that we're running, then we'll ask people to come to the event. Like over the last couple days, we've run some. Retreats focused on some of the revenue stabilization efforts that we're still trying to achieve in EPIC around various different components.

And so we've had a number of retreats over the last two days. And those retreats may be four hours working with like people with your operating partner. Add a physical space and expect folks to come in to help support our operating partners with those retreats.

Okay great. I know we didn't get to everything I wanted to ask you about but is there anything else you want to highlight before we close today?

No, I, I think is As all of us in IT, I think we live with, kind of the two sides of our brain. The one side, which is we have to be exceptionally focused on making every day work, right? And so, right, that's security, that's reliability that's making sure that we use all 📍 Functions of the software we've already bought and that's effort and maximizing what we've already bought.

And then the other side of our creative side, wants to dabble in some of these other pilot programs of, generative AI and I feel like competence in the first part gets you a ticket to the second part, but you can't just focus on the second part and think the first part's going to run itself.

Totally agree. Totally agree. It's a ticket to the second part, which every organization is anxious to get to. Excellent. Yeah. Perspective. Well, Robert, thank you so much. Really appreciate it and hearing about how things have gone there with the EPIC migration and what you're doing with the workforce and AI.

So this has been great. Thanks so much.

Okay. Thanks for the invite.

Thanks for listening to this week's Town Hall. A big thanks to our hosts and content creators. We really couldn't do it without them. We hope that you're going to share this podcast with a peer or a friend. It's a great chance to discuss and even establish a mentoring relationship along the way.

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