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if we're thinking even 20 years out, and we think about more care happening in the home like, what ends up being the purpose of a facility, a big hospital facility in the next 20 to 50 years. And I think it ends up being really the tertiary care, like.

Super high acuity, flexible space that we need. So we're thinking about things like, should every room be able to be converted into an ICU room at the drop of a dime, for instance, right?

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 Dustin Hufford, Senior Vice President and Chief Information Officer at Cooper University Health Care. Dustin has been in this role since 2019. Really looking forward to talking with Dustin today and hearing what he and his team at Cooper are currently focusing on.

Welcome, Dustin. Hey, thanks, Sue. Happy to be here with you today. Let's start by having you briefly introduce yourself and tell us about Cooper University Healthcare.

Sure. So, as you mentioned, CIO at Cooper. I've been in provider healthcare for 18 years or so in various roles.

Started out my career in consulting, traveled the country, and saw the various states of provider health care, from like a single doc practice, critical access hospitals, all the way up to larger IDNs, where I did some merger and acquisition work with them. Stepped out of consulting to take a role as a community hospital CIO around that time, around the time that Meaningful Use was coming online.

So all the rage was implementing all the functions for Meaningful Use. Did a lot of that, and then the health system I was working for decided to join ProMedica, which is like a 12 hospital system out in northwest Ohio. And there we decided to implement Epic across the board. We went from a very best of breed model to Epic Enterprise.

After my tenure there, I decided I wanted to come back home. Closer to the family, which was sort of outside of the Philadelphia area. So, brought me to Cooper. So, I was AVP of applications for a few years and then like you mentioned, CIO since 2019. Cooper is an academic health system. We're headquartered in Camden, New Jersey.

Do about 2. 3 billion in revenue. So we serve as South Jersey's only Level 1 trauma center and actually see the most trauma cases in the region. We've traditionally been a one hospital system, a very large tertiary care center with a large ambulatory footprint, but decided last year, actually, to bring on a second hospital.

Into the family and we're in the process of basically finalizing the regulatory approvals there. So, just about done. But over the last few years, Cooper's seen tremendous growth well over 10 percent annually. we've been bucking the trend when it comes to margin by maintaining a very healthy, positive margin consistently over the last 5 years.

So that's us in a nutshell.

Excellent. I can relate to a few of those things. 1, wanting to move back by family. So that was probably a good move for you. And you ended on the fact that Cooper has a strong margin. So that may play into this next question in terms of what your current priorities are for 2024 and you know, what things might look like in terms of your IT budget, given many organizations have significant financial constraints right now.

Yeah,

so priorities in 2024, we've got a few buckets. The first. Bucket is the continued growth as I mentioned. So, we have the second phase of our our licensed services and our massive new ambulatory campus, that we opened actually in November for the first phase. First phase was just well, not just, but around 100 ambulatory exam rooms brought online in the second phase of the Ambulatory Surgical Center, Radiology Lab, Physical Therapy, Cancer Infusion, and a few others.

But we actually took an old Sears building and repurposed it and We've surfaced the outside and just gutted the inside and created something really cool. Lots of pictures out there. I encourage folks to look at it. It's pretty innovative. A lot of technology went into it. We're looking forward to the second phase of that, but we're also in the thick of planning for a redesigned main campus where our large hospital is.

We're actually building three new towers and planning. We're really planning out the first one now that's an enabler for the other two towers so we can move services out of an older infrastructure building that needs to be taken down. But same kind of deal. planning with technology right out of the gate to make sure that we infuse latest and greatest and also things that really make sense this day and age.

But also trying to plan for, it's a 50 year building at minimum, so we're trying to think through how adaptable and flexible can we be with the new campus at this time. So that's even going into the rooms and saying, like, you know, we're used to putting new cables in every time we need to do something.

Is there a different way that we can think about the room and the technology within it? So we have some cool external partners that are helping us. Kind of think through some of those challenges. Also priority is just addressing some of the technical debt that still exists from the pandemic.

Everyone knows we, we pretty much had to pause all of our normal IT life, just like everybody else did and focus on, responding. Now we've got a bunch of systems that still need to be upgraded and or replaced or whatever, and we're just working through that still.

So

that was systems that you weren't able to address during the pandemic that have now fallen behind on maintenance? In some cases, yeah,

or it's just, the optimization of certain systems that weren't centered to the whole pandemic response, just some love and intention just like some of the other systems we had.

So, yeah. Yeah, and then getting ready for Hyperdrive Epic, which is kind of moving to the web based version. A lot of the systems need to be upgraded for that. And then finally, the big project that I'm most excited about, at least in the short term, because it'll have the fastest gains is kind of redesigning and overhauling our contact center moving really It's a true omni channel setup with customer relationship management at the core and really starting to think about how much we can automate in terms of things that our patients need from us and making sure we route people to the right place the first time and so they don't get bounced around in our phone system and then really taking some of the latest, greatest technologies like ChatGP and having an assist in answering questions and delivering services, so we're looking forward to that.

That's great. I'd like to dig in a little bit more on the last 1 you talked about in terms of the contact center and some of the stuff that you're doing there. So, just tell me more and like, where are you at right now with, building that out, the role that IT is playing in that, is that something that you're partnering with another senior VP on, or are you part of driving that?

Definitely part of driving it. The other 2 partners from a senior vice president level that are Really into this, our chief experience officer. She actually oversees our contact center. And then our SVP oversees ambulatory across the board. Cause we're really thinking about our ambulatory services and again, how we get people to the right place at the right time, and really starting to think about the routing of services down to the physician level, like, are we getting them to the right person without.

A lot of headache, right? So a lot of attention being played to how we're structured operationally to really deliver on that. So we created as a first step, what we call ambulatory experience centers, which are groupings by institute of folks who can handle everything for that institute. So it's not going into the practice.

The call is not going into the practice anymore. It's being handled by a team of people that can handle refills, lab results triaging, all that kind of fun stuff for a specific group of specialties. Cross training to be able to handle that as an extension of our main contact center, which is doing basically the scheduling and all the traditional stuff, just answering basic questions.

And then we're laying on, some of the tech to make sure that, when they ask the question, so it's more of a, hey, tell me why you're calling today kind of question coming from an automated system. And then trying to get that response nailed down to get it to the right person at the right time.

And if the system can, through automation, answer the question, it will. We're even thinking about similar technologies to what's been implemented in like Walgreens and other services where it knows who you are and it can tell you what services are available to you, like refilling your medication, which ones are eligible for refill, and maybe even transacting that and finishing the process.

So, that'll be a journey, like our first step this year is to go live with the basics, answering questions and some of the routing, and then just keep layering on services over time to speed up and automate and hopefully add less frustration for everybody in the process.

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Great. So follow up question on that, are there any other health systems that you see as a model for their contact centers that you're looking at and trying to learn from?

Yeah, there's a couple Cleveland Clinic, Intermountain, and St. Luke's in Pennsylvania are the three that we've really talked to that have taken some big steps when it comes to customer relationship management and automation. little further ahead of us in this, but that's good because we're learning from, some of the same people that implement some of the technologies there and and also trying to add some extra features to it that hopefully will have a big impact.

So That's great.

I just tell you as a as a consumer, whether it's in my health care system and, going through, contact center, the portal, et cetera, et cetera, or, consumer in the retail world, we all have stories of what works really well, what we're happy with, what was easy.

And then we all have the stories of like, what was, you Awful. And just get me to a person. Let me talk to a person. Don't route me this way and that way again. I just need someone to help me.

Right, right. And to your point, I mean, the companies tune or maintain those systems very well, you end up in the loops and the issues where it's like, I'm trapped, like I can't get out of here, and it's actually not helping me do what I need to do.

So I think we're pretty sensitive to that. Like, we're not going to trap people in the loop. If someone says agent, you're going right away. There's no stop. There's no extra question that's coming after. It's right away. And then I'm starting to think about the fact that the technology's evolved even the last couple years because of open AI and others coming to the scene is that, they're using large language models, more effect, like you had to build out intents with these systems in the past and the intents had to be And specific orders and you had to rearrange the orders to make sure that if someone asked a complex question that had multiple pieces to it you had to build out each of those pieces individually to be able to answer that question and enter, chat GDP, and you can ask a pretty complex question to the technology and have it, as long as it has access to the data sources and the processes around it it should be able to transact it without a problem.

Asking more questions or just getting generally confused and frustrating you to the point where you're like, agent. Yeah, agent.

Let me talk to your manager, right? So, just one other follow up question on that and I love this conversation because this is probably an area that a lot of organizations are looking to improve on and address.

Do you at Cooper have a patient and family advisory council of any form? And if so, are you leveraging it as you design the contact center? We do

in a sense that, yes, we're trying to tease out what are the actual issues that you have. And I think that leads to the question of we, as a system don't necessarily know where each individual person is calling to try to get services, right?

It's like almost impossible from an analytic standpoint to see that when you have 500 different phone numbers and everything's routed at different places. Some have high levels of tracking, some don't but you hear that from the patients and families that, hey, I got bounced around a lot, I got transferred, I called this number, they said it wasn't the right number, but that's what the paper that I got handed said, so we ended up getting directed to another number and I couldn't get the answer still and so I gave up, right?

And that's kind of the feedback that You know, we hear from different people, not just at our health system, but across the board and I think that's a good challenge to take on, and I think everybody was going after chatbots and everything during COVID which is great as long as you can integrate that into the process, but this is really more about again, getting people to the right place at the right time to the right person who can solve the problem The loop that we have is the transfer loop, right?

And the confusion of what someone's asking for and maybe sending to the wrong place. So,

yeah, I, you know, I'm channeling a story. A month ago before we had a long trip and I was helping my husband nail down some prescription refill that was going to be very problematic if he didn't have it with him when we were out of the country.

And Let's just say I'm a little more assertive in navigating and getting to the right person. And as I got on the phone, I offered to help and he's like, yeah, go ahead. Help me make some calls. And I got on the phone with one person and then, told him who I needed to talk to. And they looked that person up and they transferred me to a number.

And the person who answered the phone answered procedure room two, and I'm like, I don't mean to be in a procedure room. I'm trying to talk to someone about a prescription that they have to approve so it can get refilled. And bottom line, those of us in health care who know how to navigate and can be a little bit more assertive can get results.

But all the people who are just trying to interact with our health systems and don't have that depend on really good, accessible, easy to use, responsive systems. So, all the best to you in making this work and maybe we should talk again next year and see what the results are on

this. Yeah, so imagine a world where you called and said, tell me where you're calling today.

I'm trying to refill my prescription. Okay, I can help you with that. It looks like you have two prescriptions that are eligible for refill. Would you like to refill them? Yes. Okay, so that's kind of what we're thinking. obviously it's going to take time. It's complex. And there's, you know, we have a lot of different service lines.

So, like, it's not like everything works all at once. It's a lot of process and optimization work with individual specialties, but

and sub specialties in an academic medical center. And, Who's taking care of what? Yeah it, if only it were so simple. I wanted to go back to one other thing and just comment when you were talking about growth and the new buildings.

That's awesome. I think I want to go out and look at some pictures of your repurposed Sears buildings. Sears buildings are iconic in many cities. So that's great. You're using it in a different way. And the challenge of trying to build new towers and think up 50 years. I know when I was CIO at Brigham and we built a new tower and we had a visioning session and we talked 30 years.

I'm like, 30 years. Do we really know what things are going to look like in 30 years? So, it is a huge challenge in terms of planning for technology and infrastructure for these new buildings. But I assume that you have a good plan at this point for those new towers.

well, it's developing, right?

And we have to start thinking about if we're thinking even 20 years out, and we think about more care happening in the home as we have heard so much about, like, what ends up being the purpose of a facility, a big hospital facility in the next 20 to 50 years. And I think it ends up being really the tertiary care, like.

Super high acuity, flexible space that we need. So we're thinking about things like, should every room be able to be converted into an ICU room at the drop of a dime, for instance, right? And when you think about flexibility, not necessarily designing them for, one specific specialty in mind, but being adaptable that you could bring in those services.

And if it needs to change or flip, then it's not a many millions of dollars project. It's a, it's an operational change, right? So those are the kind of things that we're trying to think about. And how can we Think about our system is connected and everything being an input or an output so that you're thinking about real time traffic control across all these different entities, including in the home and being able to anticipate, when someone needs to come in or if they really shouldn't say.

Space or whatever that we understand that and can respond to it more effectively in real time. Right? So, hopefully that's how the industry starts to evolve over time. Just, not waste individual people's time and make people feel better about the answers and the care that they're getting.

So they feel confident staying at home, for instance, if that's where they belong. Right? So, yeah. Yeah. Yeah. Hospital at home. Do you have a hospital at home program? We are approved by CMS with the waiver and we are beginning to work more diligently on actually bringing some beds online and hopefully, within the next year we're seeing patients in the home.

Right now for us it's really a strategy around, since we are busting at the seams in our current campus setup, we need more space and lower acuity space would be great, so this is a good short term solution, but hopefully evolves long term into a more comprehensive model.

Great. Good. So 1 of the things I wanted to ask you about was, what difference it makes to have a leader like Dr. Mazzarelli for your team in terms of, your IT budget and priorities and for listeners especially those who were at QIIME in the last fall forum, Dr. Mazzarelli is co president and co CEO at Cooper University Healthcare. And he was the 1st, I think the 1st keynote speaker.

At the Timefall Forum. And I think many of us were blown away by his talk. And he was very inspiring. And I know I caught you afterwards and said, you're very fortunate to be working for him. And I'm sure many of our colleagues thought the same thing. So what's it like having a leader like him when it comes to managing IT?

Well. Obviously, it's got a lot of pluses. He's very supportive of technology being interjected into our system to solve some of the problems that he talked about, right? So his talk for those of you that didn't hear it was really around some of the books that he's written around what they call compassionomics IRIS.

And the second one was called Wonder Drug. It's really the study using actual data to show that compassion in healthcare or in your personal life leads to better outcomes kind of all around. So, it helps drive some of our technology decisions because we are all We've been really big into, like, for instance, , ambient clinical documentation in the field.

We were early adopter and we've been really helping different players kind of advance that. With the idea that if you have more time to spend with both your patients. And your family at home, because you're not writing documentation when you go home in your pajamas that you should be, more satisfied with the work that you do as long as you're being intentional about being compassionate, right?

that's just an example, but that means there's a lot of support for technology that, aid that process, right? And investing in the optimization of our electronic health record and adding the pieces that make sense. To, again, lessen that administrative burden. He's very supportive, but as is our other co CEO Kevin O'Dowd who oversees the administrative areas both of them have been phenomenal when it comes to supporting technology, not as a cost center, but as a solution to, workforce productivity challenges.

We know, I think everybody's having that problem right now in, in all different facets of the healthcare system. So we see technology as being one of the answers in addition to just, Enhancing our management capabilities people, but technology as a way to free up time and allow people to be scaled more, but not feel necessarily the burnout of the overhead that comes with that.

Right.

So, so that may be a good segue into one of the last questions I want to ask you in the interest of time here, and that's about the workforce. So, I'm sure you and it seems like all organizations are facing workforce challenges. We've got this new age of hybrid and remote work.

What kind of innovative approaches are you taking to help develop the workforce of the future in particular in IT? Yeah, so in

IT I think the, there's a couple things we're doing is one a very robust onboarding process since we're mostly remote in our department onboarding in a sense that we have a very detailed checklist that requires, new employees to talk to a very large number of people within the department to get to know what they do and how they do it and what's the proper procedure.

And also get a face to face, meeting with somebody just to learn who's in your department, what they do, right? Then we took another step and implemented Agile framework within our shop. So, cross functional teams as opposed to our traditional application or department specific teams that we had before.

That has been helpful because we're thinking more about, like, cross training people so that they understand end to end processes within an area. So we have a couple ambulatory teams, for instance, right? And part of the cross training is, from the first contact that a patient has in the health system to the point where, we're doing long term care management with them.

Like, what does that look like end to end throughout our systems? So that we're more flexible about how we can respond to different changes. Now, this is a work in progress, because it's new to us within the last year. So we have a lot more optimization to do. definitely something I think that's going to pay dividends over time.

It's certainly made us faster already. Now we're looking at quality of the implementations and how to scale more effectively. And just continue to enhance the training programs around how Agile works, the benefits, all that kind of fun stuff. So, so far so good, but we'll keep reporting back on that on it's got to be adapted, right?

Agile framework was basically a software development framework. We're using it to implement. product and develop software. But to do the former requires a little bit of tweaking of the model to make sure that you can basically take large, what used to be water 12 projects that took nine months and break them into chunks that are agile and distribute through a pretty complex, large team that has all different types of capabilities and skill sets underneath it.

Great. Good. Is there anything else that you want to highlight before we close today?

Just with all the cool technology they've been involving, I think one thing that's a personal long term passion for me is really getting to the point where patients have control over their own data and the healthcare decision making process.

And I think there's been a lot of advancements lately that can be pulled together to do that kind of stuff. So in the 21st Century Cures Act, this is one of the goals that the folks who wrote it had, which is create an internet of healthcare data where A user can own their data to some degree, and that's why we have, like, the standards for requesting the information requests, right?

When it comes to FHIR connectivity and other connectivity outside is that we want people to take power of that information. And I can't wait to see it till it comes, like, for us to be successful. With the limited number of resources that we have in this industry we need a partnership with our patients and consumers, right?

And giving them as much information that's written in ways that they can understand it and make decisions, with their families and friends the better for all of us in terms of long term success in a very expensive industry.

Yeah, great. That's a great point to close on in terms of your passion and the importance of that for our patients.

Thank you so much for talking with me today and all the best to you in the new year, Dustin.

Thanks, Sue. I really enjoyed it. Thanks.

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