The Connected Care Team

Streamlining Healthcare Systems in the Cloud

• TigerConnect • Season 2 • Episode 17

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Communication is central to a powerful tech stack. To make your cloud-based solutions work efficiently and for the betterment of your organization, you need digital products that are easy to use and adaptable, enfranchising your entire healthcare team in the process. Implementing cloud-based solutions, driving productivity, and building a happier, more efficient workplace is a top priority for Seattle Children's Hospital.

In this episode of The Connected Care Team, Dr. Chaudry discusses the hospital's pandemic-related challenges, his IT vision for 2022 and beyond, and the importance of communication.

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O'Connor: [00:00:00] Today on the show we have Dr. Zafar Chaudry. He is the senior VP and chief digital and information officer at Seattle Children's Hospital. Welcome to the show Dr. Chaudry.

Chaudry: Thank you, Dr. O’Connor. Thanks for having me, pleasure to be here. 

O'Connor: Well, thank you for joining us. I'd love to start with having you tell me a little bit about your role and your organization at Seattle Children's.

Chaudry: So I'm at Seattle Children's, it's a pediatric health system. We [00:00:30] primarily serve Washington, Alaska, Montana, and Idaho, about 46 sites across those four states. 13,000 employees. We're a $2.8 billion health system. And within that, the IT function, which includes all of the IT basics. Digital health clinical systems is about 448 people supporting all of our users. 

O'Connor: Wow. That is a, that is a vast organization [00:01:00] across a wide geography. How do you keep everyone connected and on mission over, over such a large area?

Chaudry: Well, I think a lot of it is how we communicate between all of our sites. I think working in a pediatric health system is one of the easier roles because the mission that we live to hope care and cures for kids is pretty much easy to understand and easy to support, but [00:01:30] certainly technologically, all those sites are connected.

Uh, we've used a lot of collaboration tools and certainly the pandemic has driven the use of, uh, digital collaboration tools. So as we are working in a hybrid lots of use of unified communications and we use the whole Microsoft Office Team stack to stay in touch with instant messaging. And we do a lot of informational [00:02:00] sessions for our organization, our CEO holds multiple town halls. Uh, for me and my team, I have town halls. I have all hands meetings. I have a weekly update that goes out every Friday to my, all of my team colleagues that sort of talks about life talks about what's happening in the business, things that we need to know, et cetera. So lots of communication, but of course you can never have enough communication.

O'Connor: [00:02:30] Yeah, I agree. And it sounds like you've, you've adapted to staying even more high touch during the pandemic, which you, which you mentioned earlier. What are some of the challenges that, that you've seen, uh, as a result of the pandemic as from an IT perspective? 

Chaudry: So for us, as the pandemic hit our organization, we moved about 4,000 people to work remotely. And at current numbers, we're still about 3,000 people working remotely on any given [00:03:00] day, any given shift. And the isolation of working from home, so there are benefits, obviously you're not commuting as much, but at the same time, there is a level of isolation.

Not everybody has enough space at home. Many people are taking care of kids whilst trying to work. So a level of flexibility has had to happen. I find that people aren’t able to step away from the PC or laptop. So finding a balance [00:03:30] mentally on when to work, when to actually physically stop working in the day has been a challenge.

I think, with what's happening in the world and working from home that has put a lot of mental health pressure on employees. So, you know, we actively encourage people to reach out, talk to each other. Discuss some of the concerns they may have, whether they're at work or just personal. Uh, but it is, challenging. I [00:04:00] think I think hybrid work is great. Does drive productivity up, but at the same time, it doesn't give people the work-life balance that they may have had coming into the office. Cause obviously if you leave the office, you physically breaking away from an office space where at home, you know, the laptop is only a hand away, right? 

O'Connor: Right. Well, it's interesting. You're talking about that because it seems like there's, you hear a lot about [00:04:30] burnout of clinical staff and, and rightly so, but it sounds like what you're describing has, has driven some, some burnout for you as well. Is that true. 

Chaudry: Yeah, absolutely. I think burnout and health systems also include support services. So people in HR, finance, It are also facing that level of burnout. I think, you know, we have a lot of back-to-back meetings on collaboration tools. Uh, prior to pandemic, you could have a meeting [00:05:00] and you were physically looking at a person. Now you're spending 10 plus hours a day staring at a screen and seeing people in two dimensions.

That can be isolating as well as taxing on your eyesight, brain, and everything else. And you have to be more actively engaged at times. The people don't tend to get up as much. You know, when you were in the office, you would get up, go somewhere, take a break. Go to the cafeteria for lunch. [00:05:30] At home, we've sort of put everything in front of us, on our office desks and we're eating in the same place and moving around the same place.

But we're not necessarily taking the break that we need to, to step away from the machine. 

O'Connor: You're describing the setup on my desk fairly accurately, right now.

Chaudry: Yeah. You and me both, right? 

O'Connor: I'm keeping my food off, off camera for sure. Well that, you know, it has, it has been an [00:06:00] interesting move, um, for the IT staff as well. And one that doesn't get talked about, uh, as much, but one we're going to continue to have to adapt to, as we move forward, in the coming years. What, what do you see, coming for us and, and for Seattle children's in particular, in, in 2022 and beyond?

Chaudry: So certainly from this topic of homeworking remote working, we have decided at Seattle children's that a certain percentage of people in our [00:06:30] business will remain in the hybrid mode, working from home probably 80% of the time and coming into the office 20% of the time. That's allowed us to let go of leases on buildings that we no longer need because they're not being occupied.

And that will save us money over a sort of seven to 10 year life cycle. So I do think flexibility that the pandemic has driven must continue. I don't think it's a [00:07:00] good strategy to force people to come into the office when in certain cases they don't really need to. And technology is a good stack for that.

Right? A lot of my people if they're engineers working on code, they can code from anywhere. They don't actually have to physically come into an office. So I think we're going to see that continue. For us, 2022 is about operationalizing some of our new builds. So during the pandemic, we continue to build our [00:07:30] facilities out.

So we have a new tower on our main campus and some new clinics coming online. They have to be operationalized fitted out and brought to go live. So that will certainly happen by mid 2022. The other focus areas for us are going to be replacing our enterprise resource planning system. We've had it for many years.

Uh, you know, during the pandemic, we actually moved [00:08:00] from Cerner to Epic and went live and we're about 12 months post go live on Epic. And now it's time to replace our aging ERP system. So that's going to be a focus. And the third pillar focus for us will be well strategically, we will focus on mental health in kids and we will focus on virtual care. But from an IT perspective, we will have to support all of those initiatives [00:08:30] through front door, digital apps, um, enabling more telemedicine and figuring out how our patients can consume those visits in a more equitable way. So one of the things we learned in the pandemic is not every patient parent caregiver has access to a decent piece of hardware, whether it's a laptop or a tablet.

Not everybody in the state of Washington and other states that we serve [00:09:00] has a decent internet connection. You know, you could, you could be living in rural Alaska and you don't have enough connection to actually have a decent tele-health visit. So we've been solving some of that by loaning equipment and loaning mobile hotspots.

But of course we don't have enough equipment for everyone. 

O'Connor: Talk to me a little bit more about the mental health aspect here, and you know, you and I have been around long enough to see [00:09:30] that there has been, and still is a stigma attached to these types of discussions in these types of care. How do you, I mean, how do we get around that and deliver a better experience with better outcomes?

Chaudry: So I think it's, it's two prongs. So if we're talking about patients that we have, uh, kids are being effected by mental health issues more so now than before. The pandemic hasn't helped that because people [00:10:00] become isolated, can’t see their friends, can’t socially interact con participate in sports that has had an impact.

And it's really difficult for people to admit that they have a problem. So we have expanded certainly access to therapists, psychologists, psychiatrists, as part of our expanding program to do that. 

On the flip side, when we talk about employees and healthcare, [00:10:30] and you know, we've talked about clinical burnout, it is, there is a stigma, you know, when we say there's an employee assistance program. Most healthcare organizations have that, but I'm not sure people want to call a helpline. They feel like their information might not remain confidential. So we have to be spending more time and effort in expanding those programs. So we at [Seattle] Children's have expanded our assistance [00:11:00] programs beyond just calling a helpline.

We've contracted with third parties to provide counseling services in, in confidence, uh, to our employees. And you can actually stop that consumption from an app, on your smart device. So we have it, this year have expanded our behavioral health services as part of the benefits package for [Seattle] Children's.

I think [00:11:30] it is up to leadership in healthcare organizations to openly discuss these topics with their colleagues and teammates. And that is still difficult to do, certainly in IT. I can tell you that as part of my weekly series of talking to the team and providing updates, I have spent time talking to people about my own personal mental health challenges during the [00:12:00] pandemic. The, the isolation, the fact that you can't go anywhere.

I mean, you know, I, I live in Seattle, but my sister, my parents are in the UK because that's where I'm from. And it was two and a half years before I could actually see my parents' face again in person. And that was really challenging. And so I talked about that very openly with my team. It then sort of [00:12:30] encouraged people to open up back to me and others.

And you know, we're going to get through this by talking out what worries us, what keeps us up at night, what work pressures are bothering us. So I think there's a lot of work to be done across across health systems and investments made to provide a multi-pronged approach to access to behavioral health, mental health services.

I don't think we've even scratched the surface. [00:13:00] And it does start with leadership opening up and talking about what they're facing, because just because we have big, very long titles doesn't mean we don't face the same challenges that our employees face.

O'Connor: Yes. I agree completely. No, I, and I applaud you for leading your organization, um, through that. Um, I wanted to talk a little bit about, um, you, you did the move from Cerner to Epic. That was obviously a, a large project. [00:13:30] And you know, one of the things that I follow a lot and, and try to talk about a lot is the experience for clinicians, especially, but all end-users and consumers of IT at what that experience is like. And it seems like unhappiness with technology is going. up. And if you look at some of the data that are out there, um, you could see for every hour you see a patient sometimes you have to spend up to two hours in [00:14:00] EMR.

I saw a piece of data this morning that said, residents are spending up to 70% of all their time working in the EMR. How do we, how do we fix this experience and how do we make folks happy with the technology? 

Chaudry: Yeah, that's certainly a complex issue. And I don't disagree that the whole point of technology was to make your life easier, but that necessarily isn't the case when you're implementing all of the monolithic information systems that we are [00:14:30] doing. Physicians are spending more time documenting, But a lot of the documentation are sort of legal requirements based on insurance company rules, federal rules, et cetera. It's very different here using an EMR than, you know what I was the CIO in the UK and the UK, the government had decided that they were going to reduce the burden of documentation by defining what are the core basic things that should be captured.[00:15:00] 

Here we're over capturing and not standardizing. So a lot of work needs to be done on how do you personalize the patient, sorry, the physician experience in documentation? How do we train our physicians, clinicians on using some of the shortcuts within the system that you've selected? And that requires a one-to-one at the elbow personalization discussion.

And not everybody [00:15:30] has that opportunity yet. And also having the debate on, well, what is the clinically relevant information we should capture versus what we shouldn't, and you know, case in point, some physicians will dictate a medical note that could be, you know, five pages long. And other physicians won't and they may be in the same specialty.

So there's, there is that gap as well, right? In terms of standardization, I don't think [00:16:00] there's a magic fix though, unless you know, of any things that that could potentially be done. I think we're loading on more systems on a daily basis. We at [Seattle] Children's right now have 789 systems. Some are clinical, some are nonclinical.

If you're a physician, you are touching not only Epic as an EMR, but you're touching the ERP, doing timecards, doing all kinds of things, putting in your PTO, [00:16:30] lots of things that are, require you to input information. And that does take time.

O'Connor: Yeah, I think, I don't think there is a magic bullet to your point. I think, you know, paying attention to the end user and in particular, the user experience, which it sounds like you're doing is, um, you know, is, is, is the way to go.

Chaudry: yeah, I think, I think health system, certainly our approach is to acknowledge that there's a problem. You know, I [00:17:00] will be the first to tell my clinicians that I'm probably not your favorite person because I've put in this system and it's caused you more grief than probably happiness. And you know, when you start an EMR project, uh, you go to a board meeting and the board says, so when will this project end and you, and I both know that EMR projects never end because we're constantly optimizing the system for many, many, 10, 15 years worth of [00:17:30] work. So I think you have to start by acknowledging. So we, I have personally tried to acknowledge that I've not made people's life easier. We do measure how satisfied people are and yeah, there's a huge level of dissatisfaction in general, around the systems and accessibility, and this is how many hours they have to do beyond clinic to finish my notes. 

So all we can really do is provide better at [00:18:00] the elbow training and support many health systems are under-resourced in training though. We are one of those systems and I’m advocating very hard to get more trainers so that we can provide more hand-holding sessions.

And once somebody sees that light bulb, moment of how we've helped them configure their day – I've worked in many health systems where once we have really configured and optimized the system that [00:18:30] physicians are finding that they're not spending all Saturday and Sunday documenting, they're actually able to use tips, tricks, smart notes, macros, et cetera, to seriously drive down the actual level of typing that they have to do.

And that can help. But it takes time. 

O'Connor: Yeah. you know, uh, certainly, uh, as part of moving from Cerner to Epic and some of these other projects you're working on, including ERP, it sounds like you've been moving more and more systems to the cloud over, [00:19:00] over time. What's the current breakdown today of what you have on prem versus what you have in the cloud and what are your future plans?

Chaudry: So when I joined [Seattle] Children's just over four years ago, we decided we were going to close all of our data centers. So we don't have any data centers anymore. About 90% of all of those 789 applications sit in a co-location on our hardware, in a private cloud. [00:19:30] For our key systems like ERP, ERP sits in the public cloud. AWS. 

And when we decided to do the Cerner to Epic move, we have moved our Epic EMR and it sits in the Virtustream Dell Virtustream cloud, a 100% production development play environments, a 100% in the Virtustream cloud data centers. We do not manage technically the Epic system. [00:20:00] So we went in with a full managed service in their cloud.

They run it, they maintain it. They provide guaranteed, guaranteed uptimes, uh, RPOs, RTOs, upgrades, you know. We've gone from doing upgrades in Cerner, which would take us on a Sunday, a four hour window. We can now do upgrades in Epic in 38 minutes on the Sunday.

O'Connor: Wow.

Chaudry: And so very minimal downtime now and end [00:20:30] users have seen that.

And yet I really don't have any Epic technical skills, very hard skills to hire into and, and maintain. Don't have to worry about those anymore. And certainly the benefits we've seen in, in the pandemic have been around no supply chain issues. If I want to grow my Epic environment, it's pretty much done uh,

within days, I don't have to order any equipment or hardware and I'm so glad I I'm not in that[00:21:00] situation because you can't really get the equipment you need in a reasonable timeframe.

O'Connor: You know, that's, that's a tremendous improvement on downtime and probably the experience to the end user as well, right? And you know, you can live if the thing is down for half an hour for an upgrade, but the multi hour downtimes, in the past where you would have to be writing paper orders and doing all sorts of things, um, it was a lot of work. That sounds like a really big improvement.

Chaudry: Yeah, well, you know, [00:21:30] anything we can do to win friends in the clinical space is always a win because you know, working in technology, nobody ever calls us up and said we did a great job, but they always tell us when something didn't go right.

O'Connor: Yeah, that's for sure. That's for sure. Um, speaking of things, not going right, we’ve had several in the past year that were very public around the United States, [00:22:00] uh, ransomware attacks on health systems. And as you're adding more and more, uh, people, um, and devices to your environment, how are you keeping all of this secure?

Chaudry: So I think you're spot on, I think the security posture and risk to healthcare is exponentially increasing. We seen the same. The number of attacks we see on a daily [00:22:30] basis has absolutely gone up. We have invested at least 25% more into security than we did two years ago. We bought a lot of tools. We have a lot of partnerships.

We have people monitoring our environments around the clock. But there's never a day you come into work, not worrying about what's going to happen with security. Most people know that our biggest risk is [00:23:00] our own employee. Funnily enough, people in healthcare love to click on links in emails that tell them they would be the beneficiary of $10 million dollars from somewhere.

And so people love clicking on those links. And so we have gone to mandatory security training. Everybody has to do that every year to certify and continue working here. We do randomly [00:23:30] attack our own people through orchestrated phishing and malware attacks. And I can, you know, I'll be the first one to raise my hand and say in the last two years, uh, my own team has caught me out once.

I did click on that attack and I was told off, and then I was sent to mandatory training to relearn that I shouldn't click, but it was a very, very sophisticated attack. And then, so I have [00:24:00] to admit, right. And I'm supposed to have my eye on the ball for security and it even caught me out. So I can only imagine what it would be like for the average end user. 

O'Connor: Yeah. W we, we undergo some of the same, uh, same training and, um, we're focused on, on all the same things. This is really making sure we keep that environment secure, but you're right. The, the number one threat is always your own employees, just innocently clicking on a link that they, uh, that they receive. So we've, we've had [00:24:30] to do a very, very similar.

Talk to me a little bit about what you see as immediate challenges for 2022. We know that lots of health systems are struggling coming out of the pandemic. What do you see as some of your immediate challenges that you're going to be facing?

Chaudry: So certainly top of mind would be employee and staff shortages, whether they're clinical or not. So it is very difficult to hire enough nurses, [00:25:00] enough physicians, allied health professionals, and the same happens in health IT or even, HR. It's very hard for us to retain and recruit lots of competition and demand for technology, skilled workers, especially in my geographical space, but across the country, if not across the world. 

And so keeping people and keeping them happy enough to remain with us has been a challenge for [00:25:30] sure. In parallel, as we're getting more demand, more competition for the same roles amongst healthcare systems, if not tech companies and healthcare systems, we're also seeing this challenge around cost. 

So it's more expensive to hire the best talent that then impacts the bottom line of any health system. The pandemic itself has affected [00:26:00] margins. You know, sometimes you're allowed to do elective surgeries. Sometimes you're not allowed to do elective surgeries. Uh, so overall the, the revenue, while the profit that we make on our revenue has eeen driven down, but yet our, what you would call static costs keep going up. 

So in 2022, you'll see a lot of healthcare systems talk about cost improvement programs. We are certainly doing that, looking at our costs, but at the [00:26:30] same time, how do you retain the best talent and not lose them to a competitor or a tech company? And we’ve seen that, um, you know, we've seen turnover and our health system go from an average of 13% to currently almost 19%.

 So you lose people. If you bring in new people, there's a learning curve, takes time to get them up to speed. Um, and it's, and it's, um, a big challenge in that in parallel to [00:27:00] that, there's the whole equity, diversity and inclusion.

We want to be able to also hire a diverse group of employees because we, as a pediatric health system, 58% of our patients are diverse. So we want to reflect in our workforce what we see in our community. And that's also challenging because then you have to do more national searches to find great talent of a diverse [00:27:30] nature. And then people either want to, or don't want to move from one place to another.

With, with remote working, there's more demands for, I don't want to move, but I want to work from my state. And as part of this, uh, we, as an organization have expanded what states people can actually work from. So Washington, Alaska, Montana, Idaho are our main states, but we added, you're allowed to work from Texas, Georgia, and Florida to [00:28:00] try and overcome some of these challenges about, I don't want to move, but I still want to work for your organization.

We've tried to expand that to. 

O'Connor: well, it certainly sounds, like you're setting yourself up for, uh, for a great 2022 and you're paying attention to a lot of the right things from really your focus on mental health with your employees, what the IT experience is like. And, uh, I learned a lot today and really thank you so much, Dr. Chaudry for, uh, for joining us on the [00:28:30] show and hope you will, uh, come back and talk to us again soon. 

Chaudry: Thank you for having me. It's been a pleasure chatting with you today.