Provider Experience

CHIME CIO Interview Series – J. Joshua Wilda, CIO, Metro Health – University of Michigan Health

As a community healthcare organization, Metro Health values the ability to engage the community at a local level. Joshua Wilda, CIO, ensures the organization is nimble in its approach to patient and provider engagement, offering innovative solutions by creatively partnering with local employers to offer additional flexibility to the communities they serve. Joshua offers candid and shrewd advice for blossoming healthcare IT professionals as they seek to grow and advance. He also shares acuity surrounding the meaning and importance of health information technology. In his words, “we are not IT professionals in the health care industry we are health care professionals in the IT industry.”

Key Insights

Historically, we have focused on the provider experience which is extremely important. However, if we make the patient experience seamless and successfully address that aspect, providers will have their experience change as well and the entire care team will be able to leverage technologies to drive better patient outcomes and satisfaction.

We evaluate how the technology can be used to manage the care by the entire care team and how that team can support and utilize the information, as opposed to having the burden be wholly on the physician as the entry point and manager of that information. Just as the I.T. industry is tasked with managing big data, providers have been tasked with the entry, management and output. A daunting task when their value is being with the patient. By enabling technologies that allow providers and their care team to manage and interact with the patient at the center, more of the information can be used to better treat our patients.

We must consider what are our payers are going to reimburse us for and that’s been a struggle. There are many technologies that can be leveraged to treat a patient but if there is no reimbursement for the use of these technologies, smaller organizations can be hindered by what they can take advantage of due to cost.  

We are not IT professionals in the health care industry we are health care professionals in the IT industry. Metro Health isn’t an IT organization, its focus is and needs to be on quality patient care. I.T. is only a vehicle to be driven where healthcare can go, and I’m all about instilling that mission and passion in my folks.

Campbell: Thank you for taking time out to speak with us. Please tell me more about Metro Health and your background

Wilda: In healthcare, we tend to describe ourselves as the size of our beds. As a community based hospital, we have a 208-bed village campus and we have a large number of neighborhood centers where different services are geared towards outpatient care. Several years back, our organization had the foresight to transition from sick care to health and wellness management, in the communities where the patients live, not solely in a hospital. We have invested in outpatient centers and clinics, specifically with primary care services. We now own and operate 17 outpatient facilities where we have a multitude of services, mainly rooted in primary care and outpatient specialties.

From an IT perspective, we describe ourselves with the EMR that we use. As a small mid-market hospital we understand the value I.T. can bring to the patient experience and have invested heavily in I.T., more than most organizations our size. We were one of the first of our size on Epic, with a full enterprise deployment. We’ve been a Most Wired hospital for 10 years running and have very much made I.T. part of our strategy. We have been a HIMSS stage 6 organization for both Ambulatory and Inpatient for the last 5 years, with our stage 7 assessment coming soon! We have been part of a very large competitive market, and with Metro being the smallest, our CEO focused on positioning Metro to be the top choice in the market. We used technology to help drive that choice, whether it be with our provider base or with our patient base.

Campbell: Metro Health formally affiliated with the University of Michigan in 2016 and it was shortly thereafter that you were promoted to CIO in April 2017. Please tell me what CHIME means to you as a result of that promotion.

Wilda: I’ve been with Metro for the past 11 years and originally came on board as a systems analyst. I started my career working on the Epic implementation here at Metro and got the opportunity to rise through the ranks to now being the CIO. I am an alumnus of the CHIME Bootcamp from back in 2009. Our previous CIO, William (Bill) Lewkowski, is still with Metro Health as our Chief Strategy Officer. Much of what we’ll talk about in this interview is attributed to the framework of what Bill built over the past 23 years, anticipating where healthcare was going. A lot of my strategy is based upon honoring that history and advancing and innovating it to the next level. At 37 years of age, I’m considered a young CIO, and I’m fortunate to have gotten the opportunity to lead a healthcare organization.

In terms of the value of CHIME, it’s such an invaluable resource to be able to ask for advice and perspectives from folks who have been pioneers and peers who are considered future thinkers.  Healthcare IT is a vast industry with many facets, opportunities and challenges to overcome. CHIME is a tremendous resource. I considered myself part of the next generation of healthcare I.T. leaders driving what technology means. In attending the CHIME forum this fall, it was interesting to hear where some of my peers are (as far as their career) and to hear their struggles of how they are still trying to get themselves to the table with senior leaders. They are trying to change the perception of I.T. as being a commodity, providing operations and maintenance, and instead having it viewed as a valued capability to driving and shaping organization’s missions and strategies. I am fortunate to be at an organization where they understand our capabilities and continue to invest in our growth. CHIME is a resource which helps me understand what capabilities our team may need to focus on, where we may have gaps and provide valuable resources in how to stay ahead of the curve. Metro focuses on how we can leverage digital transformation to represent the brand of who Metro is to support patient focused services and create loyalty among our patient base.

Wilda: My background and formal training is on the healthcare sciences side. I received a Bachelor’s in Biomedical Sciences and a Master’s in Public Administration with a Healthcare emphasis, I am not the typical information technology professional nor claim to be a true technologist. I’ve had to learn the technology portion of this, so I have a unique perspective there as well. Technology for the sake of technology is never well received in the healthcare industry. We often use the word disruptor.  Disruptor, while a well-intentioned buzz term, can have a negative connotation to end users. I like to say technology is a differentiator and a vehicle to drive healthcare to new areas with a focus on meeting the triple aim plus one!

Campbell: When you can bring that multidisciplinary approach, you sometimes have opinions or views that are skewed already. That leads me to a big topic that was echoed time and again at the CHIME fall forum – physician satisfaction & efficiency and EMR usability. Can you touch on that a bit? Specifically, things you may be doing with telemedicine to help alleviate some of the burden on providers?

Wilda: Historically, we have focused on the provider experience which is extremely important. However, if we make the patient experience seamless and successfully address that aspect, providers will have their experience change as well and the entire care team will be able to leverage technologies to drive better patient outcomes and satisfaction

Technology is perceived as a burden on the provider/patient experience, and that is an area we are focusing on. We are gaining better understanding of the relationship and expectations between providers and their patients; crafting a digital experience as a benefit to that relationship rather than administratively burden providers away from their focus on their patients. To that end, we have a program with our CMIO Dr. Brad Clegg and Medical Informatics Directors Dr’s Lance Owens and Srinivas Mummadi around understanding where the physicians are spending their time with the technology. As part of the program, we partner with providers, assessing productivity and providing them with tips and tricks. Another approach is having an appreciation that technology is perceived as a disruption, there is that word, so when we introduce new advances we go to great lengths to provide engagement opportunities and education of how the introduction of new technologies will actually reduce that burden.

We evaluate how the technology can be used to manage the care by the entire care team and how that team can support and utilize the information, as opposed to having the burden be wholly on the physician as the entry point and manager of that information. Just as the I.T. industry is tasked with managing big data, providers have been tasked with the entry, management and output of that same data; a daunting task when their value is being with the patient. By enabling technologies that allow providers to manage and interact with a care team, with the patient at the center, more of the information can be used to better treat our patients, the providers can focus on the patient and not the technology! We don’t want the physicians to have to manage every single informational input, but rather, we want a team around the patient so we can leverage the collective skillset in managing patient populations. We are heavily focused on unified communications across the care team and remember, patients are a part of the care team. Our focus has been to make sure that the right information is getting to the right member of the team, whether it be the care manager, a nurse, a physician, or a PA/NP and provide communication tools to have the teams seamlessly interact with the patient and each other. This is a current gap. We have siloed technologies implemented, it is now our goal to connect them, increasing patient/care team engagement.

Campbell: Along those lines, Metro Health was one of the early pioneers in delivering remote access, allowing providers to be more efficient and get access to the point of care information in different settings. Can you elaborate on that a bit?

Wilda: Early on, we leveraged the VDI (Virtual Desktop Infrastructure) experience because we didn’t want our organization to be limited by the bricks and mortar of a PC. We wanted the care team and support services to be able to have information when the patient needed them to have that information, not when they had access to it via a bricks and mortar type of workstation.

Campbell: What is your mix of payers and what mix of value-based care is there today with your patient population?

Wilda: Like any community organization we are managing those models with a mix of government, commercial and private payers. This is another convoluted area as each has their own documentation requirements, sometimes overlapping, often having their own nuisances. We are spending too much time designing the system for their needs and not enough time focused on what the patient needs but it is how we stay in business. Just like most in the industry we must consider what are our payers are going to reimburse us for and that’s been a struggle. There are many technologies that can be leveraged to treat a patient but if there is no reimbursement for the use of these technologies, smaller organizations can be hindered by what they can take advantage of due to cost so we need to be tactful and impactful, leveraging the entire investment we do make in technologies. Larger organizations may be able to invest in different overlapping technologies. Often, value is left on the able with a large portfolio of services and capabilities. Metro sustains by being purposeful and understanding we do not have the luxury of best of breed to support all areas of technology but leverage the interoperability and value that comes from best of suite integrated solutions.

We are in an extremely competitive market. Metro’s goal is to remain a community organization which prides itself on the family culture and personal interactions we have with patients. To that end, we strive to provide choice in the market. We are partnering with local employers to do something different to drive down the cost of care. We do not have our own payer program, but we provide direct contracting and risk sharing models with local employers in town. It takes out the middle man and puts the responsibility on us as an organization to keep these employer’s staff healthy. We are directly servicing the community, we are engrained in that community and have put skin in the game.

We all have read the benefits of telemedicine. One of those is providing convenient care for patients, reducing the time away from work, away from families. The employee has got to come into the office to see the provider and often, that requires a day off and less productivity. We are examining how we can, with these direct contracts, put telemedicine into the employer’s offices and make it so that employee doesn’t have to leave or take a day from work or inconvenience their family with a disruptive office visit.  It is our belief that having immediate access at their place of business will provide convenient access to employees, increase productivity and decrease costs for employers and ultimately aid in increasing the health and wellbeing of our community. Its sends a message to the community Metro understands what a patient needs to go through to see a provider and we are focused on helping the patient manage that experience, reduce disruption in their lives and can help add flexibility. We feel like this is going to help our patient mix and managing the healthcare experience.

Campbell: I appreciate you sharing the innovation that’s taking place on a localized level. If we could shift gears, I’d like to touch on the topic of population health management and anything you may be doing with Epic’s Healthy Planet module to that regard. Are you currently conducting any sepsis detection or surveillance initiatives or perhaps taking data from the HIE to get alerts about your patient population?

Wilda: We were an early adopter of Epic’s Healthy Planet module. We are one of those organizations that always seems to be on the bleeding edge. From a patient/payer perspective, we partnered with the state of Michigan on programs which gave us a spring board to adopt a progressive care team model around the patient. That model includes a team of care managers and pharmacists which provide support to our providers in managing the wellness of our population. Epic’s module allows us to use analytics to recognize those patients which may be at great risk or need more attention and then act on those patients with greater efficiency and quality. As I stated, technology is a great vehicle to allow our care team’s great accesses, more information and deeper abilities to treat more patients. We’re an osteopathic organization, so population health is ingrained in us, the complete focus on the patient’s health and wellbeing. It’s not just about being sick care but about treating the patient holistically, from root cause to illness to changes in lifestyle. That’s what osteopathic medicine really is rooted in. We are at the table with Epic trying to design the next wave of what that means for a small organization like us to sustain that model.

We also do have a sepsis program though not as robust as a lot of the larger healthcare systems, it is serving our patients extremely well. This is one of the reasons why we partner with the University of Michigan in that we have a lot of great ideas, but we don’t have the scale to do it. Now with the University of Michigan being a partner of ours, we have a lot more access to resources to grow our programs.

We are heavily engaged with our regional HIE, Great Lakes Health Connect. Metro was one of the founding members of our HIE. Around 10 years ago, a number of healthcare organizations came together and agreed while we may be competing for patients, we should not compete on the data around the patients thus forming one of the nation’s most successful HIE programs. Over the past 10 year, Great Lakes Health Connect has grown in its members thus growing the amount of information our providers have access to. Again, HIEs information is being engrained directly into the care workflows, allowing the care team better access, a more robust picture of the patient’s care allowing us for more prescriptive care plans.

Campbell: Very good. In closing, I’d like to ask you a question around your career trajectory. You have a compelling story, having worked on the vendor side for two years and then moving to the analyst side at Metro, being developed and groomed in-house. Folks who have created their own destiny are motivational. That said, what advice do you have for the budding health IT professional? What were the key things that got you to where you were today?

Wilda: One thing I tell anyone who’s starting out in their career is to make your ambitions known. Don’t just expect that by putting in sweat equity, people will know what your career aspirations are. I went out on a limb when I first came here and I scheduled a meeting with the CIO at the time. I told him what my career goals were. Did I envision myself as CIO? Not necessarily, but I’ve have a desire to grow as a healthcare leader and I told him that. He then set a path forward, setting the expectation that he wasn’t going to hand me a seat at the table, it needed to be earned. He knew that I was hungry and gave me the opportunity to succeed and opportunities to fail and learn from my failures. You need to take time to reflect and understand what you want out of your career and make your passions known.

It goes without saying I.T. professionals need to understand their business they support and not think that they are smarter than their customers are. In healthcare I.T., we have many vehicles we support, HR, finance, facilities, direct patient care, and more. It’s a very interesting industry, because we service all those entities and it’s about building the relationships and getting out there to know our customers and partner with them on crafting solutions that increase their services and delivery. You must show that you have emotional intelligence and empathy to understand what their business is, not tell them what their business is. You must really get to understand them and be open minded.

Understanding the people that manage technologies is critically important. We have to understand how to manage people. We often focus on the technology itself, how to manage technologies, but we also must appreciate and understand the inner workings of the organization. We have to put the right team players in the right team settings to make those technologies work. I tell our department all the time, we are not I.T. professionals in the healthcare industry we are healthcare professionals in the I.T. industry. Sometimes, leaders with a pure I.T. background and perspective come at solutions with just taking into account data, the networking, the bare metal, without an appreciation for the healthcare end-users. How will that technology impact, improve, disrupt, delight or disengage the users? It is important the entire I.T. organization of any healthcare system take the time to understand and get to know the business of healthcare.

I focus on our pure I.T. professionals, taking them for occasional walks around the organization, to get them aligned behind the “Why” of what we do.  Many do not understand how the impact of their work, that phone they deployed which they may think is mundane, has a mission, is delivering some critical information to a patient. It might be used to deliver some good news, it might be telling somebody unwelcome news. It might be connecting care teams. But, if that phone isn’t working when that patient needs it to work, it’s useless and you are impacting that patient’s life. That’s the impact we have from the most robust clinical application, the most inconspicuous piece of technology, like a phone.

Metro Health isn’t solely about I.T. Technology is a vehicle to where healthcare can go, and I’m all about instilling that mission and passion in my folks. In fact, it is hard to get away from that mission. My wife is a provider at Metro and I make the joke all the time that not only do I support end-users at work, I live with one and get intimate insight when/how the technology is helping and sometimes hindering patient care. I can’t escape it nor do I want to. It provides for nice dinnertime discussion.

Campbell: What a powerful message around emotional intelligence and empathy. The perspective you bring is truly inspiring. Thanks for taking time to share.