Lance Spranger is the CIO of St. John's Health in Jackson, Wyo.
He has led the system's efforts to convert to a single-platform EHR
and is responsible for the enterprise information system's strategic
vision, including cyber security efforts. Here, Mr. Spranger discusses
the big trends in health IT and best opportunities as technology companies
further engage with healthcare.
Question: What is the best technology investment St. John's Health
has made in the past year?
Lance Spranger: From a technology perspective, the best investment has been VMware NSX.
It's a network virtualization and security platform. We have used
VMware as our base infrastructure, virtualized our servers and desktops,
and now we have virtualized our network. One of the biggest benefits is
the adaptive micro-segmentation feature, which helps with east-west data
center traffic. Over 90 percent of data center traffic is east-west. If
something malicious gets into the hospital's system, the system quarantines
it so that it doesn't affect other segments of the system.
We also beefed up our firewalls, but that isn't something you can rely
on 100 percent. Hackers are always trying to stay one level ahead of us.
Another level of protection to lock down the east-west traffic before
it causes more damage. With the ability to virtualize our servers, desktops
and networks, VMware helps us meet business and clinical objectives and
goals. Now we can improve our performance, security and convenience at
the same time, and that's a game changer.
Q: How do you approach EHR implementation and interoperability within the
system? What is your strategy for connecting inpatient and outpatient settings?
LS: Seven months ago, we converted to a single platform for EHR. Our system
had the pain points associated with disparate systems in the inpatient
and outpatient setting, which prevented us from fully providing a continuum
of care and care coordination. Now we have a single platform and record
whether the patient is inpatient or outpatient, in the clinics or the ED.
During our roll out we had excellent physician engagement and leadership.
We had 10 physicians on our Advisory Committee, and they helped lead every
stage of the process really. Because it was a single record platform,
the change affected every end user and we recognized that. We explained
to everyone why the conversion was necessary and how it would affect them.
We achieved good results clinically and financially.
When an EHR roll out goes bad, it's usually on the revenue cycle side
and that inhibits the organization's ability to do their business.
We worked diligently on the revenue cycle side so we wouldn't see
an impact there and then have to make operational changes because of a
failed implementation. We began 10 months before the conversion to make
sure we were ready for the launch date.
Change, even positive change, comes with resistance. We focused on that
and understood we were changing everyone's lives. We knew the conversion
would work technically, however from the people side there would be challenges.
We focused on the people and emotional end so they would understand the
why and see the positive impact it would have.
Q: Where do you see the biggest opportunity to improve the patient experience with IT?
LS: The continued evolution of digital medicine, access to virtual services,
telemedicine and consumerism are big opportunities in healthcare. Almost
everyone has some kind of voice assistant or digital technology they use
in their personal life. Healthcare is usually behind the curve for regulatory
reasons, but we need to make advancements because people are using their
digital technology well. It's about figuring out how to leverage that
and use it in health IT and the healthcare setting.
Home monitoring, wearables and home health kits are becoming more common.
Systems are sending home stethoscopes, glucometers, and other data gathering
technology to integrate patient data from home and avoid unnecessary visits.
However, there has to be a balance of human interaction as well. With
virtual services, if we don't continue to remember that we are still
humans and need to connect on the human level, we will fail from the patient
experience standpoint. Concerns of risk and privacy as well have to be
a part of the conversation. There is inherent risk and we have to protect
Q: How do you think Amazon, Apple and Google will change healthcare? Is
LS: They have already started. You're seeing health executives and physicians
talk about data and artificial intelligence in reviewing imaging studies.
The platforms can see thousands of slices of a CT scan and determine which
are normal and where to focus efforts. Artificial intelligence and machine
learning is where big tech partners can work with big healthcare. It will
take further innovation and partnership, but whether it's from the
EHR or imaging perspective, we can use technology to drive innovation
and push forward digital medicine. Health systems and physicians must
change their practices or be left behind. The ones that grasp the technology
and use it to their advantage will succeed; those that don't will struggle.
We have been pumping data into EHRs for years, and data management is one
of the things that Amazon and Google have done well. If they host the
data, they can provide us with tools to help the decision-making process,
such as precision medicine. We can customize it down to the individual
level. As humans, we can't work fast enough to process the data, but
machines can. Let's leverage that technical ability and organize data
to help us make valuable decisions.
Q: What are the roadblocks?
LS: One of the things that will hold us back from the healthcare perspective
is regulatory. Right now, regulations cause physician burnout and dissatisfaction,
especially with the EHR. We are at a tipping point with government and
other regulatory agencies. They finally understand the intention of Meaningful
Use isn't happening in the real world and there has to be change to
restructure that and dial it back so the physician and nursing input can
meet their goals. Right now, it's not. They said EHRs would improve
care and make physicians' lives easier, but it's been the opposite.
We need to shift gears, otherwise we will lose physicians.
This story was
originally published by Laura Dyrda on Becker's Hospital Review.