Competing with the world: University of Utah Health Care's CIO on how hospital IT has changed

With a career spanning two countries and more than three decades, Jim Turnbull, CIO of Salt Lake City-based University of Utah Health Care, has had a wealth of experience that gives him unique perspective on how many issues in healthcare in the U.S. have come to be. As CIO of a $4 billion health system that includes more than 1,100 physicians and provides care to residents across Utah and five surrounding states, Mr. Turnbull oversees the IT components of major initiatives, such as University of Utah Health Care's push for ratings transparency and the hospital's current infrastructure expansion to more than 15 regional hospitals.

Mr. Turnbull spoke with Becker's Hospital Review about how perceptions of IT are changing, competing with Silicon Valley for talent and why code writers are a dying breed.

Editor's note: Responses have been lightly edited for length and clarity.

Question: What IT projects are on your plate right now at University of Utah Health Care?

Jim Turnbull: It's a really interesting time. Up until about a year and half ago we were really focused on putting our EMR in place and meeting the meaningful use requirements that come along with that. Since we'd had things piling up in the background while that was happening, the floodgates have sort of opened up now — we're extremely busy and our organization is growing like crazy. We're deploying programs as well as building facilities throughout our service area here locally, we've developed affiliations with about 15 hospitals in the seven-state region around us and we're busy deploying our Epic EMR to those sites. It's growth and all good things, but it keeps the staff very busy. We are also relocating about 450 staff members to a new space downtown which is going on at the same time as everything else.

Q: You've handled a number of EMR implementations over the course of your career. How has that process changed?

JT: That's an interesting question. When I was CIO for Sarasota (Fla.) Memorial Hospital in the mid-1990s we were the development site for Eclipsys' Sunrise Clinical Manager, which was later acquired by Allscripts. As the development site for that product, we went through three different configurations of the infrastructure — the implementation and two total replacements. We were replacing servers like crazy and going through several upgrades with them as well. That was a little bit of chaos, but there was a lot of excitement around it, too. Since then I've done two implementations with Epic from stem to stern, one at The Children's Hospital in Denver and one here at University of Utah Health Sciences, where there was a lot more stability in the technical environment, so the focus was really on getting the application suites and programs rolled out and not so much worrying about the infrastructure itself.

It's definitely a much more mature industry in terms of the healthcare information system players. The challenge I've had in some places is there are still IT people who want to write a lot of code, and that's something that's changed. The code is written at the EHR mothership, and it's got enough configuration capability built into it that once it lands at your site. You don't really write code, but a lot of the staff were trained to write code and they didn't necessarily like that shift.

Q: Do you find that individuals across the health system have changed the way they view IT and its importance to hospitals in recent years?

JT: The answer is a very clear yes, for people within our own environment and patients. People have very high expectations. The appetite for more is a little bit overwhelming some days, and the desire for immediate gratification continues to grow. Managing the demand side is really a challenge and during this current budget cycle we're intending to request pretty significant growth in our IT team, about 10 percent of our current staff of 400. Not because we want to get bigger but because that demand is bigger. So it's interesting times, and it's not unusual for one department to have five projects underway, and another three or four that have already been approved, and another four or five in the pipeline. So people really understand the capabilities and when they understand the capabilities, they want them now. That's the biggest transition I've seen in the last three to five years — the desire for more is becoming difficult to satisfy.

Q: What are the challenges of managing an IT team of that size?

JT: The challenge for us is figuring out the right balance between full time staff and contract staff to do the deployments. That's one thing that's driving the external growth with our affiliates. The other side of it is really driven by more internal demand and the core growth of our organization. We're opening another large ambulatory clinic this year, we've just opened up a number of urgent care clinics and we continue to add faculty. All of that growth requires more and more support, particularly in training and implementation. We're doing our best to optimize what we have and continuing to leverage the resources that are already here.

Q: What other challenges are on your mind now that 2016 is in full swing?

JT: Security is definitely top of mind every single day and the No. 1 priority, no doubt about that. If you don't have security, you don't have credibility, you're going to lose the confidence of your patients and employees. Another huge challenge is really getting the governance right, it's part of the issue with managing demand as well. We're in the midst of going back and revisiting our governance structure, making sure that we have a seat at the right tables so we know what is coming at us from different parts of the organization. We're developing a healthcare plan here and starting to roll that out, which creates other needs. In some cases we haven't had a seat at the table with certain groups within the system, and we don't see the requests for IT support coming in until perhaps it's a little bit too late. Governance is a big piece of the puzzle when an organization becomes as dynamic as this one. So for us that's a big point on the agenda this year, getting that right.

I think the other piece that's a challenge is that Salt Lake City has become a very hot market for IT people. We've had a lot of companies migrate from California out to Salt Lake City because electricity, labor and cost of living are cheaper. Oracle has a very big presence here in town, Adobe just built a brand new facility here and Workday is here as well. So you're seeing a large number of companies starting to come this way and we're competing with them. They're large international companies that absolutely dwarf our $4 billion delivery system. We used to compete with Intermountain Healthcare, another major Salt Lake City health system — now we compete with the world. That makes it a challenging time around here but it also brings a lot of talent to town. That competition for really good talent is getting tough, but certain people would rather not work for those large companies and when they've had enough, we're a good alternative to that.

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