The most vital IT investments today are the boring ones: Michigan Medicine CIO on remote work, automation and data analytics

Michigan Medicine CIO Andrew Rosenberg, MD, is focused on finding methods to sustain the unprecedented level of remote work and clinical care during the pandemic while keeping an eye on the data analytics and IT investments the system will need to drive efficiencies and cost-savings in the future.

Here, he discusses the biggest questions, challenges and opportunities for the Ann Arbor-based academic medical center and health system.

Remote work — can a hybrid model work?
When the pandemic hit, many health systems transitioned appropriate staff to remote work. With the number of cases continuing to fluctuate and spread across the U.S., it's unlikely many organizations will fully bring their teams back to the office this year, if at all.

"The single most relevant challenge is the variety of technical and administrative support required to sustain remote work," said Dr. Rosenberg. "In particular for the business employees and staff who can effectively work from home and other locations, we are shifting how enterprise-level IT works to make this happen.”

Employees are now relying more than ever on accessing their firm’s enterprise networks externally with VPNs and other methods. They are also increasingly using more strategic collaboration platforms including Google, Microsoft and Slack. Many of those platforms were used before the pandemic, in much the same way telehealth existed for years before COVID-19 hit. Now, both have expanded beyond any previous expectations in the past few months.

"Remote work and telehealth are probably the most immediate opportunities to work and collaborate differently. Our challenge is as much to support these new methods and find ways to identify and no longer support (pay) for methods and means we no longer need," said Dr. Rosenberg. "One of the previous methods we have to address in health care is how we continue to use physical assets such as clinic waiting rooms, administrative offices and employee parking lots where we should look to newer industries especially in technology sectors where remote work is the norm. We are proving that we can sustain and do work from home and other locations geographically separate from our care, education and research centers. The one question then is do people want to sustain working remotely or not."

There are two competing thought processes around enterprise platforms: one being early adoption to stay on the forefront of technological development, and the other is to make the most out of legacy technology that has proven effective.

"I tend to find myself defending the well-established, ‘big-box’ technology vendors compared to some of my colleagues who are quite good at finding small, niche innovators. Both are reasonable strategies, but perhaps large, academic medical centers such as ours need the robust integration the large, strategic vendors offer" said Dr. Rosenberg. For example, we have a long history using Windows and Microsoft-related collaboration products. Now we need to more quickly adopt their cloud tools to accelerate our diverse workforce and operational needs across clinical, education and research needs.

Now, one could easily adopt 15 to 20 very cool and new vendor products that support remote work collaboration. But with a single vendor, we are more likely to get even half of those capabilities more quickly, reliably and securely implemented and integrated across needs such as our knowledge base/intranet, team-based communication and common tool and infrastructure-based data and information storage. At Michigan Medicine we do this with Microsoft and Goggle (as much with our collaboration with the University and other UM Schools). I'm finding the large and integrated suites of new collaboration tools well-orchestrated and architected are having their day because now, more than ever, you need collaborative tools to work better. My argument is that best in breed might be cool and nimble, but is not as helpful for large organizations that need predictable, integrated tools."

In the past two months, Dr. Rosenberg said his team has pivoted its entire method of work, much like other academic medical centers and universities. IT is one area that is uniquely suitable to transition to remote work, as compared to other industries, but it still takes different skills to manage teams remotely and develop people’s talent along the way.

"The people who become managers, directors and executives are traditionally developed in work environments where everyone is in the same physical space and you can directly observe how emerging leaders manage their work and teams," said Dr. Rosenberg. "How do you do that in a remote space? How do you manage this in a blended workforce with some people from home and some people working in the office? Consulting firms have been doing this for decades, but most healthcare organizations have not."

Some companies have decided to permanently go virtual while others are planning a tiered return to the office. Dr. Rosenberg has considered several options and thinks his team will eventually take on a hybrid model combining remote with in-office work.

"I read an argument from a big tech CEO saying the worst thing you can do is go hybrid or have a blended workforce because you get the worst of both worlds. I’m feeling quite torn currently about this since I can see this CEO’s point of view, but I still want to try to create some form of hybrid/blended work model. Some functions will stay remote while others come back to the office for explicit collaborative work," he said. "I also think we have to feed our social needs. We are doing well now because we have the resources to work remotely, but we will miss being around other people."

The development of a stable remote work environment shot to the front of Dr. Rosenberg's priorities during the pandemic.

The challenge for paying for the old while doing all the new; data analytics, storage and patient engagement.
Many institutions and companies are looking to predictive analytics to combat the future spread of the coronavirus and future disease outbreaks; Dr. Rosenberg, on the other hand, is prioritizing reliable real-time data.

We have not spent much time working on advanced analytics during the crises he said. I speak to many new technology firms working on these techniques, and I’m hopeful for the future, but even using some of the more advanced national and global models we still did not predict very well. Firms that continue to use the crises to promote more advanced analytics are premature for us. It feels a bit like someone trying to sell you a fully autonomously driving car; Currently, I would favor one that has more safety features and maybe a few that augment human decisions in order to reduce accidents. When we find an Earth-shattering event like COVID-19, some leaders tend to look for what is new and use the moment to catalyze a disruptive new method. Frankly, what we need is something as basic as the most reliable, available network for all those remote staff, clinicians and patients to get their care and work done."

Before the pandemic, if the network went down, hospital executives likely wouldn't notice. They would be busy in physical, face-to-face meetings. But in the virtual environment, if the network goes down even for a brief moment, the meeting will suddenly end, and texts and mobile calls start arriving within seconds asking what happened. Our non-technology leaders have never been more involved in our basic infrastructure than during this period.

As health systems accelerate data productions (newer imaging, sensor and molecular data), a new challenge arises: how will they continue to store these data? "I find it very unlikely we will succeed in either eliminating old data to use existing storage. Therefore, we will need to find new compression and storage methods both on premise and in some else’s datacenters." Health systems are currently very ill-equipped to stop doing something else in order to free up monies to do something that sounds as prosaic as buying more data storage. But if we are do advance in IoT, sensors and significantly more imaging (digital pathology, advanced radiology), we will need to do this. The challenge for IT and Finance leaders is how to do this while also investing in all the new technologies to support more remote work.

At Michigan Medicine, Dr. Rosenberg and his team are working on replacing its baby abscondment system, which is 18 years old. It will cost many millions of dollars to replace the current system. Alternatively, the team may look to use existing technologies to reach the same goal.

"I want to figure out how we can use new capabilities of Wi-Fi and RFID to update the baby abscondment system because we don't want to spend extra money there," he said. "I'd rather use patient engagement technology, tracking and wayfinding technology we already have."

New tech investment
One of the challenges to bringing in and adopting new technology is reducing the costs associated with doing work in a new way; that may include staffing costs or moving away from pre-existing technology platforms and methods. When CIOs propose new IT projects that require additional spend, CEOs and CFOs typically ask for a budget trade-off; Dr. Rosenberg says the trade-off shouldn't come from the IT budget, but from other departments that realize the efficiencies.

For example, a health system that implements a robotic system to automate processes may decrease the number of needed clinicians. Amid the pandemic, one of the opportunities for automation is chatbots that can field questions and triage patients with specific symptoms. Health systems can also add robotic process automation to the revenue cycle and business operations.

"That will create efficiencies in terms of unified communication and alerts that allow staff to increase their work productivity 10-fold," said Dr. Rosenberg. "If you're walking through the halls of a hospital and you get intelligent alerts that are truly meaningful based on filtering and intelligence, it will make you more efficient," said Dr. Rosenberg. "A tele-ICU intensivist can cover 10 times as many patients remotely as they can physically."

Clinical care preferences
During the pandemic, patients from across generations had to become comfortable with telehealth and remote communication. IT departments have rapidly expanded capabilities for virtual care; now the next step is scaling them for sustained use.

"How do you manage patients from healthy outpatients to sick inpatients, aging patients and dying patients as well as their families when we have had a couple hundred years of mostly physical contact," said Dr. Rosenberg. "Most of healthcare includes personal and social connections between patients and providers and their families. How can we shift our industry remote? How can we disrupt it? Millennials can put their symptoms into their phone and receive information about potential diagnoses, but at the end of the day when you're sick and scared, you're not going to your phone for help."

Dr. Rosenberg sees the distinct need for continued in-person visits, even in cases when care could be done virtually.

"Healthcare fundamentally is still an industry, regardless of the transformation of COVID, we are still people talking to each other about important health issues," he said. "Even with the tele-ICU, we have been able to put a video screen in patient rooms so they can ask nurses urgent questions or explain an issue. It's about being able to see each other and interact."

Dr. Rosenberg sees a combination of virtual and in-person interactions necessary between healthcare providers and patients going forward. The over reliance on technology to supplant interpersonal discussions between healthcare providers and patients could become a concerning trend, he said. However, he remains very optimistic that engaged clinician-technologist executives will find the right balance for now and what lays ahead.

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