What it's like to work with 'every EMR known to mankind,' according to LifePoint CIO Al Smith

Overseeing health IT for 62 community hospitals and 33 specialty hospitals across 29 states is definitely not "one-size-fits-all," says Al Smith, senior vice president and CIO of Brentwood, Tenn.-based LifePoint Health.

"When you're in a smaller system, you just don't see that kind of disparity, that kind of variety," Mr. Smith told Becker's. "We aren't in a system that's going to be on one EMR, one supply chain — that would be utopia. That's just not the world I live in. So you get to work with lots of different vendors, lots of different customers and lots of scale."

He spends a lot of his time on improving the digital patient experience, digitizing clinical workflows and analyzing clinical data — as well as all of LifePoint's mergers, acquisitions and divestitures. Founded in 1999, the private, for-profit health system is the country's seventh largest, according to a 2021 Becker's analysis.

"Every single acquisition spawns off 40 projects of security and infrastructure and all the other [health IT] things," he said. "So that's always interesting: How are you going to integrate, and what are you going to convert them to? Do you convert them? How much money are you going to spend? How do you integrate them into your IT support model?

"We believe at LifePoint that care is local. So a hospital up in Washington has different needs than a hospital in South Carolina, whether that's different risk-bearing models, ACO versus fee for service, etc. So we aren't able to really be one-size-fits-all. We've got to be flexible. So how do you do that across 60-plus hospitals plus different business lines? That's a challenge."

A long career in health IT

Mr. Smith got his start in health IT at a "smaller" hospital group, the former Carolinas HealthCare System (now Charlotte, N.C.-based Atrium Health) in the late 1990s. He later worked for Cerner and as interim corporate CIO of the former Vanguard Health Systems, based in Nashville, Tenn.

He previously served as senior vice president and CIO of Capella Healthcare and RCCH Healthcare Partners, two for-profit hospital chains similarly based in suburban Nashville that have since been absorbed by LifePoint. He is also a partner with healthcare venture capital firm Caduceus Capital Partners

He has seen the CIO role go from a technologist to a business operator, starting with the rollout of EHRs.

"We laugh sometimes that pretty much no projects happen without somebody off my team being involved somewhere, because it always impacts IT somehow," he said. "We're just critical to the underpinning of pretty much everything everybody does."

Managing health IT across the nation

Even though his system doesn't operate on a single EHR, he and his team are able to make it work.

"Because we're in so many different states, I don't have to be super interoperable," he said. "There are not a lot of patient referral patterns from Idaho to South Carolina for a small community hospital. Where it does get interesting is that I need solutions that interoperate with every EMR known to mankind. So if I'm going to look at digital front door, I can't just pick Epic and ride it. I can't pick Cerner and ride it. I need something that wraps around the EMR that interoperates with the EMR but is EMR agnostic. So it makes it a little bit more difficult."

When it comes to EHRs, Mr. Smith said, "If it's made, we pretty much have it. We've got 'em all." But if there's a business case or the acquired hospital is dissatisfied with its system, he'll aim to switch the facility to either Meditech Expanse, Cerner or Epic, he said. It largely depends on the geography, as different vendors typically dominate different states.

He also said LifePoint's data center footprint "is not massive," but the system has worked with Google and Microsoft Azure on cloud projects and companies including Athenahealth, Ultipro and Kronos for software-as-a-service applications. He said its data is about half on-premise and half in the cloud.

An effective collaboration

Mr. Smith said he's proud of the health system's partnership with health tech company Eon, which uses computational linguistics to identify patients at risk of lung cancer. LifePoint has an equity stake in the firm. 

"We have some great success stories of where we have found potential cancer, have gotten people in early for treatment and they were treatable, that probably would have gone unrecognized for a long time and been a much bigger deal," he said.

"So it's been a great thing in terms of patient satisfaction, it's been great from a quality or an outcome perspective, and it's more than paid for itself, which is kind of the trifecta. There are a lot of things I work on that don't pay for themselves. You can draw a hard line to a hard [return on investment]. And this is one where we can really check all three boxes."

In the current economic climate, Mr. Smith said CIOs are "all being asked to do more with less." He's been revisiting vendor contracts to see if they're still needed and focusing on retaining talent. "Many of us are seeing, especially when you get into the cybersecurity and the technical realm, they can work for Google, they can work for lots of places," he said.

'Inward-focused innovation'

Mr. Smith has also worked to digitize internal operations to make them run more efficiently, through enterprise resource planning systems or EHR applications to increase nurses' productivity, for example. He calls it "inward-focused innovation."

In the future, he said health systems will be going toe to toe with "the Amazons" and "the Googles" of the world: "Everybody's looking at healthcare saying, 'How can I take a piece of this pie?' We're gonna have to be more creative and compete against people that we didn't compete against in the past. And some of them are really savvy from a tech perspective. Google, as an example, is really savvy, probably a lot more than Cerner or Epic — so how do you compete with those?"

In health IT, "we used to talk about a five-year strategic plan," he said. "You can create one, but it's going to be shelf decoration fairly fast."

So hospitals will have to figure out how to automate, cut down on wasteful spending and get providers practicing at the top of their licenses, all while rolling out new initiatives in areas like urgent care, telehealth and digital pharmacies, he said.

"We're going to continue to have to look at new care models that we didn't have to look into in the past," he said. "Exactly what that's gonna look like? My guess is as good as anybody else's. But as smart people at the top of the organization operationally figure those out, my job is to figure out how do I support them and how do I make it come to fruition."

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