Nick Jacobs isn’t just a popular blogger. He’s also president and CEO of Windber Research Institute and Windber Medical Center of Windber, PA. A couple of readers suggested I talk to Nick about small-hospital technology. If you think that’s an oxymoron, read on about what this tiny rural hospital of a few dozen beds is doing.
Thanks to Nick for the chat.
Tell me about Windber and about yourself.
The hospital is 101 years old, started specially as a hospital to take care of the coal miners for the 40+ coal mines of the Berwind-White Coal Company. When the town of Windber was constructed, it was seen as what would be a model town for the industrial revolution. Every house had a central heating system provided by the coal company, schools, hospitals, and churches. It was like the Celebration community in Orlando. The commitment was made that this hospital would be one of the most outstanding in the US.
For the first 40 years, the starting physicians were innovators, to the point they held numerous patents and successes. They studied with the Mayo brothers, like learning to remove the thyroid without leaving scar. Celebrities came for the surgery, like Betty Grable, Arthur Godfrey, and Jeanne Woolworth.
We’re 30 seconds from where Flight 93 went down. I came in 1997. We have 550 employees now and a $21 million payroll.
The issue for me when I came was that the hospital had been given a death certificate by Ernst and Young. In the coming era of capitated managed care, the hospital had a short life left. That gave me a chance to challenge my board. I told them, “We can let it go, or we can try to go back to innovation and technical advancement and high-touch care.”
We had the first hospice in the US, founded in 1977, for a rural area. I was able to use that as a model for physicians and the board, telling them, “Look how people are treated in the hospice. I want to take this hospital-wide.” We’re a Planetree hospital now, the third in the US of what is now 200. We embraced the concept of spiritual, holistic, mind-body-spirit care, the highest touch concept.
Having interviewed at Boys Town Hospital in Omaha in 1992, I got to a hospital that looked like Windber but was called National Research Hospital. I asked a priest why. He had 38 PhDs and was a genomics center in 1992. I found myself at a dinner party with our local Congressman talking about the Dean Ornish CAD Reversal Program. I explained it to him. He said, “We’re spending $1 billion a year on heart disease in the military.” We launched partnership with Walter Reed the following year.
Then, a board member got breast cancer and came to our hospital. That made me uncomfortable. I wondered why she didn’t go to Sloane-Kettering or MD Anderson. She went through it at our place, then went there for a second opinion. She went to our Congressman and said, “These guys have figured it out.” We have massage therapy, popcorn, clowns, family access, everything. She told the Congressman that the military was spending all that money, but nothing in our district.
We built a research facility with 50 scientists and 40,000 of the most highly annotated breast cancer tissue samples. These are longitudinal studies because they’re in the military. We built a team of biomedical informaticists who have perfected software and methodologies for mining huge quantities of medical-related data.
Because I’d never worked in a research institute, and in fact didn’t get into healthcare until I was 40 because I was a high school band director, one thing I discovered is that I didn’t care about the past and wasn’t tied to it. When I had a chance to create a research center from scratch, I decided I would meet with my first three PhD hires and ask them what the bottlenecks had been. First, all science is called small science. You get an idea for secret sauce, go to NIH for money, build your team, then I might take it away from you. I decided that instead of creating divas, I’d create a ensemble of people who could work with each other.
Also, I decided that all information would be stored together instead of on individual PCs. So, we had terabytes of data to study, but had to build from scratch data mining. I hired a Penn bioinformatics director, hired 10 people, and worked with dozens of companies to come up with trademarked capabilities. Researchers in our institute can query all 40,000 ladies in our database. How many of you drank coffee? How much coffee? Then, you can do an analysis of which ones got breast cancer. This was set up in a manner so that not all donated serum and blood and tumors were cancerous. Interesting. Maybe those who drank the most coffee don’t have breast cancer. It creates a way to query issues that could be pertinent to disease states. It was not disease-specific. It can apply to any disease.
I found that PhDs don’t talk to MDs. I hired some MDs and got teleconferencing to meet weekly with oncologists and pathologists from the Army about problems with individual patients. We took those back to the bench to find solutions. That’s translational medicine. We’re way out ahead of everybody’s headlights, and for those mired in the traditional system, they’re not only afraid but desperate victims because it changes the way they get funding.
To communicate information back and forth to the Army, we have a network of OC-48 capable dark fiber. We can transfer entire hard drives in seconds. In Windber, PA, a town of 4,200 people, we have some interesting opportunities. The space and missile defense command that had the original Star Wars defense program had a civilian who put together a team of $7 billion worth of research to fuse infrared and radar together to detect missiles from outer space. His sister died of breast cancer. He vowed to have those algorithms declassified for us to fuse ultrasound and digital mammography. GE is a partner doing research with us. We have three MRIs with breast-scanning capabilities doing fusion of technologies to find better ways to avoid misdiagnosis. All in a little 50-bed hospital two hours from Pittsburgh. It’s a fascinating evolution that came from the mind of a band director. [laughs]
Describe the hospital’s IT systems and their role in your strategic plan.
Because of the system that we’ve put together, we have interest from all over the world, except in the US. Go to the Netherlands, there are eight academic medical centers cooperating, but they didn’t have tools to mine the data to make it translational. We’ve been back and forth for a year working on software we created here to mine that data.
We get breast cancer tissue donations. We can do a genetic analysis in-house to determine which genes contributed to it. Then, we have the capability of determining which proteins were contributors to spreading the disease. Both of those modalities create huge quantities of data. Then, we do histopathology and molecular research, clinical and diagnostic data. We have mountains of data. One piece of equipment can create six months of data to research. We can see the potential impact of alcohol or obesity. We think it will contribute substantially to future cures as we analyze the data.
On the downside, we’re way out ahead of the headlights. We’ve spent millions trying to get software companies to cooperate with each other and designers. In one meeting, we had six companies involved in the data collection process. We had to put them in a room and lock them in until they agreed. Everybody was afraid to let their secret out. One large company that I’ll leave nameless – they can mine huge quantity of data for retail and banks, but in biology, they walked away and said, “We can’t and won’t do it becuase something that’s brown 1000 times turns green. It just happens.” They had no way to turn their analytical tools into biological analytical tools to meet our needs.. Another company asked for a meeting and in the NDA said, “Anything you say that we can remember, we can use.” [laughs]
How important is IT overall to a hospital’s success and to patient outcomes?
We just put out another $3 million for Meditech.
Concentia Digital of Columbia, Maryland … Duane Shugars is president, a young guy. His company was hired by National Geographic to digitally catalog all their images and films. If you want a picture of a lion with a bird on its nose, you can search for it on the Web and buy it on the Web. Then the NFL contracted with them to catalog and organize plays, so when they said, “Here are Terry Bradshaw’s top plays”, they can find them. Then the CIA and FBI hired them. They came to us through an acquaintance. Everything we do is digitized and put into their repository. With 40,000 samples, a single pathologist has done an analysis. He’s a research pathologist instead of a clinical pathologist, so instead of 20 things, he looks at 120. Theoretically, any scientist anywhere in the world looking for samples can be search and those samples would come to them visually.
They say politicians can have national influence, but they still have to be re-elected by the folks back home. Windber has a lot of national publicity, but you’ve said locals don’t really know much about the hospital. How can you bring the national message back home where it can do some good?
In 1977, we had the second Johnstown Flood. We had the largest out-migration of any urban area in the US except East St. Louis, Missouri. Our demographics look like Dade County, Florida. We have large quantities of octogenarians. The average person has lived in their home for 38 years. The hospital went through a tough decade in 60s and 70s. If they have a bad experience, they don’t easily forget it.
Our publicity has been in Forbes, Fortune, Wall Street Journal, CNN, the Today Show. That’s not where they live. It’s been a 10-year uphill battle to get our locals to realize that this is a unique place. The national infection rate is 9% in a hospital. Ours has been below 1% for almost nine years. So, how do you put billboards up and say, “Come to Windber and you’ll die less”? [laughs] It’s a challenge that doesn’t make for happy competitors.
We’re starting to get local recognition, but it’s happened because of my blogs. The former public relations director of the Pittsburgh Symphony, now 81 years old, said, “Why aren’t you blogging?” I wrote my first blog in May 2005, having no idea that I was the only hospital CEO with a hospital-endorsed blog in the country. The local paper asked me to write op-eds about healthcare. Another little paper asked me to write a comedy column and I became a local folk personality, the baby boomer with the child problems. Then, there were other blogs. The bad news is that none of them pay, but we’re getting the word out. When I was in the Netherlands, they said, “We love your blog.” [laughs]
Tell me about the Planetree system.
Angela Thieriot had to have surgery in the 1970s. She went into a San Francisco hospital and had the typical hospital experience, like being a lab rat. You’re a number and an organ and it’s cold and detached and there are heavy duty rules based on the military system of triage. She came out of it wrecked that American healthcare was so insensitive and cold.
She convinced the hospital to give her a wing to design care that doesn’t require leaving your dignity by the door. A hospital in Oregon tried it and was interviewed on Bill Moyer’s “Healing and the Mind.’ She became a folk hero in a little 50-bed hospital. The movement started to get traction. It did well for eight or so years, then died. A hospital in Connecticut bought the franchise rights and I was the third hospital in the US to become a Planetree hospital.
I’ve been on their board for four years. We’re pushing 160 hospitals worldwide. It’s catching on as Baby Boomers become patients. They’re not happy with instant Sanka in a pack. They will want a decaf latte with skim milk. It’s the best of a hotel, hospital, and spa. Patient empowerment and patient care. Care isn’t centered on physician times and dates or employee’s availability. It’s based on centering care around the patient. Every patient in our hospital is touched multiple times every day by caregivers other than RNs and MDs. We provide beds for loved ones, kitchens, showers, and beds in the OB suite.
The greatest compliment was when surveyors from state were here two years ago and couldn’t fund anything wrong. The surveyor said she wasn’t from around here and it was the 35th hospital she’d been in this year, but told her husband that if anything happened to her anywhere, no matter what, bring her here.
I’m 60 years old and have six heart stents and my mission is to change the way healthcare is delivered. I’m saddened by how science works and how hospitals don’t cross the line of taking care of souls and not bodies
Can the hospital succeed as an independent and can anybody compete with UPMC in western Pennsylvania?
I don’t know. If we had not made the choice made by our board, there would not be a community hospital here. Was either decision a good one for the community? The board chose to take this on and try to compete. We only represent 6% of the healthcare in this region. It’s not like we can put them out of business. On any given day, if you say “Go Penn State” or “Go Pitt”, you’ll make half the people in the room mad. It’s not just an UPMC juggernaut, it’s also a Geisinger juggernaut.
Three, four or five years from now, will Conemaugh survive? UPMC has already made a run on this area and it didn’t go the way they hoped, but they have their joint ventures and insurance here. It remains to be seen if Geisinger comes in. We can survive only if we put all the pieces of the puzzle together. Oprah drops off her dog at a spa 20 minutes from here. If I can get her in here and beat that 30% error rate … I think the answer is yes, we can survive, but that’s an uphill challenge.
You mentioned in discussing Michael Moore’s Sicko that we’ve never had a health policy in this country. Why do we need one and what will it take?
I’m not a policy wonk and I was out front in rejecting Hillary’s last plan. It doesn’t do any of us well to have what England or Canada has. The waiting time is years. People come across the border from Canada for heart surgery. I’m not sure that plan is the best way to go.
Internationally, we’re through the roof, #1 in cost and #42 in quality of health. I’ve seen a lot of diagnostics that relate to typical overhead. With a private insurance company, it’s 20%. With Medicare, 3%. There’s got to be something in between that makes this work. UPMC is positioning themselves to be a global player in single payer. Highmark is doing that. Does that look like Medicare or a modified insurance system?
I can be the least expensive hospital in the US and it doesn’t matter because the insurance company doesn’t have to pass it on to the consumer. We have to find a solution that doesn’t permit this outrageous 47 million people to be uninsured. That’s unconscionable. Some kind of single payer has to evolve or it will become a worse and worse train wreck.
You’re speaking at a blogging conference this month. What’s your message going to be?
So many of my peers are finance guys who stick their heads in the sand and go with business as usual. It’s kept us locked in the industrial revolution. I’m doing a podcast next Friday with someone from Mayo. Transparency will be huge. Communication through the Internet is huge. We’re more connected than we’ve ever been in history. A political leader who could lie to his people is being checked internationally by hundreds of young people. We’re finally totally linked.
I wrote a blog that I thought the demise of Imus was because of that. It wasn’t that he hadn’t said something like that 1000 times before, but everybody grabbed onto it and made something out of it. Get with it and figure it out. It’s the new world order. New tools will reach out to people in a different way that will make or break your business.
If you weren’t CEO at Windber, what job would you want?
If I’d been talented eough, a top level orchestra director. It’s the most rewarding thing I’ve ever done. Touching people’s lives like this is important, though. At this stage of my life, I’d just like to speak and write to change healthcare. I love getting the message out and shaking up the status quo. It’s not my system, it’s an old system that needs re-evaluated. Some day I’m going to write a book at how being a high school band director is like being a hospital administrator. It really is.