Winjie Tang Miao is president of Texas Health Harris Methodist Hospital Alliance of Fort Worth, TX.
Tell me about yourself and the hospital.
I’ve been in healthcare for about 12 years now, all with Texas Health Resources. I guess it’s rare nowadays to be with an organization that long. THR is a faith-based, not-for-profit healthcare system in the Dallas-Fort Worth area. We have about 25 hospitals, a large physician group, and other healthcare services.
In my 12 years, I’ve been really privileged to work in three of our facilities, but most recently at Texas Health Harris Methodist Hospital Alliance, a brand new hospital that just opened in September.
When you look at the organization’s overall positioning and strategy, how important is IT?
I think it’s essential. Our stakeholders are demanding more of us, “us” being healthcare and the healthcare industry as a whole. We need technology to help us met their expectations of us, and honestly, our own expectations of ourselves.
Do you see the technology becoming more visible to patients or becoming more of a competitive differentiator?
Yes, I think it’s definitely already more visible to patients. For example, in our facility, we have technology now where you can look at your medical record in real time while you’re lying in your bed. You know what the physician has ordered for you in the morning and the afternoon.
The education that’s been ordered for you now gets automatically pushed out. If I’m a congestive heart failure patient and I require some smoking cessation education, for example, technology enables us to make sure that patient gets that education and that they receive the education as documented in real time. All of that is direct technology that the patient sees.
I think there’s a lot of technology, though, that is really there to enhance the human capacity that patients may not necessarily see. Those are some of the things that I’m most excited about. How do we make the environment more user friendly for our caregivers, our physicians, our nurses, and all the staff that are at the facility? Because as we know, as the baby boomers retire, the workforce is going to shrink. We really need that technology to help bridge that gap.
In terms of being a competitive edge, I think there are certain parts that are going to be non-negotiable. I think an EMR is going to be non-negotiable. You’re going to have to have it, so I don’t think that’s a competitive edge. But I think having some other technologies — like proactive tools that will help improve management of chronic conditions and those type of things — would be a competitive edge.
What is the most innovative of the technologies that you’re using or planning to use?
What I would say is innovative is not necessarily the technology in itself. We do have a patient information device. We do have RTLS throughout our facility. But it’s not the technology that is innovative for me.
I think what is innovative in this particular facility is how we’re integrating all those technologies together. How does Vocera talk to RTLS and to nurse call? How does that mean that, OK, now that I have I have a patient discharged, I can just take their RTLS locator tag, dump it in a box, and because it’s in that box, it automatically sends a note to TeleTracking to say, “Now it’s time to clean this room.” The housekeeper on Vocera automatically gets notified because through RTLS, we know that that’s the housekeeper on that floor. A process that normally would take either multiple phone calls or multiple clicks on a computer is now automated in real time.
As a new facility, you’ve probably had conversations with vendors about what technology you’re going to use and how you’re going to use it. Is that different from what the other Texas Health Resources hospitals use?
I think the extent that we’re integrating all the technology is more than what other Texas Health facilities have. That required many vendors to come into the room and have a conversation that they’ve actually never had. Vendors who had never met each other, even though we’ve had their systems in some of our hospitals for years, because it was very siloed. We bought the nurse call system or we bought the Vocera system or we bought Epic or whoever it was. We bought these systems, we implemented them vertically, and then we integrated them horizontally.
There were a lot of vendor meetings that we had. In fact, as we were choosing what systems to go with, one of the most essential criteria that we made the decision on which vendors to go with was either past history and experience that they could demonstrate a
successful collaboration and integration or a willingness that they showed to be able to do that.
Is the IT support centralized, do you have some IT people locally in the hospital, or some of both?
All of our IT is centralized at the system office. From the system office, there are certain members of our IT team that are deployed locally.
What expectations do you have of the IT department and the folks leading it?
I have the same expectation that I have of any leader in the organization, which is one of collaboration, transparency, communication, and all those good things.
In terms of specific IT leaders, though, I’ve had the opportunity to work with a variety of IT leaders in my career. I think that what separates the good IT leaders from the exceptional IT leaders are the ones who are able to balance that creativity and desire to be on that leading edge and try new things with an understanding of hospital operations. Having that knowledge, having the common sense, and really sometimes the humility to say, “You know what? That’s a great technology. I’d love to put it in, but it really doesn’t make sense for us, and here’s why.”
In terms of the risk involved with being innovative, is there conclusion about how much IT innovation is the right amount?
I really think it’s based on the culture of the organization that you’re in. Implementing new technologies and being innovative is really about change management. If you have a culture that is used to change, open to change, wants that change, is able to function still and maintain high performance while going through change, then that organization, I think, can tolerate more innovation.
In an organization where perhaps you don’t have as talented of leaders, both from the IT and the operational side, to manage that change through, then it doesn’t matter if it’s even the smallest of innovations, managing that is going to be difficult. You’re not setting yourself up for success. I think being able to gauge the level of tolerance in an organization is important, but for those who have that capacity, then I think go for it.
Between the operational leadership and the IT department, who should look for something innovative and who should lead that change if and when it happens?
I hate to give “it depends” answers, but I think it depends. [laughs] When I look at how we created this facility and all the technology that we’re integrating, some of the best ideas came from the IT side and some of the ideas came from the hospital operation side. It’s really a blending of the two.
I think ultimately deciding whether or not to pull the trigger on a specific technology requires everybody at the table. Then once that decision is made, clear delineation of roles and responsibilities for that particular technology, because again, all technologies aren’t created the same, either.
You may have something like telephones. We made a decision to go with a particular platform. While that’s really read better from the IT side, it’s not as invasive from a clinical standpoint, Obviously we all need telephones, but it doesn’t require a whole lot of clinical expertise to do telephones. We just need to make sure they’re programmed correctly so the clinicians use them properly. But you take something like Vocera or nurse call or AirStrip OB, which is much more clinical, I think the ratio changes.
I think having a “one process fits all” solution is unwise. I’ve seen that happen sometimes. I think that’s where the roadblocks come in and some organizations have run into trouble. But to really look specifically at the innovation, and for this particular innovation, what are the roles and responsibilities going to be? A strong PM does that and can manage that through the organization for a successful implementation.
In large health systems, the smaller facilities or the bigger ones or the ones that are furthest away sometimes feel they’re not getting the right amount of IT attention. What’s the IT secret to making sure that you’re engaged and feeling like you’re well served as part of an organization that has several people who want those same things?
It’s funny you ask me that question. I mentioned that I’ve been with Texas Health for 12 years. I’ve been at one of our largest facilities — it’s 850 beds. In fact, that’s where I started my career. Then I went to literally the smallest facility in our system, which had 36 beds.
What I’ve always said is I think the key to success from an IT standpoint is understanding that smaller facilities don’t have less needs, they just have different needs. I say that from a management standpoint, too.
I remember being in a larger facility early in my career. I’d look at the smaller facilities go, “Gosh, they have it so easy. They only manage this and it’s a small patient population. Of course they’re outcomes are great, because they only have 18 patients to manage compared to the 800 that we’re managing here.”
And I remember when I first got to the smaller hospitals, I’d look at the larger hospitals and think, “Gosh they have it so easy. They have all these layers of support and people that just do education. Whereas at the smaller facilities a lot of times, the managers take on additional roles and wear multiple hats because you can’t have a million FTEs taking care of 36 patients.”
When I had those two experiences, I remember one day sitting back and going, “It’s not that one job is easier or harder than the other,” which is the perception when you’re in those facilities. They’re just very different jobs. I think from an IT standpoint, it’s the same thing. The needs aren’t less, they’re just different. The good IT leaders can go in and understand what those needs are and deliver on those.
I would think it’s unusual for someone with a degree in biomedical engineering to be in a leadership role. Do you think that gives you more affinity with the IT operation or are you an outlier among your peers who went through a more traditional undergraduate program?
I would say that I’m definitely an outlier amongst my peers. I’m not familiar with any of my peers who have an engineering degree.
I think that having an engineering degree and understanding systems and processes and being trained in that gives me less angst in terms of dipping my toe in the technology waters, because I have a little better understanding of how things work. Clearly I’m not a computer programmer — the last time I programmed was in C++ , so that’s definitely not something you want me doing [laughs], but at least the philosophy behind that and how it works. I think the mystique is maybe less and so the apprehension is less.
You went through a construction project, which forces you to be as innovative as you can knowing that you’ll be stuck in that footprint for a while. What are some of the innovations in the new facility that would not have been common in older facilities?
I think that if you look at older facilities and facilities that were planned 20-30 years ago, most healthcare was provided in a hospital or in a doctor’s office. You sought healthcare because you were sick.
Today, your healthcare happens in a variety of environments — from your home thanks to telehealth, to the doctor’s office, to even your local drugstore. Walmart now has minute clinics or different things like that. Or you go to a surgery center or a freestanding lab. There’s a lot more venues now to deliver healthcare.
We understand that we need to optimize well-being in order to really control healthcare costs, not just take care of people when they’re sick, which is what we were focused on doing 20-30 years ago. For us, designing a new facility was trying to design a system where care is rendered where it makes the most sense. Going back to that engineering background that I have, how do you optimize the system, both from a cost and a convenience perspective?
In our facility, for example, we don’t have a large outpatient imaging area because a hospital isn’t the most cost-effective place to the get that service. In our facility, we have a separate ambulatory surgery center that’s wholly owned as part of the hospital. We did that for two reasons. One, patients don’t want to pay a high hospital deductible in order to have some-day surgery. They want to pay whatever it is on their plan, $250 co-pay and have their surgery and go home. But a lot of times, we’re still doing those outpatient surgeries in a hospital.
Secondly, I can build that surgery center space at significantly less cost than I can build hospital space. I’m not going to get into the details of why that is, but that’s just how it is. If we know that we can deliver that care in a more efficient setting, we’re going to do that.
And of course, technology has played a big part in building design as well. The most obvious example is the first hospital I worked in had a medical records department the size of a football field. At our facility, we have a fully deployed EMR, so we didn’t build medical records storage at all. We get to use that space for other things. Those are just a few examples.
In that planning of what the future looks like, both healthcare in general and your organization and your facility specifically, what are the most pressing opportunities and threats looking five to ten years down the road?
I think the biggest opportunities are being creative and developing those new processes and systems to address things like coordinated care across the continuum. As we move towards managing the health of populations and ACOs, what does that look like? Do we build that? Do we partner with somebody who’s already an expert in that? Do we acquire that? How does that all work together?
Getting to create something new in an industry is fun and exciting and a great opportunity for a lot of innovation and growth. I think the challenge to that, though, is that our current reimbursement system is still build on that per-click system. We take care of you when you’re sick, and when you come to my hospital and you need your appendix taken out, I get paid for that appendix to be taken out.
What we need to be careful of is that as we transform our organization and as we optimize health and well-being, that the timing is appropriate and sustainable for the organization.
The final wildcard which I’m sure everybody is aware of and throws out there is, we still do not understand the full impact of the Affordable Care Act. All that is still being developed and rolled out. How do we implement the exchanges and what are the rules for exchanges? All that good stuff is still coming, so I think that’s still a big wildcard.
What would surprise people most about what it’s like running a hospital?
I will tell you, what surprises most people that I talk to outside of the healthcare industry is that either (a) we do not employ our physicians, or (b) a physician does not necessarily run a hospital. People really think, “Oh, physicians don’t work for you in the hospital?” That’s really the thing that surprises people the most.
What do you like best and least about your job?
I think what I like best is that at the end of the day it’s very fulfilling and challenging work. It’s an exciting time to be in healthcare. There’s a lot of change going on. What we’re doing hopefully at the end of the day improves the lives of the people in the community you serve. Having that fulfilling, big-picture goal drives me and sustains me.
In terms of what I like least, I think that just like anybody else, the parts I like least are the parts that aren’t necessarily value-added to meeting the goals of the organization and making necessarily our stakeholders’ lives better. Things that perhaps required from a regulatory standpoint, or certain things that we do that we have to do for governmental reasons.