Dr. Sarah Muttitt, Vice President, Information Management and Technology and CIO at Toronto’s SickKids, has come full circle since she first practiced at the hospital 30 years ago as a newborn intensivist. Sarah is one of four panelists participating in Gevity and Divurgent’s co-sponsored symposium at eHealth 2019 on Tuesday, May 28 from 11:15 a.m. to 12:15 p.m.

She recently spoke to Gevity about her transition from the clinical to the healthcare IT world and the perspective and insights that her extensive international, national, provincial and hospital-level experience has given her.

Gevity: Tell me a bit about yourself. How and why did you make the transition from physician to CIO?

SM: I am a physician by background. I was a newborn intensivist and I trained and practiced here at SickKids, so it was kind of a circle of life for me to come back here. During some of my work in pediatrics and pediatric rehab, I was doing some clinical trials with patients from around the world with neuromotor disabilities – things like cerebral palsy, spina bifida and other disorders that can affect premature babies and newborns in general. We couldn’t have patients flying back and forth to Toronto for regular follow-ups to assess their progress on new therapies, so I started to use videoconferencing and got involved in telehealth. It was my first foray into technology and it proved that physicians embrace technology that they really need. If a technology provides value and it works, it really is much easier to get physicians to adopt it.

I worked in telehealth for five to six years; I ran the Manitoba Telehealth Network for couple of years and then I joined Canada Health Infoway as the Vice President of Innovation and Adoption and was responsible for change management, knowledge management and benefits realization. Then I got really involved in electronic health records and health information exchanges. I gained a lot of experience working across Canada and was then recruited to Singapore, where I became the CIO for the Ministry of Health and the Ministry of Health Holdings. Their mission was to implement a national e-health record, which we did. I was there for five years before coming back to serve as the CMIO of Alberta Health Services for three years and then here to SickKids. All of that provided a great opportunity to see the implementation of technology at various levels; it gave me a lot of perspective on things that work well and some of the success factors.

Gevity: Did the time you spent in Singapore affect your approach to Canadian healthcare system transformation?

SM: In some ways, yes. Singapore is such an interesting example; it’s a small country, it’s an island, it only has 5 million people, and it’s relatively new. They have built a high-performing healthcare system with outcomes comparable to if not better than many other developed countries, despite only spending roughly four per cent of GDP on health. As we look at healthcare reform and try new models, there are things we can learn from other jurisdictions and it’s exciting to think there are different ways to provide more integrated-, patient-centred and affordable care.

Gevity: SickKids embarked on its Epic implementation in 2017 in partnership with the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa. Did partnership further complicate that initiative? 

SM: SickKids’ journey began with trying to understand if our existing systems would support us to achieve the outcomes we wanted as an organization. We were a best-of-breed, multi-system, non-integrated and hybrid environment, so we had lots of paper and lots of systems within particular areas – all of them siloed – but they were significant investments. We spent a lot of time asking ourselves if this was how we wanted to continue or if there was a better way, and we decided we would get more value from an enterprise-wide information system. That’s really where the journey began: we decided to move from best-of-breed to a single system. Our goal was a big bang, cross-enterprise implementation. We went through all the normal procurement exercises and Epic was identified as the preferred vendor, strongly supported by the clinical decision-makers.

We decided to do it in partnership with CHEO, and yes, it was even more complicated because we were not building at same time. CHEO had been on Epic for many years, mostly in ambulatory, and when we decided to do this, they began to move toward implementing it for inpatients as we were doing the enterprise build, so we were on parallel streams of activity. That made it very difficult for us for to do a lot of joint builds, although we made a lot of effort to standardize where we could. It really required close attention to governance, strong executive leadership across both organizations and clear principles on decision-making; those are some of our key success factors.

It was very difficult to be on a single path but we’re getting closer with plans to integrate our teams more effectively and develop a shared annual workplan; on June 1 of this year we will go live jointly with our Epic 2018 upgrade and it’s real evidence of success because it is so hard to do. We have separate executives and separate boards – and 400 km between the two organizations. It really is a different undertaking than many of the shared instances you hear of in the U.S. where they are a single entity with distributed sites. It’s also different from the Atlas Alliance implementation in Ottawa where they are doing it together at the same time and creating everything together from scratch as a collaborative, so it has been a really interesting journey. People ask why we did it. We did it because we believe we can set standards around pediatric care on a shared platform. We share about 10 per cent of our patients, who tend to be the sickest and most complex (transplant and cardiac, for example). To have a single shared record between our two organizations really serves the families of those patients very well. The Ontario government was recommending shared instances but we really did it more out of a vision for pediatric care.

Gevity: What were the most important lessons learned that you think other Canadian healthcare organizations that are either looking at implementing a new system or replacing an existing one could benefit from?

SM: We had a lot of learnings leading up to the go live, and certainly a different set of them post go live. That is an important distinction: they are different parts of the journey. We talk a lot about the fact that your journey starts after you go live in many ways. You build, design, configure, train, do all the change management and then you turn it on and say, “Why did we do that; why did we make that decision? That’s not working at all.” At some point, you do have to flip the switch and take the learnings and be very committed to continuous improvement and optimization to make it fit better with your work flow and realize the benefits more seamlessly. You don’t know what you don’t know until you go live, and I knew that, but I hadn’t really experienced it as much.

I know we talked a lot about it to our stakeholders and they were also surprised – you just can’t prepare enough for the fact it takes lots of hard work to go live! But the hard work is really just beginning in many ways, and you have to commit to that longer journey.  You can’t just take a project team and let it evaporate post go-live. There is still a lot of work to be done, and if you think about how Epic is rolling out now, with their quarterly releases, you will always have people doing day-to-day business operations but you also need people for that constant improvement and adoption of new functionality. I don’t think historically we have done that very well in health care – we buy and implement systems and then we move on to other projects. But this is very different; this is a journey, a long-term commitment, and organizations need to constantly feed and water it to really get the maximum value out of the investment.