Lou Capponi, Vice President and Chief Medical Informatics Officer at Denver, Colo.-based SCL Health, began his career as a general internist but grew into IT leadership roles as he saw how data and technology could support better clinical care. Lou is one of the four participants in a symposium Gevity and U.S. partner Divurgent are hosting at eHealth 2019 on May 28 from 11:15 a.m.-12:15 p.m. The event, which focuses on how healthcare organizations can maximize the value of their Epic implementations, will share lessons learned and strategies for success. Lou spoke to us about his experience working with Epic over the years and the importance of defining success – before you begin implementing.
LC: I’m a general internist by training but early in my career I had the opportunity to get involved with a teaching program at New York University as a faculty member and then as a staff member at a large community-based clinic serving an underserved immigrant population in Manhattan. That was the beginning of my formal career as a doctor, and those experiences shaped my perspective and priorities. There were limited resources at the clinic, so there were also plenty of opportunities to improve the way care was delivered. As a result, I started to participate in a lot of quality improvement activities, which led to taking on more medical leadership roles, and that has been the driving focus of my career – serving in a leadership capacity for clinicians and technology professionals.
About 10 years into my formal practice, I became the Chief Medical Informatics Officer at New York City Health+Hospitals (NYCH+H), which is the largest municipal hospital system in the country, with 11 hospitals in Manhattan and its surrounding boroughs. It’s a tremendous organization with a great mission and it faces great financial challenges taking care of uninsured patients. At the time, it was becoming an integrated delivery system – a common phenomenon across the U.S. in which most smaller hospitals are becoming parts of networks. Some of those networks are quite large and provide acute and ambulatory care services, and sometimes post-acute services. NYCH+H did all three of those on quite a large scale: there were about 1 million emergency department visits, 6 million outpatient visits, and 225,000 discharges per year.
I had been in New York City for 31 years and with NYCH+H for 20 of those, so I felt it was time to get out of my comfort zone. I found a job at the Cleveland Clinic where I got to work with Martin Harris, MD, one of the premier CIOs in the country. He had really helped that organization accelerate its implementation of EMRs and other technologies. It was a very different organization in that it was well-resourced; in making that move, I had gone as far out of my comfort zone as I could get. It was a great opportunity because everything was different: not just the geography, but also variations in how medicine is practiced and how the healthcare organization worked.
I’ve been at SCL Health for 18 months now, but I’ve already had two jobs: I came in as the CMIO and then the CIO retired so I stepped in as the interim CIO, so I’ve been burning the candle at both ends but it’s been a great experience all around.
Gevity: What is your experience with Epic, how has it evolved over the years and where does it offer the greatest opportunities?
LC: I joined SCL Health only 18 months ago but the Epic implementation here is about 10 years old. I do have experience with Epic in other organizations, though. I was very involved in the launch and in establishing the goals and objectives of the first implementation I participated in. Epic is now a fairly robust and integrated system, and fortunately, the vendor market is maturing quite a bit. But complexity has been built into the system – with good intention – but without really understanding the burden it was placing on physicians and nurses. Right now, vendors and providers are focusing a lot of attention on simplifying the system as much as possible and removing the elements that don’t add value — assessments people initially thought were important, or alerts, for example. In addition, the toolset has become more powerful and sophisticated so we have more opportunities for automation that we didn’t have in the past.
We’re also starting to see opportunities to leverage the foundation that we have – e.g., with big data. There are now companies, including our core EMR vendors, who understand data science and are applying it to the big data sets we have to improve predictions so that we can try to intervene earlier: we can better predict if a patient is going to have a bad outcome, is at risk for readmission, or will have to stay longer than expected. It’s really exciting! Also, the other thing we have learned is we can’t solve every problem in health care with an EMR. In the past, if something happened or there was a perceived safety issue, the tendency has been to go straight to seeking a technology solution and that resulted in a lot of bloat in the EMR rather than the intended positive outcomes. The fix should be to look at your organization’s culture, the root causes of problems, the skills of your clinicians, and then the technology; you have to take the time to think about other processes and redesign the system, not just the technology.
Gevity: Are there any Epic implementation lessons you’ve learned that you think are applicable to the Canadian context?
LC: I think there are common success factors not just to Canadian or American clinical transformation initiatives, but to most large transformational projects. As you approach your project, you need to understand what you are going to achieve and how you will measure it. Think clearly about what your outcome will look like – whether it’s the quality, the efficiency or the clinician or patient experience. You also need to determine the data you want to have to drive future improvements in your business. Health care is still trying to catch up to most other industries that have figured that out. Early in EMR development, we didn’t have a vision for how to best use all the data available to us.
Gevity: Does SCL Health, as a non-profit healthcare organization, have more in common with Canada’s government-funded healthcare organizations than with U.S. private sector hospitals?
LC: SCL Health is a not-for-profit, faith-based organization with a mission to serve everyone we can so we pay special attention to the poor and vulnerable. Those are often populations that don’t have access to comprehensive healthcare insurance, and we put a lot of resources into supporting those patients. One important thing to note is that the majority (62 per cent) of hospitals in the U.S. are not-for-profit; another 20 per cent are government-sponsored. The remaining 18 per cent or so are for profit, so it’s a relatively small number of hospitals. Most not-for-profit hospitals are working on very slim margins. Health care in general is a very challenging endeavour and the cost pressures are very real. I understand Canadian health care faces the same challenge – how do you take the best care of your population with the resources you have?
Gevity: Can you talk about your personal evolution to the technology side of health care? Do you think the role of the healthcare CIO will increasingly require clinical expertise?
LC: The CIO role, whether in health care or any other industry, requires that you understand the industry. I have worked with CIOs who are physicians and with those who are not, and it’s not about clinical knowledge at that level. It’s about understanding the business and the strategy of health care and leveraging technology and its associated disciplines to meet the needs, objectives and goals of the business. It’s not even really a technology job – it’s really a leadership and strategy-focused job. I’ve also had the opportunity to work with CIOs with and without a technical background. At this level, it’s not about knowing everything, it’s about knowing who needs to know everything, and then making sure their efforts are very closely aligned with the strategy of the organization. The CIO oversees mission-critical operational assets and must orchestrate resources and investments with strategy.