What innovation looks like at a large academic medical center

For New Orleans-based Ochsner Health, innovation is an enterprise-wide effort.

"It's my job. We wake up every day and this is our mission – we're not getting pulled off on other short-term issues that are important in the day to day operation of the business,” said Ochsner physician Richard Milani, MD. “We're able to devote our energy full-time to this."

One instrumental way Ochsner leadership sought to support system-wide innovation, in fact, was to "produce a dedicated team toward that end," he said. "So instead of just paying it lip service, the CEO went out and said we're going to create a new role, Chief Clinical Transformation Officer, and invest resources into the whole process of innovation."

Milani knows better than anyone, since he is that CCTO, a role he's held since 2012. (He's worked at Ochsner for two decades as a clinical leader focused on cardiovascular diseases.)

innovationOchsner keeps heatlh system focused

As CCTO, Milani is also medical director of innovationOchsner, or iO, a tech accelerator launched in 2015 whose laser focus on innovation has helped the health system stay ahead of the leading edge of healthcare technology.

Whether it's working as one of the three-dozen health systems to pilot Apple Health Records, making tweaks to its Epic system to help combat the opioid crisis, or winning (as it did this past month) a HIMSS Enterprise Davies Award, Ochsner is at the forefront of innovation, and iO is the engine driving it.

As one of the biggest independent academic medical centers in the U.S. and Louisiana’s largest health system, Ochsner's 30 hospitals and 80-plus health centers and urgent care facilities employ nearly 20,000 people, including 1,200 physicians.

The iO team, whose stated mission is to use "technology and data to create precision-focused, patient-centered solutions to keep patients healthier and providers more efficient," is small – just 30 or so people, Milani said. But its various innovations are deployed throughout the health system and have had large and lasting impacts.

For instance, some of the projects that helped Ochsner win its Davies Award were developed by the innovationOchsner team: three data-driven initiatives focused on improving care for hypertension, diabetes and obstetrics. iO created dashboards, EHR apps, remote patient monitoring tools and updates delivered to patient's MyChart portals to help guide interventions and encourage lifestyle changes.

The numbers so far tell the story: The Hypertension Digital Medicine project successfully controlled in 71 percent of previously uncontrolled patients within the first 90 days; Diabetes Digital Medicine was able to achieve a 1 percent drop in A1c levels and boost retinal exams; the Connected MOM app helped bring about a 30 percent reduction in the number of in-person routine obstetrical visits.

Beyond recognition at the executive level of the need for innovation, the creation of a dedicated team devoted to that mission has been key, said Milani.

"That's the first thing – recognition of the need, and the willingness to devote time, energy and resources toward it," he said. "To do this well, you need a dedicated team. This kind of stuff is difficult to do as a part-time side job, because you're always going to be pulled into the needs of your first job."

Through it all, the team stays focused on the big questions: "What are the cost drivers? What are the pain points? Where is the friction in the system? And how can we aim our energies at those and try to create efficiency and improve quality and safety?"

Even though iO is still a small team, it's getting bigger as the projects it's working on proliferate.
"We have groups focused on the hospital environment, we have folks aiming at the outpatient environment in terms of digital care. We have areas we focus on with regard to the process behind the scenes, how we manage it and use it – including artificial intelligence. How can we improve the patient experience? All of those domains."

How do those decisions get made? How does Ochsner decide on which clinical use cases are in need of innovation?

"It's really not a top-down strategy," said Milani. "It's not the CEO or CFO saying, 'Go fix this,' or anything like that. It really is sort of bubbling within the iO group. And a lot of it is just listening to the physicians and the nurses – and even the back office people, the business people. Hearing what the issues are, putting our heads together to say, 'What are the things we can do to make a difference? Is it something we can tackle? Is it going to have a high impact?"

Enterprise-wide innovation starts with early adopter testing group

The aim is for the innovations at iO to be "meaningful over a substantial portion of the organization or for a substantial portion of patients," he said. That's why the projects that get tackled are in areas such as hypertension and diabetes.

"Chronic diseases are responsible for 86 percent of the money spent in healthcare, and 70 percent of the deaths," said Milani. "Hypertension is the most prevalent disease in the United States. Diabetes is becoming one of the top two or three most prevalent and it's growing at a fast clip. We've got another project coming out this year with COPD. We're going after things that are high impact."

But in an organization as large as Ochsner, disseminating those innovations enterprise-wide, encouraging uptake of the tools and strategies the iO team creates can be a challenge.

"There's science behind how innovation is diffused across any company or entity," said Milani. "There's a wonderful book by Everett Rogers called Diffusion of Innovations, where he categorizes employees into different groups, based on their natural tendencies. Some people are early innovators or early adopters, some people are late adopters and some people are laggers — they're not excited about change and they may even resist change."

At Ochsner, that means identifying early adopters in the primary care group, for example, and working with them at first to test emerging technologies and get their feedback, rather than having too many users involved.

"That's been one of the key elements in how we spread this. If they like it, and they adopt it, then they become the champions for spreading it among their brethren, so others who were more late adopters would begin to catch on,” Milani said. “And as we've been able to pick up momentum we've been able to show results.”

As evidence that the model works, Milani pointed to iO's hypertension and diabetes initiatives, which now have a 100 percent participation rate among primary care doctors.

"And they see the real value in it. But you couldn't just flip a switch on day one and start with 100 percent. You have to let them be comfortable with it, understand the value of it, understand how it works, get feedback from patients and from other doctors who were utilizing it, so they could say, 'Y'know, this is really good, I think I'll start using it.'"

Investing in key staff fosters success

Ochsner is clearly a leading light when it comes to innovation. Its size and scope mean it's more able to invest the staffing and resources to experiment with new approaches than many smaller health systems.

That said, there are lessons other providers can learn from successes like iO. For those hospitals serious about fostering a culture of innovation, "the principals that we've gone by still apply," said Milani.

To start, "these things are hard to do without leadership behind them. I report directly to the CEO, so I'm not having to go through 100 layers."

When it comes to creating innovation teams, "you don't have to have 30 people – you can have two people whose full-time job is to work on this. That's not a big investment, to start with one or two people. It's certainly doable. You could do that at a community hospital. You don't need to be a big health system to do those things."

Twitter: @MikeMiliardHITN
Email the writer: [email protected]

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