CHRISTUS Health is a sprawling healthcare operation headquartered in Irving Texas, with primary acute care facilities in Texas, Louisiana, New Mexico, Mexico, Chile and, coming soon, Colombia, as well as long-term care facilities in Georgia, Iowa, Texas, Louisiana and Arkansas. Lynn Gibson was brought in almost four years ago as CTO to help CHRISTUS gird for change, and Network World Editor in Chief John Dix recently stopped by his office to get his take on where they stand and what comes next.
You joined the company about four years ago before a wave of change at CHRISTUS, give us a bit of the background.
I came into a new role for CHRISTUS to help with data center consolidation and infrastructure improvements, to create a new organizational structure and to help with projects focused on improving the service management team, project management flow and the business analytic structure. When I walked in the door on the first day and given a tour of our main data center I was told they had a proposal on the table to double the floor space because they had been told they were going to run out of space in three to five years. Our secondary data center was at 100% capacity and utilizing more power than was being directly feed into the UPS systems, so some of it was basically running off supplemental battery power. Both data centers had equipment aged beyond support. Our network had several single points of failure and a security program that was minimal at best.
Today, we are over 95% virtualized, with 4,000 VMware virtual servers on 200 physical hosts. We have regained over 60% of the floor space in our primary data center and 50% of our secondary site. We have centralized our applications to our primary data center and our regional data centers have been reduced to a much smaller
environment supporting needs for local storage. We have expanded and improved our network and now have a growing security program that removed a number of vulnerabilities. We still have some work ahead, but nothing compared to what we had encountered four years ago.
Does your main data center support all of the organization’s locations?
It doesn’t support the international side right now. I’m working with our international offices to look at making it the disaster recovery site for them. It’s the central point for the U.S. sites, with one exception of some systems for the New Mexico facility
Are all your servers x86 based and do you call it a private cloud?
We have a few UNIX boxes, but not very many. We’re predominately a Windows shop. No mainframes. We consider ourselves a hybrid cloud environment. We have private cloud activities but also have cloud services we provide to associates that extend outside our environment.
Speaking of cloud, as I understand it, many healthcare software suppliers have been slow to shift to the cloud. Has that been your experience?
Yes. Most of what Healthcare utilizes was built back in the ‘70-‘80s timeframe and it’s very expensive for them to move away from those investments.. Every vendor is trying to get into the cloud business because that’s where the money is going in the future. But when you get to be our size you really have to analyze how much control you want to give away to an outsourcer. There are some people projecting that hospitals and healthcare organizations don’t need data centers. I think that’s a little cavalier. If you start doing that you’re giving away control of your patient information and patient data and that’s where the money lies. The key to everybody’s future in healthcare is going to be around the knowledge that you gain out of the data you maintain.
Do you service everything internally then?
We’re not 100% internal. We have new urgent care centers out in different regions and we’re setting up a separate infrastructure for them. Their business model is very different and their needs are different so we’re providing a different structure for them. It’s more cloud based and the needs are less demanding than what it takes to support a normal hospital.
Just to finish the infrastructure picture, can you give us a thumbnail of what the network looks like?
The network is owned and managed by us, and we’re Cisco based. We’re right around 35,000 domestic drops. We have dual feeds to each of our eight main regions, and we run lines from there to different points of service. For example, we have two 10GB lines into our main facility in Corpus Christi, and the main hospital there has feeds out to ancillary hospitals. It is all IP based, including our phone system, except for our patient rooms and basic trunk lines.
Going back to your comment about the future of healthcare being about knowledge, can you expand on that?
The nature of our business is changing rapidly. Historically in healthcare you were paid for how many heads you put into hospital beds. Now we’re going to be paid based on how well we take care of the population we’re assigned or we contract to take care of. The goal is to treat patients well enough to keep them out of the hospital. So now, instead of billing the insurance company a given fee per day per bed, they will be giving us a set sum fee up front to handle a population and we get to keep as much as we don’t spend, but we then have to cover what we spend beyond the set fee.
Is that part of Obamacare?
Obamacare really is an evolution of things that have been going on for 20 years in healthcare. Back in the ‘90s it was called a capitated model. Obamacare took a bit different approach because capitated care of the ‘90s didn’t work. They tried it in a couple of states and it worked initially but then cratered because it was too complicated and our culture was not ready to accept it. Now we’re seeing a sort of natural evolution. One of things driving change is businesses that want to avoid the complexity of negotiating healthcare contracts, opting instead to give employees money to go buy their own insurance, or limit it to a smaller package because the costs keep going up.
How does the insurance shift impact your world?
The payment model changes our business model, which means the requirements to support our business change. Right now I’m looking at trying to create different infrastructure models to support the changing business models because we’re in that state of transition. The standard need five or ten years ago was to constantly improve your hospital connectivity and the majority of your systems were hospital based. Now we’re focused more on what services we’re going to be providing in ambulatory or urgent care clinics, physician based clinics, outpatient imaging, outpatient radiology or other similar type services. Because the more we do with outpatients, the lower the cost model will be. And if we can treat patients there and keep them out of the emergency room, out of the hospital, the more money we save the system. In reality, it’s better care for the patient, and you always want to try to deliver the best possible quality of care for your patients.
Another thing, if the market area around a hospital starts changing, and demographics do change, the cost of moving a hospital or shutting it down is high. We can stand up three clinics in different shopping malls much quicker, and if things change, we can move them much more easily to the market area that needs the service.
So, while we stand up these new clinic environments, what we’re doing is running two different worlds, one for the traditional acute care model and another for the clinics. We’re creating common feeds of information out of both to our data analytics warehouse, which is going to help us maintain our financial as well as our clinical quality on both sides.
If you think about it, most people who go to an urgent care center don’t generally have a primary physician, otherwise they would be going to see them. They show up at an urgent care center if they have the flu or their child got hurt at school, or they have something they are not sure how to treat. We can then connect them to one of our primary care groups and, if it’s something more serious, say an an ulcerated hernia instead of a stomach bug, we can move them from a primary care group to see one of our specialists, insuring we keep them in our network and insuring they are receiving the best and proper care.
By doing that, patient care quality goes up because we can track the history more readily through the continuum of the care, versus going to Dr. X who has no real relationship to Group B and no idea about the post-op care after that. We’ll maintain the history. If four months or a year later Joe shows back up with the same kind of symptoms and the same kind of problem then you start talking to the patient differently about it -- “What’s your lifestyle like? What are you doing?” -- to try to find out why this problem is re-occurring.
So the core issue is analytics. Is data integration a problem?
Infrastructure is not the issue anymore. It’s really trying to capture the right data. Data integration has been a challenge, and interoperability, and interconnectivity between different systems. Today if you have a patient who shows up at an urgent care center that has no relationship with us, all that information just stays there and dies there. You don’t know what happened. They may have been told to go see a cancer specialist, and if they look up an oncologist and the oncologist turns out to not be in our system, the whole information process starts over again.
How close are you to being able to stitch it all together?
We have some elements of that in place right now and we’re building up the rest. That’s the challenge for the next year or two, to completely build out that marker and determine where the gaps are.
We’ve standardized our model. We’re using Teradata and Informatica as our platforms and we are producing dashboards through another tool, MicroStrategy. The idea is to reach a common understanding of our real business; where our cost points are, where our problems are, so we can now have the opportunity to improve.
As an example, one of the biggest problems in all hospitals is sepsis contamination. By measuring, monitoring, and giving all the hospitals their relative clinical markers by department, we’ve been able to very quickly and successfully address that in the clinical care area. This is the type of thing that we want to be able to attack and you can only do that if you have the information.
With the right data you can look at the types of patients, the types of protocols, the procedures, and even get down to the point of knowing what room they were in to see if there’s a pattern. You start looking for patterns and then you start changing what you do to break that pattern.
Switching gears a bit, what’s going on in healthcare with mobile tech?
This is a growing problem. For example, the basic demand on our Wi-Fi network is growing at an accelerated rate. We have a tremendous amount of demand coming in from our physicians and hospital guests. Patients and visitors want access not just to their data, but to the network so they can access things outside while they’re here – maybe more information about their particular issue or even entertainment sources. It’s almost becoming an expectation that you provide that. If someone is visiting a family member in the hospital with some critical issue, they want to be able to connect and share progress reports, and we want them to have access to certain things for patient and caregiver education. And in some cases while they’re sitting in the waiting room for three or four hours they want to get on Netflix.
On the physician side, every doctor’s practice is a little bit different. If you go to an academic center they’re going to want more than what you’d have at a community center just because of the nature of what they’re doing.. But in the patient room, it becomes very similar. They may want to be able to show medical images for education and treatment purposes, to help the patient understand the type of care that they’re going to need.
Most but not all doctors carry mobile devices at this point. We have a growing number of mobile devices, including mobile carts, available to them in every hospital. Some docs use tablets, but many have found touch technology isn’t the same between devices. While some can manage through their smart phones, others prefer the more traditional models. Video conferencing is showing up on all types of devices, but the use is just beginning for us.
Is there a role for a Siri-like tool?
Other people are going to disagree with me, but I think that is still several years away. With Siri or Cortana or whatever, you have to spend too much time training the system to understand your words, your inflections, your accent. The individual dictionary that is required to understand medical terms can be significant. There are a growing number of cloud services, but in the end it is all about speed and efficiency for the physician.
Looking into the future a bit, any big changes in healthcare on the horizon?
Right now primary care patients that are coming in to see us are really the baby boomers and a little bit of the Gen-X, but in 10 years it will be the millennial generation who will be in their mid to late-30s or early 40s. When they start having health problems that come with being that age, they are so used to the Internet and doing their own research and ordering things online, that online services will have to increase.
They’re not very prevalent today but you can already order an Internet connected cube that has different modules for different Lab functions, one of which lets you put a bloodspot on an indicator sheet and put it into the cube which runs tests and checks in with a central site which comes back and says, “Here’s your lab results.”
So it pushes the clinic into peoples’ homes.
Right. What if you could order a paper-like hazmat suit that’s been run through with electronic ink and you could plug that into your computer at home and hit a switch and it would do a full body scan in the privacy of you home for a half to a third the price of what it costs today to go into an outpatient clinic. That would be a game changer. That would be a disrupter because it would change your business model, change your business flow. I think that kind of technology will be happening more in the next 10 years.
How do you plan for that as an organization? Do you have brainstorming sessions?
We do. We have people who are constantly looking at the market and trying to anticipate what is coming. That’s why we’re getting into the urgent care business now because of the trending, of where things are. You have to stay very close. You have to have people who are dedicated to spending time with Washington because you never know what they’re going to dream up and change the rules. You have to anticipate how to react and respond. And you have to be close to the technology world, not IT technology, but the new stuff coming out and how it might be used.
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