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CDIO interview - Dr Zafar Chaudry has taken Seattle Children's on an epic journey

Mark Chillingworth Profile picture for user Mark Chillingworth June 5, 2024
A star council drives the technology destiny of major paediatric hospital, Seattle Children

An image of Seattle Children’s Hospital
(Image sourced via Seattle Children’s Hospital)

CDIO Dr Zafar Chaudry has been on an epic journey as the digital leader of Seattle Children's, the paediatric hospital. That journey has encompassed the changing role of technology and, therefore, digital leadership in healthcare. Since joining Seattle Children's from the UK's NHS, he has led the implementation of a new electronic healthcare records (EHR) system, changed title, modernized data archiving and continues to look for ways to help the healthcare provider deal with rising demand and costs. 

Chaudry says of the organization, which has a revenue of $3.8 billion: 

We have 46 sites across Washington State, Alaska, Montana and Idaho, and we are a hospital as well as a research institute that is in the top five for NIH (National Institutes of Health) paediatric grants and also the number one for infectious disease in paediatrics globally.

Epic journey 

During the COVID-19 pandemic, Seattle Children's was not only dealing with a healthcare emergency but also implementing the Epic EHR system. The implementation had to be done, as Chaudry explains: 

We had been using Cerner in our organization for over 15 years, and we had over-customized the product, and it was getting hard to maintain. When I join an organization, one of the things I like to do is listen to the needs of the clinicians. 

Doing this, I realized that we were still implementing Cerner, and we hadn't rolled it out to outpatients, plus there was still a lot of paper being used, and that baffled me. 

Chaudry brought 300 clinicians together and asked for their help in determining whether the hospital was on the right path. 

After two full days of evaluating our workflows in Cerner and Epic, I asked them which system they wanted, and 290 of them voted for Epic.

My job is to do the will of the people and I used that information to go to the board and say I would like to write a business case for moving to Epic, as it is what everybody is asking for.

Chaudry reveals that 80% of US physicians are trained in Epic as part of their education, so the sway of the vote didn't surprise him. With the business case accepted, funding in place and an integration partner selected in early 2020, the move from the Cerner EHR to Epic began. 

We started the programme, and then the pandemic hit, and my deodorant failed me. I thought, how am I going to get this programme done? You don't want to delay projects of this scale because of the cost implications.

Pushing on turned out to be the right course of action, with Epic implementation being completed by late 2020, on time and on budget. 

We have had 100% uptime and are able to upgrade every quarter in 30 minutes. From a clinical perspective, we have Epic deployed everywhere, and the patient has access to charts and can book appointments. For clinicians, it has integrated speech recognition software, so you don't have to type your notes, and you can see all the information in a single pain.

And for me, I don't have to buy as many printers or keep as much paper.

These programmes, akin to an enterprise resource planning (ERP) change in the commercial sector, require significant change management and stakeholder management skills, and Chaudry experienced resistance to change: 

It is interesting to watch that journey, it's like a hype cycle of denial, anger, bargaining and then acceptance. Now, if I were to take it away from people, they would have my head on a stick.

Data analysis

Changing EHR is about more than the technology; these systems contain the most vital information clinicians need to treat their patients. As a result, clinicians want that data to be instantly available to them, whether it be a record from the day before or 11 years earlier. Despite it being possible to port the health records from Cerner to Epic, Chaudry knew that this would incur major costs, as Epic is charged by the size of the database. The digital leader got the clinical teams to agree to have the last 18 months' worth of data on the Epic system, and for the rest of the data, he told them: 

I would build a system that was open and would have the other 13 years' worth of data, which would be contextually mapped into Epic so that it was a seamless experience.

Chaudry partnered with Ellkay, a healthcare data and connectivity specialist, to develop an open standards cloud database. For the clinicians, an icon within Epic informs them that a patient has archived records, and by clicking on that icon they are taken to the archive without leaving Epic. The user experience for the archive was developed in partnership with the clinical staff , and the digital leader reveals it took 17 iterations. 

The importance of governance

The new technical architecture aims to avoid the over-customization that Seattle Children's had with its Cerner platform, but as Chaudry says, the platform is only part of that: 

We had a very strong governance structure with the project and post-project. There is a council made up of clinicians, which means whenever we are adding or changing something to Epic, it has to be approved by the transformation council or it doesn't get done. This means we are able to track every single thing that we do, who approved it and why. That means we can maintain the code in clean shape.

This also benefits the technology team at Seattle Children's: 

If somebody asks for something that is crazy, then usually the transformation council will say no. No, it is a difficult thing in health, but now they realize it is not IT making the decision, though I am on the council. The clinicians are driving their own destiny.

This also led, in 2021, to Chaudry's title changing from CIO to Chief Digital Officer and CIO. The new technologies and expectations necessitated the change: 

I think titles are really related to how the industry changes over time. So as the paradigm has shifted to digital and patient experience, that was the time my role changed to make it more relevant to the people I interact with. 

Technology leadership today is very business-centric. We are not in the business of technology; we are in the business of patients, and my job is to translate the technology for people on the front line, as well as patients. So you are spending a lot of time translating and listening in order to build solutions that make sense.

This has become important as the next generation of clinical staff are digital natives, he says. 

Alongside Epic, Seattle Children's counts Workday, Microsoft, Google and Dell as its major technology suppliers, and has 90% of its technology in a private cloud, but plans to increase the level of public cloud usage. 

During the pandemic, Seattle Children's, like many in healthcare, was at the forefront of adopting remote care. However, Chaudry says remote care is losing its impetus. Varying connectivity performance, access to devices and language barriers all make remote care harder than in-person. In addition, remote care has not proven to be economically viable for healthcare providers. Insurance and state organizations pay for healthcare with a consideration for two services, the care and the facilities, but remote care is not viewed as fitting either of these. During the pandemic, it did, and levels of bureaucracy disappeared, but sadly, this is now returning. More importantly, patients still want to sit in front of a clinician. Despite these challenges, Seattle Children's loans equipment to patients and offers remote care. 

Remote care is not the only revenue challenge facing the healthcare sector. Revenue reimbursements from insurance firms is also a difficulty: 

The challenge is the cost of delivery has completely changed, both in labor and technology. It has gone up by 30%, but the reimbursement levels have not. So there is a lot of work going on to optimise and automate because we don't anticipate that the reimbursement levels will match these cost increases. Between the government and the insurance industry, we expect an increase of five percent.

Chaudry moved to Seattle Children's from Cambridge University Hospitals NHS Foundation Trust in the UK, and stresses how the challenges are identical, whether healthcare is completely funded by the taxpayer or a blended mix of state and insurance funding. 

My Take

The journey of Chaudry and Seattle Children's reveals how the CIO role is maturing and evolving. Off the shelf technology provides the core of IT to an organization, so the CIO no longer operates technology, they have moved to a focus on how patients and staff experience technology, and the complexities of data protection and management that comes with that. 

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