James Turnbull, CIO of the Year
The CHIME/HIMSS John E. Gall, Jr. CIO of the Year, James Turnbull, who oversees all things IT at University of Utah Health Care, is informed by experience he gained at several other healthcare systems before coming to Utah five years ago. His stints, including one in Canada, exposed him to a number of ways healthcare systems - and health IT teams - can be effective.
Turnbull's career spans 37 years. Prior to joining UUHC, Turnbull served as senior vice president and CIO at the Children's Hospital in Denver from 2000 to 2007, and senior vice president and CIO at Sarasota Memorial Hospital in Florida from 1993 to 2000.
The College of Healthcare Information Management Executives (CHIME) and HIMSS gives the award each year to recognize healthcare IT executives who have made "significant contributions to their organization and demonstrated innovative leadership through effective use of technology," The award is named after John E. Gall, Jr. who pioneered implementation of the first fully integrated medical information system in the world at California's El Camino Hospital in the 1960s.
University of Utah Health Care is a billion dollar business. It tallies a million ambulatory visits and 27,000 inpatient admissions a year. It has 1,200 faculty members in the school of medicine. Of that group, probably 500 are clinically active, says Turnbull, who notes that the system has "a small army" of researchers and educators. There are 11 community clinics scattered up and down the Salt Lake valley area, and there are about 100 family practitioners, all faculty members. It's typical size for an academic medical center, Turnbull says.
Turnbull spoke with Healthcare IT News about his approach to his work, some of his successes and the challenges ahead.
Q: What do you see as your primary mission as CIO?
A: When I think of a single word for it, I think of enablement or enabling. That has several aspects to it. First and foremost is enabling the organization to fulfill its mission and achieve its long-term vision. So that's a big piece - ensuring that I bring the resources and the expertise to the table and the solutions that are needed to support the mission of the organization. And there's hardly anything we do anymore that doesn't have a foundation on information technology. The second piece is more directly related to my own division - and that's to enable my own staff to fulfill their roles and to do that without too many roadblocks: sort of taking the reins off them and removing the barriers so we can really execute to the maximum of their abilities.
Q: How has your job changed over the past five years?
A: It was in 1989 when I really took a change in career direction. I'd been a chief operating officer of a five-hospital system up in Canada. When I look back to that period of time, there wasn't that much of a focus, it was just starting to emerge, on the electronic medical record and the clinical side of healthcare. Certainly that is center-stage nowadays. The interesting part to me, in moving from Canada to the states, is that in Canada we were already focused on the clinical side because they didn't have to worry about the financial side. We had 1.5 full-time staff in our patient accounting department in a five-hospital system up in Canada. It was quite eye opening to come down here and view the magnitude of the overhead that exists in the American health system just to get a bill out the door, and get payment too. The thing that I see happening right now is we're so engaged in every strategy for the organization as we move through meaningful use. The incentives to do this are a different spin on things, but it hasn't changed our strategic direction in any way. We were going to do it anyway, so it's nice to have the financial support from the federal government. We may have done these things anyway, but we probably wouldn't have paid as close attention to achieving certain goals and measuring the outcomes.
Q: What has been your proudest achievement?
A: The thing that really puts a smile on face is seeing my staff achieve things that they might have thought were not possible to do. Just seeing individual accomplishments. There have been many of them, but those are the things I'm most proud of. I've encouraged a lot of my staff over the years to seriously consider returning to school and upgrading their academic credentials. Many of them have thought I was crazy when I proposed this to them. But they've gone back, and they've graduated from different programs. It's just so amazing to see that quiet smile of accomplishment. They're very proud of themselves, and I'm proud them. The technical stuff is all very interesting, but it's the personal achievement that makes me most proud of my team.
Q: What has been your biggest challenge?
A: Where it's frustrating for me - I've got a tremendous amount of operational experience. I've got a lot of strategic planning experience from some of the roles I've had over the years. But being CIO you're still considered the IT guy. I feel like a V-8 engine running like a little V-6. I have not been able to crack through this barrier of being seen as the IT guy despite a wealth of experience and knowledge in these other fields. It's more of a personal frustration. I have a feeling of frustration of not being able to use all of my capabilities.
Q: Is there anything you would change about today's EHRs?
A: The most frequent concern I hear from the physicians is they are not intuitive, and I would totally agree with them. They're all not friendly to navigate. The functionality is there, there's no doubt they all ought to be more user-friendly from the physicians perspective. We need to keep pushing on that side of it. They all say the same thing: 'I can use any application on the iPad almost immediately, why can't I do that in the most important part of my life?' The user interface is the biggest challenge.
Q: What keeps you up at night?
A: What keep me up at night are still security-related issues. It's not likely we'll have a lot of them. It's like that saying: 'the devil you know and the devil you don't know.' That to me is always my big concern. We have very, very little downtime here. But I am administrator on call. When I get a call in the middle of the night, my first concern is that, if we're down, we're the victims of a service attack or something like that. At the application level, we have such a strong team here. With all the security stuff that's out there, it's those characters we don't know, and we don't what they're up to.
Q: What do you envision for healthcare IT 10 years from now?
A: We're just wrestling with exactly that issue here. We've just gone through our capital budget again this year. Our capital budget for IT, for the first time, has actually started to go down. The reason for that is we've basically installed a very rich revenue cycle management, we have a decision support environment in place, a great data warehouse. The baseline is all in place now. I think what we're going to be moving to is mHealth - that's where it's going to go.
We'll get through that last mile into the patient's home. We'll be doing a lot of remote monitoring, particularly for chronic conditions and for patients that are sort of early post-discharge from the hospital. It will be a different situation. It won't be them calling us to tell us that they think they need to come in. It'll be us calling them to tell them they better come in, that they've got some issues that they may not be aware of. I think that's where the game is going to change.
As a tertiary care hospital, we're going to be doing a lot more monitoring of patients outside the institution. I think telemedicine is about ready to just explode. Not traditional telemedicine where we think of a doctor or a patient doing a consult with a doctor in a remote location, but telemedicine with the patient themselves within their home settings. That's so inexpensive. It's very inexpensive on the technology side. You really need to change your care delivery model and resources that you have here at the hospital that are supporting that delivery system. I think it's going to be so different 10 years from now. n