Cedars-Sinai CIO: Workflow integration is a bigger problem than interoperability

By Jonah Comstock

Between experiments with virtual reality, iPads for patient engagement, a novel surgery simulation center, and many pilots from its in-house startup accelerator, Cedars-Sinai Medical Center in Los Angeles has a lot of innovation irons in the fire. But the 958-bed hospital manages all these different by holding onto a handful of guiding principles and by being intentional about the innovation projects it invests in.

On a recent trip to LA, MobiHealthNews had the opportunity to speak with both Cedars-Sinai CIO Darrin Dworkin, who says Cedars-Sinai’s journey toward innovation began with the realization that the convenience of mobile technology was here to stay.

“Like many big enterprise organizations, we were getting confronted with the fact that people were using delightful technology at home and, let’s call it, slightly less delightful technology in the enterprise,” Dworkin said. “And it was ok for a while for us to say things like ‘That’s our standard’ or ‘We’re concerned about security,’ but ultimately as the technology was converging we made this decision that we would stop fighting it. We’d figure out how to join it.”

That move toward mobile started with nurses, with the adoption of hospital communication tool Voalte, then extended into bringing its Epic EHR to mobile via Haiku.

“Now we sit at a place where almost all of our clinicians have access to an iPhone-based application and our patients — as quickly as we can roll it out — have bedside applications with tablets and more and more of this is integrating with consumer devices in the home space,” he said.

Early on, Dworkin said, leadership decided that the hospital would integrate all its new technology into one hub as it rolls out.

“At the physician and nursing sort of level, the belief is that we have a core EMR. For us, we license a tool from Epic which we love. And the tools we’re going to integrate into that we will tightly integrate at an enterprise level, so it’s seamless to the clinician as they’re moving between our different tools, that’s the game. It’s a very high priority for us that’s even guided through how we select applications. … For our patients, we’ve gotten a lot more serious about it and we have a strategy we refer to as our virtual services strategy. It’s built on the premise that we as Cedars-Sinai won’t allow anything to disintermediate us and the patient. There will be one flagship app, the Cedars-Sinai app.”

As the company works with startups, integrating them into the workflow in highly intentional ways allows the hospital to continually assess whether a startup is meeting their needs.

“It’s especially helpful in today’s digital health race that every other day there’s a company that’s announced that’s going to solve the world’s problems and probably backed by a VC for some ungodly amount of money. So as they move around so quickly, this gives us a way to plug them in,” he said. “The other thing that’s more difficult to us is … no one vendor wants to stay in their lane. So we pick one vendor because they say they’re going to do A and that’s great except that they decide they need to grow topline revenue so they’re going to go into B, which happens to be [something we’re already doing with] another vendor. So a lot of it is making sure that we’re controlling the features and functions.”

In fact, Dworkin says that workflow integration is actually a bigger problem then that favorite complaint of the health IT space, interoperability.

“I know we’re supposed to complain about interoperability, but it’s not a challenge,” he said. “The hard part is workflow integration. It’s not about getting A and B to talk to each other. It’s about creating the experience for Dr. Miller, who doesn’t know whether he’s in A or B and, by the way, shouldn’t have to care because we’ve integrated the workflow. And I think that’s where, when we’ve done things like that that’s when patients are happy and physicians are happy.”