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Today on Keynote

(Intro)  All of us as CIOs, we have to every day prove the value of IT

we're a cost center. We're never gonna be a true revenue generating department in a large, multi-billion dollar organization.

So how do you show the value of it? Every single day?

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time. Our keynote show is designed to share conference level value with you every week.

Now, let's jump right into the episode.

  (Main) Hello, I'm Sue Shade, Principal at Starbridge Advisors and one of the hosts for the Townhall Show at This Week Health. But today I'm doing a keynote interview and my guest is Heather Nelson, Senior Vice President and Chief Information Officer at Boston Children's. So welcome, Heather.

Thank you so much, Sue.

It's a pleasure and honor to be here.

I'm excited to talk to you. We talk often, but not in this format. We first got to know each other, I think, really well in 21, right? Yeah, we did. Yeah. So I was, for our listeners, I was the interim CIO at Boston Children's for about eight months. And then I was delighted when the decision was made that Heather Nelson was going to be the permanent CIO.

And She came on board and we had our short handoff period. Since then, which is almost three years, you and your team have accomplished a lot. I'm very impressed. And we're going to talk about it today. I look forward to hearing more about what you've been doing. Let's start Heather, by having you describe Boston Children's.

Sure. Boston Children's Pediatric, as freestanding pediatric hospital here, right in the heart of Boston. We're about 485 licensed beds, about 13, 000 employees, and growing by the minute as we continue to extend our care across Massachusetts and the U. S. Really excited that I got to come here because there's so much opportunity and it's Boston Children's.

What more can you say? The clinical care that we provide is just, I'm always in awe and I'm so proud to be not only an employee here, but being able to enable and support the technologies that care for our patients and our communities and the families across.

across Massachusetts in the Boston market. So really excited.

Great. It is an amazing organization. I had the same response when I was asked to do the interim it's Boston Children's, how can I not do that? Yeah, it's great. Recently, you went all EPIC. I know some of that history, obviously, given the work I did there.

So you moved from the hybrid EPIC Cerner model to all EPIC. Tell us a little bit about how that decision was made and I know you called the Project Mosaic. Why that name?

Sure. you mentioned you really teed it up for us, Sue, and I know you did a lot of the heavy lifting and really doing the interviewing with the clinical partners, with the administrative partners across BCH about, why do you think we should do this?

And so that was teed up, really, me stepping in and being able to go to the board to say, this is what we need to do. Do we have your support? They were definitely on board. And then doing the bake off, which was the appropriate thing to do between Oracle Health and Epic, because that was the environment that we had.

All of our inpatient, our ambulatory, from clinical trials to genomics to Cosmos, you name it, we did this. And one of the things that, I'm really proud of is what alludes to the title of our project, Mosaic, was we had over 400 custom built or, third party applications that were either bolted together, in our legacy environments or were standalone.

And we brought that all together in the enterprise EHR. And, we're down to about 186 now and there's more interoperability. And integration than we ever had before. So really proud of that. And so that's why the mosaic word and title stuck. Because when you think about what a mosaic is, it's pieces and different mediums, different textures that come together to create.

A portrait or a creation. And that's how we felt. We were taking the best of Boston Children's, the best and brightest and bringing that all together. And Another thing that I'm super proud of because of that collaboration and unity was that over 80 percent of our resources were internal to Boston Children's.

That is

impressive. That is 80%.

We budgeted 60 and we had 80. And, again, that spoke to the accountability and the willingness of the organization to say, I want to be part of this. Now, we're live, we've got a lot of work to do still, as Dr. Churchwell, our president and CEO says, this is just the beginning and now we're into that stabilization and optimization.

So how do we. continue to build our mosaic into the future. So that's where we're at now. And I'm really proud we went live. We were on target and under budget and, I think all of us can appreciate a project this big and complex and in a large academic medical center is no small feat, but we did it.

Impressive. Yes. Congratulations again. I didn't realize the 80 percent or over 80 percent were internal resources. Did you bring someone, another firm in then to help with some of the legacy during this? Yes.

Yes, we did. We did leverage Impact Advisors to be our implementation partner. They've been great.

And obviously we had tremendous, epic resources from Verona. as we were, Doing the contracting with EPIC, I met with Judy and Carl and submit and said, I want the best resources that you have to be part of our project. And we do, and we have and it's very much going to be a partnership moving forward, especially as.

Epic builds out their AI roadmap. We're right lockstep with them and, really excited to have a seat at the table with that voice of the pediatric hospital.

That's great. So what were some of the unexpected challenges that you encountered? And I know you have been through other major Epic implementations at previous organizations, but what were some of the unexpected challenges at Boston Children's?

I would say a little bit of underestimating the willingness to change. I think, we all can come together, whether that's in a go live readiness assessment or an executive steering committee when you're going through an initiative this big and everyone's nodding on the Zoom that we're ready to go.

And maybe just double checking some of that. I think, having a transformation lead, and this is something, Sue, you were very instrumental in helping us. But I was surprised to hear how we weren't always willing to hear what others had done and take advantage of, those that had gone before us.

So don't underestimate that, some of that pride which is important and is, it is good, but there, there's still things you got to change. And. Trying to help the organization understand that technology enables the change. Technology can't dictate the change. And I think that for many of my colleagues, I think it was even up to the minutes before we went live.

It was still, I'll believe it when I see it. You can't underestimate that. I think what we always can't underestimate is the role of governance in an initiative this big and making sure that your sponsors are lockstep. We were lockstep with our sponsors. Our sponsors were our CNO and our CMO, and we met with them weekly, sometimes twice a week really leveraged them to help us.

understand what hills to die on, what hills not to die on. From an IT perspective, it's not just about the technology, but it's also about we have to understand the business and having their guidance and then having a forum with the executive steer co to say, we're not getting people signing up for training the way we should.

We committed as an organization that 100 percent of, team members would be trained and before they could get access to go. So don't ever underestimate the power of strong governance.

I would add, based on what I know that not only did you have the strong sponsorship from the CNO but from your boss.

Do you want to comment about that a bit?

Sure. So I have the privilege, I report to the executive vice president and chief financial officer. And he's The finance guy, but also he understands technology and he understands transformation. And he was very clear to me as he was interviewing me what needed to happen.

And he was looking for a team to come in and really help affect the change. And he was so supportive, not just being able to go to the board and talk through the finances of this. But really understanding how important moving to an enterprise EHR is for an organization like Boston Children's.

And so I can't thank him enough. He also knew he wasn't going to fight a clinical battle. And, that's why I think, having our executive sponsors as, being the CNO and CMO were great, but Revenue cycle reports into him. So he also had big skin in the game because we were now, consolidating and driving towards a clinically driven revenue cycle.

And that was, a guiding principle that we all agreed to as, from, Dr. Churchwell all the way down. And. He had to make sure that his teams also understand it's going to be different. Even though we had legacy EPIC from a revenue cycle perspective, if we couldn't lift and shift.

So he was very supportive of making sure we redesigned even our rev cycle processes to support a clinically driven revenue cycle. So having the support of the CFO as a CIO never goes

unnoticed. Absolutely. And he. And when I was there, I assume he still does strategy, innovation, network growth, as well as finance, right?

And facilities. And

facilities.

Absolutely.

What I always appreciated about Doug was the broad picture that he had. And I want to comment on this in the context of so many CIOs often think, I got to report to the CEO. Or it's a no deal, and I truly believe that can, be different, very successful in different organizations.

It depends on that person. , you want someone who's really got that broad picture as a CIO in terms of who you're reporting to. And I think you have it there

no, I appreciate that. All of us as CIOs, we have to every day prove the value of it.

,

we're a cost center. We're never gonna be a true revenue generating department in a large, multi-billion dollar organization.

So how do you show the value of it? Every single day? And sometimes you can quantify it and sometimes you can't. And you're absolutely right. It's. What seat do you have at the table and who's advocating for you at that table? And it doesn't have to be the CEO, like you

said.

Yeah, absolutely. That's great. You're not resting on your laurels with the big EHR behind you, but moving on to ERP, I know, let's talk a little bit about that in terms of what's next for you and maybe some of the lessons that you're going to apply from Project Mosaic to this next big one with the ERP plans.

Yes, I remember going to our board of trustees at their yearly retreat five days after we went live with Mosaic and giving an update and then asking for support to start the due diligence for an ERP modernization and they all looked at me like maybe they thought I hadn't slept for six days, but Did get that support and they do recognize that, this is just one of our strategies and our pillars and our enterprise strategic plan is unifying practice and platforms and IRIS.

ERP is one of them. And when you think about an ERP from my perspective and in my experience, it's bigger than an EHR. It's going to be a very complex project for any of us that have done an ERP implementation. It touches everyone. This is truly where. This truly touches every single employee of the organization.

So yes we've kicked off our due diligence. Obviously we're, we're doing a bake off with some of the ERP vendors that folks are probably, know and are implementing as well, we haven't made our decision yet. We're still in the due diligence phase and pulling together all of the pieces what the budget will be.

And I think the lessons learned. That we're bringing from Mosaic to the ERP modernization is really, you can't plan early enough. specifically around your resources. And I think, to get to that 80 20 that we talked about earlier, Sue, I'm still going to shoot for 60 40 for the ERP when it comes to internal resources versus external, recognizing that it's a little bit different in the ERP space when you have a system implementation partner that we're also thinking about.

So making sure that we've got the right resources and that they can be pulled. 100 percent into the ERP project, not a fraction of an FTE, because I think when you start doing that, You just can't get the momentum, and then it becomes the consultants implementing, and that's not what we want, because at the end of the day, it's ours to support and to care and feed for, so I would say just that resource planning and getting the people in place before we kick off the project.

We were still doing some hiring after we kicked off in some areas of Mosaic. And had we had done it over again, I think we would have, done some of the resourcing and getting them in place a little bit earlier. And that's definitely a lessons learned going into TRP.

That's great. I like your philosophy in terms of the You own it.

And as many of your people who can be on that project from the beginning, the better. Yeah. Let's talk about your organization. I know you restructured made a lot of changes. Restructuring changes are not easy for leadership but needed. And I know you've really pushed forward on that over the last couple of years.

I'd love to hear whatever you want to say about that. And in terms of the new structure, as well as have you run into any situations where you're like, yeah, really good. We did that, that's working. And maybe some other situations where, didn't work so well.

Yeah I think anytime you come into a new organization, you have to spend some time observing and listening and not talking.

And, I had a really great mentor say for six weeks. Just take notes. And on the seventh week, you need to have a plan, at least your first plan. And, I did some of that and a lot of it was assessing the skill sets and trying to identify what roles I needed. And I did start in my leadership team recognizing I did not have an application lead and moving to a new EHR, I knew to get that position in place.

And I also knew that I needed to bring in some more external colleagues and team members with fresh sets of eyes. Not to say that I haven't done internal movement and internal promotions, that has happened, but I knew to kickstart my leadership team, I needed to make some changes.

Done a couple restructuring, trying to align with the business and where the organization was going. I think I made some good decisions. And I think that. I have some decisions that I maybe wish I would have done a little bit differently, but I have the opportunity to learn from that and, as we're moving into this stabilization and optimization world with Mosaic, we have a new operating model.

I have a managed services provider now for my service desk and my field services teams. That's different. We now have a 24 by 7, service desk so that and field services team. So the organization knows that they can call at any time and there's someone's going to answer the phone and someone's going to help them.

So I think, bringing some of that out. To the forefront I'm very proud of, and I'm proud of my leadership team for helping to execute on that and strong partnership with my HR colleagues. But, there were some decisions and some movements, like internal movements of, here's your new reporting structure that I thought made sense at the time, and now that some of the strategies, especially in my infrastructure spaces are changing I'm going to have to move some things back, and so I have to balance that.

Because I don't want my team members feeling the whiplash, because that it impacts morale. Yeah. I'll own it. If it wasn't the right decision, I will say listen, I thought at the time it was the right decision I was wrong. Definitely play a huge role in this team, you're just going to report to someone different.

It's much easier than saying, your role has been eliminated. To balance the restructuring with, what that means. And my next phases coming up is more about. Just getting people in the right phone room in my team to support the new strategies that are coming forth.

Okay.

And I'm sure you don't want to talk about that yet, but it will continue to evolve. It sounds as you optimize it. And, that's what organizations do.

Yeah. I think, talking to my peers, all of us are in this boat, how do we, again, show the value of IT, but don't come every year with, I need 30 more FTEs, right?

Exactly. Not as do more with less. I definitely don't have that mentality, but it's just making sure you've got the right people. And if we can upskill people like we did with the EHR, that we're going to do with the ERP, like what we did with my implementation of a 5G cellular network, with my plans to do a, software divine data center and VDI, like giving people the opportunity to learn new things.

That's what it's about.

Yeah. And as I recall, there are a lot of long time. Employees at Children's Hospital, kind of place people are mission driven, want to be there and are there for a long time. So being able to upskill them, get them into new more appropriate, right roles as things evolve makes a lot of sense.

  📍 📍 📍 📍

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📍 This may be a good point in our conversation to talk a little bit about your career journey and where you were, what you've done before Boston Children's and how all that prepared you for Boston Children's.

Yeah I would say, coming from UChicago Medicine, where I was the senior VP and CIO there for four years.

I was at UChicago for seven years total. Cutting my teeth in the academic medicine world , is good. And I think all of us can say, if you've seen one AMC, you've seen one AMC. moving from, an AMC or an IDN where you had adult and pediatric hospitals, is different than coming to pediatric hospital.

would say, as I was going through the interview process, there were skeptics who 📍 thought, We need someone that has only worked in pediatric hospitals. But what I brought, to the table, working at UChicago Medicine and before that Bay State Health here in Western Massachusetts, and then Butterworth Blodgett, then Spectrum, now Corwell Health in Michigan.

Understanding the complexities of an IDN. You've got the adult space, you've got different payer mixes, you've got different diseases, you've got a lot of that complexity to, coming to. Boston Children's, I think I brought a lot of good things, understanding what it means to do acquisitions to do joint ventures and partnerships with other health systems as well as knowing what it means to do big EHR implementations or ERP implementations, or just being transformational when it comes to technology.

I learned a lot. I started out as an analyst. I have a biology degree and have my master's degree in healthcare administration. I'm not a programmer, didn't use a computer in college, but really had good people around me. And I think I had strong mentors in my earlier in my career which said, You are a people person.

You're not computer program. I'm like, you're right. I love operations, Sue. And being an IT leader, you have to understand operations and you have to build those relationships with your operational counterparts, whether they're clinical or administrative. And that's just something that I pride myself in.

I ask a lot of questions. And I never want technology to be the tail wagging the dog. And I think I learned that throughout my career. And as I've gotten to Boston Children's, not to say I still don't take my lumps. and still don't learn every day. But that's part of leadership is sometimes you just got to learn and you got to pivot and I'm okay with doing that.

Absolutely. So one of your counterparts speaking of counterparts is John Brownstein Chief Innovation Officer and I worked with him. I think he's wonderful. I, and I interviewed the two of you together a while back for the town hall show. I assume you still continue to have a great partnership there.

So what have been some of the most significant collaborative projects that you've worked on together?

I would say standing up our Boston Children's Chat GPT environment. It's just been incredible the vision that John has and his ability to just bring people together. And he recognizes that it's not just his or his teams and partnering with him on this stuff and thinking about the governance.

has just been fantastic. And, we're just so excited that we've got people excited about AI and coming to us with use cases, whether it's in finance or HR, or even our medical education department has helped to develop a Gen AI tool called MedTutor which helps provide learners with the scale, personalization, and on demand access.

for medical cases. So they're learning virtually. So it's like a tutor. And our team from the divisions of gastro internology, hepatology and nutrition, they were the ones that had this foresight. And so that's just an example of, having a partner like John. that's willing to dig in and let's try something has just been fantastic.

And my teams are here to support. We help support the technology. We help manage , the relationships , with Azure and our vendor partners. But it's just, it's fantastic. And I just see this, and as we are starting to look at our next fiscal year strategic goals, Gen AI is You know, how do we leverage AI to transform care and transform the business at Boston Children's?

That's awesome. I would love to talk more about that with you at some point. And you said the adoption has been good?

The adoption's been great. We're giving people a sandbox. We wanted to do that because we all know as CIOs, if you don't give someone something, then they'll go buy their own and create their own teams.

So we were very intentional with creating the sandbox and with full endorsement from our EVP of health affairs to make sure that, we have a place for people, whether they're doing research. Or thinking about, research to the bedside, or thinking about how do I automate, some tasks in my, from an administrative perspective, giving people the opportunity to play, and then prove it out.

So we're not, expending precious resources on things that may never go anywhere. So putting those guardrails in place, I think, has built trust in the organization that now they're willing to come and sit down and talk through what the potential could be, and they're willing to iterate. And then if it doesn't work, they're okay with, all right, let's just stop this.

It didn't work, not dragging something on for three years, hoping it'll work.

Have you established governance related to this effort and AI overall?

So yes, we have and we're refreshing it a little bit in it. John and I are haven't quite synced up on that. We're doing that with Dr.

Lawson, who is our EVP of Health Affairs next week to provide some recommendations. We started by slotting it under our data and analytics steering committee to start as a pillar within that and our data governance. But we recognize it needs its own. And it will definitely, tag into data governance.

It will tag into the IT executive steering. It will tag into, other core strategies in the organization. So more to come. So maybe another town hall with John and I in a couple months.

Okay, you're on. I'd love it. . That's good. I'm gonna switch gears. Yeah. Talk about any initiatives in terms of improving the patient and provider experience, which are, both important and two really different avenues.

But Any examples you have in terms of how you've applied new technologies to improve those experiences, and as a children's hospital, any heartwarming experiences, maybe with patients and their families in particular?

Sure, would start with, I'm really proud that Boston Children's is the first of its kind in healthcare, having a 5G private cellular environment network across our entire enterprise, whether it's in the ambulatory setting or inpatient.

And that really started, as part of the EHR implementation, we knew that we needed a new clinical mobility platform. Our legacy was the Oracle Health products, Spectralink and CareAware, not scalable, wasn't going to transition into the new Epic platform. So I also knew that we were getting a lot of complaints on our Wi Fi network when it came to mobility.

Wi Fi is not meant to be a mobile platform, right? You go to Starbucks, we have to get onto the Starbucks Wi Fi, we come into Boston Children's, we're on the guest network. And So with T Mobile, we have implemented this and we went live with it. And we were getting calls and getting alarms and alerts in the sub basement, in elevators, in stair, true mobility.

And I will tell you the morning of GoLive I offered to help, recover the old devices. I had nurses. willingly giving me back those old phones and just hanging on to their new iOS devices. And we're so excited because they were part of the selection and they under, they didn't quite understand what 5G mobility meant and, but they knew that my calls aren't going to drop.

I can, I rely on that. And when you think about, and this is what, I think I brought some of the T Mobile people. To tears was think about, you have a kid in the OR and they need to be transferred to the ICU and the conversations and the communications that have to happen because they're not right next to each other, you don't want a call to drop.

You don't want to alert a message to fail. And, having that is just fantastic. And I will also say. Because we were on a legacy Epic and legacy Oracle health platforms, our patient portal wasn't ideal very customized and a little kludgy and moving to the MyChart platform and replatforming my children's has been amazing and I received, I don't know how heartwarming this is, but I received an email from a patient's mother and I don't know how she got my email.

But she wrote me a note and just said, I heard about this EPIC implementation, and I don't know what it all means, but all I know is I have information at my fingertips for my child that I never had before. And thank you very much. And, for a patient's family to recognize what technology did to enable the care for their child I shared that with my teams just to say this is why we're here.

This is why we do what we do. Yeah.

That's a great story, and I was, when I was there, aware of the, I think you, did you call it clunky or kludgy? Kludgy, clunky,

yeah. All the above. Portal.

The portal. We did the

best we could. The teams did the best they could. Yeah,

Yeah, the best you could, best we could considering the systems available at that time.

But I always thought with Children's Hospital, you're talking children and their parents, and you're talking a younger demographic that is very used to a lot of online transactions and just really crying out for a better portal. I'm not surprised that story that you shared, Heather that you got that note.

My teams are so excited enhancements that we now can do on my platform. So we're really excited.

Yeah, that's great. That's great. As we come to wrap up here, Heather looking ahead, what are your top three priorities over the next five years, in terms of the IT and innovation strategy there?

I'm going to pull on fiscal year 25, our upcoming fiscal year enterprise strategies that are in front of us right now. One, I'm going to start with enabling connected care at Boston Children's. And really, when you think about connected care, it's the whole gamut. It's e visits. It's e consults.

Making sure that we've got the right scheduling templates, that we've got self-service, self-scheduling for our patients. Now we've got the enterprise tools. How do we now operationalize all of that in a way that's meaningful and measurable for our patients? So there's a lot of operational, churn right now to figure out how do we now take it to the next level.

And what's nice is. I don't think we need to buy anything. But we need to innovate from a workflow perspective and think about how do we do things differently? Because the technology now allows for that and enables that. So that's one thing. And then I think I touched a little bit about unifying our standards and practice and platforms.

The new ERP is one of those, we're replatforming for success. We're also in this huge optimization, as I mentioned, Dr. Churchill said, this is just the beginning. So we're working on enhancement sprints. We're going to be doing upgrades every quarter. Like we're going to take advantage of the investment that we've made.

And make sure that we're turning things on that delight and improve, the experiences, not only for our care teams, our researchers, but for our patients and their families. Really looking at that, looking at how do we continue to ramp up Microsoft 365. We're on a Zoom right now. We also have teams here.

Making some of those business decisions and where do we use the technology when and more important for team collaboration internally and being the employer choice, how do we make sure we've got the right tool sets like Microsoft Teams, et cetera. So we're really taking a look at that.

And then, we talked a lot about harnessing AI to drive transformation. As we continue to grow as we continue to think about the capacity of our team members, how do we, create some automation so that team members can focus on the more complex work? So I would say those are the three kind of themes, if you will, and you can imagine there's a lot underneath each of those that IT and informatics will be part of.

Excellent. You have plenty to do. Yes. Plenty to do. And I will take you up on your offer. Yes, please. You and John about your AI and chat GPT initiative there. That would be great. Yes. We'll do that. All right. Deal. Okay. Thank you so much, Heather. This has been awesome. And I'm sure it'll be useful for your colleagues in the industry when they hear it.

Thanks so much.

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