A Forward-thinking Approach to Health IT: Dr. Martin Harris, Cleveland Clinic NOW #132


Dr. Harris, it’s great to have you here. Glad to be here. You know, we first met, I think, four years
ago when we did our first visit here to the Cleveland Clinic and I had become fascinated
by this commitment that everybody here seems to have to the Cleveland Clinic way. So, I know you’re the latest author to come
out with a book with your twist on it about patient care. I want to talk to you about that, but before
we dig into that, let’s talk about you and who you are, and why you are doing what you’re
doing today? Sure. So, I am a general internist here at the Cleveland
Clinic, but I think it’s more a question of, where did I come from. And, I have to tell you, I’ve always been
associated with great institutions. So, my educational background is at the University
of Pennsylvania, and I started as an undergraduate, and at the end of my sophomore year, they
had a program called the University Scholars Program. So, you could sit down and write up a program
that you thought required resources from across the University and they evaluated the program. And if they thought it made sense, they would
admit you into that. So, I put together a program that combined
information management and the practice of medicine many years ago. I was just going to say at a time when that
was very very uncommon Very uncommon, and why? What was the instigation? So, I always had a sense, that both, that
system science was really going to be important to medicine. And thinking about quality and cost at the
macro level was a great interest of mine, and I understood that computers were going
to play a role in that process. And so, that’s Forward thinking of you. So, that’s the program that I put together. And at that time, the best computing program
in the university was in the business school. So, I ended up getting a Wharton MBA, not
because I wanted to do finance or accounting, but actually because I wanted to do operations
management and information management. Did you get a joint degree or I have a joint
degree, MD and MDA. Wow Two years of medical school off the Wharton’s
back to medical school Again, very forward thinking and not typical. I think more typical today, but not typical
back back then. Yeah. And so, how much of what you believed was
going to come true, came true? So, I think all of it at some level has come
through. Now, timing? It’s all about timing, right? The timing was a little bit different. You knew you were going to be right, it’s
just about how long it takes. That’s exactly right. So, I was certain it would be, we would be
good in about three years, and I would say it’s been over the two decades, many of the
things that I wrote in that paper have come true. Now, sort of, the magical piece, because I
have to tell you the internet wasn’t the internet when I wrote that proposal. And so, that was a, sort of, a magical piece
of infrastructure that enabled a lot of things that otherwise wouldn’t be possible. But from there, the idea that we would be
using technology in the practice of medicine, which was absolutely foreign, began to evolve. And so, my first, sort of, research study
was focused on asthma in the emergency department. And so, the only thing we had as a source
of data was the billing system in the emergency department to do the analysis. Nice structure, nice analysis, nice methods,
everything. But when you looked at the results, it made
no clinical sense whatsoever. And the reason, was it was a billing system
and not a system designed to actually describe care. And that’s what really flipped me from ending
up on the faculty and being an academic, to thinking, well, if you want to make this change
you have to go do something. Do the change. Do the change, that’s right. And so, that moved me from, sort of, the academic
model to the line role and ended up being the first CIO at the University of Pennsylvania. And, a time when there’s no, probably, CIOs? There weren’t, there was, I was the first. There weren’t any before. Now, there were others in the industry, but
they were just starting and they had different roles and positions inside of the organization
than they do now. And so, your blend of, how much time you spend
doing everything. I know we didn’t get to how you got to the
clinic yet. So, at the time, when you were CIO there,
was there a blend of practice and, and actually work that you needed to do to set the stage
and lay the foundation of being the first CIO? Yeah, that’s right. So, it was really, I started out, I’d say,
about 60/40. Which way? So, 40% still on the academic side, so I had
to practice in there, and I had a research responsibility. And then the 60% was, I didn’t begin as the
CIO, I became, began as the Director of Ambulatory Information Systems. Again, probably the first one there. Very first one. I’m starting to see a trend, Dr. Harris, of
what you create. There’s no fit for you exactly, so they create
these roles that then get defined, quite frankly, by your vision and what you believe needs
to happen. And, that’s why I have always been associated
with great institutions, because I was at an institution that, from an educational point
of view, supported that kind of thinking, and then ultimately, in a place where I could
actually have it play out. Okay and then, so, how long we were you there
and how did you get here? So, I ended, I stayed there for about a decade. So, I went from becoming the Director of Ambulatory
Systems to becoming the first, I think they called it, Associate Vice President and Chief
Information Officer. That was for, what was then, the medical school
and the practice plan together. And then, that was right at the beginning
of the integrated delivery systems. So, all of the large health systems started
acquiring practices and integrating them and I spend a lot of time implementing registration,
and scheduling, and billing system, and practices, all the way across Southeastern Pennsylvania. Did that for three or four years. Wanted to turn my attention back to the clinical
side of the house because I kind of got distracted from that. And, there was clearly a business need to
keep doing that. I was running out of time and I ended up being
called by the CEO the Cleveland Clinic then, who was Fred Loop, and after some conversation
it was clear we wanted to get started on the clinical side of the agenda, and that’s what
brought me to Cleveland. As CIO? Dr Harris: As CIO. As CIO. Okay. And so, of course, not just satisfied with
being just CIO. It sounds like you also created a number of
things here that you write about in your book, and I want to dig into that in a few minutes. But, tell me about your journey here at the
clinic, from when he got here, till today. Very early on we created what I call the strategic
roadmap, and we called that eCleveland Clinic. And it envisioned a day when patients, doctors,
nurses, all the caregivers, would be using a shared tool. And then, we began down that road. Now, we started in a very unusual place. We, we actually began by doing more registration
and scheduling, so we had to replace that here. Because we couldn’t get there from where we
were. While we were doing that. one of the earliest systems we did was an
online second opinion program. Which is not where you might think you would
start, but given the Cleveland Clinic and the clinical expertise we had here and the
number of people reaching out trying to get those opinions by fax machine and then growing
email and telephone, we knew that we could Or on a fax machine. Yes. We knew that we could drive something that
was, clearly, much more representative of where we were going and the internet was coming
into view. So, that was one of the earliest programs
that we did and then that was followed very quickly by the full rollout of the electronic
medical record. And then we attached a second opinion program
to the electronic medical record. So, whether you ever came to the Cleveland
Clinic or not, you received a Cleveland Clinic medical record number and you would be a patient,
whether you physically arrived. So, very forward-thinking, and there’s a thesis
behind this book, and there’s, there’s, this is the fifth “Cleveland Clinic Way” book. I want to ask, what’s different about this
one, and what your thesis is. Because, I think the title says a lot, obviously,
with, it’s all about patient care. But I want to hear a little bit about, as
you were being thoughtful on how you package your wisdom and present your wisdom in a useful
way, what led to this? So, I think the one thing that is common across
all the books, is really, this idea of patients first. And so, I, I think if you look at the overall
leadership team, you will see that we are singularly focused on that idea. And then we bring our particular expertise
to make it work. From my perspective, this book and the core
thesis of it, is, it’s about patient service. Not about the technology. The technology is necessary in order to bring
that service alive. And then the second thing, it’s about the
connection between patients, I would now say, and consumers, and the caregivers who provide
the service going forward. That, that was always at the heart of this,
and it’s the thesis of this book to say, think about what you’re doing. Don’t think about the technology. And then, if you’re doing that, the technology
will become evident to you. So, that’s really the core. And, what do you hope someone reads? So there’s, my guess is, there’s different
types of people who are going to be picking up the book. There’s clinicians who want to understand
more of how to think about innovation, how to think about transformation. I think you have great roadmap in here. I also think there’s people, entrepreneurs
in particular, who want to figure out how to get inside Dr. Harris’s head and the heads
of other executives, in organizations where, quite frankly, there is an incredible need
to be very thorough in figuring how to navigate and bring things to the organization that
are going to make a difference. So, tell me about a couple of the different
use cases for the book that you saw as, how you see that’s used. So, one of the things I’m really hoping is
that, one, if you’re coming at it from a patient’s perspective, it will help reset your expectation
about what care actually means. And so, it will suspend the built in model
today, which says if I’m going to receive care, I have to go to it. And for a patient, I think we need to keep
driving the expectation that care can be delivered in the right place, by the right person, at
the right time, if we can manage the information properly. So, that’s a total redefinition, and our patients
have been very active in that process. So, in here you’ll hear a story about the
use of the online portal, that we call “MyChart.” So, this is giving patients access to their
information quite directly. And, I can tell you, when we first brought
that system online, the local news station caught the story, and I went on television,
did a little interview and then I literally had to turn my phone off for a week or two,
because, I’m sorry. Hey, no, no, the other way around. Oh. Literally, patients were calling saying, “this
is the worst idea. Putting this on the internet is the worst
idea I’ve ever heard. Don’t do it.” That lasted for about two years. And then, all of a sudden, patients were,
you know, we’re kind of good with this idea. It’s like credit cards in the 90s with buying
stuff. How I remember in the 90s just, started my
first company, people were like, no one’s ever going to buy online and give your credit. That’s right. Right? So, it was that kind of thing. And now, if you look at it, our patients are
way I was just going to say, now you’d be the rock star, for you people saying, that
when I go to Cleveland Clinic ,this is how I get This is the way it works. That’s right. And more and more and more the expectation
is, literally, everything should be available. Okay. So, what about the entrepreneur? So now, for the entrepreneur, what I would
say is that I think this is a golden opportunity to understand how a large enterprise, not
just the Cleveland Clinic thinks, and how to think about bringing the value of what
you’re doing into the organization in a way that it can be consumed. Okay. Which chapter is that? So, so, I Because, all joking aside, right? Entrepreneurs want to know how do I do it? Tell me, not a shortcut, but just tell me
what I need to do in order to properly bring something here for consideration and I think
I can add value? And, they really just want, they want a roadmap. So, I would say, if you look at the equation
in this book, that big equation is the value equation. And you need to arrive with that at the top
of your list. Not the product that you’re bringing, but
the value that you can bring to the organization. That’s one. The second is Let me ask you about that though. So, everyone has a value prop, right? What makes your equation different, or how
do you, why don’t you tell us the formula, because I think that’s, I was looking at it
thinking to myself, some people might dismiss it as my value prop. What makes yours different and how do you
Yeah, I’m not sure that it is different, and all I’m saying, is clarity goes a long way. And so, being explicit about what you mean
by value helps to drive the cycle of change. The vaguer the goal, the longer the cycle. Which is what we were talking about before. Everyone says the same two sentences when
they first describe their companies. So, you gotta dig deeper. You’ve got to dig deeper than that. And so, how does that then play out. So, I think for most people, they, if it truly
is a value play. Odds are, you’re not talking to one person. So, a company that comes in and tries to sell
to the CIO. Or sell only to the CEO. Probably doesn’t doesn’t have the value proposition
well-formulated in their mind. Which includes the customer and who buys it,
benefits from it, uses it. Yeah. So, you need to start with that entire cycle
and be able to demonstrate that to a large provider like this. Because we do care. Getting back to patients first, we care about
the difference it makes for our patients, we care about the difference it makes for
our caregivers, and then we care about the value that it actually drives. So, you want you want to be spoon-fed the
information, just like they want to be spoon fed the information. Tell me what I need to know that matters to
me, otherwise, it’s a waste of That’s exactly right. Okay. So, that’s the first one. That’s, sort of, first. That, to me, gets you through the door in
a way that is different than a cold call can get you through the door. Now, the second thing to me is, then, there
has to be engagement right up front. Because, whatever you have. There are few exceptions. It’s going to attach to something that already
exists inside the healthcare system. So, how does it fit in the workflow. So, how, workflow, and the ability to make
that actually happen in a way that produces a round wheel and not a square wheel, is incredibly
important. Let me ask you a question. When you think about the entrepreneur who
comes in the wrong way. Yet, you need to tease out of them their value
property. You need to tease out of them what you’re
looking for. How often do you guys participate, co-develop,
co, you know, co, collaborate on what they’re doing, versus bringing a ready-made solution
to you? Yeah. So, that’s a great question. So, the first thing I would say, if we go
back to, if you think about who the buyer is in the organization and you convene the
right group of people, the outcome from that process is likely to be what you just described,
which is an engagement process. Which means, we see the idea, we get the value. We know it’s not going to work perfectly,
but we’re willing to work with you. And the reason for that, is that most healthcare
delivery organizations are not software development organizations, and if they recognize that,
they see an opportunity to partner with a company that can bring real value. So, for example, we, a long time ago, had
a product developed inside of the IT division that was called eResearch. It was a classic idea, purpose-built, supporting
our researchers, who do, you know, hundred million dollars or so of NIH sponsored research. And, what they wanted was a tool that would
allow them to essentially do a feasibility analysis for a study design. So, rather than writing up a proposal to the
NIH and say, “I believe,” they could write up a proposal and say, “I performed this
simulation using the data from the EMR at the Cleveland Clinic. Here’s the inclusion criteria, here’s the
exclusion criteria, and it led us to this recruitable positive impression.” It made it all frictionless. It made it frictionless for them and it gave
them the reason to believe that if they actually carried out that study at the Cleveland Clinic,
that they would actually be able to recruit the patients, which is the number one failure
for a research study, is that you don’t recruit enough patients, so therefore you can’t draw
a conclusion. So, we did that work and then we realized
that we had an idea that was bigger than we could deal with. An entrepreneur came in at that time who was
looking to drive some value in the organization. Had a general idea of what they wanted to
do. Didn’t have any technology and saw this tool. So, they presented a concept. We had a tool. At the end of the day, they acquired the right
to use that tool, and they built that into a product that we now use. We did not guide that path. They were able to do that. But what they had was a purpose that was important
to the Cleveland Clinic, and they were able to morph that several times into other areas
that were important. So, they were entrepreneurs. Yes. And had an entrepreneurial mindset. If you could wave a magic wand, what would
you love to see your external engagement look like with entrepreneurs, with startups? I mean, you just described a couple of really
successful scenarios, but I’m sure there’s plenty of ones that didn’t work. Wave a magic wand. What would be the ideal setup for you? Let’s take, go out five years so we don’t
look at, like, the next year or two. What would this look like to you? So, here’s what I imagine is going to happen,
and that is, that I come back to core healthcare organizations responsible for delivering care
to patients, like the Cleveland Clinic, are not going to be able to be principal developers
of solutions going forward. So, the first thing that I would say is I’m
looking for a partner who gets the solution idea., And we talked about this earlier. That bringing me a piece of technology is
becoming less and less interesting. Bringing me a solution that I can describe
with my colleagues is becoming far more important, and bringing me a solution that is meaningful
to the patients and consumers is of the highest, and caregivers, is of the highest value to
me. So, the interaction I’m imagining going forward
is, one, because of books like this, I think people will have a better sense for what’s
actually going on inside of a healthcare organization. I think you can make some basic assumptions
about how it works. Is there an EMR in every hospital you’re about
to go into? Yes there is. Is there a workflow that’s built around that
EMR? Yes there is. So, why would you enter and assume that there
isn’t? You should begin with the understanding that
it must be going around like this. Now here’s how I’m going to add incremental
value to that workflow. Even better, here’s how I’m fundamentally
going to blow it up. Now, if you’re going to fundamentally change
that workflow, then your idea has to be crystal clear. If you’re going to augment the workflow that
already exists, you have a little more leeway. What is the biggest misconception by entrepreneurs
and startups about how you just, you know, what you just described. Misconception. What do you see, being in the wrong, being
done wrong? So, I would still come back to, it is workflow. That their biggest misconception is that whatever
we’re doing will be built around the tool that they’re bringing. And what they need to understand is that their
tool needs to enable the workflow that currently exists or help us modify the workflow that
currently exists, so that we can do something differently. Many times I see a beautiful, I mean, I’ve
seen beautiful product designs that have no hope of being actually integrated into an
operating organ. Do you tell them? Tell them right away. You do. We do. Good communicator? And so Feel like you’re doing a good job communicating
that? You’ve got to make that right up front and
make it clear and be clear about why it doesn’t work. Now, I think the flip side is, we also now
need to be open to new ideas and be willing to do that work. But, if someone comes with the idea that they
understand your workflow and they’re trying to insert into it or alter it in a way, that’s
engaging. If you come with the idea that you will work
around my model that I’ve never even seen before, that’s disengaging. So, I asked, I asked Dr. Cosgrove this morning
on stage about what you would tell young physicians, just graduating school and coming into, you
know, the industry, and whether it’s bright-eyed and bushy-tailed, thinking it’s one way
or another. What do you tell that, you know, just graduating
or just finishing residency physician? I would tell them they have great timing. That when I think about the world that I entered
coming out of medical school and the world they’re entering they have the opportunity
to make impactful difference in healthcare and to do it with novel ideas, that they have
had formal educational training and clinical experience to identify, to be able to describe,
and to be part of driving the change. What’s great about their timing is that they
don’t have to get over the belief that there will be an internet. They don’t have to get over You’re like,
this is a piece of cake. That there is consumers. Right. Exactly. They don’t have to, they need to accept that,
embrace that, and drive the change, because their timing is wonderful. Excellent. That’s a very optimistic view of the future
of medicine, and in particular, healthcare professionals. Let’s shift gears as we wrap up, and I want
to talk about who you are a little bit on the personal side. What else do you do, besides practice, and
besides, probably, geek out on technology’s my guess, and, you know, spend probably plenty
of time researching and playing with technology. But what else interests you? Yeah. So, you know, I, one, I love to travel and
I love to engage with people outside of any professional setting. So, I’ve had the wonderful experience, and
this actually goes back to my college days, but one of the things that they would do during
college is simply send you to another country and put you up with a different family. So, I’ve gone all over the world with very
little connection to people and been invited into their homes, made friends. So, you love Airbnb. I love it. I think that idea is fabulous. I think it causes you Do you stay at Airbnb? So, we usually do You’re like, you’re like
the other way. At home away yeah, yeah. But, I love that personal connection. I think the human connection is one of the
most powerful things You’d rather do that than stay at a hotel. Absolutely. That’s interesting. It just, it causes you to think about places
and people in a completely different way. So, that’s kind of the, you know, human connection,
if you will. Then, I’m a big sort of health and wellness
person, so I try and work into my day all those things that, generally speaking, should
be good things to do. So, activities of daily living are really
important. If you think about, just a range of motion. If, as you age you’ve kept your range of motion,
the likelihood that you’re going to fall and break a leg and develop pneumonia and have
all those complications drops dramatically. So, my goal is to be as healthy as I can and,
sort of, contribute to the economy, if you will, because I’m not consuming a lot of healthcare. Good. So, you’re like our longevity moonshot today. Love it. Adding fifty plus years. Absolutely. Fantastic. And what’s your favorite app on your phone,
not work-related? So, it is the pacer app, which is really,
sort of, a general activities app. So, it does heart rate, it does pedometer,
it does those kinds of things. Big fan of those kinds of things? I am. I did like one of the ideas at the event today
which, really, if you looked at it, it was more in the nutrition space. What I liked about it, is it took the work
out of the process and I think that’s dramatically important. Remove that friction. If you remove that friction, you will see
adoption go up dramatically. Okay. Last question. One word to describe Martin Harris. Optimistic. Love it. Thanks so much for being on the show. Great thank you. Thanks. It was great.

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