"With innovation, you need to be prepared to recognize that every idea is not a great idea."

Q. John, what does your title mean in terms of the areas of responsibility for your role? Can you describe the applications landscape as well? 

John: I have worn many hats in the 12 years at Penn Medicine for a long time. I was the infrastructure executive responsible for enterprise infrastructure, component data centers, networks, telephony, video services, storage, et cetera. My role there was focused on resiliency and availability, which is critical in any academic health system where I built the information security team. We went from about four employees to about thirty-two dedicated security professionals in less than four years. However, my focus for the last couple of years has been around what we call entity services, and we refer to as entities, hospitals, and other major functions. Today, we have 13 of those today, six inpatient hospitals, several other areas like primary care physicians, specialist providers, home care, school medicine, et cetera. Each of those entities has an Information Officer and Information Entity Officer. So, the entity services team is comprised of about two hundred people across Penn medicine, delivering services like clinical engineering, platform support, network support. They have just been designed to allow the entities to have some autonomy regarding their priorities and resourcing their needs. My role has been for about ten years now and is part of our special sauce, making our information services team successful. It has personally brought me closer to what we do as an organization in providing world-class healthcare. Many of the different hats across the last several years have given me a unique perspective around what it takes to run a large-scale organization in an academic health system.

Our primary application is Epic or what we have started calling PennChart. We started installing Epic probably twenty years ago in the ambulatory setting. About six years ago we migrated to Epic on the inpatient side of things and have since installed many of their specialty modules, like Uptime for the OR, Cupid for cardiology. We also leverage several of their mobile platforms with tools like Haiku and Rover. Epic customers will be familiar with those terms and we use Epic tools that allow us to work with other physician practices in hospitals, things like what they call “healthy planet” care everywhere community connect. We also leverage some of their modules for the data analytics-based tools. Lastly, we use their patient portal for facilitating communications with our patient population for things like appointment scheduling, test results and medications. 

Q. You are about to launch a new hospital which I believe is going to be the hospital of the future. A lot of new technology enablement aspects are going to make for an interesting and improved experience for people. Can you talk about that? 

John: It is an incredibly exciting project and by far the biggest one I’ve ever worked on in my thirty-five-year career. I think it is the biggest capital project in the history of Penn, which goes back about two hundred and fifty-plus years. Our first meeting on this topic was over seven years ago, and we are set up to be patient-ready by the October-November timeframe this year. It is in our West Philadelphia campus, across the street from the hospital of the University of Pennsylvania and the new building. It’s a $1.5 billion investment that includes about 1.5 million square feet, 500 state-of-the-art private patient rooms, 47 state-of-the-art operating rooms in this 17-floor facility. This innovative hospital facility is designed to support our world-class researchers, clinicians, and faculty. It is trying to create a stage for these world-class folks to do what they do best.

From an IT perspective, we view this as an opportunity to significantly improve our patients’ and our providers’ engagement with technology. We have designed the building to support a fully digital experience with Wi-Fi and cellular coverage throughout the facility and have developed what we call the patient footwall, which has really been around designing the integration of several different technologies that will make the patient stay more comfortable. The technology will also enable providers to engage with the patients during their stay. The hospital will be 5G ready, aggregating nurse call and nursing alerts to a mobile app to reduce nursing fatigue. At the center of this will be a seventy-five-inch TV, a centerpiece for education and entertainment for the patient. A tablet in the room will allow patients to manage the room, the temperature, the shades for lighting, noise levels, privacy, potentially ordering dietary requirements, full integration with our electronic health records. As soon as staff enters the room, the patients will know who they are, their role, and potentially why they’re there. All the environmentally friendly components in the facility will help us be responsible from an environmental perspective and reduce some costs. The common theme for us with this Pavilion on the campus is connectivity. The need to have a patient care facility like this with advanced connectivity is fairly evident. When you think about extending this connectivity beyond just IT and creating a seamless patient experience across the campus with transitions of care, you’re talking about some game-changing improvements in patient engagement.

We’re there to take care of the patients and their needs and focus on them. The intent was to have a highly private facility for our patients that would be comfortable for them and their family members and make it a good experience and have the room outfitted so that it does feel like an improved patient experience. We intend to provide a hospitality experience. We talked to Disney and others so that we could work them into our design.

Q. The tech can doeverything but developing this unique and differentiated experience requires a whole different level of understanding of human needs. Can you talk about design process to design the experience carefully? Also, how long did it take you to design this patient room of the future?

John: We brought in subject matter experts from architecture and design from across the globe. And then built out a half a floor in a warehouse out of Styrofoam, brought in time emotion studies, and made some significant changes to our original design based on actual people, wheeling gurneys through these Styrofoam hallways. We looked at access and traffic patterns and did all kinds of timing exercises of how long it would take to get somebody from the ED to an OR. As fun as the technology was, if you design and implement it right, it’s right. Getting it right from a design perspective is a whole other level and I think we knocked it out of the park. 

It almost took three and a half to four years to design the room from start to finish. We found some slick ways of a nurse sitting at a desk outside of the patient room like we mirrored the patient room such that a nurse could monitor two patients at the same time through these windows. We have done some innovative things in the bathroom and the shower design and brought those in these units by leveraging the city’s views. It was an extensive design process. We have also designed flexibilities into the room to be used for many different purposes. In the old days, you had your normal patient care rooms and then you had specialty rooms. These rooms are all designed with booms to move patients and capabilities that can become more specialized on the change of a dime. Over 500 rooms in this net new building are designed and set up in this way.

Q. How do you ensure that you have adequate security, data, security,and patient privacy? What additional considerations went into this when you were putting the design together?

John: If you think about this patient room, many components are of the Internet of things. Whether it’s the lights or the devices in the room that are more typical Internet of Things type devices, everything that sits on the network poses a potential concern. So, we teamed up with several subject matter expert partners. We set up a lab environment and implemented all this technology in the lab. If you walked into this lab, it would almost look like the patient room to you. We rolled in the monitoring equipment and everything else to be really a good mirror of what would be happening in the new Pavilion itself. Then we made sure that we had the security we were looking for in that room. We did some exercises to try to tap into the network through some of these devices and asked our vendors to work in their labs at their own manufacturing plants. The technology that we have integrated and the standard tools we put in place to manage security across the enterprise is in pretty good shape. But in this business, you need to be vigilant. The threat landscape changes dramatically over time. Health care organizations have really become the focus of cyber-attacks over the last several years. It started with medical records being more valuable to criminals than credit cards and has only been exacerbated with organizations like ourselves that are in the center of COVID research and vaccine distribution. Patient privacy and ensuring that we’re a secure organization are really important to us, so we have redoubled our efforts with this new facility to ensure that we’re in good shape. Devices like network segmentation, network access controls, building profiles can change their behavior; we have a chance to isolate them and pull them off the network in case they could have been hacked or breached and could be a vulnerability. We are making sure that new Pavilion and the rest of our enterprise is secure.

Q. You have a ton of data that’s going to be available by observing the way these devices and the software of the services used by patients or caregivers and how the devices interact with one another. Can you talk about how you’ve laid a data and analytics layer on top of this infrastructure? 

John: We started to make investments in our data analytics group from the last three years and have continued to make those investments. With this additional information, we will focus on how we turn that into knowledge, with that data, people can make informed decisions. So, we have matured our efforts on the data analytics side, but we are still trying to identify the best way to use all this data. We are excited by the opportunities and looking at how to make future investments in this informatics to make sure we’re leveraging all this information. Through this data, we make sure our clinicians and executives are aware of what’s available and then optimize it based on that information.

Q. Are you leveraging the cloud in any significant way either for posting your applications infrastructure, especially for this new facility, and for the data?

John: I call our cloud strategy – opportunistic. From a Gartner perspective, what they call a fast follower. Cloud technology is not new by any stretch, but we need to make sure that we have business associate agreements in place with the cloud vendors. We spent a significant amount of time building out our private cloud capabilities using hyper-converged capabilities. We have seen some great efficiencies there and been able to move a significant amount of our workload from different vendors, storage and platforms that are computing. Our focus has been on the HIPAA conversion private cloud. We have also been leveraging SAS applications wherever possible. Many of our applications are cloud based in addition to things like Office 365. We’ve made some investments in the infrastructure applications, but we know that in a long-term perspective, we need to leverage private cloud, public cloud, hybrid clouds so that in any time of the day we can move our enterprise workload to the least cost and in the most secure environment. We continue to work with Azures and the Googles and others out there to make sure that we’ve got the right agreements in place. We have got a rather large high-performance computing that’s used on the Research and School of Medicine side that we’re looking to move to a cloud environment. We don’t drive things to the cloud just to drive things to the cloud. We do when technologies at the end of its life where there is an opportunity to be more efficient. I would say today we probably have close to eighty five percent of our workload in some type of a cloud environment. 

Q. So, over time you have moved a significant amount of enterprise workloads to the cloud. But you look at everything on a case-by-case basis and it’s not a default decision to just drop something into the cloud just because that is where you want it all to be in future. How do you do the tradeoffs?

John: We look at the workload itself and look at what kind of data is on those workloads and then what we’re doing today. If it’s in a hosted environment that we’ve outsourced, we look at what’s the cost of that environment, what are the pros and cons of running it in that environment, speed to market, the way they secure their environment, and so on. We look at it from a cost benefit standpoint and start to check what are the things that would make us more responsive, more agile to get things time to market. We also look at the ways that can take our resources and focus them where we want them to be focused versus running our own data centers and setting up servers and managing the servers and storage. We look really at return on investment and risks.

Q. I have heard often that moving things to the cloud may end upcosting you more if you’re not careful. Can you comment on the ROI part of it? 

John: I think we found the same thing, particularly with our high-performance computing capabilities. It looked attractive on the surface, but the devil is in the details. Once you start to pick up things and move it over, you learn quickly that there’s some hidden costs. There are times where you’ll accept those costs because it reduces investments and resources that you need in other places. But we have learned the hard way that sometimes the cloud is actually more expensive.

Q. How would you describe the State of the Union as it relates to interoperability across all your applications in your landscape?

John: We have taken a three C approach to applications that stands for – common systems, centrally managed, and collaboratively implemented. It is one of the mantras we use in IS, and it’s been key to our success over time. In the last 10 years, we migrated many small applications into these large suites that I talked about earlier, like Epic. It’s allowed us to be efficient in our spending and resources and drive a lot of cost out of the system. As we look at integration or our ability with new applications, we lean on those standard systems first. And then see if they can work for us versus adding in a new best-of-breed type of application. 

Secondly, the legacy there is centrally managed. So, pulling everybody together into a corporate IT organization has allowed us to eliminate most of the shadow IT in some organizations. Shadow IT resources are the ones that in many cases introduce new applications that are hard to integrate or hard to interoperate. Between those two things, we’ve built a pretty effective corporate organization that can deliver the standard solutions fairly quickly and economically. 

The last C, which stands for collaboratively implemented, is our secret sauce. We have business projects that involve technology which means that both IT and the operational folks are at the table with skin in the game. This has really delivered very good results for us, because as things start to go wrong, we lean heavily on each other to make sure that we get good results. This strategy has really helped us eliminate overhead and eliminate the need to integrate and interoperate platforms that may be a challenge. 

Q. Most health systems try to consolidate all the applications into their core platforms. But on the other hand, they also must be open to bringing on new innovative solutions. How do you manage this?

John: On the one hand you must keep your network and clinical systems up and running twenty-four by seven. That requires a certain strategy, mindset, and skill. It’s not an easy job but getting there on time takes some work and focus. At the same time, you must have an innovative mindset to stay ahead and leverage these new capabilities. This requires a whole different strategy, mindset and skillsets. Leading teams that are responsible for both can be a challenge today. With innovation, we feel like you need to be prepared to recognize that every idea is not a great idea and failing fast if you are not going to be a winner. But our environment, where a learning organization, we see many entrepreneurs on campus, comes out of Warton, other schools, and is incredibly bright. We have a place on campus that is called Pennovation – a lab space. Their tagline is ‘where ideas go to work,’ which encourages people to come to Penn to do innovative work and to do emerging technology work. So, we often see people knocking on our door saying, “We work for Penn or we graduated from Penn, and now we’re part of a startup. So, we see a lot of these technologies. And I would say one out of every 10 to 12 has got some real value here. It is addressing a pain point that we have, and it’s something that we can’t go to one of our established partners and ask for the capability. So, we have set up a new technology review board that looks at all these and uses a governance process to ensure that we are fair and consistent. So, not only do you need to keep your legacy applications up and running, but you need to stay focused on innovation where it can be a game-changer for you as an organization.

Q. What is the advice you have for startups across the country that have something interesting to say and want an audience? 

John: I think there are two things. One is timing. You must have robust technology that is ready for prime time. People knock on our door many times, and it’s a concept and we don’t have the cycles with everything else we have going on to work through the concept and spend those kinds of cycles there. Timing is key and it’s got to be close to being ready. Another essential part is finding an internal sponsor, a champion, somebody who is willing to be the representative internally around that technology and speak to its benefits. Look at the cost benefits, ROI, and a partner who will help design functionality and capabilities. Also, find the sponsor, the internal person that can champion that.

Q. Is there a best practice that you would like to share with your peers in the industry? 

John: The best practice is to engage with others. What we learned with the Pavilion was that looking outward was a game-changer for us. This sounds simplistic, but we have brought to the table several technology partners and several integration partners and said – “we want you to partner with us and do development on your dime and later you’re going to be able to talk about how you partnered with us.” Getting the right spirit of partnership and getting the right ability has been a game-changer for us. The best practice for us was as big as we are and as talented as the people we have, both on the IT and clinical sides, partner with folks that has significant resources themselves.