The Promise of Technology and On-the-Go Patient Care

Host: Well, today we welcome Kevin McDonald to the CereCore podcast. Kevin is the chief information officer for HCA Healthcare’s South Atlantic division. Under his strategic direction, he and his team support large complex hospitals, emergency surgery and urgent care centers throughout South Carolina, Georgia, and Florida — all known for outstanding patient care, innovative technology and pioneering new medical procedures.

Kevin began his career with HCA HealthCare in 2011 with the auditing group. Transitioning to a number of senior facility director IT and operations roles before moving into his current CIO role. Prior to joining HCA Healthcare, he spent time with J.P. Morgan Chase and Company.

Kevin earned his MBA with an information technology management concentration from Western Governors University and a Bachelor of Science and business administration with information systems focus from “The” Ohio State University.

Kevin, welcome! Thank you very much for joining the CereCore Podcast.

McDonald: Thanks, Phil. Love the emphasis on “The” Ohio State University. I’m happy to be here.

Host: Well, you know, watch enough football and you understand how it's supposed to go down.

McDonald: That's right.

Host: Well, Kevin maybe, we'll just start with a little bit about your background. We touched on it a little bit, but if you wouldn't mind, give us a little bit more details and information about your professional background, and then your role as a CIO in the division that you lead.

McDonald: Yeah, certainly, it's been a journey. So, I decided, in 2008 to leave my career and finance and seek an opportunity with an industry that I felt would make a big difference. I could really find that ethical and moral compass that led me to satisfaction when I came home every day, and that's when I found HCA Healthcare. So, I started within their internal audit team.

So, I was doing IT audits, security, and compliance type of audits. After a couple years in the audit department, I decided that I wanted to move into a role where I was not telling our hospitals how they should be performing certain functions. I was actually doing that. So, I found a CIO in Houston that was willing to take a chance on me.

So, I moved into a hospital director role in Kingwood, Texas. I spent a couple years there. We were starting the separation of our North Florida division and creating the distinct South Atlantic division. I thought wow, it would be neat to be part of a new creation of an IT division. That is when I decided to reach out to the current CIO at the time and found myself in a role over two hospitals here in Charleston, South Carolina. So, I was over Trident Medical Center and Somerville Medical Center both outstanding care facilities here in the low country.

Not too long after that, we acquired a major hospital in the Savannah area. That became my first introduction to Epic and my first introduction to a major acquisition and integrating a health system into HCA. So, I spent almost a year in Savannah and returned to Charleston after we got that acquisition on track. And low and behold, our VP at the time called and said, hey, “we are doing another acquisition in Asheville, North Carolina. Would you like to lead that?”

So, I was given the opportunity to move to Asheville, North Carolina and lead the acquisition of Mission Health as the IT on the ground lead there. I was there for three years. My boss back here in Charleston decided to take a role in our Texas at one of our Texas divisions.

And he said, “do you want to come back and serve as a CIO here?” So, that's how I ended up back here in Charleston for the second time and have been in the CIO role for about two years. And it has been an amazing experience and an amazing journey within HCA.

Host: That is excellent. And I appreciate you touching on the whole concept of that mission driven value when you are thinking about career. Because that is certainly something that all of us that serve the healthcare community feel on a daily basis. I think that is why we remain and do the work that we do.

So, I certainly appreciate you saying that and what an incredible journey. And, quite frankly some experiences that not a lot of folks get to have in and around leading the acquisition sorts of the work that needs to take place to bring an organization that has been operating for years and years into a new operating environment. So, that's very neat.

So, maybe tell me a little bit about your leadership philosophy, particularly when it comes to building high performance teams and certainly you have had to do that in a lot of different roles and responsibilities over your career, but certainly those are areas that are critical to the healthcare IT industry.

McDonald: You know, for me, it's really all about making that investment in our employees. I know that if I invest in the development of our employees and I invest in the growth of our employees, that is going to pay dividends and I'm going to have a motivated workforce that wants to come to work every day and wants to continue to grow in their own personal journey and career. So, that's really been a cornerstone of how we have elevated the South Atlantic division.

I started here with a fantastic foundation, but we have been able to continue investing in our employees and we have set up several training programs, technical programs, clinical programs, and then we advocate for them.

We advocate for their career growth. If the career growth is outside of my division, I accept that, and I pick up the phone and I call the hiring manager for them, because at the end of the day, I'm going to cross paths with that employee again. If they take a job with our corporate office in Nashville, they are still going to be supporting me. So, I would say that is the secret sauce of this division is to develop, grow, and create a highly engaged workforce that we can objectively measure through our engagement surveys, and continue to focus on raising that bar every day.

Host: Yeah, that's great. I think, certainly when we talk about mission, it does start with the people that are around us. Right? You take care of those people, and they are going to take care of the work, which then takes care of our communities.

So, I think you are spot on with that approach. So, as you are building those teams there is a lot going on and a lot of demands. How do you keep your teams nimble and able? It is easy to fall into that operational mindset, but how do you keep those teams nimble? So, they can respond to the types of demands that pop up on a day-to-day basis? And, heaven forbid the cursed thing in IT happens — an outage?

McDonald: So, I think we can do everything possible to prevent an outage or prevent an unexpected demand, but we know the inevitable is going to happen. So, for our teams, if we look at an example of a downtime, the biggest thing that we have done is create a repeatable framework that we can quickly put into place in the event we have an outage.

So, we work heavily with our corporate counterparts on the IT operation center, but we have developed our own critical event framework and that starts with having an accountable leader 24 by 7 who manages that incident from the get-go.

We leverage our tools very heavily. So, Webex Teams, our instant messaging tool, has really been a game changer for how quickly we can respond to an incident and pull in the right resources to resolve that quickly. And that is ensuring that everybody knows their role when you hit that red button, when that alarm goes off.

So, do we have the ability to quickly engage a network engineer, system administrator, a clinical resource to identify the issue, triage the issue, and then restore. So, that framework, and playbook, if you will, has allowed us to be ready at any moment's notice to go into that reactive recovery mode.

And then after we have that incident, we take a step back every time, and we say, “What could we have done to prevent that? What do we need to adjust going forward to prevent it?” And if we don't think we can completely prevent it, how do we respond quicker, more efficiently, and more effectively next time this type of incident occurs.

We have grown so much in this space, from a maturity perspective. I cannot believe how quickly our teams engage and reach a resolution compared to where we were 5 years ago. It's really incredible to see. But your goal is always to reduce those incidents and be as proactive as possible.

Host: Yeah, absolutely. You hit the nail on the head. So many organizations do not take the time to install that documented process. But, at the same point, it is one thing to have the process. It is another thing is to train people on it, to make aware of it, and to keep revisiting it — just, as you said, to make sure that okay, are there things that we can do better to really close those time loops and identify those other areas. I mean, technology is technology. Sometimes stuff just breaks.

McDonald: Yep.

Host: And it is all in how we respond. So, can you think of a time or an experience that you all had when a particular technology helped the hospital get through one of these sorts of events?

McDonald: Yeah, I think, one that really comes to mind is when we had an outage of our thin clients at our hospital in Savannah, a very large hospital that is heavily dependent on in room and at nurse's stations and workstations. And what had occurred, it is a little bit interesting, those devices had a certificate that expired and that connected them to the wireless network. So, they all lost connectivity simultaneously.

So, our clinicians did not have that natural access to the patient chart that they were used to. One of the things that was so incredible was I was talking to our senior IT director there and really gauging how impactful this was.

Obviously, in my mind, it was going to be tremendously impactful and what we could do to help mitigate this. He said, “they are naturally picking up their iPhone's and just using the Epic Rover technology to look at the patient's chart, to look at the medication, continue to do safe medication scanning, and lab scanning.”

So, it was really impressive to see that natural adoption of a mobile technology in the event of a thin client downtime, without IT even saying, “Hey, everybody grab your iPhone's and start using Rover.”

So, that one really stands out to me as a pretty remarkable and natural way for people to adopt that technology in the event of a downtime.

Host: Absolutely, that's fantastic. And first and foremost, having it in place and available. And two, I think at the end of the day, our clinicians and clients, they know what is at their fingertips.

Especially if we are on top of things and training them and they are going to figure out new and creative ways. It is fun to listen to them. It's part of the rounding that I'm sure you do all the time, and your team does all the time with the clinicians to see, “Hey, what are you using? How can things get better and where are those gaps?” It is part of that never-ending learning process for those of us in IT to help make things better. So, that's great.

McDonald: Absolutely.

Host: So, now you have had a good bit of experience on the Epic side of things, on the system side of things, and maybe what are some of the accomplishments that you are most proud of?

McDonald: Yeah, I think, Rover adoption is really something that we are proud of in the Savannah facility for our nurses. But one of the other mobile technologies that I am always astounded by is how much our physician base has adopted the Haiku and Canto mobile solutions for Epic, the physician facing mobile solutions. We have some of the highest mobile adoptions of any hospital within HCA. Our mobile adoption, in Savannah, is higher than some of our divisions.

It is really remarkable to see. And our CereCore partners have enhanced that solution even further within the last couple of weeks by having a PACS image viewer directly available on that mobile device. So, we have truly given those physicians and all-encompassing mobile platform for their usage when they are on the go in the hospital, at home, or on call. It is an adaptable solution. So, I am incredibly proud of where we have come with physician mobile adoption, along with nursing mobile adoption.

I think that we have got so many opportunities within Epic. It is really remarkable what we can do from a scheduling perspective. We are starting to look at the ticket scheduling options. I call it the “Resy solution.” Where you can say, I'd like a sooner appointment if one becomes available, and it notifies the patients when that appointment slot opens up. I think that we are scratching the surface with some of these next generation Epic technologies. But I am really excited about it. We are looking at “Hey Epic!” We are also looking forward to the future of what we can do within Epic, and what we have already done.

Host: It truly is amazing when you get these technologies in the hands of the physicians and the clinicians, and just to see them say, “Oh, this is a game changer.” You just saved me this amount of time, you just enabled me to have this information when I needed it during a critical situation, or to really provide care that otherwise I would not have been delivered. So, again, it is back to the mission. That is fantastic.

Well, one of the things you brought up, and thank you for bringing it up, is partnerships. Certainly, in your role and every CIO's role, there are those partnerships that you rely on. So, maybe you can share words of wisdom just to share about partnerships and relationships between CIO's and their partners.

McDonald: For me, there are so many partnership opportunities with the structure of our company. So, I look at our partnership with our corporate resources as an extension of my team, and I treat them with the same respect that I would a member of my team.

I look at our CereCore partnership. CereCore, for the folks listening in, they support our Epic system for us. I view them as a natural extension of my team and include them in things that I would include my same direct team members. I really try to build that personal relationship with those individuals. So that has really been the secret sauce. Don’t look at them as a vendor, or a vendor partner, but look at them as a natural extension of your team.

For somebody like me who has grown up in a matrixed organization, that comes naturally. But I think the tendency to not view them as a natural extension of your direct team can cause that relationship to build a little slower than it would otherwise.

So, that's my best advice to fold them into your inner circle, make them part of the team, set the expectations, hold them accountable, but also create a good personal relationship with them. And I promise they will be there for you in your time of need, and they will perform how you want them to perform if you treat them respectfully as a member of your team.

Host: That is fantastic advice, Kevin. Certainly, when you do that, that line of communication is always open. There is no guesswork that is going on between the partner and the hospital or health system. So, great words of wisdom.

As we wrap up today, I always like to just kind of throw the door open a little bit for any sort of last CIO perspectives, words of wisdom, or things that you have learned over your tenure, both at HCA and really just in your career in general that you feel like other CIOs should at least be aware of, or paying attention to.

McDonald: I think the biggest thing for me is I grew up in a world of operations and having clean running operations to me is the foundation to allow you to execute on your strategic vision. So, that has always been a major platform of mine. If I have built the foundation of operational excellence, then I get to do the strategic and innovative activities. So, for the CIO's out there — don't take your eye off the ball of operations.

At the end of the day, the nurses in these hospitals they want to do their jobs. They want to take care of their patients, and we want to help them take care of their patients. And functioning high available systems are the cornerstone of that and then we can start to build those additional capabilities out.

So, that's always been a big driver for the way that I run my IT programs.

Host: I think you are spot on I think I've heard another CIO mention, operations needs to be quiet.

McDonald: Yes!

Host: When operations are quiet then you can get to the proactive projects that the entire organization is clamoring for.

McDonald: Absolutely.

Host: Excellent. Well, Kevin, thank you so much for your time today. I really appreciate your partnership, but also your time, words of wisdom, and insight for our viewing audience. I greatly appreciate it.

McDonald: Thank you, Phil. It has been fun.