An Innovation Playground—a Conversation With Jerry Vuchak of Children’s Nebraska

Jerry Vuchak is the chief information and innovation officer of Children’s Nebraska, based in Omaha, Nebraska.

Q: Tell us about your background and how you arrived at your current position?

A: My journey in health care started in 1991 and my background prior to Children’s Nebraska has primarily been working in large adult academic medical centers. I was at Houston Methodist for 15 years where I served as a vice president and eventually as the CIO for four of those years. From there, I went to BJC Healthcare in St. Louis, serving as the CIO over Barnes-Jewish Hospital. My role expanded over time from Barnes-Jewish to St. Louis Children's Hospital to Barnes-Jewish West County Hospital. Eventually I assumed responsibility for all 15 hospitals at BJC, managing what we called application delivery and support, with a focus on electronic medical records.

My favorite hospital to support during that time was St. Louis Children's Hospital. There’s just something really special about pediatric medicine. Team members in the organization are very tied to the mission, vision and values of pediatric care. I wasn't looking to transition from BJC, but the opportunity came to be the CIO at Children's Nebraska. I came and interviewed, and I had a wonderful interview experience and saw the great work that was being done here. I knew after my first interview that I wanted this job and came to the organization in 2019.

Q: I’ve been in many rooms with health care leaders who introduce themselves by saying they are a “recovering CIO.” What is it about the CIO role that lends itself to that description? How did expanding your title to include innovation change your role related to broader governance?

A: I know how limiting the CIO title can be, where folks don't see you as a collaborative partner or they just dump things on you to work on, but I think I've had the unique opportunity not to be pigeonholed into being seen as the typical CIO. When I was at BJC, I almost switched careers from being in information technology to organizational development, because I saw the power of bringing folks together across the organization.

The education I received around organizational development carried over into governance. As you are probably aware, many technology initiatives fail because hospital operations is not as invested as they could/should be. My modus operandi has always been that we're not taking a project on unless an operational leader is right there beside me. It took some work, but now it's a much more collaborative process and technology is seen as an enabling partner with the rest of the organization in advancing our strategic planning efforts.

We now have a very streamlined strategic plan that’s a living, breathing document. We don’t create a five-year strategic plan and put it on the shelf to check back in after five years; we meet quarterly to see how we’re doing, what we’ve learned and what we might have to change. The enablers of our strategic plan are our people, our financial sustainability and our use of technology and innovation—those foundational elements support every decision we make in the organization.

Q: I read that your organization proactively crowdsources ideas from staff in using technology, even hosting an Innovation Cup each year. Then there’s Bright Foundry, the organization’s accelerator that provides additional opportunities. Do you have a means of fast-tracking these innovations within your budgeting cycle?

A: When we started our innovation journey, we realized we had to have a way to prioritize, because innovation can mean a lot of different things and it can set people off on courses that might not fit the strategy of the organization. So, we formed a strategy council that guides prioritization of our innovation initiatives. I chair it, and it includes the CEO and other senior leaders of the organization.

In an organization’s planning cycle, best practice is that on an annual basis about 60 percent of your work should be planned and 40 percent unplanned. That allows us to have a little leeway to do more of those creative innovations during the year. Creative ideas that arise first go through a group that we call Enterprise Opportunities Management, and then if we think they're valuable, they go up to the strategy council (if appropriate) and we prioritize based on due diligence and discovery regarding potential positive outcomes. As an organization we can't do everything, but having strong governance and leadership support allows us to launch really creative ideas into the stratosphere.

We also have a platform called Bright Ideas where any team member across the organization can submit an idea at any time. Our innovation team will do a first glance, and we’ll personally get back to the submitter. Some of the ideas are just not feasible in our environment, but then some of them go into that pipeline of things we’re going to do, and we thoughtfully schedule them out. To help us with prioritization in our goal planning work, we'll sometimes focus on categories. An example of that might be that our patient experience or Net Promoter Scores aren't what we want them to be, so we will encourage our team members to submit their creative ideas around that category so that the ideas are focused on goals that we really want to advance strategically in the organization.

Q: Children’s Nebraska also recently opened its Mammel Innovation Center (MIC), where you’re evaluating a range of digital solutions from 3D printing to virtual reality and even holographic technology. Are there some early prototypes or test cases that you would highlight?

A: First let me explain our intent with the MIC. As we were embarking on this innovation journey, we were doing a lot of research around innovation in pediatrics and it was really alarming to us that of all the dollars spent on health care innovation, only around two percent is dedicated to pediatric medicine. That’s stunning, because you want to intervene early and often with care for kids to set them up for good health in adulthood. That's why we built the MIC—to create this groundswell of interest in advancing innovation to drive positive patient outcomes.

And we've had some really terrific early wins. You mentioned the holographic visit. We were really on the forefront of virtual care. We have tens of thousands of virtual care visits in behavioral health and wellness every year. Sometimes children and young adults struggle to be open in a virtual environment like a Zoom call, so we worked with some partners to see how we could make that experience better. We are now enabling this interaction in a comfortable and more serene environment stripped of the typical tech. The patient and their family can be in a pod, and the caregiver appears as a 3D image—a hologram if you will. It’s a much more intimate environment and our medical director of behavioral health and wellness will tell you the patients are more open and comfortable. We're really excited about that. We have two of these pods right now, and our hope is to expand their use and partner with primary care doctors across rural Nebraska for enhanced virtual behavioral health and wellness services.

Elsewhere, we have a lot of patients that need MRIs, which can be really intimidating and scary. Historically, 100 percent of those kids’ families would opt for sedation, which is not ideal. We introduced virtual reality into that environment, where we can simulate with the child what the MRI experience is going to be like, and we eliminated sedation in 98 percent of those cases.

Our 3D imaging is also excelling. For example, we had a 13-year-old adolescent girl who had a tumor that encased her lungs and aorta. We were able to do a 3D image of her entire torso, and the surgeons were able to practice the surgery using 3D modeling and virtual reality. They removed that tumor in one eight-hour surgery, where typically it would have probably required several surgeries and that patient would likely have been under sedation for 12 hours each procedure. Any time that we can use technology to intervene in that way to have the best outcome possible is what we're really striving for. By using virtual reality to perform simulations, we've reduced surgical times by as much as 20 percent in several cases across our surgical optimization efforts. Those are some really great outcomes in the short time we've been doing this.

Q: Given the results you just mentioned and the other innovations you’re exploring, is there a fundamental reason why pediatric care is often overlooked in terms of broader digital health funding and research? What needs to be done to chip away at this gap?

A: I think in general health care vendors find pediatrics hard and adult health care a little more predictable. And when you're a developer or funder trying to get things to market quickly and pay for your development cycle, adult health care is just easier. Even going back to electronic medical records, those were all geared toward adults. We're finally adopting Epic's pediatric content that they developed over the years. Back when we first implemented Epic, we had to create that content ourselves.

We're flipping the vendor dynamic a little bit. One of the things that we're doing here is reaching out to forward-thinking vendors that know technology to see if they're willing to work with us to understand pediatric health care. We've got a couple of partnerships going on right now. For example, we’re close to signing an AI development contract with a company to do two prototypes: one for clinical effectiveness and another on operational efficiency. I even think some of these forward-thinking vendors that are coming from outside of health care may eclipse some of the big incumbents in certain areas because they can be more agile and quickly adapt to what's really needed in pediatrics.

We also have a very active foundation. We received grants to support efforts like the MIC and to advance innovation in pediatric behavioral health and wellness, so a lot of the innovative work we're doing is funded by philanthropy. And people in our community don't want to just necessarily fund bricks and mortar—they are enamored by how technology and innovation can advance pediatric health care for better outcomes and to keep these kids out of the hospital.

Q: I previously interviewed the COO (now CEO) at Nebraska Medicine and we spoke about all of their innovation efforts. I’ll ask you what I asked him: how did Omaha become such a hub for health care innovation?

A: It's really interesting. We have a lot of nonprofits that are focused on the development of tech talent in this region, and we perform research through our Child Health Research Institute in conjunction with our academic partner the University of Nebraska Medical Center. When I came to Children's Nebraska, I thought this was one of the most talented IT teams I've ever worked with. That desire to be a place of education and development is really drawing folks here. One of the goals of our strategic plan is to develop the pediatric workforce of the future and that includes technology and innovation.

The other thing that's true about Omaha more than any other city I've lived in is there's a lot of philanthropy here—people with big hearts who want to make a difference in the community. It's a combination of things coming together and the commitment of the community to really be a pioneer in technology and innovation. I think our reputation in the community is growing as well because we do really special things here.

Q: I read a post you had authored where you wrote, “One of the key lessons learned during the development of our strategic plan was the power of simplicity.” When thinking about everything from AI to other emerging technology, how do you simplify focus to make measured impact?

A: I'll give you an example. When I took over strategic planning here, we had eight values in the organization. If you walked around and asked people to state our values, people might be able to say three of them. Our CEO wanted to change this, so we did some focus groups, and we came up with innovation, collaboration, accountability, respect, and excellence (I.C.A.R.E.). Now everyone knows our values.

Another example is that it's very common for 80 percent of an executive's incentive plan to be based on key metrics that are reported to the Board and then 20 percent on individual metrics. I proposed to the organization that instead of having 20 executives with two individual goals each, we establish five high-impact team goals; each team goal would have a group of executives assigned to it and would support some arm of our strategic plan. So, one goal might be around care transformation and what we're doing with harm events. One might be how we're managing team engagement in the organization, etc.

When I first took over IT, we established one of our guiding principles as “simplify” the environment. For example, if you have three products doing the same thing, let's pick the best one and eliminate the other two. If we’ve got a process that's overly complicated in revenue cycle, let's do some work to get back to the foundation and simplify it for our team members. We did that with the structure of the strategic plan and it's paying dividends. We found success in keeping it simple. With innovation, everything is an opportunity, and everyone has great ideas, but we have to prioritize and have our resources focused on the things that are most important to us to advance our strategic plan and care outcomes for our patients and families.

This blog post is part of an ongoing Q&A series with digital health leaders at organizations across the US. These in-depth interviews aim to provide real-world perspective and insights in this rapidly evolving space. Don’t miss the other blogs in the series, found here.

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