From Ski Industry Management to a Career in Healthcare Information Technology: How Improving Healthcare Became a Skier’s Passion

Greg Miller enjoying snowcat skiing in the Uintas during the 2013-2014 winter season.

Working in healthcare information technology was never part of the grand plan when I went to college. In fact, I graduated with a ski industry management degree back in 1985. My grand visions were to pursue my passion for snow, mountains, and alpine skiing within the business side of the ski industry — perhaps I’d even invent the next great piece of ski equipment.

Mother Nature, however, had other plans that year and didn’t give us much snow. As a result, ski industry companies were laying off employees, and they certainly weren’t interested in hiring a newbie like me. I remember feeling very frustrated and disappointed because I was broke, saddled with student loans, and anxious about my future.

Dashed Ski Dreams to a Job with Tufts Medical Center

Exploring the financial services industry

Many friends of mine had moved to Manhattan after graduating from college, securing lucrative careers in the financial services industry. I followed their lead, and after a couple months of pounding the pavement in the concrete jungle, I convinced two firms to offer me a job as a retail stockbroker.

I was very excited and appreciative to have these job offers, but deep down, I knew that I wouldn’t be happy in Manhattan, so I turned down both offers.

My father thought I was nuts! But I had to follow my instincts. As I thought about my next move, I figured Boston might be a friendlier city with a plethora of job opportunities. The city was certainly closer to mountains and skiing, so it was more appealing on those levels. Unfortunately though, I was starting the job search from scratch again because I didn’t know anyone in Boston.

Finding a mentor at Tufts Medical Center

That’s when the healthcare industry appeared on my radar. My father told me about one of his old friends, Bob Raco, the chief information officer at Tufts Medical Center in Boston. I remembered Bob from my youth, but I had no clue what his job title meant. My dad called Bob and arranged for us to meet. This seemed like a good opportunity to network, so I drove to Boston for lunch.

When I met Bob, we spent the first few minutes reminiscing about our families, skiing, and boating. After Bob explained his job responsibilities as a healthcare CIO, he described Tufts Medical Center’s new management-control system that was designed to help improve quality and efficiency, reduce cost, and eliminate waste. We also talked about Deming’s principles for continuous quality improvement, which I remembered well from college management classes — classes I enjoyed because my brain likes to organize things in terms of processes.

A time of upheaval in healthcare

During the course of our lunch, Bob educated me on the pressures hospitals were facing as well as the changes that were happening in healthcare. One of the major upheavals included Medicare’s diagnosis-related group (DRG) payments system. This was a mandatory reimbursement system that CMS rolled out in 1983.

Because of the new DRG model, hospitals needed to move from a cost-plus and fee-for-service reimbursement environment to a fixed payment reimbursement model — a significant change. For most hospitals, the fixed payment model accounted for about 50 percent of the population they served, which meant they needed to learn how to reduce their costs and become more efficient while still ensuring high quality care.

Tufts Medical Center’s management control system

Bob also shared some exciting news about a management control software system that had been developed at Tufts Medical Center. Hospitals from around the country were interested in purchasing the system. Because of the interest, Tufts Medical Center was thinking about spinning off a separate company to further develop, market, sell, and support the new software system as a way to help other health systems manage the changes occurring in the industry.

The job offer — a brave new world

And then it happened: Bob uttered the magic words, “Do you want a job?” I replied, “Doing what?” He just smiled and said, “We’ll figure it out.”

When I was in college, I remember two subject areas that I had absolutely no interest in — healthcare and information technology. But what Bob described to me didn’t sound like either per se, rather it was about applying management control and quality improvement principles to the “manufacturing” of healthcare. I was definitely interested in joining the team.

Readying the Management Control System for Deployment

During my first six months at Tufts Medical Center, I served as a jack of all trades, working to further develop the management control system and ready the system for deployment outside the hospital. I coded in Fortran and COBOL, developed implementation and training plans, and wrote documentation. This was all a brave new world for me, far from the snow and mountains, but I thought it was cool.

The most exciting aspect of the work, however, was when I could think about ways of re-engineering processes to reduce costs and improve quality.

But to understand the processes, I needed to spend a lot of time learning about them firsthand. Some examples included the following:

  • Sitting in labs to do bill of materials explosions into supply and labor components
  • Observing nurses at nursing stations to do time and motion studies to document the time it took to complete a task, such as filling out patient charts
  • Mapping and re-mapping workflows in the lab
  • Rounding with physicians to learn how they delivered care
  • Watching surgeries to analyze utilization patterns
  • Working with teams to develop protocols for improved care delivery

During this time, finding the answer to one question in particular became fascinating: why is there so much variation in how care is delivered? I remember naively asking that question over and over and over again, many times just getting “my patients are different” or “my patients are sicker” responses from physicians.

Success Brings New Opportunities

Once the management control software was in place, Tufts Medical Center began to see real improvements in care delivery. Two other hospitals in the mid-Atlantic area took notice and wanted to buy the software.

Then, about eight months after I started at Tufts Medical Center, the health system formed a separate subsidiary called Transition Systems, Inc. (TSI). Five of us from Tufts Medical Center became employees of TSI, including Bob as CEO.

TSI was very successful, deploying the first real management control or decision support system in healthcare. Many folks thought of it as a cost accounting system, but it was much more than that. In reality, the system matched cost accounting data to utilization and then organized the data by service lines for analysis. With this functionality, users were able to understand variations in care, identify opportunities for improvement, and develop best-practice guidelines.

As the company grew over the next 15 years and I gained in-depth knowledge about the healthcare industry and its problems, I became extremely passionate about helping organizations across the country drive down costs, eliminate waste, and survive in an ever-changing healthcare landscape. It was quite the honor to be on that mission during the tumultuous changes in the industry during the 80s and 90s.

Healthcare Concerns Today vs. 30 Years Ago

The healthcare industry continues to face massive changes, especially as it moves from a world of fee-for-service to value-based care. Interestingly enough, though, current concerns aren’t all that different from the ones we faced at Tufts Medical Center 30 years ago as DRGs were being introduced. The same issues still prevail: the need to decrease costs, maintain or improve quality, and ensure patient satisfaction.

There is considerable talk about population health these days, which is what we were doing at Tufts Medical Center and hundreds of other hospitals across the country on a service-line-by-service-line basis across the care continuum. But the fundamental issues still exist today because of the massive variations in how care is delivered for each individual patient. These variations result in excessive waste of unnecessary healthcare services. In fact, according to the Institute of Medicine’s 2012 report, about 30 percent (about $750 billion) of total healthcare spending in the United States is wasted on unnecessary services.

Solving the Dilemma of Variations in Care Delivery with Healthcare-Specific Technology Solutions

Technology has made significant advancements since my days at Tufts Medical Center and TSI. And I’m honored to now work at Health Catalyst, a pioneer in the healthcare technology industry.

Health Catalyst offers solutions to help health systems solve their problems of identifying variations in care delivery with a unique, adaptive, flexible, healthcare-specific Late-Binding™ Data Warehouse along with advanced analytics applications and a clinically-vetted content system of best practices.

Like every other technology aficionado out there, I‘m like a little like a kid in a candy store when I talk about the cool solutions we offer. But the reality is that it’s not just the technology that makes Health Catalyst so unique — it’s what health systems can do with the insights they get by using the technology.

Not only does Health Catalyst offer a data warehouse that’s tailored for healthcare’s unique analytic challenges, but the company also has a sophisticated transformation methodology, which we teach to customers, so they can implement immediate and long term changes that affect how care is delivered.  For me, I had to learn how to do this “in the trenches” manually, in my early days at Tufts Medical Center. I’m so excited that health systems can now employ an EDW and analytics platform along with clinical content, evidence-based guidelines, and a methodology to affect positive and lasting change.

Although I sometimes feel like I took my own ride “back to the future” in a DeLorean — doing things I did almost 30 years ago — I’m right where I belong, continuing my passion to improve healthcare. What’s different this time around is that I live in Utah and have backyard access to the “greatest snow on earth.”

I’d love to hear from you! How did you get into the healthcare information technology field? What is your health system doing as part of its population health management improvement initiatives?

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