One of the most common pieces of advice offered by those in leadership positions is to take risks. Get out of your comfort zone. It’s solid guidance, and for the most part, isn’t difficult to follow — unless, of course, you’ve been on the losing end of a big gamble. In 2015, Aaron Miri accepted a leadership role with an organization that aimed to make patient care a luxury experience. But after just a few years, Walnut Hill Medical Center closed its doors due to financial troubles. For most, the experience would be enough to scare them away from risky moves.
Fortunately, Aaron Miri isn’t most people. Last summer, he assumed the CIO role at Dell Medical School at UT Health Austin, a cutting-edge organization that places a high value on value-based care, innovation, and using social determinants to improve care. For Miri, the opportunity to return to his home state of Texas and work alongside some of the brightest people in the industry was too good to pass up.
In this interview, he talks about why he was willing to take another leap of faith, why he’s a strong believer in ‘open-door leadership,’ and the importance of building a solid professional network.
- About the organization (includes Dell Medical School, medical practice & research arm)
- Austin’s “up and coming” market
- Updating the medical curriculum
- Being in academia – “The faculty are always eager to hear about what’s on the horizon.”
- Going “all in” on value-based care
- “At the end of the day, it comes back to workflow.”
- Providing “World-class care” for indigent populations
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I get the best of both worlds. I get to interact with the more traditional physicians and leading pediatric cardiology surgeons in the country, all the way to the year-one medical student who has a glimmer in their eye and wants healthcare to become like Star Trek.
For a place like University of Texas to start a medical academic healthcare program is unheard of. And so for me, the opportunity was one I could not pass up.
At the end of the day, it comes back to the workflow. I tell people all the time, ‘Take the technology out of it, and put it on paper. What would you do? How would you handle it? Then build the technology on top of that process and that workflow.’
We tether those learnings and those teachings back to the real world, back into our healthcare program and say, ‘This is what the textbook says. This is what we learned in real world. Here’s where rubber meets the road. Here’s how you go about it.’
Gamble: First off, congratulations on your new role as a CIO of Dell Medical School at University of Texas at Austin.
Miri: Thank you so much, I appreciate that.
Gamble: The best place to start, especially in this case, is with some information about the organization. Can you provide us with an overview?
Miri: Dell Medical School is the newest medical school in Texas. They’ve been trying to bring a medical school to Austin for a long time. And around the 2015 timeframe the school opened up its doors, and we should be graduating our first class of students next year.
With the school came the UT Health Austin practice, which is a multidisciplinary ambulatory practice that covers everything from oncology to musculoskeletal to women’s health — all sorts of different types of practices. We’ve partnered with Ascension Health System, specifically with the Seton Ministry, to leverage their acute care hospital so that they’re almost a teaching hospital for all of our faculty, our GME program, and our physicians. We also have pediatrics. There’s a Dell Children’s campus, where again we have a close partnership with Ascension. It’s a symbiotic relationship that has seen the practice grow tremendously.
For me, coming from Dallas and most recently Boston, I always assumed it was a very mature market like those two but, in fact, Austin is up and coming, growing and bursting at the seams. They really needed an academic medical center in this area to bring the next generation of research and functional understanding to the market.
Our research arm is growing fantastically well. We’re bringing in a lot of very well-known folks across the country, including Karen DeSalvo, Elizabeth Teisberg, and Dr. Martin Harris, who was at Cleveland Clinic for 20 years. When I look at the slate of who teaches here, who works here, and who is building the next generation health system and medical school, I couldn’t say no to. It was just amazing.
Gamble: It’s an interesting time; we’re seeing medical school curriculums trying to make sure the curriculums really reflect where the industry is going.
Miri: That’s the other dynamic that I really appreciate here; I get the best of both worlds. I get to interact with the more traditional physicians like Dr. Charles Fraser and his group, some of the leading pediatric cardiology surgeons in the country, all the way over to the year-one medical student who has a glimmer in their eye and wants healthcare to become like Star Trek.
And so, how do we provide an environment where we’re leveraging augmented reality and providing the latest tools and machine learning at their fingertips so that they learn on a platform that will be mainstream by the time they finish their residency and are entering practice themselves? It’s a cadence of understanding where the market is going, and in some cases, partnering with large partners to build the next generation, and teaching that to your students and working with your existing physicians to make sure they are able to deliver optimum care.
Gamble: So Dell Medical School is part of UT Austin Health?
Miri: Yes. When I say Dell Medical School, it’s not just the academic component. Dell Medical School (DMS) refers to the entire health enterprise of University of Texas at Austin. The entire medical district, from our UT Health Austin practice, to the actual medical school itself, to our very robust research arm — all of it is under the umbrella of DMS, and that’s part of the University of Texas at Austin.
Gamble: What falls under your responsibilities as CIO, and it is similar to what you’ve had in previous roles?
Miri: It is, and it isn’t. It’s healthcare delivery. As CIO of healthcare delivery, there’s the electronic medical record. There’s patient care. There’s all the tools. All the modalities. All the interfaces. There’s data interoperability. There’s all of the nuances you’re going to be dealing with as you’re seeing 40,000 or 50,000 patients come through. There’s the medical school component — personally, I’ve never had the actual curriculum component in my career. It’s very appealing to learn the academia world.
Case in point, we’re one of the few medical schools that allow EMR access to students. Most medical schools are still teaching on traditional paper. How can we bring even more robust tools? Leveraging augmented reality and a simulation lab to be side by side while they’re doing actual cadaver work — those types of things. And then there’s the research component, which I have had in my past, and looking at new therapies. How do we enable our researchers that are looking to cure Alzheimer’s or get in front of dementia to achieve those goals?
There are three verticals that academic medicine can allow you to experience. To do that at a university typically means going to places like Harvard or Stanford that are well-established and have these processes in place, and so you’re able to really get the ball going. For a place like University of Texas to start a medical academic healthcare program is unheard of. And so for me, the opportunity was one I could not pass up, which was, ‘Enable us to take this to the next level, grow this, make it something that’s world class.’ You couldn’t ask for a better opportunity for somebody with my background, where I’ve gone from adults to pediatrics, to building product, and now putting it all together. It’s an immense opportunity.
Gamble: It’s surprising that the curriculum is still the way it is still in most medical schools. But I guess these things don’t change overnight.
Miri: They don’t. I love interacting with faculty because they’re always eager to hear about the new things on the horizon, and always asking, ‘How can we get there?’ What’s also interesting about academia side of things is how the other colleges interact with you, like the College of Nursing, the College of Pharmacy, or the College of Social Work. Because you’re not just training your med students, you’re also working together with the other schools as they bring their students together to gain practicum experience. For example, the College of Nursing here at UT sends some of their more senior level nursing students to get practicum hours in our clinics. How do we make sure that their curriculum transfers, they’re getting experience they need, and they’re taking that back to their peers to teach them?
The other unique thing about the UT Health Austin practice side of it, which then ties back to academia, is we are all in on value-based care. The New England Journal of Medicine recently ran an article about the fact that we don’t have waiting rooms. None of our clinics have waiting rooms. Think about that for a second — we built a state-of-the-art multidisciplinary practice with no waiting rooms. Now from an IT standpoint, take a half-step back and think about the conversations I had to have with all of the healthcare vendors and say, ‘I know you programmed your software to deal with waiting rooms. We don’t have that. So let’s figure it out.’ It was definitely unique. They’ve never really encountered that where a major institution put their money where their mouth is and built a beautiful, state-of-the-art facility with no waiting rooms. That means your patient registration, everything all the way through being seen and done has to be spot on, and it is something of a constant partnership with the vendors to make sure they can keep up with the pace of it.
Gamble: That’s a really interesting concept, but I imagine it does present some challenges and it means having more conversations with vendors about how this all works.
Miri: You do, and so what I always tell vendors who don’t quite understand that concept, because they’re very used to traditional facilities is, ‘Come visit us. See what’s going on and understand why it’s so important that our processes are mapped out so that we clearly understand what the workflow looks like.’ And at the end of the day, as we’ve always said in health IT, it comes back to the workflow. I tell people all the time, ‘Take the technology out of it, and put it on paper. What would you do? How would you handle it? Then build the technology on top of that process and that workflow.’ Oftentimes we’re having to design new workflows or modify existing workflow the vendor maybe hasn’t considered to say, ‘This is how it’s working in practice.’
Here’s another example. Our managed care contracts are all value based; we don’t do a lot of fee for service. We do a lot with our payers that are all value-based; so we look at patient-reported outcomes. We look at things the industry is just now beginning to consider, and we tether those learnings and those teachings back to the real world, back into our healthcare program and our master’s program with our value institute and say, ‘This is what the textbook says. This is what we learned in real world. Here’s where rubber meets the road. Here’s how you really got to go about it.’ This what the payers are learning from us.
Even those we partner with in the payer community are saying to us, ‘You’re seeing tens of thousands of patients. What have you learned, and how does that inform us as we work with the rest of the healthcare community?’ It goes back to the roots of what UT is all about which is blazing a trail forward and saying, ‘Let’s do it differently and try to teach the rest of the world what we’ve learned.’
Gamble: Right. It’s a forward-thinking idea, but one that makes so much sense at its core. Everyone has to adjust to this new way of doing things, this new model of care.
Miri: Exactly, and here’s the other wonderful dynamic about this medical school and why UT got into this business. At the very onset, it was how do we take care of our indigent populations in Travis County and in the city of Austin? The city of Austin has struggled for some time with needing additional mental health services, needing health for the homeless and disenfranchised, and helping those in rural parts. From Austin, if you drive 60 miles either east or west, you’re in the rural part of Texas where they don’t have ready access to facilities. Austin is not like Dallas or Houston where it sprawls on for miles and miles. There’s a joke that says you can drive for two hours in Houston and still be in Houston. That’s not the case in Austin.
And so how do we take care of those parts of the state — that central part of Texas that hasn’t traditionally had access to the specialists that an academic medical center can provide? We have to focus on all of these dynamics in indigent care. We partner with the safety net clinics in the area to help with their indigent care, whether it’s psychiatric services or anything else across the stack. Last year alone, more than 10,000 patients were paid for by public programs that we assisted. There were almost 600,000 hours worked by physicians at 60 clinics and hospitals to help take care of indigent populations.
At the end of the day, not only is UT building a next-generation facility and growing the next generation of medical students, they’re coming to me and saying, ‘We’re also going to provide world-class care to the indigent population.’ That hits on every dimension that I stand for, which is how do we give back and really make a difference.
Chapter 2 Coming Soon…