Mayo Clinic last week rolled out a new electronic health record system at its main campus in Rochester, Minn., part of a $1.5 billion installation of an Epic system that started last year with Mayo Clinic Health System in Minnesota and Wisconsin. Facilities in Arizona and Florida will be transitioning later this year. It's one of Dr. John Noseworthy's final big projects before he steps down as CEO next year. Noseworthy has held the top job for nine years, but he's been at the renowned research institution for 28 years. He announced in February that he would be leaving. The health system's bylaws state that a new chief executive—always a physician and always chosen from the current Mayo staff—must take over every seven to 10 years. Modern Healthcare Editor Aurora Aguilar recently spoke with Noseworthy about his transition and Mayo Clinic's future. The following is an edited transcript.
Modern Healthcare: What do you hope to accomplish with the EHR installation?
Dr. John Noseworthy: This is a multiyear initiative to make Mayo Clinic more responsive in our healthcare environment. With our staff working together on a common system, we can provide a better experience for our patients and bring the best of Mayo Clinic to each of them.
The modern EHR is more than an electronic version of a medical record—it's the engine that drives operations, making this project one of the largest in Mayo Clinic history. Thousands of people across the enterprise have been involved in planning, building and testing the system. Working with a unified system, we will take the best practices of Mayo Clinic to benefit all patients at all sites and for generations to come.
MH: Why is it important at this time to have a physician leader at Mayo?
Noseworthy: Leadership today is all about change. A physician leader can identify, from his or her past, how medicine can be practiced better. It's easier for a physician leader to identify with those who need to change the most—the physicians and their administrative partners, nurses and so on.
One way Mayo has been successful is that every major division, department, service line has a physician leader paired with an administrator. The administrator is as good at his or her profession as the physician leader is. The physician is there to help understand the direction on how you enact the change, how you meet the needs of the patient; the administrator knows how to make the change happen, and understands the business side of Mayo. Many healthcare organizations are choosing a physician leader. I think it's probably a good move.
MH: What are the greatest challenges for Mayo's next CEO?
Noseworthy: The challenges are really what's happening on the national stage. We have an aging patient population, we have payment reform, we have a tremendous opportunity with nontraditional partners entering the arena.
It's an age of consumerism, so how are we going to best work with consumers to define how to provide high-value healthcare in an affordable, sustainable way?
Then we have the issues of population health and rural healthcare delivery. All of these are bubbling to the top, and when one is leading an organization that manages well over 1.3 million patients in multiple states and from many countries, these are all key issues. The opportunities are huge because there's a lot of frustration across the patient population. I think partnering with patients, partnering with providers and working across multiple sectors, not only the healthcare sectors, but those that impact healthcare—nutrition, transportation, education, government—all of that needs to come together to provide solutions to these vexing problems.
MH: Some of the most prominent disrupters—Jeff Bezos, Warren Buffet and Jamie Dimon—called you for advice on their venture. What did you tell them?
Noseworthy: I told them that I think it would be very advantageous to have a person lead this endeavor who is identified as a healthcare leader and understands the complexity of healthcare, the various sectors and the interface with the other sectors that I mentioned.
Clearly this person will have to be a change agent and be able to see the opportunities of disrupting the way we're currently doing things. This is going to be very intense work, because we have so many layers in healthcare, and everything is going to have to change, from the way insurance companies run, to how medicine is practiced, the way life science companies work, the way pharmacy benefit managers work, and so on. I think it's going to take a transformational person to help bring this together. I think we are only going to reach a good outcome if we keep the patient at the center of the healthcare system. Creating this so that it works for one sector simply doesn't work.
At the moment, the voices of the patients and their families often seem to be lost in this kind of conversation.
MH: All of this disruption can lead to hard decisions for healthcare organizations. You saw backlash from residents in Albert Lea, Minn., after cutting back services there. How could you have handled that differently?
Noseworthy: First of all, when things are going OK, transformational change never happens. Things have not been going ideally in the medical profession in our country for quite some time, and there is a need for change. But change also is very difficult.
In this situation, we changed 5% of the healthcare services and that impacted five to eight patients a day. It doesn't seem like a lot, but it feels like a lot to the people of Albert Lea. No one has lost their job. We continue to invest heavily in the community, we want the community to be strong. But I think it's on us, that we didn't do an adequate job in helping them understand that the reason for the change was that we couldn't be certain we could provide continued, high-quality safe care, because we had a shortage of high-quality healthcare professionals to staff intensive-care units, inpatient surgery units, gynecology units.
We studied this issue for two years, but the answer we got was left-brain. It was an analytical answer. We didn't anticipate the fear and the concern that patients feel when their healthcare is being changed.
In rural healthcare, the local small hospital is usually a driver of jobs and employment, but healthcare in rural America can be addressed through new delivery models, the use of telemedicine and so on. Those changes are all still in their infancy.
In the meantime, we didn't feel we could continue to provide safe inpatient services to this hospital in the absence of a predictable workforce, so that's why we consolidated. It's been tough, but every healthcare administrator has had to reduce services or close hospitals. It's terribly painful for the community, I understand that.
MH: As these changes start to take place, how do you see the role of the hospital within a community changing?
Noseworthy: We have moved Mayo away from being heavily weighted on hospital services for surgery, for diagnostics and so on. We were at the front of the pack for that.
We need an awful lot of that innovation in the local communities. How that's going to translate to a vibrant, local economy remains to be seen, and are they going to be supportive at the state level? That also remains to be seen.
Mayo Clinic essentially has two different business models. Mayo is a destination medical center for patients with serious and complex illnesses who come from 140 to 150 countries every year and all 50 states, to Mayo Clinic in Arizona, to Mayo Clinic in Florida and to Mayo Clinic in Rochester. We see the most complex patients who have difficult diagnostic problems, and we see patients who need to have important surgeries or innovative new therapies given to them.
In the meantime we are committed to providing the best care we can to the communities we serve, and we, along with every healthcare system in America, have tried to figure out how we can provide the best healthcare to people who live in the rural communities. The old-fashioned ways of building large community hospitals just simply cannot work for the reasons already articulated.
MH: What's ahead for you?
Noseworthy: We have a very strong pool of folks that I have been putting in major roles at the various sites, Arizona, Florida, Rochester and elsewhere, but also with whole enterprise activities, whether it's in artificial intelligence, international areas or research. It ought to be a very smooth handoff to someone who understands our strategy, who is well-known and well-tested by the organization. Mayo Clinic is not about the CEO, it's about our mission and our ability to meet the needs of our patients.
I'll transition to doing other things. The path is being mapped out. I'm not able to speak about that, but I am going to remain active. My goal is to spend more time with my family. But I also want to give back and make a difference and take advantage of what I've learned. I'll continue to work, but I won't go back into practice. I was a neurologist for about 25 or 30 years and loved every minute of it, but I've been away from that now for a number of years, and I think it's better that I apply what I've learned in this role to help others create this sustainable healthcare system in a good way.