Dr. David Knoepfler has a unique background for a health care provider.

He was involved in the tech industry before Bill Gates or Steve Jobs were household names. And it was that background and that hardwired way of looking for solutions that have served him and Overlake so well. It’s a quintessential story of “hometown boy makes good.”

HCB News: What inspired you to pursue a career in health care?
DK: I wasn’t one of those who finished sixth grade and decided I wanted to be a doctor. My father was a doctor and as often is said, that was a negative influence rather than a positive one. I went into college and graduated in the early ‘80s when the computer industry was taking off. I started my career as a programmer for testing equipment in the aircraft industry, found it monotonous and moved to the department of bioengineering at the University of Washington. That was where I was reintroduced to health care biology and learned how information systems could interface with research and even care. That was the transition point that led me to apply to medical school.

HCB News: What drew you to Overlake?
DK: Bellevue and Puget Sound’s eastside cities are hardly little suburbs anymore, and despite the fact that we are now a region approaching 1 million, it still really feels like home. In addition, the Seattle area, like the Bay Area, is a mecca for high tech. Being in my home community and the fact that technology and world-class health care are such big parts of Seattle, was a great combination for me.

HCB News: One of your experiences was in developing and implementing Overlake’s EMR system. How long ago was it implemented?
DK: We went live with EPIC in May of 2013. We, like many institutions, were using our EHR for billing purposes and really just to hold information rather than a useful tool in terms of being an interactive system designed for the safer delivery of care. Additionally, we didn’t do documentation or place orders in the system, so we took a step back and analyzed where health care was going as well as the drivers for putting in the EHR systems. We spent a year evaluating our options and choosing EPIC for our big bang implementation. Ultimately, it was a transition from a paper documentation system to 100 percent electronic and achieving HIMSS Stage 6 and a “Most Wired” designation from the American Hospital Association for three years straight.

HCB News: What takeaways did you gain from that experience?
DK: Use big quotes: “Change management is hard,” and there are so many layers to that statement. Looking at providers, we had a medical staff of 1,100 and they were 90 percent independent and 10 percent employed. So it entailed working collaboratively with the provider community to help them recognize the value of the EHR and that this was a real win from the patient standpoint. Having access to information and using that information to guide care were the ultimate goals. For physicians, money isn’t the scarcest commodity, it’s their time. Therefore, the key was collaborating and to help them understand that although most EHR systems will not save them time, the focus on enhanced patient care via the EHR was a huge win. We worked to get them engaged in the process of design and build and paid them for their time.

With the non-physician providers, we adopted the same approach: these folks interact with the tool all day long and it therefore makes sense to have them be an integral part of the design. In the end, I would call our implementation a great success due to the genuine engagement and shared ownership from the entire spectrum of users.

HCB News: Do you collaborate or partner with any other organizations?
DK: In this region, we are one of Kaiser’s inpatient provider partners and we have a very cooperative relationship. The key to our success is that we don’t make a distinction between our Kaiser providers and our employed or independent providers. Their physicians provide care in the hospital just like any other provider at Overlake. In addition, we fully integrate them into our medical leadership structures and even some of our ED call service lines. I think that helps build a level of trust and collaboration and therefore it’s a great model. We have other partnerships such as with Evergreen Hospital just seven miles to the north, the Eastside Health Network and Eastside Health Alliance. The institutions are very culturally aligned. We can focus on providing value-based care and meeting mutual quality and safety objectives.

Within the region, we’re always looking as to how we can be a better partner with the employers in the community. Our partnership with Expedia whose headquarters are in Bellevue led to the creation of a clinic physically located in their building. The employees can walk down the hall, get excellent care and return to work without extensive time away and with an aligned care delivery partner. They can bring family members in for appointments as well.

HCB News: What challenges does the medical center face?
DK: On a macro level, it’s all about the changing health care environment nationally. The Northwest is a little late to the game as far as accountable care penetration, but we are ready and both Overlake and the Eastside Health Network are positioned to meet those needs. When we look to the future, I think our greatest challenge is how we prepare ourselves and delve further into the world of pay-for-performance and accountable care. We are already one of the top performers in the state in Medicare’s value-based purchasing program and want to be sure our community and local employers know that.

HCB News: With the ongoing debates about health care reform, are there any concerns for your facility?
DK: I think if you stay focused on the fact that you must do what’s best for the patient, you can always adjust to the various external pressures that exist. Despite all the focus on value-based care, we’re still very much a volume-driven, fee-for-service payor environment. We must balance those two driving forces and keep our focus on high-quality and safe care. We remain quite certain that no matter what the various whimsies of politics do in the background, as long as we adhere to the core tenant of high-quality care, we will serve our community well and remain strong.

HCB News: How do you predict health care will evolve over the next decade?
DK: Unquestionably, it’s going to become more patient focused, which is a wonderful thing. At every step of the way, we’ll need to take a step back and ask if what we’re doing is best for the patient. The double-digit increases in health care costs have to slow, if not stop, in order for our nation to move ahead. Despite the politics, I believe that the current pressures that exist within the health care world are ultimately going to drive care in a direction that’s positive. When you strive to best practice standards, when you strive for usability within your EHR, when you have a culture of safety within your institution, you’re going to make the decisions that are best for your patients. Employers are certainly focused on cost, but what they really want is a healthy workforce that pursues a health maintenance philosophy and that ultimately costs them less in every way. It’s good for there to be financial pressures on the industry, as it really forces you to be thoughtful in your delivery system, but the key is to not let it paralyze you.