CHIME

HealthIT CIO Interview Series – Harun Rashid, VP of Information Services & CIO, Akron Children’s Hospital

Harun Rashid is passionate about the impact of health information technology for pediatric care, and sees his position being extremely rewarding in improving quality and safety, patient satisfaction, innovation and outcomes. In his past role at UPMC, with the help of telemedicine, he brought the level of care that healthcare delivery organizations were able to deliver domestically to other countries. He’s also leveraged patient engagement technology to reduce administrative burden on nurses and transform the pediatric waiting room experience at the hospital. And while he gets excited in delivering impactful technology to healthcare, he understands the huge concern of cybersecurity threats and the vigilance required to ensure the organization is in a defendable position to protect its assets, people and patients. In this interview, Rashid discusses physician burnout and efforts underway to evolve the EMR past being a billing system to be more intelligent and allow caregivers to make decisions properly, reducing alert fatigue, and enabling them to focus on the highest risk areas. He also discusses how population health management is very much front and center and initiatives in progress to incorporate Social Determinants of Health (SDoH) to identify community resources and amenities available to patients.

Key Insights:

I learned a lot from that experience as a data processing operator, running the back-end systems for a hospital in Meridian, Mississippi. You name it, I did it – the applications, load disks and tapes, run mainframe jobs, print patient bills, endpoints, and reports. I witnessed first-hand the complexity that is involved in running a hospital. EHRs were only used in less than 30% of hospitals in US at that time. Most non-healthcare businesses have maybe ten to fifteen systems they are running, whereas that is representative of just a particular department (i.e. laboratory, cardiology) in healthcare.

As with most healthcare delivery organizations, population health management is very much front and center for us, specifically with PCMH (Patient Centered Medical Home). Epic’s Care Everywhere plays a role in facilitating healthcare interoperability and the exchange of information between different institutions. It has alleviated the need for request for records, which in the past were delivered via fax or mail and were incomplete. It’s also allowed us to have a broader view of the patient’s medical history so that the appropriate level of care can be given regardless of how the patient has transitioned in or out of our hospital.

We can do a lot of the service recovery through patient engagement in the hospital if they have a negative experience. We are creating environment that is different, where we are leveraging patient engagement as a distraction technology to focus on the wellness aspect.

I’m a big believer that within five years or so, basic care will be given everywhere except in patients offices. There will be virtual care, patients will go to CVS or Walgreens to get their flu shots, maybe even for a well visit checkup. We’re really going to decentralize the model of care and the future of medicine as we know it is going to be very different in the next five years than it is today, especially with artificial intelligence, chat-bots, and virtual care gaining traction.To make matters more complicated, on one hand, the government and other entities say you need to share information, but on the other hand, if you have a breach, you  may be penalized severely. It’s a double-edged sword as you want to enable interoperability and health information exchange, but on the other hand, you have a responsibility to make sure that it is highly secure. It’s a challenging time when it comes to security and sharing, and we just have to find that happy medium.

Campbell: You have a very decorated background, as you’ve served in leadership capacities at Children’s Hospital of Pittsburgh of UPMC (University of Pittsburgh Medical Center), Rush Health Systems, Gateway Health Systems, Jefferson Regional Medical Systems, and now at Akron Children’s. With this background, can you tell me a little bit more about yourself and how you got into healthcare information technology?

Rashid: Right out of college, my first job was in healthcare and it was unbeknownst to me to at the time that I would be in healthcare for such a long time. I learned a lot from that experience as a data processing operator, running the back-end systems for a hospital in Meridian, Mississippi. You name it, I did it – the applications, load disks and tapes, endpoints, print schedules and bills, run mainframe programs, and reports. I witnessed first-hand the complexity that is involved in running a hospital. Most non-healthcare businesses have maybe eight to ten systems they are running, whereas that is representative of just a particular department (i.e. laboratory, cardiology) in healthcare. I learned a lot from that experience and it helped me grow within the organization to be Director of IT within four and a half years.

I subsequently took on a role at Gateway Health Systems in Clarksville, Tennessee and one of my chief responsibilities was the evaluation of an EMR and PACS solution. We put in place the first EMR and PACs system at the organization, which came with a lot of challenge. For instance, we had a radiology department that wasn’t fully bought-into a digital PACS. They hadn’t embraced technology, as films were the way they had done things traditionally and weren’t trained to leverage the technology or have IT so embedded in radiology systems. They came on board over time and loved it once we were live, ultimately taking control and ownership of it.

And so, the journey took me from there to doing Health IT strategic consulting, which allowed me to see the other side of how healthcare operates. Not with the day-to-day operations but looking at it from a strategic perspective as a consultant, helping CEOs and CIOs understand how to do analysis and strategically position IT to leverage its value to meet business objectives. A core philosophy I’ve always held is to align IT strategies with organization-wide strategies to make sure IT is supporting organizational mission and vision.

Campbell: You’ve also led the expansion of Children’s Global Health Program (Children’s Pittsburgh of UPMC) in several countries including Colombia, Mexico, Ecuador, Brazil, Kazakhstan, Dominican Republic, and the Middle East. Can you elaborate on your role with that organization and how it got you to your current position at Akron Children’s Hospital?

Rashid: When I joined UPMC, I started out as the CIO of Children’s Hospital of Pittsburgh that subsequently grew into managing the Children’s international program. I helped build their telehealth program in several different countries that allowed us to manage intensive care units or see patients in ICU units directly from Pittsburgh, without having to put physicians on the ground. It was a groundbreaking initiative, because at the time in 2010, physicians domestically didn’t view telemedicine to be revolutionary, and looked at it as unnecessary, thinking that patients preferred in-person visits.

I subsequently moved from that role into a corporate role, serving as Vice President for International Business Development and Telehealth at UPMC. My focus was going around the world and working with other health systems or government agencies to embed healthcare solutions or healthcare practices that would be at the level of standard that is in the United States. A lot of these government agencies or private entities were looking for partners to identify how they can improve their healthcare through utilization of U.S.-based physicians and using U.S.-based protocols in their local community to improve outcomes. We partnered in two ways – some physical presence on the ground, and through telemedicine as a vehicle to improve the outcome for transplant, oncology and other disciplines that were lacking in those countries. Instead of sending those patients overseas for treatment, we attempted to keep them in the community and only bring them to UPMC should they need care beyond what is possible locally.

This experience helped me tremendously in that it enabled me to better understand how to use technology to leverage the gaps in those communities, and how to take what they had in terms of EHR or other functions and bring that back in a fashion such that we’re able to integrate that into our guidelines and protocols. What was revealing was that most people thought that countries like Ecuador and Colombia were looking for high-end, specialty medical care, and they instead were looking for basic medical care and support. To provide a higher level of care, coordination was needed and so we performed physician technical training via video conference or other mechanism that IT setup to be able to enhance the experience. Through this use of telemedicine, our physicians were able to reduce post-surgical mortality by 8%-12% over the course of 24 months in Brazil and Colombia.

I then came to Akron Children’s Hospital, which is a very progressive, the largest independent hospital in north-east Ohio. Our organization has an end-to-end Epic EHR product and we have a vision of growing our IT to be the gold standard of the industry. I came here and along with our executive team, put the vision together to identify how we could leverage IT to meet the strategic goals of the organization.

Campbell: Speaking of achievement, you led Pittsburgh Children’s to HIMSS EMRAM Stage 7, the first pediatric hospital to achieve that and are on course to achieve the same at Akron Children’s What’s been your approach to physician adoption in leading the organization to that standard?

Rashid: We were awarded the HIMSS EMRAM Stage 7 at Akron Children’s in October.  I’ll talk about the methodology used when Pittsburgh Children’s went through the HIMSS EMRAM stage 7 journey in 2009. Things were very different back then. The goals and protocols were very different. It was more about the ability to digitally convert information from paper and certainly more focused on CPOE adoption. The requirements are much more stringent now. There were a lot of nursing adoptions and physician collaboration that needed to take place to be able to demonstrate that we were working as cohorts in improving the care of the patients, and quality and safety. There is continuous collaboration between IT nursing informatics, physician informatics, IS, and other departments. Analytics and innovation play a key role in the current requirements for a successful adoption.

Campbell: Outside of EMRAM criteria, a large area of focus in the move from fee-for-service to value-based-care, and certainly a focus of healthcare policy, is interoperability. In terms of facilitating care coordination through interoperability, can you touch on how you connect with affiliate practices in the community?

Rashid: We have a referral network of affiliated practices, some of which have a robust EMR, where we’ll offer them the opportunity to connect with Ohio’s HIE to get our data and vice-versa. If the practice is a standalone independent physician practice, we work with them to determine if they are interested in the Epic Community Connect Model supported by Akron Children’s Hospital IT. There are a few that are still using fax, which we are trying to move away from and connect them electronically.

Campbell: Population health is most certainly a part of the care coordination strategy. Could you touch on population health initiatives that are taking place within the hospital and particularly use of Epic’s Healthy Planet? Are there subsets or niche areas of PHM that are a specific focus for you, perhaps with the use of social determinants of health?

Rashid: In terms of social determinants of health, we recognize that 52% of our patients are Medicaid patients. As such, its critical for us to have insight into the social determinants for those patients and have a better understanding of how to address some of those elements where there are gaps. Our VP of Population Health, Dr. Steven Spalding has been working with other organizations, health systems, and community sites to make sure that patients have awareness of and access to the resources available to them, whether they need transportation, food, home care, shelter, etc. We recently adopted a system that allows us to identify community resources and amenities available to patients electronically. Our care coordination group uses the system to connect with those community organizations so that the patients are getting the proper level of support when they go back to their homes and communities.

As with most healthcare delivery organizations, population health management is very much front and center for us, specifically with PCMH (Patient Centered Medical Home). Epic’s Care Everywhere plays a role in facilitating healthcare interoperability and the exchange of information between different institutions. It has alleviated the need for request for records, which in the past were delivered via fax or mail and were incomplete. It’s also allowed us to have a broader view of the patient’s medical history so that the appropriate level of care can be given regardless of how the patient has transitioned in or out of our hospital.

Campbell: That point really resonates and is common to those healthcare delivery organizations taking part in PHM initiatives. You’re able to segment out those who may be at risk and assign them a care coordinator who identifies community groups and resources publicly available to them, and potentially prevent the patient presenting in a high acuity setting.

Rashid: That’s the thing. If we intervene ahead of some serious adverse event, we’re going to be able to do just that. That’s where telemedicine and other vehicles come into play, providing the ability to address the at-risk population and enable consultation for prevention. I’m a big believer that within five years or so, basic care will be given everywhere except in patients offices. There will be virtual care, patients will go to CVS or Walgreens to get their flu shots, maybe even for a well visit checkup. We’re really going to decentralize the model of care and the future of medicine as we know it is going to be very different in the next five years than it is today, especially with artificial intelligence, chatbots, and virtual care gaining traction.

Campbell: Absolutely and that decentralization would seemingly magnify the importance of centers of excellence in providing specialty care, whereas more general care is being commoditized. Shifting topics, how is technology playing a role in patient engagement efforts at your organization?

Rashid: We’ve delivered real-time integration with the EMR and caregiver, allowing the patient to engage with the care team to understand and identify ways to engage each other. We partnered with TVR (PCare) to manage our patient engagement. For instance, let’s say we have a child that presents at the hospital with asthma. We provide waiting area engagement such as TV, gaming, and a tablet for the parent with PCare on it. Based upon admission diagnosis of the patient and predefined guidelines from clinicians, the system can send videos that parents can engage in, so they can assist in better care of the patient once discharged. Once they do those things, that information can automatically be fed back into our EMR, thereby minimizing the amount of time the nurses spend documenting what is captured from the parents. We can do a lot of the service recovery through patient engagement in the hospital if they have a negative experience. We are creating environment that is different than the traditional systems. Our patient engagement is being used as a distraction technology to focus on the wellness aspect.

Campbell: You’ve touched on patient engagement, telemedicine, population health and social determinants of health. That said, what other initiatives are front and center for you that you hope to finish up or achieve before the end of the year?

Rashid: One of the things that’s very important to not just me, but all healthcare delivery organizations is cybersecurity. We’re tightening the belt more and more on what we must do. It is a very important initiative for us to ensure that we are resilient and vigilant in how we react to breaches as they take place. Every month I get reports of XYZ hospital that are being penalized for lack of proper security practices or negligence. Most of the security pitfalls are within the organization and its people that accidentally do something which creates problems for the organization.

We’ve already moved some of infrastructure to cloud technology as we couldn’t sustain the level of on-premise not only due to the greater costs associated with that approach, but because of cybersecurity as well. We just put our entire ERP on Amazon Web Services and we’re evaluating our portfolio to identify which solutions could potentially reside in the cloud to not only facilitate scalability, and reduction of cost, but also hardened security.

Another area of focus is analytics, specifically predictive analytics and artificial intelligence. The infusion of this capability is going to be a game-changer for our organization. When I talk about analytics, I’m talking about how we develop intelligent EMRs, not solely focused on billing. Evolving the EMR so that it allows our caregivers to make decisions properly, assists in clinical documentation, reduces alert fatigue, and enables them to focus on the highest risk areas. The documentation and charting associated with EMRs is creating significant burnout, and analytics and AI can play a role in engaging the physicians to address that issue and transform our EMR. For instance, Google is investigating doctors using natural language via Google mini in the exam room and having that get transcribed into a note. We are looking to pilot some similar concepts at Akron Children’s in the near future.

Campbell: Going back to the original point you made on security, you had authored a white paper with five steps for responding to hospital ransomware attacks. You mentioned having bad actors within the organization and a real easy thing to do is to send out a phishing email from the IT department. For those who do click, you can use it as a learning opportunity. What other advice can you impart?

Rashid: That is a technique we use. We continuously train our staff, but you’ll be amazed at how trusting people are sometimes. They have good intentions, just bad execution. They trust and click when we instruct not to. It must be a continuous cycle of education, practicing and repeating so that it becomes reflexive to check the originating email address and make sure none of the advanced flags are triggered. That said, attacks adapt and become more personalized where it is extremely difficult for a user to decipher the attack medium being used. HIMSS has also shifted their EMRAM standard to make it more rigorous in terms of the security aspect with Stage 7, and the cybersecurity aspect can’t be underscored enough. To make matters more complicated, on one hand, the government and other entities say you need to share information, but on the other hand, if you experience a breach, you may be penalized severely. It’s a double-edged sword as you want to enable interoperability and health information exchange, but on the other hand, you have a responsibility to make sure that it is highly secure. It’s a challenging time when it comes to security and sharing, and we just have to find that happy medium.

Campbell: A salient point to end on. Thank you so much for all the compelling insights that you offered up and best of luck with the remaining projects your wrapping up before year end.

About Harun Rashid

Harun Rashid serves as the Vice President of Information Service and Chief Information Officer at Akron Children’s Hospital where he is responsible for providing oversight and strategic planning services to Information Technology, Clinical Engineering, Health Information Management, Enterprise Data Warehouse, Clinical Informatics, Telecommunication, IT Clinical and Telemedicine. Rashid has over 19 years of experience in the information technology field of which 15 years have been dedicated to the healthcare industry.

Rashid has held several chief information officer positions in large scale healthcare integrated delivery networks at Children’s Hospital of Pittsburgh of UPMC (University of Pittsburgh Medical Center), Rush Health Systems, Gateway Health Systems and Jefferson Regional Medical Systems. He has also served as the Senior Vice President over Rural and Community division for Phoenix Health Systems hospitals nationwide.

Rashid has been essential in the expansion of Children’s Global Health Program (Children’s hospital of Pittsburgh of UPMC) in several countries including Colombia, Mexico, Ecuador, Brazil, Kazakhstan, Italy, and the Middle East. Under his leadership, the telehealth program has grown regionally and internationally and includes agreements in Latin America and Europe. Children’s was one of the first to establish a telemonitoring service with an international hospital for eICU.

Through his work, Rashid has assisted health systems in achieving various national recognitions/designations. Rashid received a prestigious award from CIO Magazine as one of the Top 100 CIO in the country for the most innovative use of technology to support patient-care. In 2016, Children’s achieved the prestigious HIMSS Davis award for the use of electronic medical records (EMR) and analytics to enhance safety and quality. In 2018, Akron Children’s received HIMSS 7 award under Rashid’s leadership.

Rashid holds a Bachelor of Science in computer science and business management and an Executive Masters of Business Administration.

HealthIT CIO Interview Series – Tom Andriola, VP & CIO, University of California

The University of California (UC) is the premier public research institution with 10 campuses, 6 health systems and 3 national laboratories. Each year it serves more than 270,000 students, conducts billions of dollars of sponsored research, and cares for more than 5 million patients across the state of California. Tom Andriola, University of California VP & CIO, based at the University of California Office of the President (UCOP), oversees the IT function across the UC system, which includes 9,000 IT staff. To foster innovation within an organization of that size and scale, he believes it is key to engage and collaborate across locations, applying lessons learned and leveraging strengths and focal areas. While Andriola’s perspective is shaped by his experience as a global business and technology executive, he is pragmatic in his approach to the pursuit of innovation and collaboration at the university. In this interview, he discusses UC’s continued pursuit of cloud technology, exit from the data center business, and utilization of commonalities across campuses to drive efficiency and scale. He also shares his approach to consistent communication using social media and a blog, and his view on how best to tackle the broad area of population health management.

Key Insights

One of the things that my global experiences gave me was a great understanding of diversity and that environments aren’t better or worse, they’re just different. In all the situations I’ve been presented with, I’ve taken the approach of identifying the best pieces available and putting them together in ways that create unique competitive advantage.

The fact that we have six semi-autonomous health enterprises that are also collective on some level, allows us to collaborate on initiatives while pursuing them in a timeframe appropriate for each institution. We collaborate on vendor selection criteria, but it may be at different points in the road map for each entity. One institution then can pave the road for another, so the others can follow with less friction.

There is also the element of getting that story to the rest of the system and outside world to inform and educate our executives, customers, students, and patients. It reinforces our message that IT is not just a cost center, but in fact is a strategic enabler for the university and its mission.

Population health is not just a way for us to manage care and dollars, it’s also a means for us to find where we need to energize the level of innovation.

Campbell: You come from a background at Philips and joined the University of California as vice president in 2013. You’re very active on social media and very active in the community, especially with the upcoming conference. With that, can you provide background about yourself, what brought you into health information technology and some of the initiatives you are working on?

Andriola: As you mentioned, I worked for Philips globally, where I built an IT services group running a global transformation program and running IT operations across three continents. The program was essential, after a series of acquisitions, to bring the business back in-line with profit expectations for their $6B medical device business. From there I moved into a General Manager role leading the company’s largest healthcare informatics business at the time. It was at the point that healthcare finally decided that it was an information-centric industry and started to move away from its focus on better and faster medical devices (in our case scanners) and concentrate instead on the value they were creating for clinicians and patients with the data coming out of the scanner.  Then I focused on new business development and built a portfolio of IT software and services businesses in growth markets such as Brazil, China and India. Philips is a very global company, and these roles gave me the opportunity to not just travel the world but live in other places and build teams in completely different cultures.

In 2013, I transitioned to the University of California, the world’s most prestigious public research university. UC is a $33B organization that contributes in the areas of teaching, research, healthcare and public service. It consists of many entities – 10 campuses and 6 health systems, with more than 220,000 employees and 270,000 students, and $11B in patient revenues. It also co-manages 3 national laboratories. My experiences with Phillips provided me with the opportunity to step right in and help the academic medical centers figure out how the digital healthcare world was going to affect them. It also allowed me to show UC how to take advantage of the unique capabilities that academic medical centers have in terms of tertiary and quaternary care for the most complex patient populations and leverage not just technology but also, more importantly, the data to improve the quality of medicine, improve patient access, and drive down the cost of care.

Campbell: I appreciate that background. In terms of your global experience, and coming from the vendor side, how did that shape you as a healthcare leader. You’ve previously shared your philosophy on the importance of communication and collaboration. If you could, elaborate on that and speak to how that’s leveraged in your role with UC.

Andriola: One of the things that my global experiences gave me was a great understanding of diversity and that environments aren’t better or worse, they’re just different. In all the situations I’ve been presented with, I’ve taken the approach of identifying the best pieces available and putting them together in ways that create unique competitive advantage.

In joining the University of California, I have encountered great people and assets in the healthcare enterprise. We have deep domain expertise in the system, and it allows us to leverage that expertise to address our most challenging situations. In response to the challenges in the healthcare industry, we’ve created a coalition allowing six health systems and the Office of the President to come together, and look at things both at local and enterprise-wide levels. For instance, one of our locations has deep expertise in digital health, while another’s focus is on gene therapy. It’s a complementary rather than competitive arrangement, and allows us to approach 3rd party partners by putting forward our best-of-the-best along with the UC brand.

Campbell: It sounds like a unique situation for collaboration, and thus offering a competitive advantage. In fact, a recent article featured how six CIOs connected to the University of California, of which you are the group facilitator, have been producing strong results through broad strategic collaboration. That collaboration resulted in the first time ever that two US academic medical centers have linked up to be on one instance of Epic. Can you provide some background on that project in which UC Irvine Health and UC San Diego Health share the same Epic instance?

Andriola: You hear about moving to the new world of healthcare, moving to the cloud, and getting out of the data center business. We are living it. We have one instance hosted by Epic for UC Irvine, UC San Diego, and UC Riverside. The other health centers – UCLA, UC Davis, and UC San Francisco – are looking at their strategic roadmaps and determining when would be the right time for them to decide about going in a similar direction.

The fact that we have six semi-autonomous institutions, that are also collective on some level, allows us to collaborate on initiatives while pursuing them in a timeframe appropriate for each institution. We collaborate on vendor selection criteria, but it may be at different points in the road map for each entity. One institution then can pave the road for another, so the others can follow with less friction.

Campbell: That’s remarkable – the fact that you are leveraging each other’s strengths and using each other’s experiences to buoy the collective whole. That is what makes CHIME so great, that is, the ability for CIOs to collaborate amongst peers and share best practices. You are doing this on a micro level across the health systems, which is compelling.

Andriola: We do have somewhat of an advantage because there is a single governing body. Linkages, like shared financial incentives, also help align those activities.

Campbell: Absolutely. Shifting gears for a moment, The Huffington Post featured you as one of the most social CIOs on Twitter. You are also an avid blogger, bringing awareness to events, awards and news within UC. Tell me about the importance of having a social media and blog presence, and how it helps you to communicate key initiatives, both raising awareness and also potentially soliciting feedback from the IT staff.

Andriola: Our social media strategy serves both an internal and an external purpose. I’ll start with the internal. We are blessed to have 9,000 IT people across the university who come to work every day and try to make this the best darn research university and healthcare enterprise in the world. That’s part of the reason we use social media – to ensure people know that. We highlight the great work that people do, especially the most innovative practices that are going on. The blog and other communications strategies offer a mechanism for our people to learn from each other. Anecdotally, this could be someone hearing about an initiative at UC San Diego, when they’ve been talking about something similar at their own institution, and so being inspired to engage some UC San Diego folks to help solve the issue they are tackling. It facilitates peer-to-peer learning and reduces the time-to-value of technology efforts.

There is also the element of getting that story to the rest of the system and outside world to inform and educate our executives, customers, students, and patients. It reinforces our message that IT is not just a cost center, but in fact is a strategic enabler for the university and its mission. My job is to make sure that the outside world knows about what we’re doing – whether its healthcare, education, or research funding. I see my role as raising awareness about how UC is one of the most innovative places to work and how technology is a huge part of how we are innovating. The fundamental research we conduct changes the way in which domains are perceived and the way that we take care of patients. I use social media and communications as a means of telling the story of IT and sharing the great work that our people are doing. Everyone likes to have their story told, and that also supports engagement and retention.

Campbell: While on the topic of innovation and knowledge share, can you provide an overview of the University of California Computing Services Conference (UCCSC) that recently took place?

Andriola: When I came here almost five years ago and learned that UCCSC existed, I thought it was a great vehicle to drive collaboration. One of the things I was trying to figure out was a good strategy to connect the 9,000 folks we have in IT. At that time, UCCSC involved roughly 200 to 250 people, and was very grassroots oriented. The CIOs didn’t attend. I thought we needed to invest more into the grassroots conversation, but also bolster the impact of the event through executive presence. And so, we really shifted over the last 5 years as we’ve tripled the size of the event, with close to 700 people attending this year, including 11 CIOs. We took it from being a small event for the same people each year to a true communitywide activity, complete with swag.

It speaks to this collaborative fabric we have now across the organization – the realization people have that, “If I’m struggling today, there is likely someone else in the university who is probably struggling with the same thing. How do I connect to them quickly, and how do I extend my network to solve the problem more efficiently and effectively?” While we have tools in place like Slack, which 4,600 of our IT professionals use daily, the conference provides an in-person experience for sharing insights, best practices, and innovation outside of day-to-day tactical issues. This year I challenged the team to use the network to find colleagues and save 30 minutes out of their week.  It seems like a doable thing for most people. And at 9,000 people, recovering 30 minutes is equivalent to hiring more than 100 new people.  That’s the power of networking.

Campbell: Speaking to this collaborative fabric, an article was recently published on the UC IT Blog providing an overview of the results from a survey UCSB CIO Matthew Hall conducted of the UC location CIOs, asking them to prioritize issues for IT leadership and the university. Can you elaborate on some of those priorities for healthcare, specifically around population health?

Andriola: Population health is one of those initiatives where there is no silver bullet, and it’s not one size fits all. We are moving away from a stance on population health that’s been very individualistic across our UC health enterprise. That doesn’t mean one-for-all population health deployments for all UC institutions. Some of them are multi-billion-dollar enterprises and may have three or four different population health plays. Some extend Epic; others use third-party tools to connect into Epic. We’re trying to take a step back and look at the population health needs in the changing landscape of reimbursement and patient distribution. We are tailoring our population health strategies to allow us to use the data we have, now that we’re fully digital, to make more timely and intelligent decisions.  It’s a challenging space. Epic is certainly a large part of it, but it’s not the only part. There are a lot of other systems that have relevant information about patient conditions and experience that we want to pull into repositories so we can generate insights into how to better reach patients.

Campbell: You share the sentiment of a lot of healthcare CIOs, in that they want to steer away from the boil the ocean approach, and instead address specific use cases. There are components that go into making use of the data, access being one of those, but also transforming the data into the format that’s needed and governance as well.

Andriola: One of the other things that is of benefit to us is that, as academic medical centers, we have a teaching and research component to our enterprise. Some of the insights provided help inform us about where we should be innovating more quickly, and where we should be doing pilots. Those pilots are leading us to work with different types of partners who support home centric care models, for instance. As such, population health is not just a way for us to manage care and dollars, it’s also a means for us to find where we need to energize the level of innovation.

About Tom Andriola

Tom Andriola joined the University of California in 2013 as vice president and chief information officer (CIO) for the system. He provides leadership across the university working closely with campus and healthcare leaders to explore opportunities for technology and innovation to enhance the UC mission of teaching, research, patient care, and public service.

Andriola brings over 25 years of experience as a global business and technology executive, having served as a business transformation leader for a multi-billion-dollar enterprise, a global CIO with staff around the world, and the first employee of a brand-new business.

Throughout his career Andriola has been a champion of change inside organizations, as well as a leader for innovation in the marketplace, having brought first-of-kind solutions to market and led the creation of several new businesses.

Andriola is active in higher education and healthcare associations and serves on several boards, including the Corporation for Education Network Initiatives in California (CENIC), OCHIN, the Pacific Research Platform, and the Risk Services Software Company.

With his background in technology and innovation, Mr. Andriola maintains relationships with UCSD’s California Institute for Telecommunications and Information Technology, UCSF’s Bakar Institute for Computational Health Sciences, UCSF’s Center for Digital Health Innovation, the UC Berkeley Haas School of Business. He is a sought-after speaker on a variety of technology topics in healthcare, higher education, and the changing CIO role.

Andriola holds a bachelor’s degree from The George Washington University, a master’s degree from the University of South Florida, and completed the Stanford Executive program.

HealthIT CIO Interview Series – Mathew Gaug, Lima Memorial Hospital

Mathew Gaug, CIO

Mathew Gaug, MSIS, ITMLE, Executive Director, Information Technology, Lima Memorial Hospital

Lima Memorial Health System was founded in 1899 as Lima City Hospital by the citizens of the Lima, Ohio community. The hospital is a not-for-profit health care organization with more than 1,500 employees, and 25 facilities in their 10-county service area in the region. Lima’s CIO, Mathew Gaug, works hard to ensure that technology enables a convenient, efficient and high-quality experience to that same patient community that was originally responsible for the founding of the organization. Like many other healthcare delivery organizations, Lima Memorial is challenged with a non-integrated ambulatory EHR and EMR. As such, driven by its physician community, it is pursuing adoption of Meditech’s web-based ambulatory product to replace eCW. Ultimately, this will offer a streamlined solution to improve provider efficiency and consequently, patient experience, while providing a foundation for additional patient engagement and telehealth services to be offered.

Key Insights

From a historical context, our organization took a best of breed approach where we went MEDITECH for the acute side, but eClinicalWorks for ambulatory practices. We recently embarked on a new strategic direction, where we are looking to consolidate applications and making a patient-centric decision to have only one record across care settings.

An integrated system enhances the historical context, as the ambulatory side wouldn’t necessarily always have access to the acute side. It greatly simplifies things, as there is only one medication, allergy or problem list to maintain. From a provider perspective, harmonization of different nomenclatures isn’t as burdensome.

We rolled out the ideas of a consolidated ambulatory practice, had demos, and evaluated products. We were vigilant in ensuring it was a physician-based decision rather than being driven by IT. Our physicians drove the evaluation as to keep the status quo or to adopt a new workflow and mentality with the technology used to practice medicine.

 A lot of the communities we serve are rural and telehealth will allow for our patients to have better and quicker access to care. Our goal is to have it integrate to our new patient portal, which will make visits for our patients that much more convenient.

Campbell: Tell me a little bit about Lima Memorial, your role within the organization and your background.

 Gaug: Lima Memorial is a community hospital in Northwest Ohio. We have roughly 1500 employees and 25 facilities in 10 county service areas. We are an affiliate of ProMedica, but at the same time we are the furthest south, so we kind of stand on our own when it comes to medical and clinical decisions, and decision-making processes. In terms of my role here, I’ve only been at the organization for about 1 year now. I came to Lima via the Cleveland Clinic as a promotional opportunity. I was looking to spread my wings a little bit, as I’d spent 20 years at the clinic. My formal title is Executive director / CIO, and I have a team of 56+ with everything IT-related rolling up through our group, which includes technology, development, biomed, communications and informatics.

Campbell: Coming from Cleveland Clinic, obviously you come with the perspective of an organization that’s typically on the forefront of healthcare information technology adoption and it’s probably doing some innovative things that may be ahead of what the broader marketplace is doing. In terms of the application portfolio that you manage tell at Lima, can you tell me a bit more about that mix. Namely, the mission-critical applications, the history of those applications within the organization, adoption rates and any optimization you may be pursuing today?

Gaug: Our main application within the hospital today is MEDITECH. We upgraded to 6.15 a month after I started in the organization, and as such, the project was well underway when I got involved. The team did a fantastic job of getting that implemented. From a historical context, our organization took a best of breed approach where we went MEDITECH for the acute side, but eClinicalWorks for ambulatory practices. We recently embarked on a new strategic direction, where we are looking to consolidate applications and making a patient-centric decision to have only one record across care settings. As such, we are looking to adopt a new ambulatory platform with MEDITECH’s web-based ambulatory product. We’re looking to adopt that same mentality and go that way with our platforms.

Campbell: The sentiment of having an integrated, single record is one that has certainly been echoed amongst the CIOs who have participated in this series and given how the MEDITECH web-based ambulatory product has evolved from a UI perspective. It seemingly limits complexity as providers have a familiarity on the acute side and more capabilities can be offer on the ambulatory side based on some of the innovation the web-based ambulatory product has offered with syndromic surveillance, population health management, and facilitation of coordination of care. I’m sure that approach is supported even more so due to MEDITECH’s acute product being well embedded at Lima?

Gaug: The hospital has been on MEDITECH in one for form or another since the first install in 1994. An integrated system enhances the historical context, as the ambulatory side wouldn’t necessarily always have access to the acute side. It greatly simplifies things, as there is only one medication, allergy or problem list to maintain. From a provider perspective, harmonization of different nomenclatures isn’t as burdensome. In addition, the providers no longer have to familiarize with two different user interfaces, workflows, etc. Most importantly, from the patient’s perspective, via the portal, they are provided a comprehensive view of ambulatory and acute visits.

Campbell: Tying into managing multiple applications across care settings, can you touch on provider satisfaction within the organization. Recently KLAS introduced the Arch Collaborative to benchmark provider satisfaction, and the new clinical informatics track at the CHIME Fall Forum was well received as it highlighted provider engagement methodologies. How do you approach provider satisfaction within the organization today?

Gaug: We have a subset of the team from my informatics group that round, visit with and train providers as one of their sole or main responsibilities. We have a 24 hour a day, 7 day a week physician hotline where providers can call and get in touch with one of my team members directly. That goes a long way in terms of provider satisfaction because the last thing we want is a provider being stuck and have it potentially impacting patient care. We are focused on providing exceptional services and response so we avoid problems with technology or issues with the electronic medical record preventing our providers from being able to make clinical decisions. Another thing that we have most recently done is separated the role of Vice President of Medical Affairs and CMIO. It was previously a single role with dual responsibilities, and it has enabled increased energy and focus for the two areas.

When we rolled out the ideas of a consolidated ambulatory practice, had demos, and evaluated products. We were vigilant in ensuring it was a physician-based decision rather than being driven by IT. Our physicians drove the evaluation as to keep the status quo or to adopt a new workflow and mentality with the technology used to practice medicine. I think that’s key with driving the success of any type of implementation of a new application. Ultimately, we want to make sure that as a result of our decision, patient care is more convenient and it’s more efficient for the providers.

Campbell: Great. Thank you for providing some color around that. Let’s talk about population health initiatives within your organization. I imagine rollout of capabilities will be eased in having an integrated platform. That said, what initiatives are taking place today? Do you maintain any chronic disease or wellness registries? Have you evaluated or adopted technology perhaps within Meditech or externally to address the potential need?

Gaug: Thus far, the adoption has been within eClinicalWorks. As such, we are really focused on the future with the Meditech ambulatory application and what capabilities we can introduce with the integration of the two platforms. There are some exciting things that we’re anticipating coming forward, but for the time being we use care navigators and our offices to make sure that our patient scorecards are being maintained and they identify opportunities for intervention.  We also have a physician group that’s within our organization which oversees all population health and care navigators that are going on in the practice today.

Campbell: It sounds like there are some innovative initiatives on the horizon regarding population health management and it should enhance what may be a manual or patchwork process today. I recently read that you achieved EMRAM Stage 6, a recognition that’s bestowed upon hospitals for achieving higher patient safety through improved documentation. Tell me a bit about that clinical documentation improvement initiative.

Gaug: That opportunity manifested itself when we upgraded to Meditech 6.1.5. We made sure that not only were we going through an EMR upgrade, but we also analyze and pursued clinical workflow optimizations. With the testing that was taking place to upgrade MEDITECH, in parallel, we went into all the clinical and ancillary departments, evaluated workflows and implemented improvements. That went a long way to eliminate non-electronic workflows and improve existing workflows as we pursue stage 7 recognition.

Campbell: Related to PHM, are there any initiatives you might be introducing to better engage patients? I recently read an article published on the Lima Memorial website that was more marketing focused, addressing how patients should plan a well visit. What other types of things are you dabbling in regarding telemedicine and telehealth?

Gaug: It’s interesting you bring this up as I recently authored an article on telemedicine’s role in advancing patient care.  One of our primary strategic initiatives in 2018 is to have telehealth and telemedicine capabilities implemented and offered if not in all the practices, at least all the types of specialties we have. Telehealth may not be achieved in every family medicine practice, but we want to have at least one of those practices using telehealth. A lot of the communities we serve are rural and telehealth will allow for our patients to have better and quicker access to care. It will also enable us to offer different services we may not have today. Our goal is to have it integrate to our new patient portal, which will make visits for our patients that much more convenient.

Campbell: Absolutely. It closes the loops they have a comprehensive view of the interactions with their provider to complement the clinical record. That’s the bevy of questions that I had for you. Thank you for sharing your perspective and insights and best of luck to you with the transition.

About Mathew Gaug

Mathew is a highly accomplished IT business professional with more than twenty years of executive experience guiding the strategy and execution of mission-critical technology infrastructure and support for large-scale health service providers. Mathew is experienced and has expertise in integrating newly acquired facilities and establishing system-wide compliant technologies as well as migrating data centers. Serving as Executive Director,  Information Technology at Lima Memorial Hospital, he successfully orchestrated the implementation of multiple technology initiatives, touching every aspect of health care operations, significantly reducing costs and increasing efficiencies within an aggressive time frame. Mathew holds a MS in Information Systems and a BS in Computer Science from Baker College. 

CHIME CIO Interview Series – J. Joshua Wilda, CIO, Metro Health – University of Michigan Health

As a community healthcare organization, Metro Health values the ability to engage the community at a local level. Joshua Wilda, CIO, ensures the organization is nimble in its approach to patient and provider engagement, offering innovative solutions by creatively partnering with local employers to offer additional flexibility to the communities they serve. Joshua offers candid and shrewd advice for blossoming healthcare IT professionals as they seek to grow and advance. He also shares acuity surrounding the meaning and importance of health information technology. In his words, “we are not IT professionals in the health care industry we are health care professionals in the IT industry.”

Key Insights

Historically, we have focused on the provider experience which is extremely important. However, if we make the patient experience seamless and successfully address that aspect, providers will have their experience change as well and the entire care team will be able to leverage technologies to drive better patient outcomes and satisfaction.

We evaluate how the technology can be used to manage the care by the entire care team and how that team can support and utilize the information, as opposed to having the burden be wholly on the physician as the entry point and manager of that information. Just as the I.T. industry is tasked with managing big data, providers have been tasked with the entry, management and output. A daunting task when their value is being with the patient. By enabling technologies that allow providers and their care team to manage and interact with the patient at the center, more of the information can be used to better treat our patients.

We must consider what are our payers are going to reimburse us for and that’s been a struggle. There are many technologies that can be leveraged to treat a patient but if there is no reimbursement for the use of these technologies, smaller organizations can be hindered by what they can take advantage of due to cost.  

We are not IT professionals in the health care industry we are health care professionals in the IT industry. Metro Health isn’t an IT organization, its focus is and needs to be on quality patient care. I.T. is only a vehicle to be driven where healthcare can go, and I’m all about instilling that mission and passion in my folks.

Campbell: Thank you for taking time out to speak with us. Please tell me more about Metro Health and your background

Wilda: In healthcare, we tend to describe ourselves as the size of our beds. As a community based hospital, we have a 208-bed village campus and we have a large number of neighborhood centers where different services are geared towards outpatient care. Several years back, our organization had the foresight to transition from sick care to health and wellness management, in the communities where the patients live, not solely in a hospital. We have invested in outpatient centers and clinics, specifically with primary care services. We now own and operate 17 outpatient facilities where we have a multitude of services, mainly rooted in primary care and outpatient specialties.

From an IT perspective, we describe ourselves with the EMR that we use. As a small mid-market hospital we understand the value I.T. can bring to the patient experience and have invested heavily in I.T., more than most organizations our size. We were one of the first of our size on Epic, with a full enterprise deployment. We’ve been a Most Wired hospital for 10 years running and have very much made I.T. part of our strategy. We have been a HIMSS stage 6 organization for both Ambulatory and Inpatient for the last 5 years, with our stage 7 assessment coming soon! We have been part of a very large competitive market, and with Metro being the smallest, our CEO focused on positioning Metro to be the top choice in the market. We used technology to help drive that choice, whether it be with our provider base or with our patient base.

Campbell: Metro Health formally affiliated with the University of Michigan in 2016 and it was shortly thereafter that you were promoted to CIO in April 2017. Please tell me what CHIME means to you as a result of that promotion.

Wilda: I’ve been with Metro for the past 11 years and originally came on board as a systems analyst. I started my career working on the Epic implementation here at Metro and got the opportunity to rise through the ranks to now being the CIO. I am an alumnus of the CHIME Bootcamp from back in 2009. Our previous CIO, William (Bill) Lewkowski, is still with Metro Health as our Chief Strategy Officer. Much of what we’ll talk about in this interview is attributed to the framework of what Bill built over the past 23 years, anticipating where healthcare was going. A lot of my strategy is based upon honoring that history and advancing and innovating it to the next level. At 37 years of age, I’m considered a young CIO, and I’m fortunate to have gotten the opportunity to lead a healthcare organization.

In terms of the value of CHIME, it’s such an invaluable resource to be able to ask for advice and perspectives from folks who have been pioneers and peers who are considered future thinkers.  Healthcare IT is a vast industry with many facets, opportunities and challenges to overcome. CHIME is a tremendous resource. I considered myself part of the next generation of healthcare I.T. leaders driving what technology means. In attending the CHIME forum this fall, it was interesting to hear where some of my peers are (as far as their career) and to hear their struggles of how they are still trying to get themselves to the table with senior leaders. They are trying to change the perception of I.T. as being a commodity, providing operations and maintenance, and instead having it viewed as a valued capability to driving and shaping organization’s missions and strategies. I am fortunate to be at an organization where they understand our capabilities and continue to invest in our growth. CHIME is a resource which helps me understand what capabilities our team may need to focus on, where we may have gaps and provide valuable resources in how to stay ahead of the curve. Metro focuses on how we can leverage digital transformation to represent the brand of who Metro is to support patient focused services and create loyalty among our patient base.

Wilda: My background and formal training is on the healthcare sciences side. I received a Bachelor’s in Biomedical Sciences and a Master’s in Public Administration with a Healthcare emphasis, I am not the typical information technology professional nor claim to be a true technologist. I’ve had to learn the technology portion of this, so I have a unique perspective there as well. Technology for the sake of technology is never well received in the healthcare industry. We often use the word disruptor.  Disruptor, while a well-intentioned buzz term, can have a negative connotation to end users. I like to say technology is a differentiator and a vehicle to drive healthcare to new areas with a focus on meeting the triple aim plus one!

Campbell: When you can bring that multidisciplinary approach, you sometimes have opinions or views that are skewed already. That leads me to a big topic that was echoed time and again at the CHIME fall forum – physician satisfaction & efficiency and EMR usability. Can you touch on that a bit? Specifically, things you may be doing with telemedicine to help alleviate some of the burden on providers?

Wilda: Historically, we have focused on the provider experience which is extremely important. However, if we make the patient experience seamless and successfully address that aspect, providers will have their experience change as well and the entire care team will be able to leverage technologies to drive better patient outcomes and satisfaction

Technology is perceived as a burden on the provider/patient experience, and that is an area we are focusing on. We are gaining better understanding of the relationship and expectations between providers and their patients; crafting a digital experience as a benefit to that relationship rather than administratively burden providers away from their focus on their patients. To that end, we have a program with our CMIO Dr. Brad Clegg and Medical Informatics Directors Dr’s Lance Owens and Srinivas Mummadi around understanding where the physicians are spending their time with the technology. As part of the program, we partner with providers, assessing productivity and providing them with tips and tricks. Another approach is having an appreciation that technology is perceived as a disruption, there is that word, so when we introduce new advances we go to great lengths to provide engagement opportunities and education of how the introduction of new technologies will actually reduce that burden.

We evaluate how the technology can be used to manage the care by the entire care team and how that team can support and utilize the information, as opposed to having the burden be wholly on the physician as the entry point and manager of that information. Just as the I.T. industry is tasked with managing big data, providers have been tasked with the entry, management and output of that same data; a daunting task when their value is being with the patient. By enabling technologies that allow providers to manage and interact with a care team, with the patient at the center, more of the information can be used to better treat our patients, the providers can focus on the patient and not the technology! We don’t want the physicians to have to manage every single informational input, but rather, we want a team around the patient so we can leverage the collective skillset in managing patient populations. We are heavily focused on unified communications across the care team and remember, patients are a part of the care team. Our focus has been to make sure that the right information is getting to the right member of the team, whether it be the care manager, a nurse, a physician, or a PA/NP and provide communication tools to have the teams seamlessly interact with the patient and each other. This is a current gap. We have siloed technologies implemented, it is now our goal to connect them, increasing patient/care team engagement.

Campbell: Along those lines, Metro Health was one of the early pioneers in delivering remote access, allowing providers to be more efficient and get access to the point of care information in different settings. Can you elaborate on that a bit?

Wilda: Early on, we leveraged the VDI (Virtual Desktop Infrastructure) experience because we didn’t want our organization to be limited by the bricks and mortar of a PC. We wanted the care team and support services to be able to have information when the patient needed them to have that information, not when they had access to it via a bricks and mortar type of workstation.

Campbell: What is your mix of payers and what mix of value-based care is there today with your patient population?

Wilda: Like any community organization we are managing those models with a mix of government, commercial and private payers. This is another convoluted area as each has their own documentation requirements, sometimes overlapping, often having their own nuisances. We are spending too much time designing the system for their needs and not enough time focused on what the patient needs but it is how we stay in business. Just like most in the industry we must consider what are our payers are going to reimburse us for and that’s been a struggle. There are many technologies that can be leveraged to treat a patient but if there is no reimbursement for the use of these technologies, smaller organizations can be hindered by what they can take advantage of due to cost so we need to be tactful and impactful, leveraging the entire investment we do make in technologies. Larger organizations may be able to invest in different overlapping technologies. Often, value is left on the able with a large portfolio of services and capabilities. Metro sustains by being purposeful and understanding we do not have the luxury of best of breed to support all areas of technology but leverage the interoperability and value that comes from best of suite integrated solutions.

We are in an extremely competitive market. Metro’s goal is to remain a community organization which prides itself on the family culture and personal interactions we have with patients. To that end, we strive to provide choice in the market. We are partnering with local employers to do something different to drive down the cost of care. We do not have our own payer program, but we provide direct contracting and risk sharing models with local employers in town. It takes out the middle man and puts the responsibility on us as an organization to keep these employer’s staff healthy. We are directly servicing the community, we are engrained in that community and have put skin in the game.

We all have read the benefits of telemedicine. One of those is providing convenient care for patients, reducing the time away from work, away from families. The employee has got to come into the office to see the provider and often, that requires a day off and less productivity. We are examining how we can, with these direct contracts, put telemedicine into the employer’s offices and make it so that employee doesn’t have to leave or take a day from work or inconvenience their family with a disruptive office visit.  It is our belief that having immediate access at their place of business will provide convenient access to employees, increase productivity and decrease costs for employers and ultimately aid in increasing the health and wellbeing of our community. Its sends a message to the community Metro understands what a patient needs to go through to see a provider and we are focused on helping the patient manage that experience, reduce disruption in their lives and can help add flexibility. We feel like this is going to help our patient mix and managing the healthcare experience.

Campbell: I appreciate you sharing the innovation that’s taking place on a localized level. If we could shift gears, I’d like to touch on the topic of population health management and anything you may be doing with Epic’s Healthy Planet module to that regard. Are you currently conducting any sepsis detection or surveillance initiatives or perhaps taking data from the HIE to get alerts about your patient population?

Wilda: We were an early adopter of Epic’s Healthy Planet module. We are one of those organizations that always seems to be on the bleeding edge. From a patient/payer perspective, we partnered with the state of Michigan on programs which gave us a spring board to adopt a progressive care team model around the patient. That model includes a team of care managers and pharmacists which provide support to our providers in managing the wellness of our population. Epic’s module allows us to use analytics to recognize those patients which may be at great risk or need more attention and then act on those patients with greater efficiency and quality. As I stated, technology is a great vehicle to allow our care team’s great accesses, more information and deeper abilities to treat more patients. We’re an osteopathic organization, so population health is ingrained in us, the complete focus on the patient’s health and wellbeing. It’s not just about being sick care but about treating the patient holistically, from root cause to illness to changes in lifestyle. That’s what osteopathic medicine really is rooted in. We are at the table with Epic trying to design the next wave of what that means for a small organization like us to sustain that model.

We also do have a sepsis program though not as robust as a lot of the larger healthcare systems, it is serving our patients extremely well. This is one of the reasons why we partner with the University of Michigan in that we have a lot of great ideas, but we don’t have the scale to do it. Now with the University of Michigan being a partner of ours, we have a lot more access to resources to grow our programs.

We are heavily engaged with our regional HIE, Great Lakes Health Connect. Metro was one of the founding members of our HIE. Around 10 years ago, a number of healthcare organizations came together and agreed while we may be competing for patients, we should not compete on the data around the patients thus forming one of the nation’s most successful HIE programs. Over the past 10 year, Great Lakes Health Connect has grown in its members thus growing the amount of information our providers have access to. Again, HIEs information is being engrained directly into the care workflows, allowing the care team better access, a more robust picture of the patient’s care allowing us for more prescriptive care plans.

Campbell: Very good. In closing, I’d like to ask you a question around your career trajectory. You have a compelling story, having worked on the vendor side for two years and then moving to the analyst side at Metro, being developed and groomed in-house. Folks who have created their own destiny are motivational. That said, what advice do you have for the budding health IT professional? What were the key things that got you to where you were today?

Wilda: One thing I tell anyone who’s starting out in their career is to make your ambitions known. Don’t just expect that by putting in sweat equity, people will know what your career aspirations are. I went out on a limb when I first came here and I scheduled a meeting with the CIO at the time. I told him what my career goals were. Did I envision myself as CIO? Not necessarily, but I’ve have a desire to grow as a healthcare leader and I told him that. He then set a path forward, setting the expectation that he wasn’t going to hand me a seat at the table, it needed to be earned. He knew that I was hungry and gave me the opportunity to succeed and opportunities to fail and learn from my failures. You need to take time to reflect and understand what you want out of your career and make your passions known.

It goes without saying I.T. professionals need to understand their business they support and not think that they are smarter than their customers are. In healthcare I.T., we have many vehicles we support, HR, finance, facilities, direct patient care, and more. It’s a very interesting industry, because we service all those entities and it’s about building the relationships and getting out there to know our customers and partner with them on crafting solutions that increase their services and delivery. You must show that you have emotional intelligence and empathy to understand what their business is, not tell them what their business is. You must really get to understand them and be open minded.

Understanding the people that manage technologies is critically important. We have to understand how to manage people. We often focus on the technology itself, how to manage technologies, but we also must appreciate and understand the inner workings of the organization. We have to put the right team players in the right team settings to make those technologies work. I tell our department all the time, we are not I.T. professionals in the healthcare industry we are healthcare professionals in the I.T. industry. Sometimes, leaders with a pure I.T. background and perspective come at solutions with just taking into account data, the networking, the bare metal, without an appreciation for the healthcare end-users. How will that technology impact, improve, disrupt, delight or disengage the users? It is important the entire I.T. organization of any healthcare system take the time to understand and get to know the business of healthcare.

I focus on our pure I.T. professionals, taking them for occasional walks around the organization, to get them aligned behind the “Why” of what we do.  Many do not understand how the impact of their work, that phone they deployed which they may think is mundane, has a mission, is delivering some critical information to a patient. It might be used to deliver some good news, it might be telling somebody unwelcome news. It might be connecting care teams. But, if that phone isn’t working when that patient needs it to work, it’s useless and you are impacting that patient’s life. That’s the impact we have from the most robust clinical application, the most inconspicuous piece of technology, like a phone.

Metro Health isn’t solely about I.T. Technology is a vehicle to where healthcare can go, and I’m all about instilling that mission and passion in my folks. In fact, it is hard to get away from that mission. My wife is a provider at Metro and I make the joke all the time that not only do I support end-users at work, I live with one and get intimate insight when/how the technology is helping and sometimes hindering patient care. I can’t escape it nor do I want to. It provides for nice dinnertime discussion.

Campbell: What a powerful message around emotional intelligence and empathy. The perspective you bring is truly inspiring. Thanks for taking time to share.

CHIME Fall Forum Interview Series: Shane Pilcher, CIO, Siskin Rehab

Shane Pilcher, CIO

Shane Pilcher, CIO, Siskin Rehab

The role of the Healthcare Chief Information Officer is changing. Shane Pilcher, CIO at Siskin Rehab, knows it’s important to be on the front lines and understand how every aspect of the organization operates. As Siskin’s first CIO, he paved the way for IT to have a place at the executive table, and now he’s finding new ways to make sure all technology is optimized to fully meet physician needs. In this interview, Pilcher discusses reassessing workflows when implementing new technology, why Siskin needs more than an acute-care-based EMR, and how telemedicine is affecting rehab. He also touches on the CHIME CIO code and the true importance of peer-to-peer connections.

Key Insights

It has been a wonderful combination for the organization, as we’ve witnessed significant growth over the past couple years that I’ve been here. IT has helped enable a lot of that growth, as well as invested significant effort eliminating legacy systems and to update and optimize existing systems.

The longer you spend with any EMR, the more invested you get, and the harder it is to make a change. But, while you get invested with customized content, optimized processes, and those types of things, when you decide to make a change, it’s important to not get caught up in trying to take your old system and fit it into the new system.

We need to spend time looking at how we do our business, optimizing those things, and then wrapping technology around that to enable it.

Not only is that information really important, but the peer-to-peer relationships that you create are critical. You cannot put a dollar value on that, it’s priceless.

I’ll also say, a good resource to have a provider that’s totally against the system as well. Through the process of engaging them, getting them involved, and making them a part of the building process, if you turn them into a supporter, you have a huge resource that will then help the other physician population come on board as well. 

In some cases, I would even suggest that the CIO is very close to having to have the same level of vision that a CEO has in an organization because you cannot focus directly on IT, you must understand the organization as a whole with all of its nuances so that you can help lead them and their technology strategy.

Campbell: Coming from a consulting background, and now working on the healthcare delivery end, you bring a unique perspective to the CIO role. Tell me a little more about Siskin, how you came to be an organization and what your role is today.

Pilcher: We are one of the few remaining, independent, inpatient, acute care, rehab hospitals in the country. We’re just under 200 beds and have been established in Chattanooga, Tennessee for 25 years now. We’re one of the primary sources for rehabilitation care in the area. I came to Siskin in July of 2015.  At that point, they had never had a Chief Information Officer, and certainly IT was never part of the Senior Leadership team. It was a fantastic opportunity to take them down a new direction and finally have IT at the table where decisions were being made and strategy was being developed. It has been a wonderful combination for the organization, as we’ve witnessed significant growth over the past couple years that I’ve been here. IT has helped enable a lot of that growth, as well as invested significant effort eliminating legacy systems and to update and optimize existing systems.

Campbell: Very good. If you’ll allow me to inquire, what are the primary clinical systems that you use today within the organization for EMR and potentially care coordination?

Pilcher: We are a McKesson Paragon shop. We’ve had Paragon in place for a little over ten years now. We are actively pursuing a different EMR, and we’ve narrowed it down to a couple of vendors. We expect a significant EMR implementation in our future within the next calendar year, so its exciting times. Paragon covers most of our areas, especially inpatient care coordination, but we also use an outpatient ambulatory EMR called TheraOffice, it’s one of the few out there that is heavily focused on therapy and rehabilitation care.

Campbell: Thank you for providing background and insight into your pending EMR replacement project. You bring a unique perspective, given that you’re a registered respiratory therapist and served in the United States Navy. Given this, tell me a little bit about how that clinical expertise has benefited you in your career and moving into healthcare information technology.

Pilcher: Absolutely. I have definitely had a varied career path. I do things unusually, in most cases, and my career path is evidence of that. I became a respiratory therapist in the Navy. I spent eight years on active duty and thirteen years in the reserves. After coming off of active duty, I joined Erlanger’s Children’s Hospital in Chattanooga and spent a few years there working as a therapist in the pediatric ICU, the neonatal ICU, the ER, and other areas. They had an opening in the IT department. They were just looking for someone with clinical experience that had an interest in Electronic Medical Records and they were willing and open to train that clinical person to build and optimize the system. So, I found my first opportunity in healthcare IT and spent a few years doing that. I then started consulting, and spent about fifteen years doing that. I was doing all sort of projects from, initially, EMR implementations, optimizations, through strategic planning and interim leadership.

Campbell: That reminds me of the career of Dr. Dale Sanders from Health Catalyst. I attended the Healthcare Analytics Summit a few years back and he talked about applying his diverse career, including command posts at the US Air Force, and how that military background can serve some purpose in offering structure to, what can be, a very overwhelming healthcare IT space, so thank you for that.

Can you tell me a little about any IP you have invested in Paragon today? I imagine having it in place for ten years there may be some technical debt in that system in terms of, perhaps, clinical rules, or documentation. If you could elaborate on the challenges of cataloging those different types of IP in systems as you plan on moving. A lot of healthcare delivery organizations today are moving from a system that is more comprehensive to an Epic or a Cerner, and I assume that is part of your decision making process.

Pilcher: Certainly. The longer you spend with any EMR, the more invested you get, and the harder it is to make a change. But, while you get invested with customized content, optimized processes, and those types of things, when you decide to make a change, it’s important to not get caught up in trying to take your old system fit it into the new system. It’s a beneficial opportunity to be able to reassess what you’ve been using for that period of time and determine if that’s really what you want to bring forward. It also allows for evaluation of established clinical workflows that you’re wrapping technology around. One of the key mistakes that organizations have made for the projects that I’ve been a part of, and even here if we’re not careful, is we try to take a current process and wrap technology around it. If the process and workflow is flawed, or inefficient, we’re just going to exacerbate that and make it worse. We need to spend time looking at how we do our business, optimizing those things, and then wrapping technology around that to enable it.

With Paragon, we have a lot of customized content in it, a lot of our assessments are there. However, because of our unique situation, we are McKesson’s only rehab client, at least up until the last year—I think they got a smaller rehab client that they’ve implemented Paragon with. So, while we have required functionality that Paragon provides us, based on CMS’s Data Regulatory Requirement feature, additional functionality really hasn’t materialized in the last ten years. We’ve had to do a lot of manual processes outside of the system to be able to overcome those gaps. While we have a lot invested in the system, it’s going to be easier for us to make that move than other hospitals only because we’ve had to do so many things outside of the system or used bolt-on third party applications to try and overcome some of the limitations within the system. Now we’re looking for systems with predefined rehab content. We don’t anticipate getting into a situation where we’re the only rehab client that the vendor has, where they don’t have specific functionalities for rehab. That’s due to the fact that while we’re an acute care hospital, we’re also rehab, and we don’t do everything like an acute care hospital does; we need something more than just an acute-care focused EMR.

Campbell: Thank you for elaborating on that. Switching gears, a little bit, can you tell me about your payer base in your market blend, and how that may be unique?

Pilcher: We’re very heavy with Medicare/Medicaid, quite a few of our patients fall into that bucket. We have a variety of other insurance providers, partnerships with organizations as well, for their workman’s comp and other injuries.

Campbell: Is there a good mix of value-based payment occurring, specifically with Medicare Advantage? If so, I imagine there might be a focus for you on HCC – hierarchical condition categories.

Pilcher: I see there being more opportunity. We partner with a few of our referral sources and their value-based programs, but as far as specifically, that’s about the only impact that has with us. Due to our payer process we get daily stipends, if you will, a certain amount of reimbursement per day from our commercial insurance partners and from Medicare. A lot of the value-based purchasing efforts in the acute care hospitals aren’t directly impacting us except as we partner with them to provide care to fit into their value-based purchasing programs.

Campbell: Tying into that, you have a state of the art facility that provides treatment for brain injury and stroke. Do you have any initiatives in place for shifting some of that rehab to home rehab, or incorporating telemedicine, or perhaps patient centered medical home? If so, can you elaborate on that?

Pilcher: The type of patients and the overall population that are presenting to inpatient acute rehab as well as our subacute rehab, is drastically changing. The typical orthopedic patients are being shifted to home health and outpatient therapies, and we’re there to help with that. Inpatient wise, we’re seeing patients with higher and higher acuity levels; they’re sicker than they’ve ever been and require a lot more care. While a lot of the orthopedic and nonmedically significant care is being shifted to home health, our focus has been to ramp up our brain injury, stroke, and neuro programs, as we’re seeing a significant increase in demand for that.  Also, we have patients coming in directly from the ICU requiring rehab, so we’re seeing sicker patients, and many of those that are not being shifted towards the home health and outpatient environment.

Campbell: Thanks for elaborating on that. That’s a very compelling point, you are acute care so obviously you’re going to deal with those who have an inpatient stay. With that said, is it mainly limited to the surrounding areas or do you get out-of-state patients who seek you out because you’re a center of excellence?

Pilcher: We do have patients who come from across the country. The majority of our patients are locally and regionally based. We get referrals from as far as Nashville and Birmingham, but most of our patient population is more local than that.

Campbell: Shifting gears again, what pop health initiatives are in place today? Do you have any care coordination that’s occurring between the acute care setting and home health, easing those transitions of care? Are there initiatives in terms of referrals and/or handing off your portion of the patient record, perhaps through an HIE or any other means?

Pilcher: All of that is in transition at the moment. We have some coordination with our two largest referral sources, the two largest hospitals in the area. They have some specific population health initiatives that we factor in with some of their patients. For some of the orthopedic patients that are not candidates to be discharged, we have programs with organizations to bring them into our organization. As far as very formal sharing of information, that’s not happening much in this area yet, but our two largest referral sources are in the process. One just went live with a new EMR that would give them that ability, and another one is planning on doing it shortly and would change out their system to a system that would support sharing of data. Then, of course, with ours, that’s a key component to whatever system we put into place, to greatly enhance the sharing of data in our area. As far as a formal HIE, that’s not present.

Campbell: Great. I want to touch on your experience at CHIME as well, and gather some of your impressions from it. I know I personally valued the new clinical informatics track this year, which focused on the topic of physician efficiency and engagement. If you could elaborate on your goals with going to CHIME and how you may approach EMR replacement based upon things you may have learned at CHIME, specifically getting clinicians to use a new system and learning the nuances of that.

Pilcher: I think CHIME is an invaluable resource to CIOs in our market space. I was actually part of the planning committee for the fall forum this year, so I’m very pleased to hear that you liked what you saw. We spent a lot of time trying to make sure that the educational content contained value and I certainly think it did. Not only is that information really important, but the peer-to-peer relationships that you create are critical. You cannot put a dollar value on that, it’s priceless. It’s those individuals that are willing to take your call at a moment’s notice so you can bounce an idea off them, and determine how they handled things. When I was transitioning from the consulting side to the CIO role, there were numerous CHIME members that I had developed relationships with over the years, and they were readily available for me to call at any time—and believe me I did—to be able to get advice from. That’s something that, while we get hundreds of calls a day, and can’t take them all, if a CHIME member calls another CHIME member, that call is usually taken. I really value that with our fellow CHIME members.

Being able to get information on how they engaged their clinicians is key because, as we know, that’s not an easy population to have completely adopt an EMR platform, and having them engaged is critical. My advice is that engaging clinicians from the beginning, early on, and frequently throughout the process is a key piece to that adoption. They have to understand that the EMR doesn’t always bring efficiencies, like it was once touted. In some cases there are some, but it usually takes physicians longer to do what they need to do versus when they did it on paper. Understanding why we’re doing it, the safety implications that come from it, and then making sure that they’re part of the process of designing the system that they’re going to use is key. Finding a physician who is leaning towards being able to use the system well is a good resource to have. I’ll also say, a good resource to have is a provider that’s totally against the system as well. Through the process of engaging them, getting them involved, and making them a part of the building process, if you turn them into a supporter, you have a huge resource that will then help the other physician population come on board as well.

Campbell: That’s a great point, to focus on those outliers and not necessarily the low hanging fruit. I agree with your sentiment around CHIME, and kudos to a job well done coordinating that event. Like I mentioned, I witnessed CIOs who are always so gracious with their time. There’s just a deep amount of trust built up among peers and that’s invaluable especially when you’re in a tough position. As you mentioned, the healthcare CIO position today has morphed, as they are the quarterback and the glue within the organization to tie information technology to administration to. I’ll also mention too that the session Bryan Bliven and Dr. Tom Silva from Missouri Health presented was profound. They shared key insights with the way they engaged physicians, making sure that there’s rounding occurring, ensuring there’s -training that is occurring right across from the break room. Those pragmatic and novel approaches were well received.

Pilcher: I completely agree with you on the rounding part. As a CIO, you cannot stay hidden. You have to spend your time out there and that’s where you are able to develop a lot of trust with your end users and not just your senior leadership team. It can be kind of scary and dangerous to get out there because you’re going to hear what doesn’t work, but if you’re committed to getting it fixed, rounding is huge. Just to follow-up on what you were saying, as far as the transitioning of the CIO role, I know a lot of those educational tracks dealt with the transitioning of the CIO and the role we play. In my opinion we are one of the few leaders on the senior leadership team that truly has to understand every business sector of our organization, every business line – understand what they do, how they do it, why they do it, where their pain points are – so that we can then help them put technology around that. In some cases, I would even suggest that the CIO is very close to having to have the same level of vision that a CEO has in an organization because you cannot focus directly on IT, you must understand the organization as a whole with all of its nuances so that you can help lead them and their technology strategy.

Campbell: Absolutely. It must be multidisciplinary, and you must be able to fortify partnerships with your clinician peers. Thank you for sharing these cogent insights and for providing sage advice.

About Shane Pilcher

Shane has more than 25 years of healthcare and healthcare IT experience. He brings to Siskin Hospital his strong healthcare, military and corporate experience in leading teams to align IS strategy with corporate strategic plans.

Shane became a Registered Respiratory Therapist in 1995 while in the United States Navy where he served as a Respiratory Therapist, Navy Corpsman and EMT. In 2003, he converted to an Intelligence Specialist where he served time in Iraq and was the leading Chief over the Naval Intelligence Reserve Region Southeast’s Reserve Intelligence Training program. Shane retired as a Chief from the United States Navy with more than 20 years of active and reserve service. He has also received his Fellowship designation from Healthcare Information and Management Systems Society and holds a BS in Business Administration.

 

CHIME Interview Series: Sue Schade, Principal , StarBridge Advisors, LLC

Sue Schade, CIO, MBA, LCHIME, FCHIME, FHIMSS

Sue Schade, CIO, MBA, LCHIME, FCHIME, FHIMSS Starbridge Advisors, LLC

#HealthITChicks show up and stay fierce, and Sue Schade may just be the epitome of that. A nationally recognized health IT leader, Principal at StarBridge Advisors, LLC, and current interim CIO at Stony Brook Medical Center, Schade has over thirty years of collective health IT management under her belt along with a plethora of awards and recognitions from HIMSS, CHIME, and other leading health IT organizations. Now part of a consulting, coaching and interim management firm, Schade has sage advice to share with other CIOs. In this interview, she talks optimization versus replacement, population health management solutions, how to measure success, and the benefits of knowing your application inventory. Sue Schade is paving the way for women in health IT everywhere.

CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Here is the next interview in the series:

Key Insights

My approach, or my philosophy, that I’ve worked with organizations on is when you’re adding new components, you first start with the core vendor: can the core vendor do it today?

Usability and number of clicks is clearly something that we hear over and over from clinicians

The main point with workflow is: do you adopt your workflow to the product or do you adopt the product to your workflow?

Vendors are looking at how they can be more user configurable to adapt to the uniqueness of an organization and their specific workflows.

Just inventorying your application portfolio can be painful. You have a lot more disparate and duplicate applications than you ever realized

I’ll be the first to say that many organizations don’t have something they can pull up and say ‘here’s our inventory.’ They should but they don’t.

Campbell: Tell me a little bit about your background, organizations you’ve worked with, and StarBridge Advisors.

Schade: Let me start with StarBridge Advisors. It’s a new health IT advisory firm that I started in the Fall of last year with two colleagues, David Muntz and Russ Rudish. We provide IT consulting, interim management, and leadership coaching, targeting the C-suite and healthcare organizations around the country. We have a network of seasoned experts and advisors that we are able to bring on engagements depending on particular client needs. I currently serve as the interim CIO at Stony Brook Medicine on Long Island, where I have been since March of this year. We are actively recruiting to fill that position with a permanent CIO.  Prior to that, I served as interim CIO at University Hospitals in Cleveland for over eight months, when I first started down this path of consulting and interim management and left the permanent CIO world. Before I went to Cleveland, I was the CIO at University of Michigan Hospitals and Health Centers in Ann Arbor for a little over three years. Prior to that I was the CIO at Brigham and Women’s Hospital, part of the Partners Healthcare System in Boston for almost thirteen years. Take all of that plus the years before that and I have over thirty years in health IT management and a lot of experience in the provider world. I also spent some time working for one of the large consulting firms, Ernst and Young, as a senior manager in their healthcare IT practice, as well as with a startup vendor in the health IT space.

That’s my background. I can tell you the experience when it comes to EHRs is different at every one of those organizations. At Stony Brook Medicine, we’re basically a Cerner shop for our clinicals, both ambulatory and inpatient; we have revenue cycle through them, and the old Siemens product, Invision. At University Hospitals, it was an Allscripts shop for clinicals on the ambulatory and inpatient side, and Cerner Soarian for the revenue cycle. At the University of Michigan, I helped them move the ball towards a total Epic environment as an integrated solution, for inpatient, outpatient, and revenue. At Brigham, we had mostly internally developed systems, which were inherited from a rich history at Brigham of leading the way in the 90s with CPOE. As part of the Partners system, there was a mix of internally developed core systems as well as some vendor products. Prior to my departure at Brigham, we had decided that all of Partners would go onto Epic, and move away from the disparate systems at each of the hospitals. They are just about done at this point, having moved most of their hospitals onto Epic. I’ve worked with the major EHR vendors and certainly have a perspective on the importance of integrated solutions.

Campbell: What an extremely decorated career with a tremendous amount of experience and wisdom gained along the way. Tell me a little bit more about integrated solutions. There is a lot of replacement occurring in the market as folks look to have an integrated system bridging the inpatient and outpatient care setting. What is your view on that? What have you steered organizations to in the past? There’s a lot of opinions between optimizing what you have versus replacing, is the replacement truly worth it?

Schade: I think so! An integrated solution from a core vendor, is optimal. You can argue that core vendors may not be as robust in all areas or specialties,  which is where some may have started from and then built upon. However, at the end of the day you’re dealing with one major vendor that can provide all of those solutions, has a roadmap, and is continuing to build out other modules that integrate into that core system. From a user perspective, there’s one system to learn how to navigate, you have much more seamless workflows, and much better data integration. I think there’s a lot to be said for that.

My approach, or my philosophy, that I’ve used in working with HDOs, is when you’re adding new components, you first start with the core vendor: can the core vendor do it today? Is it on their roadmap? Will they be able to do it, say in the next 12-18 months, or is it not even a thought of theirs? If it’s nowhere today, or not on their roadmap, then you look at a niche vendor that may have that product. If you’re so far ahead of the market in what you’re trying to do that there’s not even a niche vendor that’s looking at it, then you would consider developing it and trying to integrate it into your core system. That’s my philosophy, that’s the approach I will take. Obviously, you may go into organizations, or I may now as an interim CIO, that have a different outpatient system from inpatient, or a different revenue from clinical. You must take into account where an organization is in terms of investment, where they are financially, and where they are in their lifecycle on their contract. It’s not a one-size-fits-all answer. I do see a lot more organizations trying to move to an integrated solution.

Campbell: Sure, and if we take integration between the care settings for instance, I know there’s some sunk cost and unique IP that’s baked into the organization, and embedded into the workflows, quite frankly. As such, it’s a big forklift to be able to move that to a new platform. In terms of core EMR and EHR vendors, what is your perspective in how they are addressing population health management —a term that is admittedly very broad and often overused? It’s seemingly a fragmented market. Do you see that solution coming from core EMR vendors or do you think that they’re best suited for the transactional nature of the records they support and it’s going to be an outside vendor perhaps for population health management?

Schade: I think that some of the stronger vendors in this space are probably somewhat niche and not the core vendors, though the core EHR vendors do have offerings. For instance, we are utilizing Cerner’s HealtheIntent product at Stony Brook Medicine for the work we’re doing with what’s called the Delivery System Reform Incentive Payment Program (DSRIP) in the state of New York. There is a potential for that to be used more broadly as our population health platform, but I think it’s still too early to make that determination. Sometimes it’s vendor readiness and it may also be the organization’s readiness. Some of the population health initiatives are probably driven, very much driven, by those parts of the organization such as operations and administration, not IT, and rightly so. People get to a point where they have to make a change and can no longer wait for IT, who may still be consumed by their core EHR implementation. They stay on the lookout for solutions from niche vendors. It hasn’t quite shaken out yet, but considering what you’re fundamentally working with in terms of patient data, it makes sense that it could be driven from your core EHR vendor, if they can keep up with those solutions.

Campbell: Right, that makes a lot of sense. Speaking of the core EHR, I feel like, and maybe you can comment on this, organizations need to treat it more than a transactional system and rather a strategic asset. EHR and EMR optimization should be a continual process following implementation. Perhaps you can touch on optimizations that you’ve participated in. From the discussions we’ve had with healthcare CIOs and leaders, the toughest part seems to be determining ROI. In terms of drivers for optimization – whether it’s usability, workflow efficiency, number of clicks – what were the areas you focused on and how did you measure success?

Schade: I think you hit the big ones. Usability and number of clicks are clearly something that we hear over and over from clinicians, more so for physicians, but I think it’s an issue for our nurses as well. The main point with workflow is: do you adopt your workflow to the product or do you adopt the product to your workflow? I think there’s some happy medium there and what you don’t want to do is a lot of hard-coded customization,  because every time you get a new upgrade from the vendor you’ll have to do all the retro fitting; Organizations are trying to do less of that so that they can work within the base product. Vendors are exploring how they can be more user-configurable to adapt to the uniqueness of an organization and their specific workflows. This is where your CMIO, CNIO, informatics folks, and clinical analysts are critical in partnering with end users to make sure that the solutions that we deploy make it better for them and not worse. You commonly hear that clinicians understand and accept EHRs are here to stay but still acknowledge how cumbersome certain features are. I’ve been involved in different optimization efforts at organizations post-implementation, and I will say we haven’t focused so much on ROI as we have workflow and user satisfaction. You often get into a situation with a big implementation that at a certain point you must get it done and start creating that list of things that are going to be in the next phase of optimization. Once the go-live is complete and you’ve stabilized, you start looking at your growing optimization list. It’s important that you have clear governance and, again, that you have a partnership with your clinicians and IT so that your clinicians, with support from leadership, are driving the high priority changes that are needed in that optimization effort.

Campbell: Right and you hit the nail on the head there. I’m co-authoring a white paper with Jim Boyle, VP of IS at St. Joseph Heritage Healthcare, as they are going through an optimization initiative, and as you mentioned, there must be a partnership between IT/Administration and clinicians. At St. Joe’s Jim mentions they have established dyad relationships between administration and clinician leaders, and as such, there is perspective and vested interest from both sides. I appreciate you sharing that viewpoint.

Schade: One point I also want to highlight about optimization is training. I think the training piece is critical, as you have to connect those two to the extent that for what you do roll out, your users have to be very well trained, they need to know how to use all the functionalities, and they need to know how to use it efficiently. Sometimes when an optimization or a change is requested, when you really look at it, it could be a training issue, in that the users don’t know how to do something or lack awareness into something that is possible within the system. You should have those two tied very tightly together. I’ll use the example without mentioning specifics, but we have a go-live this week at Stony Brook Medicine introducing a couple new major enhancements and modules. Keeping tabs on how it’s going, one of the issues that’s coming up is training: did everyone go through the training that was made available or not? When you have training available, but not mandatory, you start running into issues of, people aren’t sure how to do something, what’s possible, and they might ask for it to be different, but again then it goes back to let’s make sure we have comprehensive and complete training.

Campbell: That’s a truly salient point. Recently, three prominent Boston-area physicians just contributed an opinion piece to WBUR, “Death By A Thousand Clicks”.  They postured that when doctors and nurses turn their backs to patients in order to pay attention to computer screen, it pulls their focus from the “time and undivided attention” required to provide the right care.  Multiple prompts and clicks in an EHR impact patients – and contribute to physician burnout. That said, if providers lack proper training, they may not know of the systems capabilities or have awareness of a more efficient way of accomplishing a task.

Schade: Exactly, do you use Outlook, for example, or what’s the main software you use?

Campbell: Yes, Outlook.

Schade: So people like you and me, who do not use an EHR as the system of record, we’re in Outlook all day for calendar, tasks, and email. Someone may watch over your shoulder as you do something one day and go ‘Oh! Didn’t you know you can do xyz?’ and you go, ‘Oh! No I didn’t!’ and they go ‘Here click on that.’ Suddenly you learn a quicker shortcut or method to accomplish something but in the meantime you’ve been doing it the way you’ve always done it with significantly more clicks and steps. Again, it comes back to training and people understanding what’s possible and how to do things. That’s not to say there aren’t opportunities to make the software work better for our clinicians.

Campbell: I wanted to touch base on one more broad question around application rationalization and consolidation. I’m sure it’s been different from organization to organization, but as CIO, what applications are under your purview outside of the EHR? Have you taken part in a consolidation effort in the past where you may have duplicative functionality brought on by a best of breed approach to system adoption? And did you leverage an application to do that or certain practice? If you can elaborate on your experience with that I think it would be helpful for other organizations who are looking at eliminating the technical debt legacy systems create.

Schade: We had started down that path at Michigan, before I left, so I can’t say that I took it all the way to completion. It was one of the opportunities identified as part of an overall value and margin improvement effort in attempting to reduce costs within the organization. I’ll tell you, just inventorying your application portfolio can be painful. You have a lot more disparate and duplicate applications than you ever realized, but step one is to get your hands around that current state. Let me just say this, application rationalization is something that often goes hand-in-hand with implementation of a new core EHR because you may be implementing a common system where there have been disparate systems at multiple facilities and that common system can replace a lot niche applications. The current state inventory of applications is a critical initial step. I’ll be the first to say that many organizations don’t have something they can pull up and say ‘here’s our inventory.’ They should, but they don’t.

About Sue Schade

Sue Schade, MBA, LCHIME, FCHIME, FHIMSS, is a nationally recognized health IT leader and Principal at StarBridge Advisors providing consulting, coaching and interim management services.

Sue is currently serving as the interim Chief Information Officer (CIO) at Stony Brook Medicine in New York. She was a founding advisor at Next Wave Health Advisors and in 2016 served as the interim CIO at University Hospitals in Cleveland, Ohio.

Sue previously served as the CIO for the University of Michigan Hospitals and Health Centers and prior to that as CIO for Brigham and Women’s Hospital in Boston. Previous experience includes leadership roles at Advocate Health Care in Chicago, Ernst and Young, and a software/outsourcing vendor.

She is active in CHIME and HIMSS, two leading healthcare IT organizations. Sue was named the CHIME-HIMSS John E. Gall, Jr. CIO of the Year in 2014 and holds the following recognitions:

  • “Most Powerful Women in Healthcare IT” – Health Data Management, 2016 & 2017.
  • “50 Top Healthcare IT Experts” – Health Data Management, December 2015.
  • “11 Hospital IT Executives You Should Follow on Twitter” – Health Data Management, August 2015.
  • “50 Leaders in Health IT” – Becker’s Health IT & CIO Review, July 2015.
  • “Top 10 Most Influential Healthcare CIOs on Twitter” – Perficient, April 2015.
  • “100 Hospital and Health System CIOs to Know” Becker’s Hospital Review, 2013, 2014, 2015.
  • “10 CIOs You Should Follow on Twitter Today” – FierceCIO, April 2014.
  • “Top 10 Women ‘Powerhouses’ in Health IT“ – Healthcare IT News, April 2013.
  • “8 Influential Women in Health IT“ – Fierce HealthIT, October 2012.

Sue can be found on Twitter at @sgschade and writes a weekly blog called “Health IT Connect” –  http://sueschade.com/

About Justin Campbell

Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration, and optimization of clinical systems. He has been on the front lines of system replacement and data migration is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.