If you live in a large metropolitan area, chances are you have been either a patient or a visitor in an academic medical center that has 500 to 1000 beds. If you live in a rural area, you are probably more familiar with a small local community hospital with less than 100 beds.
Because of healthcare mergers and acquisitions, these two different kinds of hospitals are likely to be part of one integrated health system. While different in size and scale, they both deliver healthcare to their community 24×7.
Small, independent hospitals are often very agile, extremely customer service oriented and supported by a loyal community. In IT, the staff are often generalists and less specialized. They may have a single integrated system from one vendor with basic functionality and limited integration points with other applications.
In contrast, large academic medical centers can be slow to make changes and appear more bureaucratic. They provide advanced medicine with subspecialists and clinical services not found elsewhere. They have to work harder to create a culture of customer service. Their community is broader and they attract patients from greater distances, including international patients. And their IT teams are larger with many specialized roles. In addition to their core electronic health record, they have many specialized departmental applications, many interfaces. Overall, it’s a far more complex environment.
So how do these different profiles mesh at merger time? Continue reading
It’s that time again. Time to close out my current interim CIO engagement and transition to the new CIO. I’m delighted to share the news that Stony Brook Medicine has hired Kathy Ross as their next CIO. She starts July 24th and we will have a few weeks together to complete the transition.
Kathy brings extensive healthcare CIO experience having served for many years as a CIO within Ascension Health. She is no stranger to Cerner, our core EMR vendor. But walking into a new environment with all its complexities and uniqueness is a challenge for the most seasoned leader.
We can only have one CIO at a time so day one, it will be Kathy. I will work out of a temporary space nearby. My focus and role will be to support her and provide as much background information as I can to ensure she gets up to speed quickly.
While I have only been serving as interim CIO since early March, my plan for what I need to fill her in on is long and growing. It includes a review of where we’re at on my focus areas during this interim. We’ll block time to review together key background information and issues needing attention. And we’ll do meetings together with everyone on the IT leadership team as part of the handoff.
I learned at my last interim to block out chunks of time to review everything on the transition outline and not let the usual day to day meetings fill all available time. Continue reading
Telehealth or connected health as some call it, takes different forms depending on the provider organization and their strategy. The primary driver may be extending geographic reach by providing telehealth services to rural areas. Or it may be largely a focus on consumer engagement.
Regardless, there are common themes for successful initiatives. Based on my experience in several healthcare systems in recent years, I offer these tips for success:
Strategy is key – The organization must first determine what the key drivers are for the initiative. Is it to extend reach or provide an easier patient experience or a combination?
Tactics and specific programs will follow – Once the strategy is clear, which specific clinical services and offerings are needed the most will become clear.
Physician leadership is needed – If the focus is on extending reach of certain clinical services, physicians are at the center and must provide overall direction. For consumer-focused services, ambulatory services or strategic planning leadership may play a more central role.
Operational issues and decisions must be considered early on – There are legal and billing factors along with workflow issues for clinicians and staff to work out before any implementation. Continue reading
Communicate, communicate, communicate. How often have you heard it said that you can’t communicate enough?
A best practice for CIOs is to have “all staff” meetings at least quarterly or semi-annually. Regardless of the size of the IT department and the logistical challenges of getting people in one place, these meetings have value. Depending on the geographic spread of the IT team and availability of meeting space, you can always leverage technology to allow staff to dial in from their workspace.
Connecting with colleagues that they only hear on conference calls or “see” via email has value. If you are able within your budget to provide food, all the better to encourage social time before or after the actual meeting.
Such meetings allow you or guest speakers to provide the big picture on your organization’s strategy and priorities so everyone understands how their work fits in. You can communicate key updates and information on major projects and new processes that impact all or most of the staff. You can use it as a forum to provide education on key topics that all IT staff need to understand such as cybersecurity or bring in a motivational speaker.
At one organization where I served as CIO, shortly after I started, one of my direct reports was quick to tell me the exact number of years, months, and days since their last all staff meeting. How do you really feel about that was what I wanted to ask him. But I quickly understood he was representing staff who missed those meetings and wanted them re-introduced. I did ask why they were discontinued. The story I got was that the previous leader was asked a difficult question by a staff member, felt on the spot and didn’t want that to happen again.
As a leader, I welcome questions, even if I can’t answer them. Continue reading
What is a “frenemy”? According to Dictionary.com: “person or group that is friendly toward another because the relationship brings benefits, but harbors feelings of resentment or rivalry”.
Within health care organizations, there is a lot of history between the people who support the medical devices that touch patients and those who support the information systems used by clinicians. It has not always been positive and collaborative. In fact, there are such differences in the culture of each group that they don’t always get along. Maybe they are even “frenemies” in some organizations.
In your hospital, you may know the function as Biomedical Engineering, Biomed, Clinical Engineering or Health Technology Management (HTM) as it is now called as part of elevating the profession within healthcare. Those in the field now refer to themselves as “HTMs”.
AAMI (Association for the Advancement of Medical Instrumentation) is a standards development organization and the professional society for HTMs. AAMI is celebrating its 50th anniversary this year. Its mission is to advance safety in healthcare technology.
Four years ago, I was the first CIO ever to be elected to the AAMI board when AAMI leaders recognized the trend towards HTM and IT convergence and integration. I have provided the IT perspective to the AAMI board as the HTM profession continues to evolve. Continue reading
What consultant doesn’t want to work close to home as much as possible? But you go where your clients are and you get used to traveling.
It was one of those weeks. There was the usual 2-hour drive plus the 1 hour ferry ride to my interim CIO engagement on Long Island. Monday was the first time I worried about missing the ferry. My “wiggle room” on the drive part evaporated with bumper to bumper traffic as soon as I got on I-95 in Providence. I sweated it but I made it!
Then there was a same day trip from New York to Chicago for a CHIME Education Foundation Board retreat. It seemed like a good idea when we agreed to fly in and out the same day but reality of that can be brutal – a very long day!
And finally, there’s the commuter rail train ride into NYC to meet my husband for the holiday weekend.
I’m happy to not depend on airports for my current weekly commute compared to many who are truly “road warriors”. I feel a little spoiled. My biggest stress is whether I’ll hit traffic on I-95 and have to take a later ferry.
When I was the interim CIO at University Hospitals in Cleveland last year, it was a predictable 3.5-hour drive from Ann Arbor. A few times I ran into huge traffic jams and a long out of the way road construction detour. But it was mainly a predictable weekly commute. And productive when I could get some calls done during the drive.
Once we moved to the Providence area, it meant a weekly flight. The Providence airport has fewer direct flights. I had to choose between connecting flights which increase potential delays or the longer ground transportation to get direct flights out of Boston. I chose the latter.
Then my current engagement on Long Island came up. Driving through NYC or flying was a non-starter. It was a “go” when I learned about the ferry option. Continue reading
You are past the big go live. You and your team are focused on optimization, enhancements, ongoing support issues, and upgrades. So, what should you expect from your vendor in this ongoing relationship?
I have worked with all the major EHR players and many other IT application and infrastructure vendors over the years. I have worked with three of the major EHR vendors just in the last 18 months given my interim CIO engagements.
My post “Keys to successful vendor management“ covered the importance of the product roadmap, service, total cost of ownership, reputation, contract, implementation, and escalation.
It’s time to look at the ongoing vendor relationship that clients should expect. Vendors, take note. I assume most of your clients would share this view. There’s a reason that the KLAS Research reports carry a lot of weight for CIOs, they are vendor evaluations from their peers.
Whether it is a large, proven vendor or a small start-up, here’s what you should expect: Continue reading
It’s that time of year. Maybe you just did a spring break trip with your kids or you are planning your summer getaway. Whatever it may be, you need to take time to reboot.
Leave the job behind and leave good people in charge and covering for you. Companies give vacation and PTO time for just that – Personal. Time. Off.
Over the years, I have gotten better at checking out and turning it off. I learned my lesson the hard way on a vacation many years ago with my family. It was ruined by being totally available for problems that arose back at work. I spent most of my time either on the phone or worrying about what was going on. Turns out, it wasn’t even concrete problems that needed to be addressed; it was just work politics.
I’ve shared my thoughts on the importance of taking time off openly so others don’t have to learn the hard way like I did. And I encourage my staff to take their vacation time and check out while away.
As it is, the days leading up to a vacation and the days following are tough enough. There’s everything you think you need to get done that just can’t wait a week or two on the front end. And then thinking you are a super human who can get through all their email for a week or two on the first day back. For those of you who can, is that badge of honor worth it? Continue reading
I am a lean leader and always willing to share my learnings. I’ve written several blog posts chronicling my lean experience at different organizations. Some of them have been quite popular with readers. I’ll call them my “lean classics”. Here’s a recap for your reference:
Huddles and Visual Management:
Leadership huddles: not just another meeting – describes my first IT leadership huddle launch back at University of Michigan Health System. As my lean coach said at the time, be willing to experiment, it doesn’t have to be perfect. We learned and tweaked it as we went through the PDCA cycle.
Making the invisible visible – describes the beginning stages of the visual board our IT leadership team created at University Hospitals in Cleveland.
Making the invisible visible – part 2 – describes that same effort several months after we launched it and how we used it as a team.
6 tips for successful huddle boards – based on experience, my advice to those considering their own huddle boards. Remember, you need to be willing to experiment.
Importance of rounding or going to the “gemba” – describes early experience with clinical and operational rounding both at Brigham and Women’s Hospital and University of Michigan Health System. Continue reading
There continues to be a lot of focus on telecommuting and open office space for knowledge workers in large organizations. Both are important yet not everyone agrees they are good – a lot depends on the organization and the culture.
But I want to focus on another “space planning” topic, co-location. As health care organizations grow, administrative departments including IT often end up being spread out in many office buildings, sometimes at great distances from the hospital with a lot of traffic in between.
The investment needed to centralize all the administrative functions in one building often takes backseat to investing capital in clinical space. No surprise. Video conferencing is always an option for bridging the miles. This technology continues to advance and become more of a commodity. National and global companies must leverage technology but health care systems are mostly local or regional.
In my many years of health IT management, I’ve experienced a variety of space situations: Continue reading