On Leadership

Ensuring go live success for large scale IT projects

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Since the pandemic, major system implementations at health systems have continued with successful go lives supported by virtual or hybrid remote/onsite teams. Many organizations have “go live” success stories in this new world of remote work. While virtual support may change some things and certainly presents new challenges, the core work of a successful go live is still the same.

In late 2019, I published several blog posts on successful go lives based on firsthand experience with a major Epic implementation. Here they are again with basic lessons and tips:

10 Go Live Command Center lessons from the field

Epic Go Live – report from the field

9 Tips for Go Live support success

I welcome your comments on any virtual or hybrid go live experiences you have been involved in during the past year. If I get enough new lessons and tips, I will write a new blog so all can benefit. After all, continual learning and sharing best practices is at the core of what we do in healthcare.

Why this topic this week? I am currently working with a client who is less than six weeks out from an ERP go live so it is on my mind a lot. We are doing what we refer to as an Independent Verification and Validation (IV&V), a framework that facilitates audits of major IT projects regardless of area and complexity.  We explore 11 categories in-depth.  The topics range from governance and budget to training and QA.  The detailed analyses for each area involve document review and interviews to ascertain the status of the project.  A risk score is assigned in each of the 11 areas and mitigations are suggested based on the findings.  Ideally, over the life of the project there are three IV&V sessions conducted prior to go live and one session after go live to ensure that projects stay on course, make corrections as necessary in a timely manner, and achieve the defined objectives.

If you think an IV&V from my advisory firm, StarBridge Advisors, is something that your organization can use, please contact us to discuss.

Vaccine rollout – it takes a village, part 3

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Let’s start with the big picture and some good news. There are downward trends in the key COVID-19 indicators – the number of new COVID cases, hospitalizations, and deaths. But we know there is no good news in 3,000 deaths per day and nearly 500,000 deaths since the pandemic started a year ago.

In terms of the vaccine, there is good news at a macro level. According to the Bloomberg COVID tracker, 48 million doses have been given in the U.S. with an average of 1.62 million doses administered per day, 14.6 doses have been administered for every 100 people, and 70% of the shots delivered to states have been administered. (as of 2/11/21 at 6:25PM)

There are more examples of mass vaccination sites with thousands being vaccinated in a single day at stadiums around the country. UC Health in Denver is offering a playbook for mass vaccination sites to other health systems – best practice sharing is something we do very well in healthcare.

Dr. Anthony Fauci projects that by sometime in April, the vaccine will be available to anyone who wants it. That seems very optimistic considering many states are just now in mid-February beginning to vaccinate anyone over age 75. President Biden says there will be enough vaccine supply to vaccinate 300 million in the U.S. by the end of summer.

Access issues continue with a lot of confusion and frustration for those in qualified groups trying to make appointments either online or by phone.  It has become a family affair for many as younger family members try to help their elders figure out how to get vaccine appointments when there are multiple channels possible in their state or city and multiple different websites to go to. I applaud the various initiatives of software engineers in Massachusetts and New York who based on their own frustrating family experiences created a way for people to check availability of vaccine appointments. But we should not have to rely on such solutions. I would expect our government agencies to have made it simpler to begin with.

I just learned of another tool that notifies people via text message when there are leftover doses in their zip code so no dose goes to waste – Vaccination Standby  List. According to the website, their mission is  “to reduce COVID vaccine waste, reduce unnecessary lines and crowds at stores, reduce misinformation of leftovers, and allow as many people as possible to take advantage of any leftover doses”.

Disparities in vaccine distribution are real. We need more examples like the one in South Los Angeles where Dr. Jerry P. Abraham and the Kedren Community Health Center set up a walk-in site described in the Los Angeles Times article by Erika D. Smith on January 29, “Column: How a South L.A. doctor is beating the system and distributing vaccines equitably”. In Dr. Abraham’s interview on MSNBC’s Rachel Maddow Show on February 5, he said that he and his team are extremely solutions oriented and recognized that people with no car, no Internet access, and no email needed a workaround. Continue reading →

Vaccine rollout – it takes a village, part 2

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Last week’s blog post on vaccine rollout took longer than expected to write as I compiled multiple resources and articles to comment on and share. With the vaccine rollout as massive an undertaking as it is and so many stories (good and bad), I decided to do part 2 this week highlighting best practices, technology challenges, and health disparities.

Best Practices

Last week, I mentioned Atrium Health and their local partnership to do mass vaccination events. It was encouraging to see their update on vaccinating over 20,000 people had a special emphasis on underserved communities.  We need more focus on underserved communities – more on that in a bit.

Another health system doing drive thru vaccination clinics at scale is Memorial Hermann in the Houston area. They are getting calls from health systems across the U.S. asking for guidance on how to design similar large-scale vaccination events and are more than willing to share their blueprint for others to replicate according to Binita Patel, Vice President of Pharmacy Services for Memorial Hermann Health System. The location (NRG Park) and staffing (700 people including many volunteers) were key to their success.

We cannot forget that there are many people leery of the vaccine, sometimes referred to as “vaccine hesitancy”. Education and public health messaging campaigns will be key as the vaccine rollout continues over the next several months. Based on the Kaiser Family Foundation’s latest COVID-19 Vaccine Monitor report, there are key messages that resonate with people. They are listed in this short article from Becker’s Health IT : “8 most convincing messages to promote COVID-19 vaccines”.

Many health IT vendors pivoted their products and services to support COVID-19 over the past year. Vaccine scheduling is the latest focus area for vendors like Kyruus which shared best practices and insights from their customers in their recent blog: “Eight Best Practices for COVID-19 Vaccine Scheduling Online: Insights From Our Health System Customers”. A great transition to the next topic.

Technology Challenges

I mentioned the Vaccine Access Management System (VAMS) in my post last week as a system provided by CDC to states and other organizations for pre-screening, registration, scheduling and tracking. Not surprisingly, a software solution developed quickly and made available for many different but similar situations and workflows has experienced problems as captured in this article from MIT Technology Review. I would hope the problems can be resolved so organizations using it do not have to switch systems midstream with vaccine rollout already in process and moving rapidly. Continue reading →

Vaccine rollout – it takes a village

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The vaccine is top of mind for many of us and a lead news story most days. Whether we are in a prioritized group wondering when/how/where we will be able to get the vaccine or are helping a family member in one of those groups sort it out. We are disappointed to hear the supply from Pfizer and Moderna is so limited at this stage. We are frustrated and anxious not knowing when we will be able to get the vaccine.

I share all those feelings. I am anxiously waiting to learn when my state of Rhode Island will start vaccinating 65+ so I can get my husband and I an appointment. With the percent of doses administered overall in Rhode Island only 56% of what has been distributed and our state currently receiving just 14,000 new doses each week, I am not optimistic that it will be soon.

In spite of any frustration you may feel about your own state’s progress, the good news at the macro level is that in the last week, an average of 1.25 million doses per day were administered in the U.S. That is even better than the goal of 1 million per day for the first 100 days of the Biden Administration. And there is more good news regarding the supply – 200 million more doses were ordered by the Biden Administration this week with the expectation that there will be enough doses for everyone who wants the vaccine by sometime this summer.

We know that vaccine plans vary by state. How to Get a COVID-19 Vaccine: A State-by-State Guide from the Wall Street Journal provides state website links and brief description of each state’s status. States vary on how groups are prioritized, the scheduling process and systems used, and the total number of doses available. In the 65+ group, I have friends and family who have driven more than 500 miles around their state for separate husband and wife appointments that they could only make at two different locations due to the demand, a couple who was only able to register for a lottery with 8000 doses to serve 250,000 people, a couple who relatively easily made appointments at their grocery chain to receive the vaccine from the pharmacist, and a couple who relatively easily made an appointment at a local community vaccine site.

The New York Times has a vaccine calculator – Find Your Place in the Vaccine Line – that puts it into perspective. You enter a few key data points and can see where you are in line within the U.S., your state, and your county – in other words how many thousands or millions of people are ahead of you. The graphic it produces helps you understand the order of groups and their relative size.

There are two trackers you might find interesting. The Johns Hopkins Coronavirus Resource Center tracks cases, testing and vaccines by state. You can see how your state is doing and where it ranks on vaccinations. The Bloomberg tracker shows how your state is doing by percent of doses used and number of doses administered.

There is a software system available from the CDC for states, counties and other organization to use – Vaccine Access Management System (VAMS). It handles pre-screening, registration, scheduling, and tracking. My state of Rhode Island will use PrepMod – a software solution in use by several states. Health systems appear to be using their own systems and assuming that patients can schedule through their patient portal or by phone. Some allow you to create an account if not already a patient.

I think we can all agree that front line health care workers needed to be first in line for the vaccine. But there have been stories of health systems vaccinating employees who only work from home, volunteers who aren’t coming into the hospital during the pandemic, board members and others who don’t appear to be in priority groups per the CDC guidelines. These systems have defended their actions by saying the more people vaccinated and the sooner is good for the community and that all staff are critical to the hospital’s operations. I can understand the frustration of people who are patients of those systems and in a prioritized group (such as elders or with underlying conditions) yet still waiting to learn when they will get the vaccine.

Let’s pivot to some positive stories of vaccine partnerships involving health systems to deliver shots in arms at scale. Continue reading →

400,000 lives lost – finally a national strategy

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On December 14 with the first frontline workers in the U.S. starting to receive the vaccine there was great optimism and hope that we had entered a new chapter of this pandemic. But six weeks later over 100,000 more people have died of COVID-19 and only 16.5M of the total 36M vaccine doses distributed have been administered. 5% of the U.S. population has been vaccinated though only 2.1M people have received the full two doses.

On Tuesday night, on inauguration eve, the new administration held a National Moment of Unity and Remembrance. A simple ceremony in front of the Lincoln Memorial to mourn and honor the over 400,000 people who have lost their lives to COVID-19 in less than a year. President Joe Biden and Vice President Kamala Harris spoke briefly, an ICU nurse from Michigan sang Amazing Grace, and 400 beams of light were lit up along the reflecting pool in front of the Washington Monument – one for every 1000 lives lost. Across the country bells tolled and buildings were lit up. It was a simple yet moving and much needed moment for all of us.

Five hours after President Biden took the oath of office on Wednesday, he was signing his first set of executive orders. Three of them including the very first were directly aimed at the pandemic – “100 days masking challenge”, rejoining the World Health Organization (WHO), and creating the position of COVID-19 response coordinator. Dr. Anthony Fauci is the U.S. representative to the WHO executive board and joined his first call on Thursday. Jeff Zients, who served as chief performance officer under President Barack Obama and led the rescue of HealthCare.gov, has begun his work as the COVID-19 response coordinator. Zients is “ready to manage the hell out of it”, as Biden said last Friday.

The new administration is getting right to work, and the pandemic is a top priority. A National Strategy for the COVID-19 Response and Pandemic Preparedness was released yesterday. Continue reading →

Health leadership and priorities in the Biden Administration

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Over the past several weeks, we have watched as President-Elect Joe Biden has announced his cabinet nominees and other senior officials. He has done it one major area at a time. The health nominees and appointees can be found here. They are an impressive, well qualified team.

The CDC appointment may be one of the most important and consequential of all given the pandemic and how confidence in the CDC has eroded over the past year. Dr. Rochelle Walensky is ready to turn that around and I for one am both excited and optimistic. You can get a sense of who she is and how she will lead the CDC in a recent In The Bubble with Andy Slavitt interview: Meet the New CDC Director (with Rochelle Walensky).

Getting the pandemic under control is the top priority of the new administration. Biden has outlined a $1.9 trillion stimulus plan that includes more than $400 billion to fight the pandemic directly. The COVID-19 portion includes $20 billion for a national vaccine plan, launching community vaccination centers, deploying mobile vaccination units in hard-to-reach areas, $50 billion for testing expansion, funding 100,000 public health workers for vaccine outreach and contact tracing, funding for health services in underserved populations, and $10 billion for pandemic supplies.

We all know that health IT is critical to healthcare transformation. In a December 15th letter to President-Elect Joe Biden, HIMSS identified the following as key health priorities for 2021 and beyond and pledged to diligently work with Biden and his administration on the issues that require immediate action beginning in 2021. Continue reading →

January 6th reflections   

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I could not write about what happened on Wednesday at the U.S. Capitol any sooner. As I have watched the images on TV the past few days and tried to process it all I wondered what I could say that would make any difference. What would a tweet, a retweet, or a like matter on social media?

I have written posts on significant events and political issues in the past – the 2016 election, Black Lives Matter movement, racial disparities in healthcare, separating families at the border, gun control, gay marriage and more. I try to come at it from a health IT perspective, somehow. I’m not sure how to do that with this one so I won’t even try.

As a leader in my profession and industry, and as someone with a social platform, I decided that I can’t be silent. What I have seen this week only strengthens my commitment to continue to lead by example and help develop the next generation of leaders who are competent, decent, caring, fair and serve with integrity. And to ensure our children know that what they saw on Wednesday was very wrong.

I had tears when I realized how bad the assault on the Capitol could have been. Contrast that to my tears of joy when the first black man was inaugurated 12 years ago on the steps of the Capitol. I remember watching President Obama’s inauguration with my colleagues at Brigham and Women’s Hospital where a large screen had been set up in one of the largest meeting rooms for employees who wanted to watch. From housekeeping staff, to nurses, to VPs – we were there, watching, and filled with hope.

I had tears of sadness in 2016 when Hillary Clinton lost to Donald Trump, but I accepted it. I was willing to give him the benefit of the doubt. But the divisiveness that has been perpetuated these past four years has hurt our country for years to come. I feared his re-election in 2020 and had tears of joy again on December 7 when it was clear that President Elect Joe Biden had not only won the popular vote but also the electoral college.

What happened on January 6 had been building for four years and more intensely for the last two months. Continue reading →

Developing next generation leaders 2021 style  

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In 2021, I have said yes to one more way I can help develop next generation leaders. I am excited to be one of the rotating co-hosts on This Week In Health IT Monday Newsday series. Bill Russell has done an amazing job the past three years growing and evolving This Week In Health IT into several different podcast series and channels. Bill shares my commitment to developing next generation leaders through his many different offerings, so I quickly said yes when asked to be one of the co-hosts in the new format of the Newsday series.  Our first episode together will be available January 11, so I hope you will check it out.

Bill’s commitment and goal is clear: develop the next generation of health leaders by amplifying the best thinking. This Week In Health IT has proven to be a valuable contribution to our industry. My health IT advisory firm, StarBridge Advisors, is proud to continue as a channel sponsor in 2021.

After a very successful 2020 with 230,000 downloads and 177 new episodes including the daily COVID Field Report series from March to July, Bill has changed things up yet again for 2021. There are several options to pick and choose from for yourself and to share with your teams. These offerings provide a no-cost, easy, accessible way for staying current and continuing to learn from others.

Monday Newsday – replacing the Tuesday Newsday show, every Monday Bill will have a co-host to discuss key stories in the news.

Wednesday Solutions Showcase – 2020 episodes highlighted AI, Robotic Process Automation, Machine Learning, End Point Security, Social Determinants of Health partnerships, Mental Health integration with primary care and more.

Friday Influencers – Interviews with industry leaders. Guests include IT leaders, health executives and experts who can shed light on the challenges that healthcare faces and the potential solutions. Continue reading →

Looking ahead to 2021 – predictions, emerging trends, and some advice

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The calendar is a familiar demarcation for the close of one year and the start of a new year. We celebrate together and make resolutions alone. Never in my lifetime has there been a year that I have wanted to see in the rear-view mirror more than 2020. I know that I’m not alone in that sentiment. But the true demarcation will only come later in 2021 when enough people have been vaccinated and we can say this pandemic is largely behind us.

Health IT leaders and their teams across the country have demonstrated incredible creativity, collaboration, resilience, and commitment to their communities this past year. I am in awe of and encouraged by what they have accomplished.

As we come out of this long, dark period in our history with so much loss and so much learned, like others I have some advice for IT professionals next year.

My StarBridge Advisors colleague, David Muntz, has already shared his thoughts on the challenges and opportunities for the coming year as he does each year in a View from the Bridge blog post – “12 Steps to Prepare for 2021 – Big Challenges – Bigger Opportunities”. As always, David has done an excellent job of capturing the key ones with his comments on collaboration, reinventing your IT organization, partnerships, life-work balance, cybersecurity, SDOH, EHR satisfaction, ERP solutions, and more.

I’ll add a few to the list:

    • Capture and institutionalize what allowed your team to work at “COVID speed” – laser focus, fewer concurrent priorities, rapid decision making, and funding.
    • Double down on efforts to increase interoperability within your system and region. Enhance your analytic capabilities. Scale and extend virtual care options which will continue to represent a good portion of care even post-pandemic.
    • Establish the right balance of onsite and remote work for your team once it is safe to return to the office. Account for both the organization’s needs, and your employees needs. Continue to be flexible knowing your team delivers regardless where they are working. Use your new model as an opportunity to rethink your recruitment and talent strategy.
    • As CIO claim your expanded role whether it is as Chief Digital Officer, Chief Innovation Officer, or leading a non-IT operational area. You have more than proven yourself during this pandemic and the rest of the c-suite knows it.

Continue reading →

8 health experts to follow

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In past years, I’ve used the end of the year mark as a way to highlight my most read blogs of the year and encourage you to check them out if you missed them. But who cares about my most read blogs? Instead, I want to amplify the voices of health experts who have educated us throughout this pandemic and who will continue to for many months to come. If you aren’t already following them on social media or listening to their podcasts, I encourage you to do so. They are often interviewed on the major news programs.

Trusting the science, knowing the facts, and maintaining objectivity are critical for all of us to do our part and get safely to the other side of this pandemic.

Here are the experts I recommend you follow in alphabetical order:

Esther Choo, MD, MPH, Co-Founder, Equity Quotient, is an emergency physician and professor at the Oregon Health & Science University. She has been speaking from the front lines of the pandemic since the beginning. She did a podcast series called Doctors’s Log – A Covid-19 Journal in the early months of the pandemic. Twitter: @choo_ek

Laurie Garrett is a Pulitzer Prize winning science journalist and author of several books including “The Coming Plague: Newly Emerging Diseases in a World Out of Balance” and “Betrayal of Trust: The Collapse of Global Public Health”. In 2007, she did a TED talk “Lessons from the 1918 Flu”.  Twitter: @Laurie_Garrett

Ashish Jha, MD, MPH, is an internationally respected expert on pandemic response and preparedness. He recently left his position as faculty director of the Harvard Global Health Institute and became dean of the Brown University School of Public Health.  His recent interview on In the Bubble with Andy Slavitt, “The Next Three Stages of COVID-19”, is worth checking out. And as I just learned, he also has his own podcast series, “COVID: What Comes Next”. He is a frequent contributor on all the major news outlets. Twitter: @ashishkjha

Vivek Murthy, MD, MBA, has been nominated as the next U.S. Surgeon General, a role he also served in during the Obama Administration.  He is the co-chair of the Biden COVID Task Force. His recent interview on in the Bubble with Andy Slavitt, “Inside the Biden COVID Task Force”, is worth checking out. Twitter: @vivek_murthy

Michael Osterholm, MS, MPH, PhD, is the director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota and is a world-renowned epidemiologist who has spent his career investigating outbreaks. He is a member of the Biden COVID Task Force. Continue reading →