April 14, 2023: Former CIOs Stephanie Lahr, current President of Artisight, and Lee Milligan, current SVP and CIO of SimonMed Imaging, join Bill for a conversation about the CIO role. What are the real challenges that CIOs in healthcare are facing today? How can CIOs manage the financial pressures faced by healthcare systems while maintaining the quality of care? How can CIOs work with other executives to effectively manage healthcare systems? How can financial pressures be addressed while maintaining innovation within an organization?
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Today on This Week Health.
Innovation especially if you think about it from the standpoint of using creativity and ingenuity to solve the problems that are in front of you, thinking about them differently and new ways to get to the end of the solution. That is an imperative. We can't afford not to do this because what you may save today to get you through this fiscal year may cause you to not be in existance in one to two years.
all right. Today we have a special keynote. I'm really looking forward to this. We have Stephanie Lahr, who is former CIO at Monument Health and Lee Milligan, who is a current CIO at Simon Med. Former CIO for Asante Health, and we're calling this episode the former cio conversation essentially is what we're calling it. And I just wanna welcome you to Stephanie and Lee to the show Veterans of the Show. Looking forward to the conversation.
Happy to be here. Thanks, bill. I thought I was gonna be the recovering CIO session.
uh, I'm not allowed to use that term anymore.
I was told after a certain time, I'm not allowed to say the term recovering cio. Okay. At least in reference to me and Lee, you're still a cio, so I,
and I'm too young for that. Come on now. Exactly. It's all just part of the flow, right.
Yeah. So here's what I'd like to do.
I mean, as former CIOs, I'd like to have a little broader conversation,. When you're in that chair, it's harder to answer questions like, Hey, what are the real challenges that CIOs in healthcare are facing today? And I'm hoping we can get just a little bit more real, a little bit more tangible in terms of things that people are facing and how they can get through it.
But I wanted to start here. You're both physicians I wanted to give you both a couple minutes to just talk about your path physician to cio and then the decision to leave. And Stephanie, we'll start with you.
Okay, yeah, sure. It's a winding path. I often tell people, if you would've asked me when I was in medical school, if you think like 20 years down the road, you might be a cio, I probably would've said, what is a cio?
Like, why would don't even know what that is. Why would I be that? At the same time, my career path has been so fun and I feel like it's been a privilege to be able to kind of jump in and out of different lanes. And honestly, that's probably really what my path, what kind of defines me. I love what I'm doing.
I went into internal medicine cuz I couldn't decide, right? I loved everything. When I was on the surgery rotation, I wanted to be a surgeon. When I was on the peds rotation, I wanted to be a pediatrician. And so, My path, I sort of feel like has been this opportunity to reinvent myself and my career about every, five to nine years in a new way that brings me new challenges as a person who wants to kind of learn continuously.
My most recent jump going from the cio, C M I O on the provider side, into the vendor space, certainly is probably one of the biggest jumps I've ever made because before that, I was still in the health system, right? It all still felt very familiar. They were my people. And so moving outside of that has been interesting.
I think, for me, where I was in making that decision were, it was kind of two things. I was so excited by the opportunity that Artisight that I'm with now presented around transformational change to healthcare systems and more than anything, that's what I was feeling as the CIO was, we can't keep doing what we're doing and yet we're not gonna flip a switch and have it change.
So how do we do this? And I started to see the light around a path that realistically could get us there and that passion that I always had. As a physician and then C M I O and c I O was something I felt like I could bring to that. And then, I think each of those steps has also been an opportunity to impact things on a different level, right?
As a physician, I was impacting one patient, one family at a time, moving into leadership. I was impacting a team, and then I was impacting an organization, and then I was impacting a community. And now I am hopeful to impact the greater delivery of healthcare.
Yeah, an entire industry as president of Artisight.
Wow. Lee, she has a phenomenal story. I'm sorry I made you go second. How did you get into the CIO role from a physician, and then how'd you decide to move to the next role?
Yeah. I can't even compete with that. That's pretty good. But I will say that like Stephanie, curiosity really drove me quite a bit.
I was really interested, like she said, in a variety of different areas, and I think just this idea of wanting to learn, continue to learn throughout the course of one's career is really a, kind a, been a driving force for me along this journey. I feel in many ways. I was very lucky that the timing of all of the regulatory changes when that happened, that coincided pretty well with where I was in my career.
And what I was looking to do at that point, and very much like Stephanie, I wanted to impact more at scale. And so that's really what drove me into working both, in the system and on the system at the same time. In terms of going from a health system a traditional community-based health system to a different scenario.
Again, it came back to wanting to learn and grow in kind of a new space. I moved into the imaging space, and specifically what I really wanted to focus on in the imaging space was artificial intelligence. I really wanted to understand how, we have this scenario where we have. Billions and billions of images out there, which are really just patterns.
And we have ICD 10 codes that correspond to them. If you think about how machine learning works and how artificial intelligence can produce value and results, it probably isn't a better model out there for actually accomplishing that. And so since I've moved to Simon Med, that's been an area of one of my focus.
Yeah. So you're actually more focused, cuz as a CIO you would've had imaging at Asante, but now you're really focused on this one space that is one of the benefits of going to an organization you can now really narrow in. I assume you know a lot more about imaging today than you did when you were sitting in that role.
I thought I knew about imaging as a CIO of a community health system. And I really had just scratched the surface. And so as they say, I'm going, a mile deep and an inch wide in this space now, and I'm learning what I didn't know before. I also realized how impactful imaging is to the rest of the delivery of healthcare within a community.
And if you think about the expenditure as well as the revenue associated with imaging, it's a huge piece of the work that they do.
So both of you seem to have gone you're following scale, and you're following innovation. I want to, because both of you're doing pretty interesting things.
Talk a little bit about innovation in healthcare. What is the promise of innovation in healthcare and where do you see the most promise today? And Stephanie, this might be teeing you up too much. I mean, but you know, essentially, clearly you see the promise in computer vision and artificial intelligence in your space.
Talk a little bit about that.
Yeah, I mean, I think it, it comes back to foundationally, you know, We've gotta solve problems and we've gotta be creative and ingenious and outside of the box a bit in thinking about how to do them. That's really, to me, what innovation is like. It doesn't have to be a building.
It doesn't have to be a new tech. It can be, but it really it's the path to transformation for me.
And so what's the problem that you're looking to solve with computer vision and ai?
The problem I'm looking to solve is how do we reduce the friction and bring the joy back to medicine?
Right? I mean, in a nutshell, we've got a workforce shortage in a situation where we've got an aging and growing population and increased needs for the provision of healthcare, a rising complexity of medical care, a desire to be more precise in how we do it, which means managing more information. And yet, over and over in healthcare, what we've done is we just
add some people create a new title and have a new person, and now those people aren't there, and so that's why we're seeing burnout at the rates that we are. That's why we're seeing care delivery and quality decline. We don't have high performing teams anymore who work together for five and 10 and 15 years who begin to really know each other and therefore how to be best impact patient care.
And we can't solve our problems anymore by just hiring more people, cuz the work isn't work that people wanna do. Nurses didn't go to nursing school to come in every day and spend 35% of their time in front of the ehr. However, we all want the data that comes out of it. We all wanna leverage that.
We need to figure out better ways to be able to get the data that we. Make it more precise, more accurate, and not do it on the backs of our clinicians. And that's where, for me, things like computer vision and natural language understanding, really creating an opportunity to think from a computer system and act like a person and take just the low hanging fruit.
We don't need to do anything sophisticated. We're not trying to replace the doctor. And I know for sure Lee is thinking about this stuff too. Cuz in imaging when AI really started coming into play, right? That was the first big thing was, oh, ai, we're in imaging, we're gonna replace all the radiologists.
That's nobody's goal, right? The goal is how do we make everyone who's here and wants to do this work better at it and happier doing it?
Yeah. Lee, what's the problem that innovation or technology is trying to solve in imaging and what's the promise? What have you seen so far?
Yeah, I would say one of the issues to Stephanie's point around the aging population is that we, just from a volume perspective, it's very difficult to keep up. So at any given time, if you look at the queue that my docs currently use, when they're pulling images out and they're reading images, it's as deep as 30,000 any given time.
That's a lot of images waiting to be read, and the timing on that can be delayed. The latency around that can be delayed. So as I look at options for how to approach this, and by the way, there's 400 plus companies right now. Independent companies that are seeking FDA approval for imaging artificial intelligence.
So picking from all that and trying to decide what's gonna be of value, I think that's the intellectual exercise you have to do first before you start going after some of this. And so I try to just think about, from a simple perspective, how do we impact operations in a positive way?
And so I asked a question which out of all the images that the doc can choose from a mammo, a ct, mr. Whatever it is, they're looking at which one is the least desirable and the least desirable is x-ray. And it's least desirable for a number of reasons. But, it boils down to reimbursement primarily.
Also the image quality compared to CT and MR is not as good. So there might be slightly heightened risk there as well. And so if that's the least desirable and those are the ones that are kind of hanging around, what can we do to kind of improve that whole scenario? So we partnered with, I came on board in July, did some investigation in July and August, and by September we launched a prototype with a company called AZ Med out of Paris.
Where we send in real time, all of our x-ray images non axial X-rays, so arms and legs basically to this company. And they run their algorithm against this and it comes back in my docs when they look at it, they see a red banner that says, suspected x-ray with a box around this specific area, kind of highlighting it and pointing it out over the course of about 30 days.
We decreased our latency around turnaround times by about 36.
Wow. And Stephanie, I wanna come back to you and talk specifically about, we talked about burnout, we talked about nurses. I like Lee, I love how you teed it up in terms of really helping the physicians. And Stephanie, you teed that up as well.
Talk about how computer vision, I mean, what kind of solutions is it offering to the nurses? Is it offering to the practitioners? That they go, oh, okay, I see it now that it's saving me, 15 minutes, it's saving me 20 minutes, or it's saving me five minutes a day, 15 times.
Yeah. I mean, it's thinking about things like if I can teach a computer vision algorithm to understand what it looks like to put.
SCD on a patient, right? The sequential devices that help prevent blood clots on hospitalized patients or when we turn a patient to make sure that they don't end up with pressure wounds. Or when I'm putting an IV in, if I can teach a computer vision algorithm to see what those things are, these are all things that we ask humans to not only do them.
But document them. So there's two elements that are problematic in there. One, the person who's doing the work is probably overqualified to be doing the documentation of the work. And two, that means our documentation and understanding of what's happening is never in real time. I can't turn the patient, put their IV in, get, help them use their breathing treatment and all thesethings,
and documented in real time. So a lot of the quality of our documentation is delayed and therefore less actionable as we wanna think about moving things forward. So I'll use an example of the bed turns. Super fast story. Little piece of trivia. The reason that we turn patients at the standard for turning patients is every two hours.
In hospitals that is the standard. Like you need to be held accountable to that patient is getting turned every two hours. That comes from war time. So we were seeing in World War ii, that there were injured soldiers coming in, and that when they laid in these infirmaries for a long time, they were getting these bedsores and otherwise, these are young, healthy guys, right?
And, but yet they came in with an injury and then they laid around and then they got these bedsores. So the doctors said to the nurses, okay, start at this end of the infirmary. Turn the patients so we can get them off of that side. They would make it all the way down the end to end of the infirmary. And then they would turn around and go back and do it again.
That took two hours. They saw improvements. So ever since then, this is our standard of care. We don't even know why we do some of the things we do or we do them because the best evidence we have is just kind of what we have. And yet to really understand how a 57 year old Asian man who's admitted for heart failure, What he might need to prevent bedsores or how much time he may need to be up and around and out of bed in the hospital to successfully go home.
Those are questions We don't have any way to answer right now. And so I think of computer vision, not only from the standpoint of I can see a menial or routine task and figure out how to just quickly do documentation and things like that, which by in and of itself is no small feat, right? Computer vision isn't magic.
There's still training and things that has to go into it. But that's the early stuff. What I see really as the future and the vision is it's kind of like having a process improvement engineer in every room 24 hours a day, where we can really start to understand what's happening, when and why, and how to individualize that.
And start to do things more methodically than based on some of the information or lack of information we have now.
All right. I love that conversation and we could do that for the next 30 minutes. I'm gonna take you in two different directions. One is, I'm gonna have you look in on the CIO role in healthcare, and I want you to sort of comment on it from the outside and say, here are the challenges, here's potentially what I would change about the job, that kind of stuff.
And then I'm gonna put you back into the role. I'm gonna put you back into the health system CIO role. Given the experiences that you just had what would you do different? So let's start with looking at it from the outside. Just in the last six months you guys haven't been in your new roles for that long.
The world's changing and it's changing rapidly. We're seeing a lot of financial pressure due to a lot of different things. The economy changing payer mix so forth and so on. Just all the way down the line. Cost of care. Has gone up cuz of supply chain issues. We have shortages of clinicians, cost of traveling, nurses, all those things.
So financial pressures are real. In healthcare and on the CIOs. So that's just in the last six months, I think it's gotten I would say more challenging to be a CIO than even when you were there looking from the outside. What are the greatest challenges facing the CIO and the CIO role today?
Lee we, we'll start with you.
Sure. Yeah. It's been nine months since I since I started this new job, and so have a little perspective now. I think at this point, CIOs they have control over a certain amount of the spend associated with the health system, right?
Let's say 3.5 to 5%, somewhere around there in that neighborhood. And every time they go to a meeting, every meeting, that includes other executive. That isn't talking about some specific clinical issue or some specific operational issue. The topic is finance, the topic is spend, right? And they're talking about how do we decrease our spend?
And I would say that there's opportunity in most CIO's budget to do something in that space, and their other executives understand that. And so they're constantly kind of looking at the CIO for, Hey, what else can be done in this? I would say across the spectrum, some CIOs have done a really good job of kind of really understanding their budget, really understanding where opportunity lies, and they've weeded that piece out and others haven't.
But those on the outside who don't understand technology, When they look at this, they don't know the difference for the most part. So I think there's a general suspicion it feels like that it is spending some money that they shouldn't necessarily have to spend in some way. And so I think the challenge that the CIO has is to constantly kind of transparently showcase the good work that they're doing.
To identify opportunities and take advantage of it. And so, my advice actually for CIOs in health systems right now would be to have a clear pathway of what you have done in order to be able to review all of your spend in a very detailed way and to showcase how you've made improvements in that space.
One of the things that I've talked about in the past is having clarity around contracts, right? Contracts pretty big spend within a health system within the IT budget, but frequently the contract process isn't as organized as it ought to be. It really, all of your contracts from an IT perspective should be in a single location, and you really should be able to have specific questions you ask
every time around those contracts. And the way I framed it up and I would suggest others think about it is I had my direct reports have ownership of the contracts that correspond to their domain, right? And they were responsible then for identifying at renewal, which ones were gonna renew and which ones were not gonna renew.
Because frequently there's overlap between. Different functionalities. Sometimes we're not even using the technology anymore, and yet we're still paying for it. I just did that in my current job. I just got rid of a contract that was here for five and a half years that nobody's used it in three years.
Sometimes the contract is set up in a certain way and yet they're charging you a different way. But what I've noticed is the way they charge you when it's different, it's always in their favor. So I just found that as well with the different contract that I had. And so if you can go through and be methodical about this and identify specific expenditures that you can remove, you can call it out for what it is.
I think you begin to gain a level of trust with your peers. That really goes a long way in terms of these difficult conversations that folks are having. Nowaday.
Yeah. Stephanie, looking from the outside in at the CIO role what's the greatest challenge that they're facing and how would you address it?
Yeah. I think the biggest challenge is I don't know anybody who's in greater demand than the CIO right now in a health system, right? Everybody wants something from them and what they want them to deliver. Is on the verge of miraculous, right? They want all the automation, they want all of the best technology, which fits the workflows, which will be adopted, which provides transformational opportunity, and they want it all to cost nothing.
And so therefore, they're being asked to be the leader, the negotiator, the inspirer, the critical thinker. Everybody wants something from the CIO right now and actually is really putting a lot of bets that person is gonna help them. Get through this really challenging time. That's a huge amount of pressure and a really big change from even a decade ago when a lot of people looked at the CIO as a ticket taker.
That is so not the case anymore. It's actually almost swung too far in the other direction. Right. They're not miracle workers and yet a lot of the way it's being asked of them is . To be a miracle worker in some respects. And so I really agree with Lee that
you have to create the story around what it is you're doing and why. I think one of the other hard parts about being a CIO in the, especially in the more traditional sense, if the true technology side the nuts and bolts of the infrastructure reports to you as well as the innovation, creative, and clinical sides.
Is people don't understand the investment that it takes in humans in the actual cost of the work. When I think about the network, I don't know everybody. It's just supposed to work, right? Like, why? Why is that expensive? Why do I need a network team with 18 people on it versus two? A lot of, that's the other challenge for a CIO is like, at least when you get into the innovation, People can more creatively understand why it's new and it might need more people and it might need what?
But then you got the old table stake stuff of, Hey, if I throw innovation on top of a crappy network and a crappy data center, and all those kinds of things, and a cybersecurity platform and approach that is not putting us in a good position, none of those things are gonna run well.
And so I think you gotta create this story. You gotta share the vision and the understanding and make it relatable as to why things cost, what they. cost Why that investment is meaningful. And then continue to build on that story. And then you are gonna have to negotiate and you do need to do the things like Lee said, and go in and do renegotiation of contracts and getting rid of old stuff that you may not need to.
We all have legacy things that we could turn off.
I'm just laughing a little bit at what Stephanie said there cuz I can relate to it so Well, when I first came into my prior CIO position I put together pyramid. And the pyramid had kind of, table stakes at the bottom. We, this is core infrastructure that we have to shore up.
We basically have to keep the lights on, right? And then up that chain at the very top was innovation, right? I talked about if we get this right, then we build on that and we can make it efficient and we can make it cheaper and eventually we can do this really cool innovation stuff.
Everybody nodded and they were all excited and that, that made perfect sense to them. And literally I finished that meeting and I got like a dozen emails of innovative stuff they wanted me to do, right? And I'm like, this is the definition of changing the wing while flying the play.
Yeah. It's, Really good technology is transparent to us and it just it helps us.
It supports us. It does all these things sort of in the background and we don't even think about it anymore. It just is and it's there and there's a whole bunch of that that exists in every health system. And you talked about the network team. What the network team does is not visible until it's not working.
That's the only time it's visible to them. It's like, but that's how it should be. But then when you start to describe, it's like, look we have these things and then there's contracts on it that are maintenance on those things. And we have to replace those things every three to five years, otherwise they become old and we have to secure those things.
And oh, by the way, it's essentially software, so there's like coding that goes on those things to make sure. Go through the pipe and get to the where you think it should get to and don't get to a place where it shouldn't get to. And you try to explain that to people and they go, yeah, I understand you should spend money on it.
But my gosh, that's, know, two and a half million dollars. That's a lot of money. Yeah. It's like, that's like saying it's $2 million to put water in on your campus for your hospital system. It's like, Hey, can you do that for a million dollars instead of two and a half million? It's like we
we just not If you want it to be clean water. Yeah, exactly. It can be dirty water or it can only go to, five of the toilets and the other five don't have water. Are we good with that? It's like, no, we're not good with that. Well, exactly. But I do want to talk about, you guys are both extremely good at creating a narrative, right?
Telling the story, creating a narrative, communicating with a new organization. I'm gonna give you a task. And the task is Financial pressure. You're having these conversations. How do you make the case for innovation needs to continue in the face of these financial challenges? And Stephanie, I'll start with you.
I mean, putting you back into the role of cio. You're sitting in front of the leadership team, make the case for, hey, we have to continue to innovate.
Yeah. I feel like it kind of comes back to what I started with, which is, The system is so broken we literally can't afford not to do this. I actually was asked that on a panel discussion, like, how do we afford to do this and take these risks that we're gonna change the way care is delivered?
And my response literally is, how do we afford not to, what we're doing today isn't working. And I think we've all said and heard a million times, right? The definition of insanity is doing what you're doing over and over again and expecting a different result. Innovation if, especially if you think about it from the standpoint of using creativity and ingenuity to solve the problems that are in front of you, thinking about them differently and new ways to get to the end of the solution.
That is an imperative. We can't afford not to do this because what you may save today to get you through this fiscal year may cause you to not be in existance in one to two years.
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All right, Lee, I'm gonna give you a different task. And that is the clinicians, you're in front of the clinicians right now and they're saying, stop moving my cheese.
You keep moving my cheese. Every time I turn around, there's a different screen, there's a different thing. I have to go to training. I have to learn this. Stop moving my cheese. And you need to keep innovating. How are you going to talk to those clinicians about, Hey, you know what? We're probably gonna move your cheese again.
Yeah I think it, it does come down to, you gotta start with the problem you're intending to solve and then work backwards, right? You have to identify what pain points your clinicians in this case are experiencing and really try to understand that and work backwards. And technology doesn't have a good track record here of attempting to do that, right?
It attempts to create something that sounds, and sometimes is really cool, and then jam it down the throats of clinicians who are trying to see patients and save. And so that friction that's been there for a long time, I see it as low hanging fruit, particularly as a physician cio, right? Because I can sit down with them and I can go through the workflows with them.
I can have those conversations, understand their pain points, and then go back to the technologists and say, okay, how are we gonna help to solve these issues? So as I think about the change and the cheese moving, the cheese should move in tandem with what actually helps. In some tangible way.
The other point I was gonna make is that I think as we think about innovation and how we continue to move forward with it, we always have to solve a practical problem. And in particular, I think there's A notion out there that CIOs and IT in general are gonna try to just put stuff in for the sake of it's cool or it's, high tech and whatnot.
But to Stephanie's point, if we can really be crisp about how we identify the problem and how we showcase that the technology is gonna at least be a portion of the solution, and I say that because in infrequently is technology, the complete. It usually includes a workflow change of some sort, policy changes, training, education, all those pieces come together, but technology is a piece of it.
And if we can showcase that we're willing to use this kind of nuanced approach that identifies all of these elements and we're willing to put all of that together to, once again identify our specific operational improve. And then have these pieces line up in order to make that improvement? I think
it can go a long way. When I was at Asante, I worked with a company. Focused on patient movement within hospital systems. And we had some serious issues around trying to get, patients moved into and out of the hospital. And of course, if you're a hospital like the hospitals in Oregon that are based on D R G.
Scenarios, then movement of patients is critical to your bottom line and to the health of your staff and also health of the patients. And so we had some real challenges around that. We couldn't discharge patients, right? We couldn't move patients from point A to point B. And so we brought this company in and the reason I chose them is because they wanted to really deeply understand the workflow first, and they were willing to sit for hundreds of hours.
With our staff to understand the current workflow in current state before recommending a technology to move forward. And ultimately we selected a technology that first took advantage of what we had already bought, right? I looked at all kinds of fancy technology out there around patient movement and air traffic control for patients, and they're very expensive.
You're talking five, 7 million plus you have to add data scientists to it, et cetera, et cetera. We ultimately landed on a space where we, once we understood our problem, We understood what future state needs to look like. Then we took advantage of the technology we're currently using.
In our case, we were on Epic, so we maximized what Epic already had available to us, but we hadn't fully built out or put together in a way that needed to happen. And then on top of that what Epic couldn't deliver at that point, that's where we brought in additional technology to meet that need.
So I think again, if it goes back to understanding the problem, And working closely with your folks who are actually delivering the care, and then creating a solution that has multiple elements to it, one of which is technology.
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That you worked on as a healthcare cio how did you navigate those obstacles that you face and how might you do it a little differently today? You guys are both thinking about that. Lee, you're gonna end up going first, cuz Stephanie went first on the last question.
Boy, there are so many challenging projects to choose from.
Where do I begin? I would say that I have some big projects. We brought on board 300,000 additional square feet onto our flagship hospital that had a lot of challenges associated with it. We installed uniform IV pumps throughout the entire enterprise, and that had ton of challenges with it but not even close to any of those was when we brought our oncologists onto our instance of Epic.
They had been using a oncology specific EHR for a long time, and they were a bit prickly, shall we say, in the interaction. And to answer your question around, what would I do different? I would've gotten ahead of it in hindsight I knew they were prickly. I'd worked with these individuals for a long time, clinically, I knew them all on a first name basis, knew all their, their families and whatnot.
But when it came time to actually doing it, they put out a different game. It changed the nature of the relationship quite a bit. And so in hindsight, I would've got ahead of that a bit more and I would've spent more time with those folks in the trenches so that those conversations would've been easier.
And towards the end I learned that lesson and applied that. But that's a true life lesson learned.
Yeah I appreciated having the additional time to think, and yet I'm not sure it brought me to any greater clarity. I actually, I feel a little bit more like it was conceptual, so again, I, when I got to, to monument, then regional, my main project was replace the entire EHR across the whole health system and bring everybody together in a unified process.
That was not minor. It was big. There are some things I would do differently. Again, anybody who's been through an E H R implementation would say that I replaced the network. I replaced the pack system. We started developing our clouds. I mean, like, again, to, to Lee's point, when you do that job for five to six.
There's been a lot of big projects. There were lots of clinical projects, during Covid. I'm the one that started nurse triage. Weird, but it had to happen. I actually would say though, toward in the latter couple of years that I was in the role, I really started pushing the organization hard in the innovation space and in ways to
partner with vendors around solving problems that we had, right? Whether that was a problem. Automating faxes into the ehr. So we didn't have to have people doing it, whether it was looking at automating prescription refills, whether it was looking at automating clinical workflows, whether it was thinking about our bedside ultrasound strategy a lot.
I was pushing a lot and it was talk about moving people's cheese, clinicians cheese. And nobody's cheese was off limits, right? Revenue cycles. Cheese was on the block. Every everybody's cheese was on the block. And that was hard. And I maybe it might have been too much of a good thing, right?
Because an organization can only tolerate and adopt so much change in a given period of time. And even for my own teams, that worked for me. Trying to help carry these things forward, that it was a lot on them. It was a lot of operational change management to happen and it might have been too much and I felt an urgency in a need to really push on those things.
But I think if I had it to do over again, I might have tried to find some ways to. Space that out differently or I don't know. But again, it's really, I don't know if it was really any one thing. I just kind of look at those last couple of years and all the cheese that was being moved and whether there was collateral damage from that just, people felt too, it was too much.
Can I just dovetail on that just for a second please. So, that's a really interesting point cuz I felt what Stephanie's describing there when she was describing it, I was semi reliving some of that. But I think in part it depends on where the rest of your peers stand in particular, where your CEO
I think Stephanie got, was able to do a lot of changes frankly, over a short period of time. And probably due to having alignment there with relationships with folks and getting them kind of on the same page. That's a big element of this. If you're a chief medical officer, if you're c e o, if you're c f O it's all on the same page when it comes to, understanding the importance of this innovation and how it.
The overall improvement of the organization. Man, it feels like you can move mountains, but if you are the one lone voice at the table saying, this is something we should do, it's a very lonely space to be at.
Yeah. Yeah. And on the flip side, I did have that support as Lee was suggesting, right. I had an amazing CEO and supportive strategic leadership team who was.
You, you know what you're talking about. Let's do it. And even in that space, and an organization that was, I'll say only 5,000 people, it's still, it's a lot of people, but it's not the size of lots of our health systems. But even that, I mean, that's a lot of people's minds to change. That's a lot of historical.
Baggage to overcome and things to get through.
I'm wondering, as you guys are talking about that, I mean, Stephanie's, the alignment you had is really interesting. I'm wondering, I mean, we all have a lot of conversations with CIOs and I'm wondering how many of 'em have that, because I mean, I've heard the, like the, hey, my CEO's really on board, but my CFO's not on board.
I've heard that. Over and over again. I've heard, well, most of these projects are operations projects. Oh, I can't get the operators on board. I've rarely heard where, hey, you know what? The entire leadership team, I mean, you could even have silent vetoes. People are sitting there going, yay.
Innovate. Innovate. And then when you go to them and go, all right, let's innovate, they go, well, sorry, we don't have any money. Go there. Yeah, we don't have any time. We can't free up the clinicians to help you. Sorry. I mean, what do you say? Is my perception wrong or do you find there are a lot of teams that are aligned?
Yeah, I mean, I think I came from a nearly ideal situation and we didn't have that total alignment. Now I will say the senior leadership team was ex was aligned, and if you don't start with that alignment, you're already sort of set up for failure. But having that reverberate. Through the subsequent levels of VPs and directors and managers and supervisors and frontline team members, that is a nut that is really hard to crack, even with a 100% aligned, flat transparent senior leadership team, which is again, really what I felt like I, I had.
Getting that translated through all of those layers. We did not have that.
And I'm gonna suggest I'm gonna set a strategy around how to make some incremental improvement in this space that I noticed in hindsight with my experience. And that is, if the idea came from me, there was actually less inclination for folks to be excited about it.
But if I could bring a convers. To a key stakeholder and have the idea be kind of a an output of that meeting or even let's say their idea that I am now supporting. I have found that changes the dynamic quite a bit, and so to the extent it's possible, I always try to include those folks in the conversations to the point where they feel like they actually almost came up with the idea the.
And they're really championing it. And if they're championing it, it changes the whole dynamic.
Yeah. The one thing I say to CIOs that I coach is this is why the interview is so important. And the interview isn't just about them talking to you. It's about you asking the questions is determined.
Is this a c e o that believes in innovation, that believes in technology? And my gosh if the answer to that is no, I don't care how good the job. If that's your read, then you might wanna run away from that position. And just because somebody's gonna go into that position and not be able to be successful.
But let's assume the CEO is, you still, in most cases today, you're doing eight, nine interviews. You're talking to the cfo, you're talking to the operating team, you're talking to the cnio and. others In the process, the interview process is as much you determining is this a good fit? Am I gonna be able to be successful?
Is this fertile ground for an organization? Because when you don't have that, yes, there are tactics that you can do in that role to be as transparent as you can be, to bring other people on board, to have operators and champions who are gonna help you. But at the end of the day that alignment at that senior level is hard to manufacture.
It is. The other thing I would say that's tricky about some of that is when you do those interviews and when you're having those conversations, I mean, I look at, to your point earlier about what's happened in the last six months and the financial pressures and those kinds of things. We are all different humans when we are put in a pressure cooker situation.
And unfortunately until you go through that with a team, you're not gonna have that insight, right? So you can ask those good questions. But the reality is I don't think the CIO job or any senior leadership team job in a healthcare system has ever been harder than it is today.
There is pressure from every single possible direction, and that will have collateral damage, which is that pressure is going to create angst between the working teams and stress, and it's just kind of the nature of where we are right now. So I think the other part of it is recognizing in your ecosystem, is it circumstantial that your team is maybe not performing the way that it could and can you get through it, right?
It's like a marriage. If every time the going gets tough, you're gonna get divorced, you're gonna go through a lot of spouses. That's a strategy you can do. it But that, if you're in it for the long haul, you gotta work through the hard times too.
I, if I put on my psychologist hat here a little bit I would say that everybody wants to do good work.
They wanna come to work and feel like they made a difference, did something positive on some level. And one, one thing they recognize is that there are finite resources within the IT space. And so if they're gonna hop onto an idea of some sort, that trumps some other idea that they had. It better be a dang good idea, and they better be part of the process of developing that idea on some level.
So as a CIO for a health system, if we can be a partner to the rest of the executive team around these good ideas so that ultimately they can feel like they're part of good stuff that's happening. That I think that really wins today.
Fantastic. I did have an exit question, but we're at the end of our time and I know that you guys both have extremely busy schedules.
I really appreciate you coming on the show. It's always a pleasure to catch up with you guys and I appreciate you sharing your wisdom with the community. Thank you. Thanks so much,
bill. Thanks Bill. Always fun to talk. (Main)
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