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January 28, 2022: Today Lee Milligan, CIO for Asante joins Bill for Keynote. The path to becoming a CIO is often not direct. How did Lee go from a small town in Pennsylvania to CIO of a 998 million dollar health system? How did being an ER doctor prepare him for the work he is doing now? Lee walks us through the first critical couple of weeks in the role. What areas was he most concerned about? How have they played out? The health IT Budget is an enigma to non-IT people and extremely difficult for even seasoned CIOs to navigate. Lee shares how he wrestled this to the ground and how it has evolved over time.

Key Points:

00:00:00 - Intro

00:08:15 - Being a good CIO is about effectively interacting with others. And that's all about developing your EQ. Or the low budget version is don't be a jerk. 

00:10:30 - You have to lead by communication, by vision and by connection with people

00:20:25 - One of the challenges of walking into a CIO role as a doctor, is gaining credibility within the technical side

00:38:20 - After a breach we have to ask, do we have the right process, procedures, investments, technology, partners and insurance contracts?

Asante

Transcript

The Journey of a CIO With Dr. Lee Milligan: Leadership, Financials, and Growth in Health IT

Episode 481: Transcript - January 28, 2021

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Bill Russell: [00:00:00] Today on This Week in Health IT.

Lee Milligan: I think it's really important to learn to write well. Written communication is key, whether it's email or a report to your supervisor, when you write something, that represents you. And when they look at that, that's really your brand you're putting out there. And so focusing on that, I think is a really important thing to do.

Bill Russell: Thanks for joining us on this week health Keynote. My name is Bill Russell. I'm a former CIO for a 16 hospital [00:00:30] system and creator of This Week in Health IT. A channel dedicated to keeping health it staff current and engaged. Special thanks to our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in developing the next generation of health IT leaders.

A great way to keep up with all the things that's going on at This Week in Health IT is going out and following us on social media. If you want to know about absolutely everything we're putting out there twitter is the [00:01:00] place to be. You can follow us at this week in HIT. @ thisweekinhit. And you can follow me @billrussellhit of course. And we're having great conversations happening over on LinkedIn as well. You can find us at This Week in Health IT. We are touching on the highlights of all the great stuff we're releasing. If you want to talk with me, we can connect on my personal LinkedIn as well at Bill J Russell. I love having conversations with you and sharing perspectives and sometimes I even [00:01:30] get to share your thoughts on the podcast. If you are more of a watcher than a listener, you can go over to YouTube. We post all of our shows there except Today in Health IT which is audio only of course.

All right. Welcome to 2022 and keynote. Our new show. Dr. Milligan is here and we are looking forward to a conversation with him. This show is going to be a little different than we've done in the past. As a lot of you know, we did the Influence show where we really focused in on the [00:02:00]technology.

We're going to still do that. We're going to go into some detail on some things, but we're also going to have more personable conversations. Get a little bit more insight into the people we're talking to. So today we have Dr. Lee Milligan with Asante Health .CIO for Asante health Lee welcome. Welcome to the show.

Lee Milligan: Good morning, bill. Happy to be here. Thanks for having me.

Bill Russell: I would say welcome back to the show, but it's welcome to the show. So keynote's new for this year and you're sort of the Guinea pig for the show. How do you feel about that?

Lee Milligan: I think you always test things out on me. I'm starting to [00:02:30] sense a theme here.

Bill Russell: I appreciate you doing it. You're also an advisor for the show. So you keep me on the straight and narrow and when you saw this plan, you said, Hey, that looks really cool. And so trying it out on you made a lot of sense. Yeah. So it's real similar to what we've been doing with influence, except normally what I would do is I'd send questions over ahead of time and they would be very focused on, Hey, what are you doing around the staffing shortage?

What are you doing around this? What are you doing around that? And we'd cover an awful lot of topics. But it felt like we just got to the surface of those topics. [00:03:00] I'm not gonna try to cover 10 topics with you and just get to the surface. Maybe get a little bit deeper. And I also want to get some of the background.

So as with all the shows, let's start with the basics. Tell us a little bit about your health system. Tell us about Asante Health.

Lee Milligan: Yeah, Asante Health is in Southern Oregon. We serve nine counties. There's three hospitals in our system. It's about $1.1 billion a year in annual revenue of about a hundred thousand ER visits per year and about 70,000 urgent care visits.

And [00:03:30] then thanks to COVID we now have about 8,000 telehealth visits per month. We have an ACO called the Asante Health network and that's been active for a couple of years now. It's growing. At the same time we're expanding as a system. We're about to launch on January 17th. We're gonna launch two cancer centers, been working on for three years.

We're also adding a pavilion to our flagship hospital. It's going to add about 350,000 square feet. And we are doing some additional medical practice acquisitions as well as additional [00:04:00]community connect. We currently extend our Epic to 10 clinics and another hospital health system. We're an Epic shop. Been on Epic since 2013. And I would say we're moderately mature on Epic right now.

Bill Russell: Yeah. So one of the things that came up, we did the webinar with Sky Lakes and they were talking about the area that they serve and it shocked me how much land there is in between hospitals in Southern Oregon. Do you have that same kind of thing? Do you have a pretty broad [00:04:30] reach from a geography standpoint?

Lee Milligan: Yeah. I wouldn't say we go all the way to the coast. We're a portion of Northern California. We are up to and including Roseburg and then east all the way to Idaho and depending on the actual sub-specialty being served, it may or may not actually overlap with Sky Lakes. So it's very broad.

Bill Russell: Wow. Do you consider yourself having to figure out how to do rural health care as well?

Lee Milligan: It's kind of a combination, I think from a technology perspective, I'm on the rural front. My biggest concern [00:05:00] is around bandwidth and folks being able to be online, as we push out our telehealth initiatives and other digital initiatives. It's great for those who, can flip up their iPhone and they live in town.

But for those who are way out in the coast or they're a bit more remote, I am concerned about our ability to connect with those folks.

Bill Russell: One of the interesting things for me, we had a hospital in Eureka, California, and I imagine my story there is similar to yours. We only had two carriers to choose from, to go to our hospital. Do you have more than that or is that sort of your story [00:05:30] as well?

Lee Milligan: No no. We have, well, we have a lot more than that. Southern Oregon has grown up quite a bit since I moved here. I moved here in 2000 and when I got here, there was one airline. Now there's seven airlines and they've expanded the runway quite a bit. And so, yeah, it's definitely grown up quite a bit in the last 20 years.

Bill Russell: It's good to have choices. I've seen your resume and your path was an interesting one to get to this role. How does someone go from I mean, I don't know how far back you want to go. Let's say Erie, Pennsylvania to CIO of Asante.

Lee Milligan: Yeah. So, when you grow up in [00:06:00] Erie, all you want to do is get the hell out. But but now in hindsight, I look back Bill and it was a great place to grow up. Great people, great space. And I even think about like my elementary school. I went to elementary school called Asbury. It sounds very quintessential for Erie, Pennsylvania, but there was a kind of a sanctuary right next to Asbury called Asbury Woods.

And, they would take us on hikes through Asbury woods [00:06:30] twice a week as an elementary school. And so, it was really a great place to grow up. In terms of college. I really entered college totally unprepared. You've heard part of my story in the past, I, I ended up taking some time off from college, did a variety of jobs.

Worked at the Gap. Worked at beacons moving corporation. I worked as a brick layers assistance for quite a while. And then it was a mail clerk at a law firm called Lakeman Walk-ins for quite a while. But eventually I stumbled into,

Bill Russell: You know Lee, [00:07:00] I don't remember seeing all those things on your resume.

Lee Milligan: Yeah, these are the ones I don't actually usually point out. But what, where I was going with that is eventually I stumbled onto a terrific gig as a summer camp counselor. In a place called camp Quia maca, which is 30 miles east of San Diego. And it was there that had the opportunity to interact with kids who had muscular dystrophy. And really, it was my first opportunity ever to interact with kids who had any kind of medical scenario.

And over the course of that [00:07:30] summer, it completely changed my mojo and my thoughts about college and what I wanted to do, and ended up going back to school with a lot of clarity around what I wanted to focus on, and that's really how it got back into school and eventually pursued my medical degree.

Bill Russell: Wow. The path to the CIO, newcomers always ask me, it's like, what do I need to do today to become a CIO? And one of the things I tell them is the path to getting into that chair are so varied and yours is, is pretty varied as well. I mean, just that portion of it alone is [00:08:00] pretty interesting. You didn't study technology, you didn't study programming or anything to that effect. You, you went the physician route.

Is there a direct path to the CIO chair and talk a little bit about your path.

Lee Milligan: Maybe in some systems? Probably not most. Certainly not in mine. I do think it comes down to the classic three things, people process and technology. On the people front it's really about effectively interacting with others.

And that's all about developing your EQ. Or the low budget version is don't be a jerk. And[00:08:30] I also think it's really important to learn, to write well. Written communication is key, whether it's email or a a report to your supervisor, when you write something, that represents you.

And when they look at that, that's really your brand you're putting out there. And so focusing on that, I think is a really important thing to do. I also think speaking effectively is key. And I'm not just talking about big speeches that you give, but really every time you speak in front of your CEO, your re-auditioning for your role.[00:09:00]

And every time you speak to your subordinate and I learned this the hard way, they amplify what you say. So you have to be mindful of what you say and make sure that you're, saying things in a way that that really makes sense. I think from a process perspective Bill, we always have to be curious and always have to ask, are we doing this the right way?

Is there a better way to do this? And, be hyper-focused on that, to the extent you can. And, there's many different ways to do things better. Sometimes you can have a Denovo [00:09:30] creation of doing something better. Oftentimes you shamelessly steal. Whatever you have to do to make sure tomorrow you're doing it better than you did yesterday, I think is key. And then from a technology perspective as you pointed out, I didn't come to this role with a big technology background, but you have to learn enough about it so that you can provide wisdom and guidance around strategically where you're going to go. And that takes work. And so I would say that, no matter how you landed or no matter how you're heading towards this trajectory, understand where your [00:10:00] strengths and weaknesses are and make sure to make a conscious effort to shore up the areas that you think you'll need once you get to that role.

Bill Russell: One of the things I tell people is it's a leadership role. The CIO used to be a technology role. Speeds feeds, ram, all those things. But now it's a leadership role and people say, what's the best thing you can do. I'm like go volunteer somewhere as a leader.

And the reason I say volunteer leadership, and I'm going to ask you, like, what, what was your first recollection of being in a leadership role? Because when I was a volunteer leader[00:10:30] look, I didn't get paid first of all. And second of all, nobody around me got paid. So I couldn't do it by title.

I couldn't do it by compensation. You have to lead by communication, by vision, by connection with people. It's a completely way. But once you learned that, once you can do that, and then somebody gives you a title, you're like, oh, well, I mean, I'm not even going to rely on title because it's not that effective anyway.

Lee Milligan: Yeah, it's all about relationships. A hundred percent.[00:11:00] One of my first experiences with leadership was being on the board of directors for our medical group here, which wasn't a huge group. About 300 docs. And it was a unpaid position, of course. And I recall having a conversation with a friend of mine who was really kind of mocking me for spending my time on this board because they weren't paying me.

And I remember thinking at the time, why would they pay me? First of all, I'm brand new to this. I don't know anything. And second of all, it's a great learning opportunity. I was learning so much about how to conduct a [00:11:30] meeting. I mean just the basics. The politics within a meeting like that high level strategy. And so it really is all about taking advantage of those opportunities to present themselves whether they pay or not.

Bill Russell: Yeah. You come from the physician background. Does the relationship with clinicians change somewhat when you move into administration and then when you move into the CIO role?

Lee Milligan: Yeah, I think to a degree I know these docs really well. We've been up to our knees in crazy patient scenarios at all hours of the night but they do give me a lot of grace, [00:12:00] I think, because we know each other so well. Probably more grace than I deserve. Frankly. But they always ask me two questions.

The first question is, are you still practicing? And that is really about, that's really geared at identifying whether they could still relate to me, I think. And the second is, do you like what you do? And I usually light up before I even start speaking, I light up and they, and they know that I like what I do.

And that's really, I think about understanding whether that switch made sense. And usually by the end of the conversation, it's pretty clear to them that it [00:12:30] did.

Bill Russell: It's interesting. You talked do you like what you do. I interview a lot of CIOs. I run into and have conversations with a lot of CIOs. And one of the things that I've known from my career is that generally I stay too long in a position. Like just past when I enjoy doing it anymore kind of thing. And that usually does not end well for me. And I don't think it ends well for a lot of people. And I interview a lot of CIOs and I, I'm not sure I see the joy in your step, in your smile, [00:13:00] in your, your tone anymore. I hear a lot of man, I'm getting beat up a lot. This is really hard. I can't. That kind of stuff. How do you stay sane in this role and how do you stay encouraged and motivated in the role?

Lee Milligan: Yeah. I mean, obviously there's definitely ups and downs associated with it, for sure. I do think comes back to the relationships. No matter how challenging the role is for the CIO, the frontline staff have very challenging scenarios. They're pulled, their whip sawed in a lot of directions.

Part of our job as leaders is to curail [00:13:30] that whip sawing and to make sure we have the proper prioritization in place so that they're not pulled in too many directions. But you gotta recognize we're all part of the team. And we're all pulling our weight best we can. With COVID and then the wildfires here in Southern Oregon, I think there was a tremendous amount of, kind of comradery and teamwork just in the essence of us kind of pulling together so we can all get to a better spot. And almost recently with the mandates and losing staff and trying to pull together. It's still very much feels like it's kind of [00:14:00] Asante attempting to shuttle the community through these crises. And when you're a part of a team like that, it's hard not to be motivated.

Bill Russell: Yeah. In a town like like Medford, you're probably the largest employer I would assume. And you're also. Harry and David comes close. Of course. But you're also healthcare. So you, you literally are at the center of the dinner table conversations that are going on in Medford. I would think.

Lee Milligan: Yeah, for sure. And it isn't always a straight line. Right. I think the Asante brand is an awesome brand. But you know, there's a lot of [00:14:30] opinions out there about how this whole thing is shaken out over the last year or so. And so we're doing our best to try to, move forward as boldly as we possibly can.

Bill Russell: All right. I want to take you back to the first weeks of being a CIO Asante. Walk us through those, first couple of weeks, like, coming into the role and sort of your thought process as you became CIO.

Lee Milligan: Okay. You tried to trigger my PTSD?

Bill Russell: I'll tell ya. Every now and then people ask me about the first couple of weeks when I was CIO. And so I'll start us [00:15:00] off here with a little truth telling. I would go to a Bible study with a bunch of guys. And they said, is there anything we can pray for?

I'm like, you could pray for me cause I have no idea what I'm doing this job. It is so hard. It is so beyond me, I remember saying that it just looks at me and go, aren't you the CIO for this hospital system. I'm like, it's such a big job. I mean, I have to meet with a hundred docs. I have to meet with, I mean, the list of people I had to meet with in those first couple of weeks.

And I was new to healthcare. And so they'd say, Hey, [00:15:30] you're meeting with I don't just pick it. You're meeting with an oncologist and I'd go, okay, what does an oncologist do? And they'd look at me. Are you kidding me?

And I go, I'm not from healthcare. I literally don't know what all these things are. Now I know what an oncologist is but they would say some of these practices that I go, what part of the body do these people work on?

Lee Milligan: Yeah. So you know, when this whole thing shook out when I got the call from my CEO, it was his first day on the job. And so I get this call. He tells me the position just opened [00:16:00] up.

And he asked me what I thought.. He didn't want to just ask me to fill the role. He wanted to have a conversation about this and which I thought was smart. And so I expressed to him kind of the characteristics and skill sets I thought were necessary to be successful in this role. And then eventually he asked me to step in on an interim basis. But I didn't accept right away.

I negotiated with him, I think in good faith. I said, listen you need this person in this role to be successful. If I step into it, I certainly want [00:16:30] to be successful. Asante needs this person to be successful in order to do that, I'm going to need a couple of things. And I, by the way, I figured the time to negotiate on something like this was right then. And so I asked for two things out of the gate. I asked for a financial person to help me put together the numbers to tell a story. And I like to talk about that at some point. And then the second piece of course, was for a CIO coach. And he didn't fully grasp that at first. He thought I meant executive coach.

And I didn't really have a need, I didn't think for [00:17:00] executive coach. I really wanted a CIO coach, somebody who had been down this road before. Understood the nuances of the role and who I could reality check my world against as I navigated this. And so he to his credit understood that after a conversation and approved both and I agreed and we were off to the races.

Bill Russell: Wow. So you step into that role. Clearly there's a little bit of insecurity in some areas. What areas were you most concerned about your ability to handle the role?

Lee Milligan: Yeah, I think [00:17:30] any CIO, no matter what your background is, you have to do this honest assessment of what you bring to the table. And I don't care if it came here via operations or technology or clinical. You walk into it and you have one piece down really well.

And there's other pieces that you don't to your point that you don't know all that well. You have to do an honest assessment and then put in place a plan for how you're going to shore those. Maybe not, you never going to become, if you're not from clinical, you're not gonna become a doctor, but you gotta learn what the definition of oncology [00:18:00] is right?

You got to learn the basics so that you can navigate that world. I have a plan for doing that. So for me, obviously I wanted to focus on compute storage, networking, kind of hardcore ITS stuff. Plus the financials And I put in place a plan for each. On the hardcore ITstuff. I thought, the, probably the best way to do that is to focus on my team.

I get to know them better. They get to teach me in the process. They'll know I'm curious, which I think is a good thing. And we can further our relationship while I'm [00:18:30] learning. And so every other month I have one of my teams come in and present to me on the work that they do and that space. So everything from stores and infrastructure, networking, et cetera, et cetera, I've learned a ton.

My team is crazy smart and they dumb it down for me so I can get a handle on it. And we furthered our relationship that way. And on the financial piece, I've done a variety of things in this space but one of the big things of course has been focusing on our budgetary process, both CapEx and OPEX, and really trying to understand [00:19:00] how we can tell stories from those numbers.

Bill Russell: I'm going to deep dive into the financials, but before we do were you concerned at all? I imagine I know the answer to this question. Were you concerned at all going to your team and saying, Hey, I don't know storage. I don't know networking. I don't understand V lands and routes and that kind of stuff.

I want you to teach me. Was there any concern in 1you doing that or did they respond well to that?

Lee Milligan: Naively, I had no concern. No, I thought honesty [00:19:30] was the best way to approach it. And I recognize that, when you first start in a role, it's a bit of a honeymoon, right? You've got a period of grace there. And that is the time to ask. Now three years later, if I don't understand anything about networking and compute, that's a different scenario. But I knew I had an opportunity out of the gate to be that honest with my team and to allow for that teaching and understanding to happen. And I took advantage of it.

Bill Russell: So I didn't become a doctor when I became a CIO. And you have not become like a [00:20:00] Microsoft certified engineer or anything to that effect. Right?

Lee Milligan: Correct. That is correct. Although in fairness, I did spend five years working as an analyst. Essentially building out a variety of Epic builds that came into production and going through that process becoming certified through Epic to, to do that. And learning about change management, how you can easily break production and working through the nuances of configuration of Epic was a really helpful thing because one of the challenges as a doc [00:20:30] walking into this role is gaining credibility within the technical side. Right. And so that that's a bit of a challenge. And so you've got to walk that fine line to some extent. I respect the heck out of the analyst and what I was trying to do was swim in their space to some extent, and I wanted to do it respectfully but also I wanted to be recognized that I can navigate this space and work effectively with them.

Bill Russell: Do you think there's a difference between being an ER doc that becomes a CIO versus being a specialist that [00:21:00] becomes a CIO?

Lee Milligan: Yeah, I mean, I would say, I would say for me, there were two main advantages of coming at the CIO role with an ER background. And I don't know this would have applied if I was in a specialty scenario.

The first is the initial workup. Somebody presents to the ER and you don't have a lot of information. And so it teaches you how to make decisions with I'll call it preliminary data. And if you think about it, it's very much like agile versus waterfall thinking, [00:21:30] right? So out of the gate, maybe all you know is patients age, their vital signs, their race.

By the way, there's a reason why they call them vital signs. And then you may learn the chief complaint. You may add some data you pick up from physical exam. You may add some additional data that you acquire via labs and imaging. You're putting together as planned. You're constantly refining as you're moving forward.

So it's very agile. And so I learned, I literally learned agile to some extent via the ER. The second piece is mass casualty [00:22:00] triage. In a mass casualty situation, picture this there's a bomb explodes. 200 people are laying on the ground. You have to figure out a way to categorize those folks very quickly.

So you can focus your attention on where it needs to be focused. And so, very first thing you do is you say, everybody get up and walk to the right side of the room.

And remember the categories are green, red and black. So green is, I don't have to do anything and they're going to live until the hospital.

Black is they're either dead or close to dead and I'm [00:22:30] not going to spend time working on them. And red is somebody who's critically ill that if you do something, you might be able to keep them alive until the hospital. So the first thing you say is get up, move to the side of the room. Everybody who moves by definition is green.

So everybody who's left is either red or black. So you got to focus your time on figuring out who's red and who's black and some of the black are alive and you don't work on it. That's a kind of a strange concept, but it's really, it's really important because if you spend 10 minutes on that person who is likely to die [00:23:00] anyways, that's 10 minutes you could have spent on the folks who are in the red category. And it was the very first time I learned the business concept of opportunity cost. So I do think there's a fair amount of applicability from that world that applies directly to this role.

Bill Russell: We're going to cover the ransomware event because it sounds to me like that kind of background and training, where you have limited information, especially at that first phone call.

And you have to start making decisions on treatment if you will. That probably [00:23:30] came in handy, but I'm going to come back to that because I do want to hit the financial. The IT budget is enigma to people who are not in health IT. They just look at it and go, man, all this money. You guys have to be building castles made of gold with all this money, because it generally is one of the bigger budgets within the healthcare organization.

But even seasoned CIOs struggle to navigate this. And I really love what you've done in this area. You you've really put a good process for framework around it. So [00:24:00] let's talk a little bit, and I know you're going to say I haven't wrestled it to the ground, but let's talk about how you did wrestle it initially to the ground and how it is evolved over time.

Lee Milligan: Yeah, I think in the beginning, Bill, it was all about creating organization and clarity about current state. So I really just wanted to understand what do we have in place. And what I found initially was concerning because in fairness to those who were asking questions from the outside, we didn't have a uniform transparent system in [00:24:30] place. And so for example, our contracts and contract renewals, we're all located on some managers, desktop someplace. And so just that simple concept of bringing every IT specific contract to a central location, where we have a single repository that we can all access, that's sortable by manager, combined with a workflow in place that allows us to 120 days before renewal do a assessment.[00:25:00] And we have a workflow in place now that asks really good basic questions. I stole this shamelessly from Wilw Weader the CIO of PeaceHealth. He actually posted one time on social media. Here are the six questions that I ask at renewal time. And, we added to that by a couple, but they're basic questions, do we still use this product?

Does this product overlap with anything? Are we calculating the cost by volume or numbers or whatever it might be correctly. And what we found over time, if you put this in [00:25:30] place, is that there has been a number of contracts that we're either being overcharged for, or we actually weren't using to the extent we thought we were, that we're able to actually drop.

And so just by doing that one thing alone and then telling that story To my CEO and my CFO, I think really helped improve the relationship between kind of external executives and the IT team.

Bill Russell: Now I want to talk about budgeting now because you and I have talked about this. You had to make the budgeting process easier [00:26:00] for your team.

And we all go through this, right? So when it comes budgeting season and our team just they're there, you can say, see their countenance, just go like, yeah oh, my God, on top of the work we're already doing, we now have to do this and I have to go to this spreadsheet and this spreadsheet and this thing, and this thing, and pull all this together for you.

And this means I'm working nights and weekends to do all this. And you looked at that and said, okay, we're good. We're going to make this better. Talk about that.

Lee Milligan: Yeah. So that was really grounded in the concept of [00:26:30] storytelling. So I really felt like whatever numbers we put into whatever spreadsheet we're using, we have to be able to ultimately pull them out in a way where we can explain things with clarity, to folks that don't normally swim in our lane. Smart people, CFO, CEO, other executives who need to understand why we're moving forward in a certain direction.

So that was the end goal. And then we worked backwards towards creating a single kind of uniform spreadsheet. [00:27:00] Manager can fill out that helps tell that story. So if you look at the spreadsheet, one of the things that asks is, if we don't do this, what will be the operational or clinical impact and, having that clear level of clarity around each thing we're spending money on allows me to ultimately at the end. Have those robust conversations, shall we say with our other executives and have clarity around what the impact [00:27:30] will be of not moving forward with that.

And so, we put together this spreadsheet, huge credit to Alison Graphis, Kate Amadei and others who worked on this for quite a while, and ultimately ended up creating a scenario where we could have all the directors have their individual spreadsheets. And then ultimately those roll up into mine.

So now I can quickly look, sort by director sort by manager and quickly see the, spend the category and the operational impact of not doing something.

Bill Russell: How did you make the process [00:28:00] easier for them though?

Lee Milligan: Well, when I started, we actually have three separate locations where they were putting things. So one of the first things we did was cut that down by, by one. So now it's only two separate and we're actually working on an integration right now where it will be just one hope to get there at some point and then we removed columns that really didn't make sense that weren't part of that storytelling process that were just added noise associated with it.

And then the other piece that I think is really important is I have them categorize [00:28:30] potential cuts. So I don't, I don't know how you guys did it when you were at St. Joseph's, but here we put together a initial proposed budget, and then usually we get feedback that requires us to go back and trim. Well, I didn't want them every time we do that to have to kind of, wring their hands and think about it and whatnot.

I wanted them to categorize things in the beginning as green, yellow, and red in terms of cuts based on operational impact, if we don't do it. And so now when I come back [00:29:00] and I say, okay, I'm going to need X number of cuts. They can quickly look and say, okay, is, are we in green territory? Are we in yellow territory?

And I can say, we're in green territory. They say, okay, here are the four things I would suggest moving forward.

Bill Russell: Interesting.

Lee Milligan: One more quick point about that. And just to give you an example of kind of how this stuff ultimately impacts how we spend most recently this last budget season, I was trying to add some additional dollars for impression security, as you might imagine. And I wanted to add three things.

I wanted to add a, an FTE. I [00:29:30] wanted to add a offsite storage and I wanted to add a NDR, right? We chose Extra Hop. And, for folks who are not in our space, they look at that, like, why are you spending more money? Are you spending a lot of money? And so I ended up putting together a slide that had only three things on the slide and on the left, what was the total InfoSec operational spend. In the middle was the ITS InfoSec spend over total ITS spend [00:30:00] and on the right was total InfoSec spend over total operational spend. And as you can imagine by comparison, that number looks not huge. And when I talk, when I show that number and I combine it with the risk to the system, then asking for those three things actually became fairly straightforward.

Bill Russell: You used the word better early on in our conversation and I think some people get sort of.I don't know, they [00:30:30] get wound up early on and they look at all the problems that they're facing. You're generally not brought in as a CIO. I'm not saying this about your situation, but generally a lot of CIOs come in under duress, right?

Something happened, CIO left and you're brought in and then they look at all the problems that there are, and they sort of get, just get wrapped around the actual, there's just too many things to solve. But what I hear you saying is triage. It's your ER background, right?

It's like triage figure out red, [00:31:00] black, and, green. And then you go on from there and then every week you come in, you go, how do we make this better? It's better. It's just a constant iteration of let's make it better. Let's make the budgeting process better next year than it was this year.

Let's make our InfoSec better next year than it was this year. It's just, everything's just an incremental improvement over and over again. We don't do a lot of like leapfrogging. We just keep making it better along the way. It's nice when we get to [00:31:30] leapfrog though.

Lee Milligan: It is. I think it's also a recognition that there are a lot of things working well. Right. So again, it's opportunity costs. You don't want to focus on, your attention and time and effort on things that are already working really, really well. So calling that out, I think does two things, one, it allows you to focus on what matters and number two, it lets your team know that they really are doing a lot of things really well. Which I think is important. Cause you don't want to come in and say, let's throw the baby out with the bath water here. Because that just sends the wrong [00:32:00] message, even if it were true. And I can't even imagine that ever be true, most places are doing something very well and we were doing a lot very well, I think, but there was opportunity and that's we try to focus on.

Bill Russell: Absolutely. All right. So you participated in our webinar on ransomware, a community connect partner of yours Sky Lakes Medical Center was ransomed. And we had four people on that webinar. So a lot of times when that happens, you only get about 10 minutes to talk.

And I'd like to expound on that experience a little bit more [00:32:30] with you. We'll start with the, the phone call, which I guess is where this starts for Asante. Talk about that night, getting that phone call and what your response is immediately following?

Lee Milligan: Oh so you want to hear the real story?

Bill Russell: No, that was, that was a great webinar. That was the real story. But the Sky Lake story was really the focus of that. So that was about 25 minutes of the total webinar.

Lee Milligan: So, okay. Yeah. The phone call was scary. Right. You get this phone call from [00:33:00] the CIO of the other system. You've got your Citrix and VPN connection and FTP all connecting to to that system.

And they call and say, Hey, we've been hacked. We don't know exactly what's going on. All we know it's this thing called Ryuk. And I hadn't heard of Ryuk before. So I'm like everybody else Googling this as I'm talking to the CIO, trying to figure this out. And that my biggest concern was the time delay.

So there was, between infection and expansion of the infection and our phone call was [00:33:30]somewhere around six hours. And so I was very concerned about that. So I pulled my team together. We immediately cut ties and then began an introspection. Essentially they're looking to see if we had gotten infected by this. While at the same time, my team is looking at Ryuk trying to understand the nature of Ryuk, trying to gather more information. So we're gathering information while at the same time, we're looking at our internals to see whether we have any infection. On top of that, this is our community connect partner, and we certainly want to be [00:34:00] mindful of the catastrophe they were experiencing and doing our best to help support them in that process. But those were kind of the initial thoughts that that happened.

Bill Russell: Is that an all hands on deck kind of event, even though you hadn't been infected per se, the fact that you were in close contact?

Lee Milligan: Yes, to an extent. I mean, there's very little like and certain people on my team can do in that circumstance. So certainly it's all hands for the directors, most of the managers and certain specific teams [00:34:30] associated with it. Obviously InfoSec, but some other teams as well.

Bill Russell: All right. So you start to weight in and I assume again, like your ER background, you start to get more and more details, more and more information as you move forward. So what are you learning as that day unfolds? As the next week unfolds?

Lee Milligan: I think I learned that the process is that , Sky Lakes talked about this. They had some challenges with their scenario around what, what vendor to go with and, looking at their their cybersecurity policy, et cetera.

What [00:35:00] I learned is that I didn't know enough about my own cybersecurity policy. And I really needed to make a conscious effort to understand the policy, what's in place and to make sure that I agree with the tenants of the policy, as well as having my, the folks on my team have a clear understanding of that as well.

I also recognize that we have this connect scenario. And it made me think about it differently. I realized that we're extending Epic to Sky [00:35:30] Lakes. Sky Lakes got infected. We could get infected, but if that happened, we could also infect other sites that we send Epic to. The other nine clinics that are on our system.

And so it got me thinking about this whole process differently. At the time we didn't have offsite storage with an air gap. And so, I'm happy to report that. We put a lot of things in place as a result of this, like everything else we've been talking about in terms of incremental improvements.

I don't know that this was a evolutionary change, but certainly we made a significant number [00:36:00] of improvements based on that experience. Now Sky Lakes talks about the fact that they had the technology in place but they didn't configure it the way they would have liked to have. We looked very critically at our own internal configuration to make sure that we were staying up to par on that piece as well.

So it basically allowed us to do this internal reflection that was ultimately good for our system. We got better because of what happened to them. But the other piece that I'll, I'll say it was [00:36:30] kind of fascinating is that I really wanted to understand if something was in our system. And I want it to get to our backups.

How fast would that would that process have happened? It was pretty, pretty quick that that process can happen. So we literally disconnected our backups for a period of time. Right. And I know that sounds a little crazy to folks, but you know, in very simplistic terms, we wanted to make sure there was no possibility that, years and years of our data could be an an encrypted and infected.

Bill Russell: Wow. I'm going to point people [00:37:00] to that webinar if they're interested, they could hit it on our website. It's the ransomware webinar. It was done in the fall of 2021. Really well attended and listened to. One of the stats I give to people.

It's such a compelling story. We do the webinar and 98% of the people stayed for 56 minutes or longer on a 60 minute podcast. And they're like, you're kidding me. I've never heard of that kind. And I'm like, it's a compelling story. I mean, it's, it's almost like a, it's like [00:37:30] a I dunno, a suspense novel that's sort of unraveling as we tell the story.

And it just happens to have a bunch of educational components in it, but it really is fascinating.

Lee Milligan: It's a John Grisham novel basically.

Bill Russell: It is. And unfortunately it is those events that cause us to step back and go, oh, do we have all the disaster recovery we need? Do we have all the cybersecurity we need?

And it usually is the events. I know for us to St. Joe's we had a breach two weeks into my tenure as CIO. [00:38:00] And and I'm sitting there going okay. And, it was man-made. Configuration error on a server. SharePoint server and it was sending information out it shouldn't have. But it was a great opportunity because when you have those opportunities as they say, never let a good crisis go to waste. You get a chance to step back and say, are we doing the right things?

Do we have the right process, procedures, investments, technology, partners, insurance contracts, I guess is one of the things we learned from this one. All right. Let's focus towards the future a little bit. As you look forward to [00:38:30] 2022. What's top of mind for the role of CIO at Asante Health?

Lee Milligan: Well, we got a lot going on as we talked about. The two cancer centers going live in January that pavilion, a huge extension to our flagship hospital. A bunch of acquisitions, a lot of community connect, additional community connect, which I'm excited about. But for me, the biggest thing by far is recruitment and retention. In that sense, I really want to make this the best damn place to work in healthcare IT. That's something that we should work on anyways. [00:39:00] And with everything that's happening in the industry, it's become absolutely imperative that CIOs focus on this, in my opinion. And really I'm going to focus on kind of four main elements.

The first is compensation. You got to get this piece right. And one of the pieces we're doing on this is we used to do a, every two year industry assessment and I've worked with HR and now they're willing to do that every six months. And I recognize you can't monetize your way out of a retention issue, but you have to pay enough so that you take the [00:39:30] money piece off the table and you can focus on the other elements associated with it.

Flexibility. Our folks are they're juggling kids, home life, COVID. As we talked about locally here, the wildfires. And as leaders, it's really up to us to create an environment where it's flexible enough, where they can balance those things and then be able to also work on the work. Balance itself, I think a combination of balance of you know delivery of product with the development of relationships. I've noticed that my staff, that the more they get to know one [00:40:00] another, the more they get to support one another, the more they're able to be effective in their roles. So striking that balance. And then lastly, really professional growth and satisfaction.

One of the pieces that we're trying to get right here is the role around the Epic analyst. In our system. We now have an associate Epic analyst, an Epic analyst and a senior Epic analyst. And we didn't always have a level of clarity around those three roles, particularly the Senior Epic Analyst role.

And so I've had the team and myself working on that to get that piece [00:40:30] right. Previously for example, we had a cap on the number of Senior Epic Analysts that we had in our system. And that cap just seem gratuitous. It just didn't make sense. And so we lifted that cap because the reality is that if somebody has, good experience is really good at what they do technically savvy there shouldn't, they shouldn't have to wait until somebody leaves or dies to be able to move into that role.

And so that's been received very well, I think by staff. We're also doing extra stuff. [00:41:00] We provide a LinkedIn learning for example. I think it used to be called lynda.com and LinkedIn acquired it. That's been really well received by the staff and they're using that as well. And then we're trying to encourage advanced degrees for folks and try to support that and actually pay for at least a portion of that.

One of my epic analysts recently got her a master's of healthcare operations degree. So you might think, gosh, how does that apply to an epic analyst? Well, understanding how the business of this world works can only [00:41:30] help an analyst do their job better. So really focusing on those four elements for my team and looking for creative ways to make this place the best damn place to work and healthcare IT.

Bill Russell: So if somebody is listening to this and they go, wow, that sounds like the place I want to work. How do they find out more information about getting an IT job at Asante?

Lee Milligan: I would encourage them to email me directly Lee.Milligan@asante.org. And I'd be happy to point them in the right direction.

Bill Russell: You know, most people, if they would say that, I'd say that's kind of disingenuous, but with [00:42:00] you, I know you're going to come back to every one of those emails which, which is fantastic.

It's interesting when we're talking about retention and those kinds of things. I think we simplify it too much and say, are we going to work in the office or work remotely? And is that going to be enough? I like the fact that you put those four factors together, but I do want to focus in on, on, on that aspect of it.

I heard one CIO say we're now able to hire in 50 states. I mean, is that practical for you out of Medford or are you [00:42:30] looking for more of a regional approach or even a local approach?

Lee Milligan: Yeah, I mean, it's actually hard for HR to do that. It costs them between 6 and $10,000 to set up the individual state stuff every time we do that. I think we're in 12 states right now. But I think the industry is heading that way. So we have to do that. I do think it's ultimately advantageous to live closer by, but the reality is we have to open up across the board and we're doing that, I think fairly effectively.

We're trying to be mindful [00:43:00] of the impact to those who are close by. So for example, if we have an analyst team that are part of a particular team and that team has to come in to do testing, for example, at one point prior to go live the team that's local, if they're required to come in, they might ask the question, well, Hey, so and so that lives in Tennessee doesn't have to come in. What's going on there. So we're grappling with those questions right now. We did pull together a team, an internal team within IT to look at this exact issue of how [00:43:30] staff can stay connected to one another and stay connected to leadership.

Despite the fact that we're in this distributed model right now, and that team is formulating right now, some recommendations.

Bill Russell: Interesting. All right. We're going to close out on the personal side. You appear healthy, you appear, I mean, after a couple of years in the CIO role, I was not nearly as healthy as I was when I started. Just based on social media, you write a fair amount, you spend a lot of time outdoors. I mean, is that sort of your outlet?

Lee Milligan: Yeah. [00:44:00] I mean, I have a ton of advantage is working in my favor. First I have a wife who's incredible, and she's my partner on, on all things. And she and I spent a lot of time outdoors.

We do a fair amount of hiking. We try to hike three or four times a week if we can kind of sneak out a little bit early. We also, interestingly, ride motorcycles. So most of my ER, docs friends give me a hard time about that. But yes, we ride motorcycles. And we do a lot of outdoor things.

We go to the coast and other places as well. We have four kids and they keep us really busy.[00:44:30]All my kids speak Spanish. So I spent a lot of time with my kids going over Spanish and reviewing Spanish with them. And that's always a lot of fun, but just trying to do other stuff, that's not necessarily associated with an LCD screen.

And not necessarily critical in terms of the decisions you make. And so things like, hiking and speaking Spanish is it's all good.

Bill Russell: I'm sorry. Did you say you and your wife go out on bikes?

Lee Milligan: Motorcycles. Yeah. And our kids as well.

Bill Russell: So if I pull into your driveway, am I going to see like [00:45:00] his and her bike there and some kids' bikes as well?

Lee Milligan: Yes, you will.

Bill Russell: Wow. For an ER doc, I mean, I had heard some of those stories. So our hospitals were in the LA market and those kinds of things, and you could actually split lanes in Southern California.

And if people don't know what that means, essentially you could drive on the white line. In traffic, which can save you a lot of time, but it can also be amazingly dangerous. And some of the accidents in Southern California from splitting lanes is,[00:45:30] so as an ER, doc, I, I assume you get more than a little heat from your peers.

Lee Milligan: I do, but mind you that I don't ride motorcycles today like I used to. So in the past, when I would ride motorcycles, like my dirt bike, for example, I would ride it. I would look for, holes and jumps and whatnot in order to hit them. And nowadays I look for those same things in order to avoid them.

Bill Russell: Understand. Lee, thank you again for your time. Thanks for going back to the [00:46:00]early days as CIO and recounting that. I think that's going to benefit a fair number of people and just to, just to have that episode, so people know hey, the first couple of weeks of being a CIO, not not all roses and sunshine. It's a process to get to where you feel like you're on top of things. And that could all change with a phone call this afternoon I would imagine.

Lee Milligan: One last thing I'll leave you with Bill, is that, when I first came into the role, I did reach out to a number of CIOs who were awesome. Ed Marks, John Halamka, Michael Pfeffer and others who [00:46:30] gave me some great advice kind of out of the gate. And they were kind enough to share with me their time. If any of your listeners are headed on this trajectory or are newly into the CIO role. I'd be more than happy to spend time with them and share with them personally, kind of some of the tidbits I picked up along the way.

Bill Russell: Fantastic. Lee, thanks again for your time. Always great to have you as a guest.

What a fantastic discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have [00:47:00] everyone on my team listening to this show. It's conference level value every week of the year. They can subscribe on our website this weekhealth.com or they can go wherever you listen to podcasts apple Google overcast Spotify Stitcher you name it We're out there Go ahead Subscribe today Send a note to someone and have them subscribe as well We want to thank our keynote sponsors who are investing in our mission to develop the next generation of health leaders Those are Sirius healthcare VMware Transcarent press Ganey Semperis and [00:47:30] Veritas. Thanks for listening. That's all for now.

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