This Week Health

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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

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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: [:

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.

hospital [:ing out there twitter is the [:All right. Welcome to:

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?

s out on me. I'm starting to [:

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?

the surface of those topics. [:

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 [:itions as well as additional [:? Do you have a pretty broad [:

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?

al front. My biggest concern [:

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.

r is that sort of your story [:I moved here. I moved here in:

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.

eah. So, when you grow up in [:n hikes through Asbury woods [:

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, [:

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 [:that portion of it alone is [:

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.

rsion is don't be a jerk. And[:re-auditioning for your role.[:

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?

etimes you can have a Denovo [:

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.

when I was a volunteer leader[:

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.

tionships. A hundred percent.[:much about how to conduct a [:

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?

y do give me a lot of grace, [:

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.

pretty clear to them that it [:in your step, in your smile, [:

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.

job as leaders is to curail [:

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.

t you know, there's a lot of [:

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?

as CIO. And so I'll start us [:

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.

are. And so they'd say, Hey, [:

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?

me the position just opened [:

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.

ep into it, I certainly want [:e a need, I didn't think for [:

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 [:t the definition of oncology [:

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.

r our relationship while I'm [:really trying to understand [:

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?

ncern. No, I thought honesty [:d you have not become like a [:e of the challenges as a doc [:rsus being a specialist that [:

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.

e versus waterfall thinking, [:

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.

econd piece is mass casualty [:

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.

ead or close to dead and I'm [:person who is likely to die [:

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.

t if you will. That probably [:for framework around it. So [:niform transparent system in [:ver time, if you put this in [:

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.

the budgeting process easier [:

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.

y grounded in the concept of [:kind of uniform spreadsheet. [:

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.

How did you make the process [:

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.

nt is I have them categorize [:And so now when I come back [:

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 [:t sort of.I don't know, they [:

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?

like triage figure out red, [:ay. It's nice when we get to [:se that just sends the wrong [:

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.

experience a little bit more [:

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.

You get this phone call from [:

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.

ction and our phone call was [:

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?

s and certain specific teams [:

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 [:we're extending Epic to Sky [:

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.

we made a significant number [:e that I'll, I'll say it was [:

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.

w. I'm going to point people [:t's almost like a, it's like [:

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?

weeks into my tenure as CIO. [:bit. As you look forward to [:t we should work on anyways. [:enough so that you take the [:he more they get to know one [:

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.

ng on that to get that piece [:e're also doing extra stuff. [:of this world works can only [:

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.

nd of disingenuous, but with [:

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.

ou out of Medford or are you [:

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 [:

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. [:

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.

and they keep us really busy.[:

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.

eway, am I going to see like [:

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.

rnia from splitting lanes is,[:

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.

Thanks for going back to the [:chael Pfeffer and others who [:

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

re a CIO today, I would have [:

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