To say that there is a strong focus on innovation at Vanderbilt University Medical Center would be quite an understatement. In fact, it’s more like a way of life at the academic medical center, which includes an acute care hospital, children’s hospital, clinic, and cancer center. If there is a tool that clinicians need, the IT team will determine whether it can be developed in-house before turning to a vendor. For Deputy CIO George McCulloch, this type of environment may be challenging, but it’s also deeply rewarding. In this interview, McCulloch talks about balancing the needs of different constituents, how practicing medicine is both an art and a science, the importance of working to meet the needs of specialists, and his organization’s road to Meaningful Use.
- The deputy CIO role and AMC governance
- The Vanderbilt IT department
- Feeling the HIT workforce shortage?
- Focusing on clinical integration
- Engaging with CHIME for professional development
The job of our leadership team is to really cover all bases—both academic research and the patient care component, and make sure that we’re driving the goals and understanding the needs of those different constituents. So mine was a new role that is not very frequently seen in our industry, but is very useful in an organization of this size and this level of complexity.
It’s really helped us take a look at the established metrics that the organization has and see where we need to the help, where we need to lead, where we need to support the organization. For example, we’ve got a metric in the organization about observed-to-expected mortality rates, and that’s one in which we’re really leading the organization.
Clinical engineering is a particular area for us at the moment, because of the new FDA regulations and data integration that we want to have. And I think that’s an area that we’re going to continue to focus on.
How do we get the next level of leader to get the kind of experiences that bring you to the CIO level, where there’s so much to be concerned about and so many parts of the business to understand? How do you get somebody to even begin to start thinking about or getting experiences in that?
Guerra: Let’s talk a little bit about governance, if you don’t mind. Being in an academic medical center, I would imagine you have different and unique governance as compared to the community hospitals. You are the deputy CIO for CIO Bill Stead. Tell me a little bit about the role of deputy CIO—what that means, is there a CMIO or CTO, and then how Bill Stead fits in, and the overall governance structure you have there.
McCulloch: Sure. We’ve got a fairly broad informatics leadership. Bill has responsibilities at the University at the Medical Center. We also have a chief operations officer that reports to Bill, and I report up through the CIO to the COO back up through Bill. We’ve got a senior leadership team in informatics that is probably six or seven peers of mine that all work together. We don’t have a formal CTO component, though we have some self-development, so Dr. Ed Shultz is really our CTO in terms of that. So we’ve got a fairly broad reach.
What we’ve tried to do is take a look at areas of focus for particular areas that we need. Bill looks at overall architecture across the Medical center in University. Dr. John Doulis, who is our COO, really manages the medical center of technology and our application components. We have at the present time four CMIO’s, which is very unusual. We’ve got one for inpatient, one for outpatient, one for the cancer center, and one for quality control. My role in all those is to move us forward in particular areas as we’ve grown and taken a look at new areas like clinical engineering, outpatient technologies, and other areas like that. I’ve spent more of my time in those areas than some of the more traditional components.
The job of our leadership team is to really cover all bases—both academic research and the patient care component, and make sure that we’re driving the goals and understanding the needs of those different constituents in the way in which it works. So mine was a new role that is not very frequently seen in our industry, but is very useful, I think, in an organization of this size and this level of complexity, with someone that’s been in the industry for a while and has a broad sense of the processes and the complexity in understanding all of the components of the business and trying to fill in where we need to in particular areas of need.
Guerra: I’m picturing lots of meetings.
McCulloch: You’re picturing it right. It’s a lot of meetings, a lot of customer relationships, and again, a lot of innovative programs going on where informatics is an essential component and we’re really trying to stay in touch. You have to either lead follow or get out of the way in terms of some technology components, and clearly here, we’re leading. So it is indeed looking at business problems, clinical problems, and operational problems that the business wants to focus on, and saying, ‘Okay, how can informatics or IT help me with these kinds of things and our judgment with them in terms of whether we can or can’t help on certain kinds of things.’ I’ve got a group of folks that do nothing but innovation and product selection, and so I get involved in some of the bright ideas that we have; thinking about how we would solve those kinds of things and going to take a look at those. So yes, there are lots of meetings, lots of customer relationships, a lot of strategy, and a lot of planning components.
Guerra: So you don’t think you have too many meetings, or it’s not so many levels of governance that you get bogged down?
McCulloch: I’m sure we could be more efficient. Again it’s a complex organization, and the organization is really working toward kind of a balanced scorecard pillar model where we’re getting better metrics on the things that we want to go do and the things that we want to focus on. So it’s really helped us take a look at the established metrics that the organization has and see where we need to the help, where we need to lead, where we need to support the organization. For example, we’ve got a metric in the organization about observed-to-expected mortality rates, and that’s one in which we’re really leading the organization to try to take a look at things like the ventilator-associated pneumonia and other clinical conditions that are impactful of that. So I think having metric as this organization has began to develop them more fully has really helped us with our governance process, because we’re able to work closely, follow that, and say, ‘Okay, if the business says this is an important metric, and then let’s go take a look at that. Let’s figure what we need to go do.’ So that’s helped a tremendous amount.
Guerra: Okay. Let’s talk a little bit about your department. How many are there overall in the IT department?
McCulloch: Over 500.
Guerra: So you have over 500. And we hear constantly about healthcare IT workforce shortages, especially for those with clinical experience and a clinical background. You got a big shop—have you felt the pinch of a lack of available talent out there for what you’re trying to do?
McCulloch: Somewhat, but not uncomfortable. I mean there are certain scarcities that we have—we’ve been down the road of CPOE so we’re not in the CPOE implementation model, which would certainly be impactful. So it’s not been terrible for us. But again, we also have a large, clinical workforce that we will draw upon for certain things. There are lots of clinical folks that enjoy bedside and enjoy sitting at the bench and doing other kinds of things, and then after a period of time, want to try to do something else. So sometimes we will take bright people with clinical backgrounds in particular or financial backgrounds, and move them into the IT organization to try to get some context there. So we’ve done okay.
Guerra: Do you have to be careful about poaching on the clinical side of the house?
McCulloch: We’ve been careful, but the business, I think, appreciates it. It’s kind of like when the CPA firms lost somebody to a firm. They’ve got somebody in on the inside that knew them and that was good, and I think that our customers feel that if they’re going to go anywhere, they should go to us; if they want to try to do something else with their life, because now they’ve got a friend in the inside that knows them, and who absolutely represents them well and said ‘No, this is how it works.’ So I think it’s been a good relationship. I don’t hear a lot of complaints about poaching too much.
Guerra: Right. So are there any other top projects you want to talk about that are on your plate right now?
McCulloch: I think that the big one in the short term for us is ICD-10. I think we’ll be in decent shape on Meaningful Use—we’ll make that one. I think we’re really continuing to try to drive the clinical quality piece and the genetic side of what we need do. And again, for us, it’s taking a look at ancillary environments—radiology, cardiology, clinical engineering, and ancillary systems or processes that maybe were not the focus that were not the focus of IT informatics before, but really need to be.
And so we’re really growing the business and trying to do integration there. I would say that clinical engineering is a particular area for us at the moment, because of the new FDA regulations and data integration that we want to have. And I think that’s an area that we’re going to continue to focus on—instruments that produce data that we need to capture discreetly that we want to decision support on. Trying to make that piece better is a particular area of focus for us.
Guerra: I wanted to touch on just one more thing before I let you go. I know that you’re involved with CHIME and especially with the CHCIO Program. How is that going, and what are your overall thoughts around CHIME—the value that it provides to CIOs and whether you would encourage people to get involved.
McCulloch: It’s been fabulous. It’s been an important part of my career. I love going and spending time with both the faculty of CHIME and some of the others. It’s just a fabulous networking environment and learning environment. I can’t think of a better way to understand what’s going on in the industry and get some contacts. I regularly post questions on CHIME on the things that I’m interested and the things I’m concerned about, and I think it’s a very collaborative group. When I post something or ask a question about to somebody, whether it’s formal or informal, I always get an answer. It may not be the answer I want, but at least I get a sense of where other people are and what they’re thinking. And sometimes they’re very mundane and sometimes they’re very esoteric. But it’s a great group. They’re very committed to the industry and to each other, and I think it’s just a fabulous organization.
Guerra: And the CHCIO program?
McCulloch: I think it’s a great step. For people growing up and understanding what it means to be a CIO, I think it’s an important component of learning. I wish that it had been there as I was developing my career, because I think it’s a roadmap to follow and it provides a level of knowledge, between that and Boot Camp, of things that a CIO really needs to learn how to do. Because the for those who are coming up—and we talk about this in our organization—how do we get the next level of leader to get the kind of experiences that bring you to the CIO level, where there’s so much to be concerned about and so many parts of the business to understand? How do you get somebody to even begin to start thinking about or getting experiences in that? And so I think the certification program is a great component of that and the breath of what’s needed.
Guerra: You’re certainly involved with CHIME. You stay up-to-date there, and you’ve joined our healthsystemCIO.com LinkedIn group and I know you’re active there with other LinkedIn groups, so you definitely must think it’s very important in this day and age to stay engaged and stay involved.
McCulloch: Absolutely. It’s kind of like when we talked about with these positions—you can’t know at all. You have to find people who know things that you don’t and ask for an opinion. Ask for a favor. Ask for some feedback. Because there’s too much to know. And again, the best experience is the shared experience of what works what doesn’t; what’s moving and what’s not moving. So I think it’s been great. I think the relationship building as it is in our business, from a clinical standpoint, is a critical component in a CIO role as well.
Guerra: All right, George. That’s all I had for you today. Is there anything else that you want to add?
McCulloch: No, I think it’s been great. I appreciate the conversation.
Guerra: Well thank you very much, and hopefully I get to speak to you again soon.
McCulloch: Okay, sounds great. Thanks a lot.