As CIO of CentraState Health System, Neal Ganguly is in a unique position. Although the organization offers ambulatory services, it is still considered a stand-alone community hospital, and is located in the most densely populated state in the country, among a sea of large multihospital systems. For Ganguly, the challenge is to forge ahead and continue build the organization by finding new ways to connect with physicians, aligning with the state’s largest HIE, and leveraging initiatives like CHIME StateNet — a forum in which CIOs can share best practices. In this interview, Ganguly talks about why strategic planning should focus on meeting immediate needs — and not on achieving Stage 7; dealing with the growing demands of sophisticated users; and the challenges of maintaining a healthy work-life balance.
- “We’re really spreading ourselves thin”
- Meeting the growing demands of clinicians
- Not being afraid to say no
- The challenges of leaving work behind
- The need to be nimble
- “It’s a scary time & an exciting time”
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We have a lot of burners, but I don’t know if we have enough cooks and chefs. And as a result, we’re really spreading ourselves pretty thin, and that’s a huge risk, particularly as more and more of what we support becomes mission critical.
Part of our role as CIO, I believe, is to begin the control that demand curve and to go back to those users who are becoming increasingly sophisticated and say, ‘Listen, we cannot do this.’ And it’s a tough position to be in.
We recognize that as a gap and are aggressively scrambling to figure out how to fill that gap. Do we bring people from the outside to help us reconfigure key applications and present them in mobile formats? Do we go back to our vendors and say, ‘Are you going to render your application in a tablet-friendly view?’
By taking advantage of certain downtimes where you’re maybe waiting on line or sitting in a waiting room, you can go through and clean up or respond to a number of emails. We find ourselves doing that a lot, and I know people say that’s bad, and it probably is, but I’m not sure how else to control the volume of work.
The public doesn’t understand a lot of what we do. They don’t really know what HIEs are, and until they do, that will also color the political environment, because they’re not going to be putting pressure on legislators to make certain rules or decisions unless they feel it’s a priority. So we’ve got some work ahead of us on front as well.
Gamble: I wanted to touch a little bit on something we talked about earlier as far as the impact that this has on staff. I know that a lot of CIOs are really concerned right now about avoiding burnout — what are your thoughts on that?
Ganguly: That’s a serious challenge. I know we’ve lost one or two good people to burnout already. Frankly, the vendor community has deeper pockets than we do and in this time of huge demand, they’re really trying to attract away a lot of our highly trained skill resources and promising them better quality of life and more money, and it’s tough for us. I can’t speak for my colleagues, but I imagine most of us are competing intensely with the clinical departments in hospital for resources being added, and justifying these resources as difficult. To use your burner analogy, we have a lot of burners, but I don’t know if we have enough cooks and chefs. And as a result, we’re really spreading ourselves pretty thin, and that’s a huge risk. It’s a huge risk, particularly as more and more of what we support becomes mission critical.
I don’t really have an answer. I wish I did. We’ve been working aggressively with our HR department to look at ways to put career ladders in place, ways to reward the IT staff for their accomplishments that might not be quite aligned with the hospital standard way of rewarding other departments, but there is no magic bullet we’ve found that’s really making the difference.
Gamble: It’s an interesting point you brought up about the vendors. That is a really tough point of competition right now.
Ganguly: Yeah. And one of the problems that, as CIOs, we face is that our users — our customers, our clients, whatever we’d like to call them — are becoming increasingly sophisticated in terms of technology, and they’re making more and more demands. So we’ve got a very steeply rising demand curve; yet by and large, the staff we have has remained fairly flat. I mean, it increases a little bit, but certainly not keeping pace with the increase in demand. And so part of our role as CIO, I believe, is to begin the control that demand curve and to go back to those users who are becoming increasingly sophisticated and say, ‘Listen, we cannot do this.’ And it’s a tough position to be in, because it’s not positive. You’re coming out with a negative message saying, ‘I see you have an idea here, but I don’t have the resources to support it.’
And so what we’re struggling with are good prioritization methodologies — how do we get our community to understand that IS has a limited throughput capacity, and that we can’t handle an unlimited volume of projects. We haven’t found the right answer yet, but certainly if somebody has, I’d love to hear about it.
Gamble: Are there demands or requests for things like certain mobile apps?
Ganguly: Yeah, mobility is an area that’s exploding right now. We’re not well-positioned to deal with it. Just simply from the perspective of supporting the devices themselves, we’re gearing up, but very quickly behind that, they’re going expect applications to function on those devices, and we’re not in a position to do that yet. We recognize that as a gap and are aggressively scrambling now to figure out how we should fill that gap. Do we bring people from the outside to help us reconfigure key applications and present them in mobile formats? Do we go back to our vendors and say, ‘Are you going to render your application in a tablet-friendly view?’ Do we develop our own apps that we push out to the general public or to our customers, meaning our in-house staff and physician? These are questions that we’re going through in our current strategic planning process that really will require some hard thinking and some answers.
Gamble: A lot goes into that and to just one aspect of that is when they’re using their own devices, how do you make sure that you have the right security in place? It’s something that you really have to think through before just giving the green light.
Ganguly: Yeah, absolutely. There are a lot of risks around that. These tablet devices really are hybrid devices. They’re not purely a business device, and you can’t expect them to be. It’s not realistic. Even if I issue the tablet and try to put controls on it, people are going to find ways to download the apps they want on it — that’s the purpose of those tools. We have to take a realistic view of that as we try to plan how we want to control the use of the devices.
Gamble: That has to be kind of frustrating when they keep coming out with cooler versions of things like iPad. You almost want to say, ‘Alright, can you put the brakes on that?’
Ganguly: I know.
Gamble: Are you finding it difficult right now to try to maintain a balance between work and the rest of your life? Do you have rules about trying to at least take a little bit of time away or even just turn off the BlackBerry at certain times?
Ganguly: It’s funny you mention BlackBerry — they’re really hurting now too. I think that the iPhone and the Android have really kind of carved into the market share, even in the business space. But I happened to be an Android user, and at this point I would say that work with us everywhere. I don’t know that it’s that unique to what’s going on today. I think this has been going on for a while, at least for most of us in the management roles. It’s almost defense mechanism. I’m going to be confronted by, let’s just say, 250 to 300 emails a day, regardless of whether I look at them in an eight-hour work day or I spread that out over a normal 12 or 18-hour day. And by taking advantage of certain downtimes where you’re maybe waiting on line or sitting in a waiting room, you can go through and clean up or respond to a number of emails. We find ourselves doing that a lot, and I know people say that’s bad, and it probably is, but I’m not sure how else to control the volume of work that’s on us right now.
So I think we struggle with the work-life balance. I will say that I think mobility has been helpful in that you can get home instead of sitting at the office and doing that kind of stuff until 8 or 9 o’clock at night. You can do some things from home and plug it in amongst the amount of free time with family, but it’s challenging. It’s challenging for sure.
Gamble: We’re hearing a lot of the same from everyone. I don’t think there are too many people who are able to really shut it down right now.
Ganguly: Yeah, I’m sure. It’s a noble thought, but I’m not sure how to do it. Even on vacation, you find that it is much easier to respond and close things off than come back to a week’s worth of unresponded-to messages and issues.
Gamble: I think there’s something to be said for that too. Okay, so we’ve touched on a lot but I want to ask you if there are any other issues you wanted to address, either anything you’re working on or any of your thoughts on what’s going on in the industry?
Ganguly: Oh my.
Gamble: It’s really a very broad question.
Ganguly: It’s a very broad question. I think we’re just at a very interesting point in time. People use the term disruptive transformation. I think that’s a really apt term for where we are right now; that the way we deliver healthcare needs to change dramatically, and I think that some of the things that are going on are trying to drive that change. Of course we’ve got the constantly changing issues of the political landscape; with this being an election year, it will be interesting to see how that may impact the next few years.
But no matter what, I think that as IT professionals, we have to recognize that our industry is in a state of crisis and that we have an opportunity to use technology to help bring it to the other side effectively. And we have to really nimble and aware of how the currents are changing around us, so that we can deliver the information to some of our colleagues in as timely a manner as possible to allow them to make those hard decisions. But it’s a scary time in a lot of ways, and it’s an exciting time in a lot of ways.
Gamble: As much as there is going on — and it is crazy, it’s important to try to keep your eye on what’s going on with a lot of these things. It is the right thing to do, kind of like what you said about health information organizations. It is the right thing to do; it’s better for patient care. It’s just a matter of getting to that point and putting all the pieces together.
Ganguly: Right. And there’s a huge learning curve out there. The public doesn’t understand a lot of what we do. They don’t really know what the health information exchanges are, and until they do, that will also color the political environment, because they’re not going to be putting pressure on legislators to make certain rules or decisions unless they feel it’s a priority. So we’ve got some work ahead of us on front as well. We have to begin to educate the general public about how health information technology can impact their lives positively.
Gamble: Absolutely, there is definitely a gap there. People are willing to use their information in other places, and I think that there is a lack of understanding about using things like PHRs and portals. It’s interesting.
Ganguly: Yeah, it is.
Gamble: All right, so we’ve definitely covered a lot, and I appreciate your time. It’s good to talk to you.
Ganguly: Same here. I love talking to you guys and I’m glad to hear that you’re on the healthsystemCIO team. I think that’s going to be an exciting growth as well. You guys deliver a lot of value to us as a community, and I appreciate that.
Gamble: Thanks, it’s great to hear it. And I’m thrilled to be back.
Ganguly: Good, I’m glad.
Gamble: Alright, I’ll talk to you soon.