The idea of being acquired by a health system — especially one as large as Sentara Health — can be daunting for a CIO. But Mike Rozmus viewed it as an opportunity to work closely with Sentara CIO Bert Reece and to try to emulate some of the success the 11-hospital organization has had in its advanced use of IT. In fact, since the merger last year, Rozmus has already incorporated one of Sentara’s best practices by leveraging physician advisory groups to get buy-in on projects. In this interview, Rozmus talks about other changes he has made since the acquisition, what he’s doing to bridge the inpatient and practice environments, the lessons he’s learned being a Meditech 5.6 beta site, and the challenges of dealing with a heavy workload.
- Staff management and leadership
- The benefits/challenges of poaching from the clinical side of the house
- Dealing with a historically heavy workload, battling burnout
- “There’s only so much organizational change you can absorb at one time”
- Stage 2 MU concerns
- How government programs are crowding out innovation
- Rozmus’ journey: From industrial engineering to hospital CIO
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Some of the best talent that we’ve brought into our clinical build teams has been non-IT talent. They’ve been nurses and sometimes physicians, pharmacists, and other therapists who have come in without IT experience, but bringing that breadth and depth of clinical knowledge that they can learn the IT. It’s just getting the right people to the table.
We would have been further along in our CPOE journey and in our Meaningful Use journey had we not hit the pause button for about 18 months to make sure that we had a safe and effective move into our new facility. We really stopped some of that because as it comes down to it, there’s only so much organizational change that you can absorb at one time.
At one time, it was always thought of as the live date for an implementation being the end, but it’s only the beginning of the next stage. And as we’ve learned, every new stage brings about more complexity and more regression testing, and you have to go back and incorporate all the changes that you’ve made earlier and make sure that they continue to be viable as you’re creating new pathways and new workflows.
I think that we have to understand that there really is no one platform that does everything and certainly there is no one platform that does everything well. In our own case, in the Meditech world, we have things that Meditech just doesn’t do and doesn’t have a module for.
There is really not enough IT talent in the healthcare industry to continue to move at the pace we’ve been moving. And it’s concerning; we’re still moving at a rapid pace, but certainly we have to be concerned about burning folks out.
Guerra: Let’s talk a little bit about staff management. We all know there’s a huge shortage of healthcare IT talent out there that’s probably getting worse by the month. One of the specialties that you had on your LinkedIn profile was talent selection and retention, which is certainly quite valuable today, more than ever. Can you give me your thoughts around managing for success in both selecting and then keeping good people once you have them?
Rozmus: Sure, I think one of the things that we’ve learned along the way is that the talent that exists in the IT department certainly needs to have talent infused from throughout the organization. Some of the best talent that we’ve brought into our clinical build teams has been non-IT talent. They’ve been nurses and sometimes physicians, pharmacists, and other therapists who have come in without IT experience, but bringing that breadth and depth of clinical knowledge that they can learn the IT. It’s just getting the right people to the table with your technology specialists who can carry on a conversation of improving the technology deployment.
So when we select talent, it depends on what we’re looking for. If we select talent that is implementing clinical systems, we will certainly look in-house for people with the experience, the interest, and the aptitude to take those technologies and apply them to the clinical settings. If we’re looking for pure technology expertise, we’ve gone to other industries and certainly brought in talent with other experiences, not necessarily just in healthcare.
Guerra: When we’re talking about the clinical talent and looking in-house, have you ever had any pushback from the department saying, ‘Hey, we need those people over here. Stop poaching on our territory.’
Rozmus: That becomes a challenge and certainly it’s understanding that sometimes the folks that are in the departments can be more of an asset to affect more clinical transformation and improve things for nursing, for example, if they’re working on the inside and developing those systems. They’ve been a staff nurse; they’ve experienced where the system was. When you’re going to develop computerized physician order management, the workflow changes quite a bit for everybody in the clinical setting, so bringing that experience in is only increasing the value for the whole organization. And we have a combination of folks working on our project right now. There are about 20 on the team that aren’t IT staff that are from the other areas of the organization that have been allocated to the project, either full or part-time, to assure its success.
Guerra: Now you’ve been over there about nine years?
Guerra: And would you the level of workload today on the IT department as being greater than it’s ever been?
Rozmus: Absolutely. I think that’s common across the industry with Meaningful Use, with ICD-10, etc. In our own organization, we have been very aggressive in doing a lot of things. Moving a hospital is no small feat; in fact, we would have been further along in our CPOE journey and in our Meaningful Use journey had we not hit the pause button, so to speak, for about 18 months to make sure that we had a safe and effective move into our new facility. So we really stopped some of that because as it comes down to it, there’s only so much organizational change that you can absorb at one time. It’s not always a limitation even though sometimes it’s looked as a limitation of how much IT resource you have; it’s how much organizational change you can absorb at one time.
Guerra: Right. Would you say — and I ask these questions because I want to bring to light for policymakers what’s going on in the trenches — that you see a possibility of burnout among some of your key staff?
Rozmus: Yes, I do see that.
Guerra: As a manager, how do you handle that?
Rozmus: We certainly need to keep in mind that this is a journey and not a race. I’m a little bit concerned about what I’ve seen thus far in the Stage 2 rules that really compress the timeframe for that 2014 compliant version of software that really needs to be installed and sandwiched in between Stage 1. Now if you were live on your Stage 1 or if you attested to Stage 1 back in 2011 or 2012, it may not be as compressed a timeline, but anybody who’s attesting later on this year and into 2013 really has to be thinking already about Stage 2 and how to get those Stage 2 requirements met in a short amount of time.
So I think that is really going to compress and also increase the amount of stress on organizations to continue these projects. At one time, it was always thought of as the live date for an implementation being the end, but it’s only the beginning of the next stage. And as we’ve learned, every new stage brings about more complexity and more regression testing, and you have to go back and incorporate all the changes that you’ve made earlier and make sure that they continue to be viable as you’re creating new pathways and new workflows.
Guerra: And this kind of goes back to our discussion about interfaces. The more interface-heavy your environment, the more difficult these changes are. Does that make sense?
Rozmus: Yeah, that comes into play as well.
Guerra: In a simplified environment with one platform its little bit easier to make these software upgrades and all these types of things?
Rozmus: Yes, it is. But at the same time, I think that we have to understand that there really is no one platform that does everything and certainly there is no one platform that does everything well. In our own case, in the Meditech world, we have things that Meditech just doesn’t do and doesn’t have a module for; some that are just newly being brought to the table. For example, we’re looking at the oncology system; that’s one of the last services that we haven’t fully automated here. Meditech didn’t have a product until the last couple of years when they brought one to market. So in certain areas they may not have a product and we have to go outside into the vendor market and provide a product that meets those needs.
Guerra: You mentioned a couple of times about the new hospital construction and how you kind of put your CPOE journey on hold. That speaks to a number of things that sometimes it’s not just everything that’s being spurred by regulation and legislation, but there are actually other things going on here that also add to what’s on your plate that maybe people making policy aren’t thinking about the fact that you may be standing up a new hospital.
Rozmus: That’s correct, and bringing up a medical group and looking at all those changes in how we do business and certainly growth — those are the things that don’t stand still. We still have to run an effective organization and continue with our strategies that are outside of Meaningful Use and ICD-10 and other regulation and policy aspects that we have to comply with, at the same time, we’re forward thinking and looking at other things as well.
Guerra: John Halamka has a blog, as you probably know, and his post today touched on the concept that there’s not much bandwidth left after all the things you have to do now. There’s not much bandwidth left to be creative or to do these types of things that you’re mentioning, and I wonder if there’s not enough left, and if that’s going to create a real problem in the industry.
Rozmus: I think it will. I really do. It’s been written and talked about for several years now that there is really not enough IT talent in the healthcare industry to continue to move at the pace we’ve been moving. And it’s concerning; we’re still moving at a rapid pace, but certainly we have to be concerned about burning folks out and really not having people that want to continue that journey because it’s just more being heaped on them.
Guerra: Right. Well I have a couple of things that we can touch on here, but let me open it up to you. Are there any other things that you had wanted to touch on — either projects or thoughts on things going on that you wanted to discuss?
Rozmus: One of the things that’s interesting that we’re involved in this year is, again, another project not necessarily related to Meaningful Use, ICD-10 and those major initiatives, but to performance improvement and the ability to increase the effectiveness of what we do. One of those things we’re calling our critical communications program. We have invested in some technology from Amcom and that technology is going to work on a couple of different levels: one is an emergency notification system and two is secure provider-to-provider communication. There’s a product called Amcom Mobile Connect which gives us the ability to send a secure text message between providers or between nurse and provider. When we built our facility here, we heavily invested into mobile technology. We probably had about 650 wireless voiceover IP handsets in the facility being used by physicians, nurses, therapists, etc. We want to be able to leverage that technology even more by providing some secure messaging capabilities in that space. We also have physicians coming to us and saying, ‘I don’t want to carry this pager anymore; I have smart phone.’ So realizing that the technology is continuing to progress for communications, people want to get to a single device or less devices — the bring-your-own-device, and we’ll talk about that a little bit, is also in play there as well. But at the same time, we need to make sure that we can do it securely and effectively. So we’re looking for the ability to use these technologies to start bringing that together.
Guerra: Let’s touch on that idea of bring your own device. What are you doing around that concept?
Rozmus: We don’t have a formal bring-your-own-device strategy. The view of it is that we provide access to a lot of our systems via Citrix, and that gives us the ability to extend that utilization or extend that access beyond our walls. And we’re leveraging that right now for folks that have, for example, an iPad or a mobile phone. They certainly can utilize Citrix from their offices, from their home, from wherever to access our infrastructure on Citrix. And those clients are certainly available for those devices.
Guerra: Right. As a final question — I don’t want to keep you too much longer — I like to touch on interesting aspects of people’s background, and I see that you studied industrial engineering
Guerra: Tell me a little bit about that and how you got from there to here, and whether you’ve been able to leverage that, or in what ways you’d been able to bring some of that to your work.
Rozmus: I actually started in industrial engineering. My college background is in industrial engineering. I had a lot of computer programming and technology exposure in that education, but at the same time I was able to get an internship working for a healthcare organization back when I was in school. That peaked my interest in healthcare. And at that time, industrial engineers were being brought into process improvement roles — back then it was called management engineering — and I guess there are still management engineers in those roles. But a lot of that was operationally based, so I was able to leverage the fact that I understood a lot of process technologies and at the same time, information technologies, and bring that into a role in healthcare.
Guerra: So you’ve seen quite a change in the computing world from 1978 to today?
Rozmus: Oh absolutely. And it was great to be able to come in to healthcare when I did learning the operations of healthcare, and then as the technology continued to progress, work into the technology role understanding that background of operations.
Guerra: And do you see the trajectory, much like others do, which is just a completely untethered mobile world with almost the PC going away and even the laptop going away, and just these tablet-type iPad devices — is that where you see everything going?
Rozmus: I think it will get there eventually. I still think we have the need for keyboard input and speech input, and most of the utilization is on the viewing mode, which I think is important to be able to use those mobile devices and those non-tethered technologies. But for a lot of the work of capturing the data, I still think that there really is a need for fixed workstations.
Guerra: All right Mike, is there anything else you want to touch on? That’s pretty much all I have for today.
Rozmus: No, thank you. I really appreciate the opportunity to talk with you.
Guerra: It’s a real pleasure and I hope we get to work together again soon. Have a great day.
Rozmus: You too, Anthony.