It’s hard to say which is more challenging — implementing an EHR system or the optimization phase. Although there are many moving parts during a rollout (particularly when it involves five hospitals), “it’s a fairly finite set of work” with a hard deadline, whereas optimization never really stops. But to succeed with either task, a CIO needs “an exceptional team,” something Mark Zirkelbach is lucky enough to have. In this interview, he talks about what his team learning by going big bang with Epic — and what he might have done differently, the fine line between fixing a system and optimizing it, the challenge of prioritizing when there is so much to be done, and why today’s IT leaders “need to be a little more entrepreneurial.”
- 5-year plan – “the vital few”
- Pre-vetting requests
- Partnering with business
- CIO of ambulatory multispecialty group — “That was a phenomenal experience”
- Loma Linda’s mission ‘to make man whole’
- MU — “That’ll be just the floor for us.”
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The volume of work that we’re trying to respond to is so massive that just encouraging people to submit requests even generates a bit of a spin that’s unwieldy.
We don’t just get to have one way where you request it, it gets prioritized. If it makes the cut, we do it and if it doesn’t, we don’t. Those days are gone.
We’re trying to be the exception and really focusing on partnering with the business, understanding the needs of the business, and having multiple ways that we can source the skills necessary to get things done, because I don’t think they’re going to wait for us.
I remember saying to some of the leadership here, ‘Meaningful use, that’ll be just the floor for us. The things that we’re going to do and be able to support from an automation perspective around care delivery will far exceed those things.’
Gamble: Are there any other major projects you’re working on right now or that are on your radar?
Zirkelbach: There are plenty.
Gamble: I’m sure.
Zirkelbach: Just a way to give you a high level view, our strategic planning process is a five-year activity and we update it each year. Right now, I’m looking at what we call the vital few. We initially identified the areas of the business that we’re supporting and so we started looking at that framework. One area, as you might imagine, is to continue to implement our integrated delivery system. All the work that we started by getting to one platform is still a big activity for us.
I’ve touched on analytics, but increasing our process improvement and our BI capability is a huge focus for us — developing the skills and the tools and the mindset on how you approach managing data is a huge effort that we’re right in the middle of as well. Population health and wellness is another major area. We’ve talked about some of that with ACO support and managing wellness as well as information exchanges and how to manage populations is a big focus for us.
We started the conversation talking about the new facilities; that’s a campus transformation project for us internally. As I said, we’ve already put up a couple of structures. We’ve had a new parking structure that was created, and all those things start to trigger this planning that has to occur, so that’s a big area for us.
You asked about affiliations. Partnerships are a big area for us. We’re working with some community hospitals in the area and some other primary care networks trying to support the business as we exchange information and develop different sorts of arrangements, joint ventures, etc.
And then patient engagement is the last of the vital few that we’ve identified. So trying to support the organization in how we make Loma Linda a place where patients, either if you’re here or interacting even remotely through the Web, that it’s a very good experience and something that you would want to repeat and share with others that you talk to about the services and care that you received from Loma Linda. That’s the framework that we’re working with, and then there are many, many projects that fall within those areas.
Gamble: Even when you talk about the vital few, those are really big projects. All of these I could see taking up a lot of time and resources, and so I want to just ask you a little bit about prioritization, something that I would think is a huge challenge right now just as far as deciding which projects are those priorities and which can be moved around a little. Is that one of the top challenges right now?
Zirkelbach: I wish I could say I’m working on a white paper to describe how well we have done that, but not just yet. We do have significant energy into our governance process. Historically, we felt pretty good in IS if individual customers could submit a request to us from a portal. That request would go down a series of reviews and vetting and ultimately get prioritized, but the volume of work that we’re trying to respond to is so massive that just encouraging people to submit requests even generates a bit of a spin that’s unwieldy.
As I alluded to earlier, we’re working with the business. We’ve identified macro process owners for key business areas and we’re really working to try what we call pre-vetting almost, where there’s not a request that’s been submitted; there’s a pool of ideas and things that we have to do from a regulatory perspective. ICD-10 would be an example of one of those things that’s on the list that we didn’t put there. It was put there for us, but there many, many other competing projects.
It is difficult to narrow it down and to pick just the ones that we have the time to do and the requirements to do, but that’s where we’re working very hard is to get much better prioritization and much better at sourcing as well. I think the days are pretty much gone where IT says we’ve used up all of our resources and we can’t hire anymore consultants, or our budget is completely blown away by the work that’s already committed to.
We have to get good at working with the business, helping to consult on solutions, helping to find business cases, return on investment analyses, cost-benefit, etc, that can be responsive. It’s a bit of a different world and it’s requiring us to be a little more entrepreneurial in the way we do our work. We don’t just get to have one way where you request it, it gets prioritized. If it makes the cut, we do it and if it doesn’t, we don’t. Those days are gone.
But being good at that and not getting blown away or overwhelmed with all the demand is really challenging because, again, the business tends to think, ‘I just submit a request to IT and they either do it or they don’t, and if I call enough or if I escalate enough eventually it’ll get done.’ I’m not denying those things still happen here. I’m sure they happen in many places, but we’re trying to be the exception and really focusing on partnering with the business, understanding the needs of the business, and having multiple ways that we can source the skills necessary to get things done, because I don’t think they’re going to wait for us.
Gamble: If anyone ever does come up with that white paper, I can imagine there’d be quite a bit of interest in it.
Zirkelbach: Yeah, for sure. Hopefully a year from now if we talk again, we can talk about all the success we’ve had in that area. I know we’re putting a lot of energy in it and the business is engaged. So stay tuned.
Gamble: Definitely. The last area I wanted to touch on was your background. You’ve been at Loma Linda since 2008, correct?
Gamble: I had seen that you’ve done some consulting, but then also had previous roles on the provider side. I wanted to talk about how you landed where you are and how you benefited from some of your past experiences.
Zirkelbach: Landed is probably a pretty good way to introduce the idea. I certainly didn’t set a goal to be at Loma Linda or at an academic medical center; it just happened. I think it’s probably the way it happens for a lot of people in their careers, but I was fortunate. I did have the desire to have an IT career and really didn’t have a particular domain of interest, although my wife being a nurse made it interesting for me to get some opportunities in healthcare.
Many years ago, I was fortunate that the Daughters of Charity were looking for people. They were building out their environment and I was able to get a position there. I was there for 15 years and had the opportunity to do a lot of different things from shared services to building internal consulting groups to large projects, working on different committees to solve different issues. I got to work with many different hospitals in different settings with different business problems from large to small.
That really was fortunate for me looking back. Again, it was accidental. The Daughter of Charity happened to be in my hometown in Evansville, Indiana. It just worked out that I was looking and they were looking at the same time, and I got that opportunity. After the Daughters of Charity — which was mostly hospital-based, although there was physician services that we did provide — I was able to do a little bit of consulting and tried my hand at that, which I enjoyed. But I wanted to try to get something where I wasn’t traveling all the time, and got an opportunity as a CIO at an ambulatory multispecialty group. That was the first time where I had been solely focused on physician ambulatory practices, and that was a phenomenal experience. I was there for three years. They were very, very dynamic in the things that they wanted to do and wanted to leverage automation as much as possible. So it was a great experience for me.
Then I had an opportunity to do some consulting again and landed, as you said, at Loma Linda. The opportunity opened up where I was able to stay here as an employee, and I have greatly appreciated all the opportunities here. There’s something unique and different about academic medical centers that really appealed to me. And so when I was consulting here and saw the different challenges, the things that we were doing to prepare people for the future, and also some of the extreme cases of care that we were involved in, it just seemed like a really good place to be. And certainly the mission here of the Seventh Day Adventist and just this model of ‘to make man whole’ all really resonated with me. I’ve been here for five-plus years; I really enjoy it, and there are plenty of challenges in front of me.
Gamble: Certainly. It’s not the easiest time to be a CIO, especially since you got there 2008 and then in 2009 we started to see Meaningful Use start to take shape. I can imagine it’s been an interesting five years.
Zirkelbach: It has been, and I remember saying to some of the leadership here, ‘Meaningful use, that’ll be just the floor for us. The things that we’re going to do and be able to support from an automation perspective around care delivery will far exceed those things.’ Of course I hope we do, but some of them have been challenging just meeting them to the letter of the law, and all the work you have to go through to be able to attest has been a body of work into itself. Plus all the other things we’re trying to do in the meantime.
Gamble: I can imagine. Well, this has been great. We’ve really touched on a lot and I would definitely like to catch with you again down the road to see just how things are shaking out in the next year or so. I think that would be very interesting.
Zirkelbach: It’d be my pleasure. We’re on the front edge of a lot of really fascinating things, and it’d be nice to check back and see how those things went. Hopefully, we can talk about the success and then maybe the next set of challenges, because they’re always around the corner.
Gamble: Absolutely. Alright, well thank you so much for your time, and I look forward to speaking with you again.
Zirkelbach: Okay, Kate, same here.