Like most CIOs in healthcare, Steve Hess has no shortage of things to do. First off, he’s knee-deep in a multi-year Epic implementation that will see him bid farewell to many incumbent vendors now, and more in the future. Secondly, he’s morphing the business side of the house from a best-of-breed environment to one concentrated on Lawson. And, as if that’s not enough, he’s working toward Meaningful Use while keeping a close eye on UCH’s ICD-10 conversion prep. To learn more about how Hess is juggling everything, healthsystemCIO.com editor Anthony Guerra recently caught up with the Denver-based CIO.
InterSystems for integration
ICD-10 prep — “We are looking at it as a massive project”
“I think the big part of ICD-10 isn’t going to be the technology, but the retraining”
Resource management in an over-demanding age
“I think pharmacy, nursing and physician informatics experts, which are very hard to find, are the critical success factors for hospitals moving forward”
Collaborative Epic shops in Denver
Budgeting and forecasting in an MU world
Microsoft SharePoint for project management
Cross-country career — from Philadelphia to Denver
I think the big part of ICD-10 isn’t so much going to be the technology piece, it’s going to be the retraining… It’s a different way of thinking and it’s going to demand even greater attention to that clinical documentation component linking to the financial component.
You have to have a way of tracking where you’re spending your time and your money, and really align the IT priorities with the organizational priorities. Everything that IT does needs to be cascading down from the organization’s vision and goals.
Nowhere have we depended on a financial plan that includes the meaningful use dollars. We’ve treated it more like icing on the cake than a necessary component of our financial plan.
It wasn’t that I was looking for an opportunity, but when this opportunity presented itself, it intrigued me—because an academic medical center was interesting to me, and implementing Epic was a huge advantage and something I was looking for.
Guerra: Tell me about your relationship with InterSystems.
Hess: That was another interesting thing. As if moving to an enterprise EMR and enterprise ERP solution wasn’t enough when I got here, we also had a decision where we were facing a fork in the road with interface engines. We’ve been a long standing eGate costumer and we’re actually planning on upgrading to the next version of eGate, which involved a fairly significant architecture change using Java Composite Application Platform Suite (CAPS). We were planning on doing that upgrade, but as we started to pull back the covers, we really saw what it was going to take.
It was complex architecture and demanded essentially a whole new set of skills for interface engineers. But our interface team is not a large team; it’s essentially three people. So what was staring right in our face was a need to upgrade this interface engine while having to essentially implement dozens of interfaces as part of the Epic project as we moved away from the best of breeds into EPIC as our core. So our interface team took a step back, and this was all happening when I was coming on board. Our interface team looked at what was out there, including the InterSystems ensemble solution, and did something pretty cool. We had them come in, and before moving forward with a solution, had them do a proof of concept with two interfaces and ADT in the lab interface, and actually had our team build two interfaces with them and send through thousands of interface transactions to test how easy it was, how it performed, how was the support, and so on. And through that proof of concept, we made a decision to move away from eGate and go toward the ensemble solutions. So that’s what we’ve been doing and as we’ve implemented Epic, we are actually literally writing, re-writing over 90 interfaces, and we’re doing them all in the ensemble engine, and it’s been very successful.
We had been told that one of the usual places that people stub their toes on the Epic implementation is with interfaces, and we have not done that. We’ve actually had very successful interface implementations as we’ve gone online with Epic, and I think part of that is because of the fact that we’ve moved to the ensemble interface engine. And obviously there are some really talented people as well.
Guerra: So that’s another big piece in addition to the Epic project, meaningful use, ICD-10. Tell me about ICD-10—what are you doing to prepare for that?
Hess: We are looking at ICD-10 as a massive project, probably 18 months from start to end. The reality is we do need the next version of Epic to have the built-in ICD-10 capability. So we are still fairly early in our analysis and we obviously do recognize the fact that this is not just a situation where you upgrade Epic and you’re done. We have to analyze a lot of our other disparate systems that still like exist and look at what their remediation plans for those are. But I think the big part of ICD-10 isn’t so much going to be the technology piece, it’s going to be the retraining of coders, physicians. It’s going to be dramatically different for folks. It’s a different way of thinking and it’s going to demand even greater attention to that clinical documentation component linking to the financial component. So it’s not trivial whatsoever; it’s a long project and it’s going to essentially turn health care on its head.
Guerra: If the other stuff hasn’t done that already, right?
Hess: Yes, exactly.
Guerra: You’ve been in this business awhile—19 years overall, five years as CIO at Christiania Care, and now here. I would think that proper resource management is going to be a skill that’s really in high demand among CIOs with all the competing priorities and the lack of healthcare IT talent out there, despite the attempts by the government to create programs to develop a workforce. I don’t think anybody thinks that’s going to be sufficient or will be able to produce the people you need in the time that you need them. What are your thoughts around how you’re going to handle resource management prioritization and all these types of things over the next few years?
Hess: Good question. I think that a proper portfolio management process and a project management office are really critical to success. You really have to have a way of tracking where you’re spending your time and your money, and really align the IT priorities with the organizational priorities. Everything that IT does needs to be cascading down from the organization’s vision and goals. I’m a big believer in taking the board goals, the CEO goals, the COO goals, CFO goals and so on, and really matching up your IT goals directly to those initiatives. From a resource management perspective, I think there are two main focuses for CIOs. One is the business analyst—so IT folks that understand enough about Web architectures, databases, network connectivity, desktops and Citrix really understand the business workflow, what the business is trying to achieve, how the people use or don’t use the system, and really use their IT experience and their IT connections to solve the business problems.
So I think that the business analyst’s role is critical to our success and I see as many people coming from the business learning the IT side as I do coming from the IT side learning the business side. But that liaison business analyst’s role is critical to success. And then the second part is that the informatics resource. I think pharmacy, nursing, and physician informatics experts—which are very hard to find—are the critical success factor for hospitals moving forward. You need those physicians, the pharmacists, and the nurses who understand enough about the workflow and maybe even are still practicing and understand enough about IT to help make decisions. So with the Epic project in particular, we’ve really focused on that. So we have a nice blend of about 120 or so folks that we have on the project and implementation. It’s actually almost split evenly three ways: one-third is more of the traditional IT analyst, one-third is more of the analysts that came from the business side, and one-third is a lot of doctors, nurses, and pharmacists who have been practicing and are now part of the project if not completely devoted to it.
Guerra: You’re going to have some pretty highly trained in-demand people when you go through the Epic implementation. How competitive is in your area—are you concerned that the other hospitals in the area might be poaching some of your talent? Is there a place for you to go poach talent?
Hess: It’s interesting, Epic does have a pretty good saturation in the Denver market. The Children’s Hospital that shares our campus implemented Epic years ago, and they’re still rolling out some additional phases. We also have another hospital in Denver that has implemented Epic, and Kaiser has a big presence in the Denver area. And for the most part, there is actually a very collaborative environment here. Children’s, Exempla, and Kaiser have all implemented the Care Everywhere product to be able to share appropriate information among organizations, and we’ll be joining that as well.
So what I found is less poaching in that we are very collaborative—we understand the commitments that we’ve all made to build up our teams, and we’re looking at how we can leverage each other’s expertise. We’ve leaned on those folks quite a bit as we looked at some of the modules that we are implementing. They have had years of experience, so we reached out to our counterparts across all those organizations to pick their brains, and it’s been great. Hopefully we’ll be able to return the favor in a few years.
Guerra: What about the CIO’s role in budgeting—have you had to work more with the CFO than you previously had? Some of your future dollars, I would imagine, are going to depend on incoming meaningful use incentive dollars coming from the government. If those don’t come, or are delayed, things can get a little tricky. What are your thoughts on this?
Hess: We have a really solid financial process here that involves committees and governance structures, so there are really very few instances of single parties making decisions about financial expenses. Essentially anything over $50,000 needs to go through a capital committee that is multi-disciplinary and includes physical leaders as well so that everything gets scrutinized appropriately. It’s a process that takes a couple of months but is a solid one, and really allows the organization to make sure that we’re making the right financial decisions. We’ve taken the stand with meaningful use dollars that we’ve not banked on those meaningful use dollars at all. We did not choose Epic and make go-forward decisions based upon the meaningful use dollars; obviously we’re doing a lot of work in that space, but nowhere have we depended on a financial plan that includes the meaningful use dollars. We’ve treated it more like icing on the cake than a necessary component of our financial plan.
Guerra: Before we talk about your career, I have a couple of specific questions. Are there any other projects you want to talk about that are top three on your list that you’re working on?
Hess: We’re actually doing a lot of work in the Microsoft SharePoint space with collaboration; really using that for project management, portfolio management, budgets—just sheer collaboration. I almost look at our three pillars of IT as Epic, Lawson, and SharePoint, and we’re doing a lot of good work in that space. That tool is maturing as well, but I think it’s a powerful tool, from both an Intranet or Internet presence, and also from sheer collaboration.
We have almost solely used it within the Epic project for everything from tracking decisions that were made to tracking issues to storing contracts, other documents, and so on. It’s been an incredible collaborative tool. I’m not sure we could have been successful without it. And we continue to look for new and creative uses of it.
Guerra: As far as your career, we know that ARRA was passed in February 2009 and you went over to the University of Colorado Hospital in July, so we assume that the process started months before that, maybe pretty soon after HITECH was passed but you can clarify that. In the move, you went from Christiana Care, which is in the Philadelphia area, to Colorado, so let’s talk about that a little bit that—you can even start way back if you want.
Hess: Sure. I was a Computer Science major in college, and I knew what I wanted to do every since I was 14 years old. I was introduced to a RadioShack computer and learned to program in basic and really fell in love with the ability to make a computer do some creative things. It was almost like my creative outlet, so I was a programmer from early stages. In college I was a computer science major but took a lot of business administration courses and really became really interested in the business side, the teamwork aspect, the leadership side. So I actually worked at DuPont for a couple of years while I was in college, and then one year out of college I left there to join what was then the medical center of Delaware in 1991. I started there as essentially an analyst and in 15 or 16 years, I probably did 10 different jobs.
I was always looking for that next challenge and expanding my learning, and so I did everything from application analyst programmer to a VAC systems manager to network to helpdesk to R&D to then management. I’ve seen every aspect of healthcare IT from the helpdesk side up through management and everywhere in between, so I’ve been able to get good perspective on the challenges that face every single person that works in healthcare IT, whether its an interface engineer, helpdesk person, or database administrator. I understand some of the challenges that they have day in and day out.
Christiana Care was an excellent organization; I was there CIO there for five years. It was a really good organization with an incredible market share—82 percent market share—between the Philadelphia and Baltimore area with two large hospitals in Delaware.
My wife’s family had migrated from the east coast to Colorado over the years so we had been out here quite a few times. I had been in the mid-Atlantic region my entire life and been in that one organization for quite a few years. It wasn’t that I was looking for an opportunity, but when this opportunity presented itself, it intrigued me—because an academic medical center was interesting to me, and implementing Epic was a huge advantage and something I was looking for. A new executive team that was striving to be great was also something that I was looking for and I saw that here. And obviously the family situation certainly helped make the decision as well, so those are the reasons I came here. I don’t feel like I left Christiana Care, I feel like I came to the University of Colorado Hospital, if that makes sense.
Guerra: It’s interesting because as a CIO when you look at a geographic region because you want to be near family, there can’t be that many possibilities, right?
Guerra: Maybe two, three? And then people could be in those jobs for years.
Guerra: It sort of worked out perfectly for you.
Hess: What you’re saying is that I was really lucky, and again, I was not looking. And frankly if you want to look at timing, I started here in July of 2009, I found out about the opportunity in March of 2009. So we’re talking about a four month process. The CIO position had been vacant for about nine months prior to that, so these were some really interesting circumstances. You never know how things are going to work out. I made this change; I left behind a lot of great people at Christiana Care and they’ve continued to be successful, but I feel like I have no regrets making this change. This is a great organization with a great foundation for the future.
Guerra: Well on that very positive note, I’ll going to let you go. Thank you so much for your time.
Hess: Thank you, Anthony.