Dave Kempson took over as CIO at Maricopa Integrated Health System in Phoenix, Ariz., at a very interesting time — not only was Maricopa transitioning away from being a county-owned facility, but the IS department was in need of a major overhaul. Kempson and his team were tasked with creating a truly integrated system, and because Maricopa had experienced IT failures in the past, the pressure was on to deliver the goods. What Kempson learned is the vendor many peg as the most expensive might be the best bet in the long term, that Rome was not built in a day — or even in one phase — and that for government organizations, the vendor selection process can be more complicated.
Chapter 3
- ICD-10/5010 readiness
- Awaiting the gap analysis
- The importance of political savvy
- Know thy board
- On surgeons and fighter pilots
- CHIME CHCIO certified
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Bold Statements
Part of what makes me nervous is the fact that … we have a major HIS implementation going on in that timeframe, and I still don’t really have a good handle on what the gap is between what we’re capable of doing and what we need to do.
When we want to move forward with something like an HIS implementation, we’re talking about tens of millions of dollars, all of which my peers in the organization would love to have… So my job becomes to politically motivate and to incentify them to understand the benefit that they and the organization will get if we go down this path.
Many physicians want to do things their way, especially surgeons. They’re like fighter pilots—it’s my way or the high way. So that becomes difficult when a CIO in an organization tries to standardize things and say, ‘I understand that you want to do things you’re way, but you have to understand that you’re working within a system. This is not your private practice.’
I believe that demonstrating your knowledge and your ability in the career that you’re in is a worthwhile thing.
Guerra: Let’s talk a little bit about ICD-10. Does that word scare you? Does it make CIOs shake at night?
Kempson: You know, it doesn’t scare me as much as it just creates this whole thought of, ‘Oh my gosh, there is all of this work we still need to do to be ready.’ You think about all the panic and stir that was created by Y2K—well, this is Y2K all over again for us.
Guerra: Where are you with your preparation?
Kempson: We’ve been focusing on two areas right now. One is 5010 readiness, and we’re well along our way there. We’ve got one more upgrade in the testing group to do with the Star side to ensure that we’re ready on the hybrid environment. With the Epic system, we’ve already got the 5010 capabilities in place. On the more pure ICD-10 side, we’ve got a project that I would say is in its forming stage; we’ve got a project manager assigned, we’ve got a steering group assigned, and we put an RPF out on the street for a vendor to come in and help us do a gap analysis or assessment. We’re close to awarding that contract; the selection is done, we’re just in negotiations right now. So I would say by the end of the month, we’ll have that vendor engaged and we’ll be going through a 12-week assessment project. As far as deliverables of that assessment, we’re going to end up with a gap analysis as well as a budget, a proposed staffing model, and a project plan of how we’re going to close those gaps. So part of what makes me nervous is the fact that we are here and the deadline is in 2013—we have a major HIS implementation going on in that timeframe, and I still don’t really have a good handle on what the gap is between what we’re capable of doing and what we need to do. I think my level of comfort will increase once that assessment is done and we all have a better handle on that, and then can just battle with the board to resource it.
Guerra: As long as it’s not too dire of an assessment.
Kempson: Right. If it’s too dire of an assessment, maybe I’ll call you up and you can help me get somewhere else.
Guerra: No problem, we’ll talk about that if it happens. Now I was looking over your LinkedIn profile and I want to read you something from there and ask you to expand on it a little bit more. You talk about it being a complex healthcare system, which it certainly is, and you say, ‘My role requires political savvy as well as competence and confidence interfacing with business and clinical professionals.’ So the two most interesting things there to me are the political savvy, and maybe you can expand on what you mean by that, and then interfacing with clinical professionals. Business is easy, but usually the CIO has come up through IT, and IT professionals are from Mars and clinicians are from Venus, and sometimes those languages translate well. What are thoughts around those two things?
Kempson: Let’s talk about the political savvy piece first. I think any executive in an organization has to know how to politic and has to know how to promote his—and his organization’s—interests. When we want to move forward with something like an HIS implementation, we’re talking about tens of millions of dollars, all of which my peers in the organization would love to have their hands on to invest in things that they want to do. So my job becomes to politically motivate and incentify them to understand the benefit that they and the organization will get if we go down this path, and why their needs should wait in order to address this issue. Obviously it helps to have a CEO and COO and CFO that are on board, so it starts there. But it doesn’t end there.
I think it has to extend down into even the middle management level; they need to understand why we’re doing this, and what’s important for them to understand. So there’s an education piece to it, but it’s really an influence piece. How can I, as a leader in the organization, politically influence these other people to see my way of thinking and agree to make this investment in moving forward. Even if I had the CEO’s approval to move forward, if I didn’t get that other level of buy-in, they would fight me and my project would likely fail. I may be able to take a few of them out with me going down in flames, but what benefit does that get anybody.
Similarly, you have to recognize that our board is a publically elected board, so it’s not like most hospital boards where they’re appointed. They have tax payers who vote them into office. So that creates another political dynamic that some public hospitals face that isn’t the same in non-profit or for-profit organizations. I think it’s important for a CIO, or really any executive in this type of environment, to understand what motivates them. Often what motivates a publically-elected board member is what will my constituents think, or what actions do I need to take to ensure that I can get reelected or get elected for that next higher office. Often those things that they want or need to do may be opposed to or different from what the right thing to do is for the organization. So I guess when I’m looking at my job and my interaction with the board, I need to understand what politically motivates them, and I need to try to take my agenda—which is what’s right for the organization—and get them onboard; that those two things are the same, or at least if there’s a sacrifice on something that they need, that it is the right thing to do in the long run for the business. And that is the right thing for them to do because that’s what ultimately will benefit them in the taxpayer’s eyes. So there is that whole aspect to it.
When we’re looking at that whole physician relationship it’s kind of similar in that what motivates a physician is often—and this isn’t any different than anybody else—self-interest; how is this going to impact me. And many physicians want to do things their way, especially surgeons. They’re like fighter pilots—it’s my way or the high way. So that becomes difficult when a CIO in an organization tries to standardize things and say, ‘I understand that you want to do things you’re way, but you have to understand that you’re working within a system. This is not your private practice—this is a system, and for the system to function well, we need to agree to certain standard. We need to agree to certain things that we’re going to work together on.’
Fortunately in my case, I’ve got it a little easier maybe than other CIOs who have the community physician practice. Because remember, we said we have a closed medical practice; all of my physicians report to one CEO, that CEO is the CEO of District Medical Group (DMG). So if I can get started with the CEO of DMG on board, he can then push word down through his executives and his chairs to the other physicians, and I have it a little bit easier because I have him on my side helping to influence them. In a traditional practice where there are physicians from the community that don’t necessarily report up to a single physician leader other than the CMO, who is kind of like an indirect report, it becomes much more difficult, especially when they have the ability to leave your hospital if you will and go practice in the hospital down the street. I can get away with a little bit more. It makes it a little bit easier in my organization than it is for somebody in that other practice, but some of it is still the same though, because that doctor who is working for DMG could also leave DMG and go down the street, and maybe we would have a hard time replacing him.
We also have our iconic doctors, the doctors that have made a name for themselves in the community or in the country, and they certainly have a lot of political capital and political influence. So I find myself, along with the CMIO and the CMO, having to really strategize and prioritize for each of the initiatives we’re working on. How are we going to get the physician buy-in on this, who do we need to go to first, and who do we need to maybe do some hand-holding with? We don’t want to create an environment where we make exceptions on the backend; we want to manage that upfront to ensure we’re getting that buy-in on the frontend before we go into it. Probably the worst thing you can do with a doctor is act, and then ask for his buy-in. You always want to get that buy-in upfront so that their issues are heard and those issues are addressed as part of the implementation rather than as a reaction after the fact.
Guerra: You said before that your system may be changing and going to a more open model, so you may not have the benefits you described for very long.
Kempson: That’s true.
Guerra: You may be in the same boat with everyone else where you’re dealing with a few hundred or a few thousand independent business men who are really not interested in being slowed down.
Kempson: Yeah. The good thing for me if that happens is we’ll already be live on Epic. We’ll already be live on CPOE, so it becomes a decision they make as to whether or not they want to start working with us rather than if they started working with us under one set of assumptions and now I’m changing them.
Guerra: Right, very interesting. I don’t want to keep you too much longer so just a couple more questions. I see that you have the CHCIO credential, which is the CHIME certification. Tell me about your motivation to seek that.
Kempson: My motivation on that stems from a couple of things. First of all, I’ve been active in CHIME since I took the job, and I’ve been interested in pursuing the CHIME fellowship, although I don’t have the qualifications for that as this point. I’m a certified project management professional; I’ve held that certification for some time, and I believe that demonstrating your knowledge and your ability in the career that you’re in is a worthwhile thing. From my standpoint, I don’t have a long history in healthcare IT, I’ve got a long history in IT. I’ve got an even longer history in engineering before that, but healthcare IT is new to me. So I’ve had to do a lot of out-of-work studying and reading and professional development in that area. When the certification came out, it was an opportunity for me to really test myself to say, ‘Have I come up to speed in the areas that I should come up in?’ Honestly, I went into the test with the thought that if I get the certification, that’s great, and if I don’t get the certification, at least I’ll know what I don’t know and can then focus on those areas and learn them so that I improve myself as a CIO—either in this organization or the next one I go to.
Guerra: So you’ve had to learn how to talk to physicians; this is not something you’ve been doing forever.
Kempson: Kind of. So I’ve spent 26 years in the Air National Guard, and I work in a medical group there. Although I do more administrative work there, I am used to dealing with physician personalities in that environment.
Guerra: They are unique aren’t they? You mentioned the fighter pilot mentality.
Kempson: Oh yeah, and I guess that’s how I can make that connection, because being in the Air Guard in the Air Force, I deal with fighter pilots and I deal with physicians—not all physicians, but certainly the surgeons. They’re cut from the same mold.
Guerra: That’s fascinating. Are there any tips you can give your fellow CIOs—maybe someone who doesn’t have that much experience or someone who’s just not able to navigate dealing with these individuals? Any tips on how to get them to see your way of thinking?
Kempson: You’re talking about with the physicians themselves?
Guerra: With the surgeons.
Kempson: Okay. So I think the first thing is to recognize that they are the way they are, and don’t take it personally. They’re going to be obnoxious and they’re going to run people over and that’s just the way they are, it’s not you. It’s why they’re so good at what they do; that’s the kind of guy you want taking care of you when you’re on the bed getting ready to code, and you want that take-charge guy. So recognize that’s just them; that’s the way they’re personality is. Also recognize that underneath all that bravado there are real needs and real issues, and your challenge is to kind of navigate through that; really understand what it is that’s needed and honestly take it as your responsibility to fulfill those needs. The surgeon is there saving lives; you don’t want to be the IT guy that puts a barrier up to him saving lives. So in the push-back you’re getting, what’s the reactionary stuff that they really don’t care about and they just want to grandstand, and what are the real issues, and can you address those real issue in a way that they’ll maybe not say good job, but at least stop yelling at you.
Guerra: Well Dave, that was brilliant, I enjoyed that so much. I think I’m going to have to end it there and let you go; you’ve been very generous with your time.
Kempson: Thanks, Anthony. It was nice talking to you.
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