Earlier this month, five organizations launched the Care Connectivity Consortium to facilitate the secure exchange of electronic data in real-time at facilities across the country. The vision, according to Kaiser Permanente EVP and CIO Phil Fasano, is for providers to have all of a patient’s information at his or her fingertips during the encounter. But before that vision can be realized, there are a few key questions that need to be answered, primarily in terms of reimbursement and standardization. In this interview, Fasano talks about how the nation’s largest non-for-profit health plan and care provider plans to deal with the reimbursement issue, how it is preparing for Meaningful Use, how it handles budgeting and project prioritization, and why data sharing is so important.
- ICD-10 preparation
- Budgeting and project prioritization
- The Center for Total Health
- Dealing with the HIT workforce shortage
- Avoiding CIO burnout
- On George Halvorson
- Financial services vs healthcare
The fact that we’re larger than many organizations doesn’t change the fact that there are limited funds for IT and IT investment in our organization. And those funds are quite critical to the success of projects like ICD-10 and projects across our care delivery organizations.
I can tell you that our organization is always looking for world class people in IT, and at the same time, we recognize that many of our people are world class and are quite good at what they do. The phrase that I always use is that the greatest asset of this organization is not just our IT people but our people.
If you’re a CIO, you have to love what you do. You have to have a passion for your work, you have to believe in your organization fundamentally, and you have to have the ability to not only influence the direction of the organization, but contribute to that direction in a way that satisfies you personally and professionally.
The benefit this industry has in now jumping in with both feet and becoming technology-enabled as many of the technology inventions of our time have been put forward and are integrated and are available to be leveraged across the portfolio of activities that we do—that makes this quite an exciting time to be in health care.
Guerra: I’d like to talk about revenue cycle, just in the sense of ICD-10. Is that a transition project, the gap analysis-type thing—where are you with looking at that and how are you going to handle with that?
Fasano: We’re well underway in terms of our ICD-10 work, and it goes far beyond revenue cycle. As a health insurance provider, our health plan systems really require a substantial amount of work to evolve them in that same direction—all of our claims systems and other systems in our health plan. And the projects are underway focused on participating in and ultimately getting to the end of the journey with respect to the ICD-10 activities that we need to put in place across all of our systems to be compliant with that requirement by the date that has been set.
Guerra: So you feel pretty good about where you are with that?
Fasano: Well, we’re a very large system so this is an enormous amount of work for us; it’s like a year 2000 event. If you recall what that was like for many organizations when it occurred, it’s equivalent to that kind of an effort within our organizations.
Guerra: There are a lot of things going at once: ACOs, Meaningful Use, ICD-10, all these kinds of things. Many think of Kaiser as having sort of theoretically an unlimited budget for IT and what you could spend, but I’m sure that’s not the case. How do you handle budgeting and prioritization and deciding where to spend your IT dollars?
Fasano: It’s no less a challenge at Kaiser Permanente than any other organization. The fact that we’re larger than many organizations doesn’t change the fact that there are limited funds for IT and IT investment in our organization. And those funds are quite critical to the success of projects like ICD-10 and projects across our care delivery organizations. So when we think about it—and we absolutely look at life critical systems as being life critical systems, we focus our attention there. We focus substantially on keeping our information secure and reliable, and like many organizations, when you start to get into the life critical business with systems, your reliability requirements go up quite a lot.
So we do spend some money in that area. With respect to prioritizing all of these, it’s no easier for us than any other organization. Our senior executive team participates in a collaborative conversation that’s quite an active conversation on the priorities of the company, the priorities of our regulators, and the needs of our patients. And all of those are taken in to account as we look at how we invest our money against our information technology infrastructure.
Guerra: In terms of other projects, if you want to address briefly the Center for Total Health which just opened, as well as any other main projects on your plate as CIO.
Fasano: I’d be happy to talk about the Center for Total Health. We just opened it last month, and frankly, it was an invigorating and exciting time for our organization. We had many guests at that opening, and we believe many of them would say the same thing. I heard the word ‘inspirational’ from quite a number of people who participated in the opening. We hope our Center for Total Health inspires an active conversation about the future for health care in this country—and potentially beyond this country, and becomes a destination for many organizations that choose to have conversations that are inspired by what we have been able to put into that Center.
It was designed with that in mind. Our hope is that it becomes a great destination and becomes a very active center for conversations about the future of health care, because we believe fundamentally that’s truly an important conversation to be having, particularly in this country. And then when you consider the fact that clinical and information technology are at such a place and have set of capabilities that the industry can really benefit by, how it integrates those capabilities into the care of our patients across the entire United States of America. That it’s a huge, huge deal for us. We made the investment with the hope others would benefit. It’s true to our core values that we believe we really want to support the communities that we operate in and the community that we serve. It aligns well with that goal, and we also believe that it will be inspiring for many people to come to the Center and participate in discussions and conversations there. It was never built purely for Kaiser Permanente’s use, although people have asked me that question. It was truly built as a community asset for the health care industry, and we hope people would really leverage it that way.
Guerra: What about any other main projects that you are working on that are on your plate personally—not that you have to execute, but things that are sort of top three strategy issues?
Fasano: Well you’ve touched on many of them as we’ve had this conversation. You certainly talked about ICD-10, which for us is a very substantial initiative, Meaningful Use equivalently. So the continued leveraging of our electronic medical record across our organization and continuing to create even further benefits from having made that very substantial investment is a focus of our organization. And also continuing to enhance our population care tools and the analytics that we’ve developed, and exploring the opportunity to provide even further benefits to our patients. We have a very substantial medical research organization across all of our regions at Kaiser Permanente, and we’re doing some extraordinary work there with respect to very broad DNA studies that we began the process of working on and undertaking, and leveraging our electronic medical records. There are over a 100,000 Kaiser members who have kindly donated DNA to the effort.
So the work that’s going on across our program is extraordinarily broad, with a primary focus to really enhance the health of the community as we operate, and particularly our members. We’re very thoughtfully conducting all of those activities across the organization. Our IT organization participates in all of it, supports it all, and is honored to be a part of a great mission. And our organization certainly has a fundamentally great mission.
Guerra: I’d like to touch on the idea of staff management and the health IT work force shortage. A lot of the CIOs I speak with are starting to feel that pain and losing some key people. You have a combination where there is a shortage of overall people and then you have the effect of burnout where you really have to work your key people very hard to meet a lot of these federal requirements and programs. So it’s almost like a perfect storm where there could be an acute problem, especially with the clinical informaticists and nurses in your IT department—the NPs and MDs, of which you have. Give us your thoughts overall around whether you have staffing issues and if you’re having issues finding new staff. You’re an Epic shop, and there is certainly a demand for qualified Epic people. What your thoughts around that whole issue?
Fasano: It’s an important issue for anyone running an IT organization. It’s absolutely top of mind for me as the CIO of Kaiser Permanente. I can tell you that our organization is always looking for world class people in IT, and at the same time, we recognize that many of our people are world class and are quite good at what they do. The phrase that I always use is that the greatest asset of this organization is not just our IT people but our people. And quite frankly, the people of Kaiser Permanente are extraordinary, and the fact is we have to do what we can to continue to employ them, give them satisfying work, and give them a work environment that is a great place to be and a place where they want to be. Because they’re here for quite a lot of hours, as you mentioned. Many of our people are working long hours and we realize that as well. Work life balances part of being a health care organization. We want our people to be significant contributors to the outcomes of the organization, but we also want our people to thrive and be healthy.
So a healthy workforce is a fundamental part of our organization. It’s become an activity within the organization that is sponsored by human resources, and many of our senior executives, including myself, participate in it and support it, and really, really focus on our people. Because as I said, they are our greatest asset in this organization.
Our people are also quite committed; they love and have a passion for the mission of our organization. The fact that we’re a not-for-profit is a core value of the enterprise, and it’s also elemental to our mission. Our people really believe that the fact that we’re a not-for-profit allows us to serve a higher purpose as an organization, and we believe at our core in that higher purpose, that that it’s really helping the community, our members, and our teams and organizations to be healthier.
We’re all working toward that same goal; a lot of our people are inspired by what we’ve been able to do over the past 10 years, and they’re equally inspired by the possibilities in front of us. So we hope we’re able to retain our best and we hope we’re able to continue to give them an inspirational place to work and a place where they’re satisfied.
Guerra: I know that a lot of CIOs are experiencing burnout or about to experience burnout. You don’t sound like you’re getting burnout; you sound very calm. You sound like you’ve got it all together, and probably the CIO of Kaiser Permanente has got a few things on his plate. So are there any tips you can give your fellow CIO colleagues on personal time management; how to maintain a good work-life balance, knowing when you need to take a break—no matter what else you could do that day, and when it’s time to go home.
Fasano: Well on the personal side, I have a wife and five children.
Fasano: I have to give you that prospective. So they all care a lot about me and like to spend time with me, and I absolutely like to spend time with them. But the one thing I would say to anyone in a CIO role is that you have to love what you are doing. If you don’t love what you’re doing, you’re probably in the wrong role. I fundamentally love what I am doing at Kaiser Permanente; I love the organization, I believe in our people, and I believe in our mission. The work we do here is extraordinary and it’s fundamentally important to both our members and to society at large, and you can take a lot of inspiration from that. It’s easy to do what I do at Kaiser Permanente because we have such terrific people, and I have great colleagues and terrific relationship across this institution.
So when you hear me talk about it, of course I have a passion for it. If you’re a CIO, you have to love what you do. You have to have a passion for your work, you have to believe in your organization fundamentally, and you have to have the ability to not only influence the direction of the organization, but contribute to that direction in a way that satisfies you personally and professionally.
Guerra: But you still have to go home, even if you love your work. Even if you’re having a great old time and enjoy the organization, you still have to go to the gym, go home, and take a break. Have you ever had any issues with having to say, ‘It’s 7:00; I have to go home, even though this thing needs to get done.’
Fasano: I absolutely agree with you. Being able to balance the stress of work—and CIO roles are stressful—and the needs of your organization and the demands on your time is not easy. And frankly, we all think of ourselves as being indestructible, but the reality is that’s not true. You have to keep maintaining your health; worrying about how you eat, eating properly, being concerned about whether you get enough exercise, and taking time for you personally all have to be part of how you balance your life.
But that is also often very challenging, because these are demanding roles. That said, you have to find ways to take time for yourself, take time for your family, take time for your soul, and also be the best you can be at work and be the best you can be at home. And all of that is something where each one of us has to find our own balance, and every individual is different in that regard.
I can tell you that I exercise all the time. We have a great walking campaign; our chairman was the founder and inspiration behind it at Kaiser. Everyone here is told about it and given great support in trying to walk 30 minutes a day, every day. We know the obvious health affects it has; I’m no different, I at least try to get those 30 minutes every day and at least get out and do a walk, if not something more intense, and focus on my health. Being in the health care industry—or any industry—oftentimes you have the Cobbler’s Children Syndrome, but our health is fundamentally an important element of who we are, as well as satisfaction in life. So you have to take the time for yourself and you have to be willing to take that time, because when you get back to work, you’ll still be able to perform, and in fact, you’ll perform better for having done it.
Guerra: You mention your chairman and CEO George Halvorson. Two-part question: what is he like to work for and I don’t know if you report to him, but what does a CIO from the person they report to in order to excel in their role?
Fasano: I report to George Halvorson and I report to Bernard Tyson, who is our President and chief operating officer. I’ve worked for and with George and Bernard for the past four-plus years. I would describe them both as enlightened, and I use that word only very rarely.
George is an enlightened CEO who I believe is a frustrated CIO; he was never a CIO in his career, he’s always been a CEO. But he has the enlightened view of how valuable information technology can be and the potential of information technology as an asset and a tool and a capability to his organization, his enterprise, and the mission of the organization. So from that prospective, we have a very strong common bond around the vision and the potential for this organization through the lens of leveraging information technology. The same is true with Bernard and me. And at the end of the day, it doesn’t hurt to like the people you work for and with, and quite frankly, on a personal basis, I certainly appreciate and like George and Bernard quite a lot and we have a wonderful relationship.
Guerra: As a final question—and you can feel free to add anything after you answer this—you have spent the majority of your career in financial services. By looking at your LinkedIn profile, it looked like from 1983 to 2007, almost 25 years, and now you have four in health care. Just reflecting back to your experiences in financial services and now in health care, what are your thoughts on those two industries and is health care behind? This is really a question that generates a lot of discussion; is health care behind from an IT point of view, and if so, how far behind is it?
Fasano: I did spend a lot of time in financial services. And I think I spent many of the most innovative years in financial services—when financial services was moving from not quite a cottage industry, but a certainly a paper-based industry, toward an industry that has become truly globally technology-enabled and highly leveraged from that prospective.
The other point I’d make with respect to financial services, particularly during the years I was in financial services, is that technology evolved dramatically. We grew up with mainframes and people invented mini computers and PC’s and the Internet, and as that technology found its way into financial services, we had to find ways to take advantage of it, leverage it, and go through those transitions of technology. The fundamental benefit that I see being in health care at this moment in time and particularly from a historical prospective with information technology, is that as much as you could say the industry is somewhat behind the curve from technology-enablement prospective, and it is when you look statically at the adoption of electronic and medical records and other capabilities, you could make that case quite strongly. The benefit this industry has in now jumping in with both feet and becoming technology-enabled as many of the technology inventions of our time have been put forward and are integrated and are available to be leveraged across the portfolio of activities that we do—that makes this quite an exciting time to be in health care. In fact, I think if there is an industry that you want to apply your intellect to more than any other industry at any at a particular point in time—and I believe this is the inflection point for this industry—this would be the time, and frankly, health hare would be the place.
Guerra: I couldn’t agree and unless there’s something else you want to touch on, I think that’s a perfect place for us to conclude.
Fasano: Well thank you very much, I appreciate it.
Guerra: Always a pleasure, Phil, and I hope to speak with you again soon.