Last summer, the 17-hospital Essentia Health system began a transition in which the operations of several organizations – including SMDC Health System, Brainerd Lakes Health, Innovis Health – were combined under one roof. For Innovis CIO Ken Gilles, it meant relinquishing some of the decision-making to Dennis Dassenko, Essentia’s CIO, which was just fine by him. Gilles believes that the new position will enable him to expand his current role while taking on some corporate-level responsibilities, particularly as Essentia rolls out the Epic EMR system-wide. In this interview, Gilles talks about how he is managing the transition, the importance of physician buy-in, the challenges of a geographically disparate health system, and how government initiatives are impacting his organization’s IT strategy.
- The importance of proper governance
- CHIME StateNet
- Work/live balance — “I’ll just say this … it’s out of whack right now”
” … who’s to say that in four or five years it’s going to be a good time. There will always be another strategic priority out there that trumps it.”
” … we’re migrating to a common lab system, radiology system, PACS, cardiology system, etc., so we can utilize that expertise across all of the regions. And patients really can have a more convenient process and not have to worry about where they’re going, how they get there, how they get connected with the right specialist and all those types of things.”
” … you can have too much process, too much governance, and things just don’t get done. But on the other side if you don’t have enough, which is why we formed this committee, you see not enough structure and too many things that are maybe are not tied to the strategic priorities of the organization.”
Guerra: One of the things we haven’t mentioned is ICD-10. I would imagine that’s coming from the corporate level—what is going on there?
Gilles: I would say that there has been certainly a lot of discussion about it; there are some groups forming to actually start getting into the meat of it, so to speak. It’s one of our strategic initiatives for our fiscal year 2012, which starts in July, so it’s going to start in full force here in a couple of months.
Guerra: Some influential CIOs in the industry have written that ICD-10 needs to be postponed; that there’s just too much going on with meaningful use set, so let’s push ICD-10 out a year or more. Is that something you would advocate?
Gilles: From a personal standpoint, absolutely. It’s one of those things that’s inevitable, and there’s never going to be a good time. So do you take it on now and just say let’s get this thing over with. When I say from a personal stand point, I mean that with everything that we’ve got going in this organization with the corporate consolidation—with the systems integration and all those types of things, if it was moved out a couple of more years and we got through meaningful use and got through everything we have happening in our organization, it would certainly be a much better time.
Number one, I don’t see it happening, and number two, who’s to say that in four or five years it’s going to be a good time. There will always be another strategic priority out there that trumps it.
Guerra: Any other major projects that we haven’t touched on that you want to talk about?
Gilles: I would say that replacement of literally all of our computer systems is the key. The other thing I would mention is that we’re bringing the Essentia Medical Groups together across all of these regions. And again, we’re migrating to a common lab system, radiology system, PACS, cardiology system, etc., so we can utilize that expertise across all of the regions. And patients really can have a more convenient process and not have to worry about where they’re going, how they get there, how they get connected with the right specialist and all those types of things. We can do all of that behind the scenes and facilitate that. I would just say that our challenge is to get all of these systems in place to facilitate that.
Guerra: I’d like to talk a little bit about governance. Can you tell me how it’s structured over there? You’ve got three regions with three regional CIOs, and you’re associate CIO under Dennis Dassenko.
Guerra: Tell me how that works and whether that is a pretty efficient process.
Gilles: Okay so you mentioned the three regions—we’ve got IT leadership in all three regions. We have an IT executive steering community at the Essentia Level that quite honestly was formed about three or four months ago. You could clearly see the need for us to bring the leadership of all the regions together with the Essentia leadership. I would just say it’s in the forming stage after three months; it’s not a tried and true process yet, but certainly there is value in the discussions now that are taking place. The IT leadership in each of the regions reaches out to all of the different hubs and sites within each of those regions to try to get the IT strategy out there, and to continually communicate the changes that are coming and solicit input on those processes before it gets there. So I would say we’re really in that forming stage.
Guerra: Governance is very interesting in that too much will kill you and too little will kill you. You have to get it just right to get the structure you need without being too much of a bureaucracy. Does that make sense?
Gilles: Absolutely, yes. I’ve been in both sides of that. Previously we had an IT steering committee—this was probably 10 years ago when we were going through a fair amount of change in the organization. And actually, the hospital we built in Fargo had a separate administrative team just because of the ownership structures. So there was really a need there when we were providing the systems to two groups and needed the strategies to be somewhat similar so that we were being efficient. And then actually when we went through the merger with Essentia, we sort of disbanded that and now it’s actually been probably a couple of years since we’ve actually had a formal IT steering committee at Innovis Health, and now it’s at the Essentia Level which I think is very appropriate because of the decisions that are made.
But you’re right; you can have too much process, too much governance, and things just don’t get done. But on the other side if you don’t have enough, which is why we formed this committee, you see not enough structure and too many things that are maybe are not tied to the strategic priorities of the organization that are taking place. So we’re just getting started here.
Guerra: Right. And one of the things that we’ve seen with too little governance is that a system gets bought over here and over there and doesn’t really dovetail with overall strategy and you have this data pool hanging out there, which is essentially the opposite of what everyone is trying to do. Too much, like you said, and no decisions can get made, things get bogged down in bureaucracy. So flexibility is important, right? In terms of crafting a strategy, most things should be a work in progress probably that can always be tweaked, correct?
Gilles: Right, yes.
Guerra: Let’s talk a little bit about CHIME. Unless I’m mistaken in my research, you are StateNet Director with Craig Hewitt and Mark Waind for North Dakota.
Guerra: Tell me about your involvement in StateNet. Refresh my memory on the goals of StateNet and how that’s gone.
Gilles: Well in terms of StateNet, I’m going to be upfront with you. I haven’t been able to attend a lot of the meetings. I certainly jump on the webinars or the calls when I can, so I’m kind of on the periphery here. But I know Russ Branzell has spent a lot of time trying to pull people together from each state to help out with Meaningful Use and with the Health Information Exchanges and those types of things, trying to bring some consistency to what each of the states is doing so we don’t literally have 50 different directions. It makes a lot of sense. There’s been a lot of learning and sharing between the CIOs and the states of what’s working and what’s not and how we can be more consistent across these states. And there’s been a fair amount of interaction with ONC trying to change some of the policies or get them more engaged to help these states or regional HIEs follow a similar architecture, process, governance or financial model. Because if we don’t do this, the amount of money that’s literally going to be wasted is incredible. So yeah, I should be more active but with everything that’s going on here, you jump in when you can and do what you can.
Guerra: Now this is something I survey my CIO panel. How is your work life balance? Are you going home at night or are you sleeping on the couch in your office?
Gilles: I don’t know if I should go there. I’ll just say that it’s out of whack right now, especially with the traveling I do. It’s not where it should be. The good thing for me is that I’m married with two kids and both kids are in college right now, so we’re empty nesters. If this would have happened say a year ago or a couple of years ago when the kids where still in high school and doing sports and activities, I honestly don’t know if I could have done it. I probably would have pulled back quite a bit, whereas now at least I’ve got the ability to do some of these things without the guilt. But it’s out of whack, and I don’t know if I’ll ever get it back in check, but you keep trying.
Guerra: Actually that’s an excellent point. So much of it has to do with the situation at home. If you have a full nest, that can be a big price to pay.
Gilles: Yeah, that’s a tough decision. I mean, I honestly don’t think I would have done it or even accepted some of this responsibility if my kids where still at home.
Guerra: Right. Well this was a wonderful interview. Is there anything else you want to add that we haven’t touched on?
Gilles: No, I think that covers it. I appreciate the opportunity.
Guerra: I want to thank you so much for your time today. I’ve really enjoyed it and I think the listeners are going to enjoy it as well.
Gilles: All right. Thank you, Anthony.