Christopher Scanzera, CIO, AtlantiCare, Chapter 2

Christopher Scanzera hasn’t been a CIO for very long — in fact, the former consultant has only been on the hospital side for a year. But that’s been enough time to develop a solid understanding of the key priorities for hospital-side IT leaders. As CIO of AtlantiCare, a two-hospital system located in southeastern New Jersey, Scanzera is focused a number of key issues, from ensuring that his organization has the technology required to support accountable care, to establishing internal and external health information exchanges. In this interview, he talks about the challenges involved with having multiple vendors, what he expects will happen with personal health records, the advantages of have a consulting background, and why he prefers the term “integrated delivery” to “ACO”.

Chapter 1

Chapter 2

• ACO presentation
• Leveraging consulting experience
• Prepping for ICD-10
• BYOD — iPhones, iPads, etc.
• Reflecting on one year with AtlantiCare

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Where is the business model going, where is the care delivery model going, where is the reimbursement model going—those are thing that are keeping me up at night as CIO in terms of making sure that we had the technology out there to support those models as they began to operate.

As far as what I brought out from consulting into a CIO-type position, I think the answer to that is exposure to the different scenarios, different processes, different technologies, and different methods of operation that you’re able to pick up from client to client. You get a very broad and deep base of exposure to how IT is delivered in multiple health care organizations, both large and small.

Those innovative ideas come back to my IT leadership team and we run them around and we identify which ones make sense, which ones can we deploy now, and which ones are going to take less of a priority. But I think the key point there is that we have a physician that’s front and center with this—not just around adoption, but around innovation as well.

We’re dealing with technology in times of great change. So it’s keeping the lights on and keeping the food and water and basic essentials, metaphorically, up and running, and taking a look at where we need to go strategically.

Anybody that’s been a consultant understands the whole notion that you’re more or less a journeyman. You’re a hired gun—you go in and assess something or you fix something or you implement something, and then you move on. You never see the benefit or the value-add of your work 12 or 18 months later.

Guerra:  You did a presentation at an Oracle user group meeting, correct?

Scanzera:  Yes I did.

Guerra:  Tell me about the presentation, what it was about, and your thoughts as a CIO on presenting different meetings—what makes you decide to present at a meeting. Obviously there is time and effort involved, and I’m assuming you are an Oracle costumer. Tell me your thoughts, first around that presentation and its content, and then just generally, you must get asked to do a lot of different things—how do you decide what to accept and to what not to?

Scanzera:  So let’s answer the first question and talk about what was actually presented. The whole notion of the presentation was around technology to support accountable care, and it was a joint presentation with Deloitte Consulting and AtlantiCare at the big Oracle user group out in San Francisco, and I guess that was probably two weeks ago by now. Basically my portion of the presentation was the story around what our experience has been and what are we looking to develop in terms of technology to support accountable care. The core of my presentation was really around the five major types of systems, first and foremost the electronic health record, and consolidating and combining electronic health records. The second component of that being the health information exchange, the third component being enterprise-wide analytics, both clinical and financial and inpatient and ambulatory, and then whole notion of continuing care systems, so that we have the technology to support the clinical handoffs from environment of care to environment of care, and the whole notion of population-centric navigation.

Those were really the five major areas that I presented and talked about in terms of where we are with in each of those. Where is the business model going, where is the care delivery model going, where is the reimbursement model going—those are thing that are keeping me up at night as CIO in terms of making sure that we had the technology out there to support those models as they began to operate.

So that was really the crux of the presentation. And I guess the second answer to your question, as far as how do I determine for whom I present or how I volunteer, really it comes down to the value to AtlantiCare as an organization. There is limited time because you do get a lot of offers, so I like to make sure that there is going to be some sort of value that AtlantiCare as an organization receives in terms of bringing back new and additional knowledge content. So really at its core, the reason I present is AtlantiCare-centric—it’s not for any personal reason or for any other vendor or system integrator.

Guerra:  So does the venue provide an opportunity to position AtlantiCare as a thought leader?

Scanzera:  There are times where, as an unintended benefit, that does come out of it. Because as an organization, we are doing some advanced things and we do have some advanced thinking in some of those spaces. So that does happen, but I guess that’s just part of it.

Guerra:  I saw that you did a joint presentation with Deloitte Consulting. I know you spent some time there—can you tell me a little bit about your time with Deloitte and what from that consulting tenure you were able to bring to the CIO position that has helped you in your role?

Scanzera:  Sure. I actually was with Deloitte for about seven years and PriceWaterhouseCoopers and Coopers & Lybrand for about seven years prior to that. As far as what I brought out from consulting into a CIO-type position, I think the answer to that is exposure to the different scenarios, different processes, different technologies, and different methods of operation that you’re able to pick up from client to client. You get a very broad and deep base of exposure to how IT is delivered in multiple health care organizations, both large and small. And experientially, being able to bring that broad and deep base and to see what has worked historically in other environments is really helpful here as we continue to deploy technology at AtlantiCare.

Guerra:  Some of your colleagues are being tempted by the consulting world and the opportunities for maybe financial advantages or travel. Is there anything you would caution them or tell them about the consultant lifestyle they may not really understand?

Scanzera:  No, I think most of my colleagues and contemporaries that are thinking about it are very smart and have been in this space a long time. They know what questions to ask and they go into these things eyes wide open. There is a time challenge, there are requirements, and if being away from home is something that you’re not interested in doing, then perhaps consulting isn’t the best career choice. But my contemporaries that are considering it, they know what it’s all about and they are going into with eyes wide open.

Guerra:  Let’s talk briefly about ICD-10. What are your thoughts around that—what has your preparation been? Is that something that’s keeping you up at night?

Scanzera:  Actually it is keeping me up at night. I have somebody that is very, very good at that in terms of project management that’s driving it in our organization right now. In terms of where we are, we’ve gone through our initial assessment, we’ve identified the systems that are going to be impacted, and we’re on the way to remediating and updating and upgrading those systems as required. The next piece of it basically is going to be around the training and education around adoption of the new code set. And we’re in the process now of identifying which population within our care delivery organization is going to need that type of training, what type of training it is going to be, and at what point in time that is going to need to be delivered so that it’s effectively absorbed to be in the position to effectively use the codes when it becomes a requirement.

Guerra:  Are there any main strategic decision points on the whole ICD-10 project where you were saying, we could do it this way or we could do it that way, and we’re still trying to figure it out. Are there any main fault lines in the project that come to mind?

Scanzera:  Nothing that comes front and center. As we did some of the initial planning around planning and analysis to take a look at what systems would require what degree of remediation, you’re always forced to ask yourself the question, ‘Do we want to remediate the existing system, or do we want to go through the rip-and-replace process?’ And there were a couple of those situations where we ultimately decided that the technology is good and we don’t necessarily need to rip and replace. So from a strategic stand point on the front end, that’s where we saw most of that type of thinking. And I think that based on where we’ve landed in terms of the portfolio that we’re going to have to upgrade, we’re in a pretty good shape.

Guerra:  Let’s talk a little bit about iPads and iPhones and what seems to be a coined phrase—bring your own device to work. Where are you on that? Do you have a lot of physicians bringing in their iPad or iPhone saying, ‘I want to be able to see into Cerner on these devices e use of the devices in the hospital system?

Scanzera:  We’re taking a look at the use of mobile devices and mobile computing through a through a couple of lenses. Currently we do have physicians that bring in their devices and are able to access Cerner through a particular network segment that is secured that allows them to take a look at the components of the electronic health record. We’re also working with Cerner to basically, in effect, identify and deploy the components that they are going to make natively available an iPods, without having to come in through a special network segment. So we’re looking at that right now. We’re also in the process of taking a look at what types of other either Android-based or IOS-based solutions we might want to push out to mobile devices for our physicians. And we’re in the process of evaluating that strategy right now and taking a look at what’s going to make sense and what we’re going be able to accomplish in 2012.

Guerra:  Do you have any overriding philosophy about dealing with these types of request from physicians? They pop into your office and you want to say yes as often as you can, but obviously you can’t do that.

Scanzera:  We actually try to handle it a little bit more proactively. I have a CMIO on staff here who is actively engaged with the physician community to talk about and consider the innovative ideas. Those innovative ideas come back to my IT leadership team and we run them around and we identify which ones make sense, which ones can we deploy now, and which ones are going to take less of a priority. But I think the key point there is that we have a physician that’s front and center with this—not just around adoption, but around innovation as well.

Guerra:  I used to speak with Dan Morreale, who was your predecessor over there. How long have you been over at AtlantiCare?

Scanzera:  I actually celebrated my first year as an AtlantiCare employee last week. I was here for approximately nine months as an interim CIO before I joined the organization officially.

Guerra:  I’m wondering if you can talk a little bit about onboarding or getting up to speed. As a CIO—and again this is all for the benefit of all your colleges for when they start a new position—did you have a method of looking over all the vendor contracts and having any initial meetings, and do you have any philosophy about just getting up to speed?

Scanzera:  Well the answer is, because it was part of the consulting engagement, a full IT assessment was performed by an outside consultancy. And it happened to be Deloitte at that point in time, because that’s what who I was with, and I was one of the leads on that body of work. So we basically went in and took a look at all of the components you would expect to look at in terms of IT staffing, IT operations, vendor contracts, and vendor relationships. And through what I believe was a pretty thorough assessment, came up with set of a recommendations and a plan in terms of what needs to happen in the next 24 to 36 months, and basically once that plan was adopted, now we were working against that plan. So I guess net-net on that is help from the outside to come in and bring that objective view and opinion is very helpful to get a lot of ground covered very quickly.

Guerra:  And how would you describe your first year. Has it been pretty intense?

Scanzera:  It’s been pretty intense. There’s a lot to be done. There’s a lot of work, and there are a lot of very, very gifted and talented people here in the organization. Working with them has been great, but again, it’s a situation where we’re dealing with technology in times of great change. So it’s keeping the lights on and keeping the food and water and basic essentials, metaphorically, up and running, and taking a look at where we need to go strategically. So it’s an interesting balance. We live in interesting times in provider IT. There’s no question about it.

Guerra:  And this is a totally different than in consulting, where you move from engagement to engagement. Now this is your baby and you own it. Is it satisfying in that, ‘I’m not moving on—I really I get to see this through the end’?

Scanzera:  I actually I get that question a lot, and the answer is that the best part of it is you get to see how the story ends. Anybody that’s been a consultant understands the whole notion that you’re more or less a journeyman. You’re a hired gun—you go in and assess something or you fix something or you implement something, and then you move on. You never see the benefit or the value-add of your work 12 or 18 months later.

The great part of being here is that all the work that’s going on over the aggregate 17 to 19 months I’ve been here, I’m starting to see the benefit of it and how the story ends of all the work that was done earlier on in the process. So to me that’s a great thing—to be able to see how the story ends and how the story continues.

Guerra:  Do you think that having been a consultant, you now have some of the inside tips on handling consultants, so as now as the CIO, there are certain things you look out for, either in contracting or anything like that—does it give you a leg up there?

Scanzera:  Sure. In terms of managing vendors and managing system integrators and managing partners, having been on both sides, there’s absolutely is an advantage to understanding the position of where the consultants or the system integrators are coming from or where the software vendors are coming from, and being able to use that to forge better partnership relationships that yield greater value and are basically set up to be very fair to both sides.

Guerra:  Now, you are a New Jersey native, correct? Bloomfield, I believe?

Scanzera:  Born and raised in Bloomfield, and educated in Florida.

Guerra:  So you got out of town for school?

Scanzera:  I got out of town for school and then came back in the mid-1990s.

Guerra:  Now were you going to stick with the consulting until a CIO position opened in New Jersey? Were you trying to stay local or would you have gone anywhere?

Scanzera:  Actually, at that point in time, I had no intensions of leaving consulting. This was just an opportunity that presented itself. It was an exceptional opportunity, and quite frankly an extraordinary organization, and I can say that with conviction, having been in and out some of the best and quite frankly some of the worst organizations around the country, to the point where I said, ‘It makes a lot of sense for me right now at this point in time in my life with this opportunity.’ So if you’re asking if I was looking for a CIO gig, the answer is no. But when I took a look at the opportunity here and the construct of the organization and the mission and vision and what we stand for here, it just made a whole lot of sense to say, it’s time right now.

Guerra:  Well Christopher, that’s about all I had for you today. Is there anything else that you wanted to add—either projects you’re working on or things you want to bring to light that your organization’s working on, or just any thoughts on industry trends?

Scanzera:  No, I think we covered a lot of really good ground today. I appreciate the opportunity to participate in the interview, and I look forward to anytime in the future where we might want to catch up again and chat, and just let you know how things are going and maybe pick your brain a little bit about what you’re seeing or hearing outside of here.

Guerra:  Well it’s slim pickings, but you can have at it.

Scanzera:  I appreciate that.

Guerra:  Thank you so much, Christopher.

Scanzera:  You’re welcome, and thank you again for the opportunity.

Guerra:  Have a great day.