After accomplishing what she set out to do at University Hospitals Health System in Cleveland, where she oversaw a major upgrade and full system deployment, Mary Alice Annecharico, RN, decided it was time for a new challenge. So she ventured across Lake Erie to Henry Ford Health System, a large, Detroit-based organization that is transitioning from a home-grown system to Epic’s EMR. In this interview, Annecharico talks about why Henry Ford appealed to her, the path from clinical nursing to CIO, and how her early career experience shapes her current role. She also discusses the importance of knowing what drives an individual, her IT philosophy, and why nurses can make effective CIOs.
- About HFHS
- From home-grown to vendor (Epic)
- HFHS and Partners following similar paths
- From University Hospitals to Henry Ford
- Know what energizes thy self
- A spin around Lake Erie
- From nurse to CIO
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I was very impressed in the interview cycle with the clinical integration theme that everyone spoke about, and most of the questions that represent my skills, my background, and my experiences were pointed in the direction of how I can help them be where they need to be.
The dynamic change is something that does excite me; it keeps me fresh. And realizing that although I hadn’t planned to make a career change from one large, very well respected organization to another, the allure of this opportunity and the aggressive timeframe of the implementation of Epic was very appealing to me.
When I met this team for the very first time, there was a Midwestern wholesomeness that represents for me one of the distinguishing characteristics of Cleveland and why I chose that. So it was not a significant cultural change, but it gave me access to the kinds of roots that I’m familiar with.
I took courses. I stayed one step ahead of what I needed to teach and what I needed to plan and execute, and year by year and experience by experience, I acquired the acumen and the delivery style to help organizations do what I’m doing here.
I think we learn from one another, and it’s really the business of technology that drives change within organizations rather than the technology itself. And if we can purpose technology to answer the business questions, then that’s where we gain our efficiencies and our effectiveness.
Guerra: Good morning, Mary Alice. I’m looking forward to chatting with you about your new role at Henry Ford Health System.
Annecharico: Good morning, Anthony. I’m excited to have the pleasure, the opportunity, and the privilege to be working with Henry Ford Health System and also equally excited to have this conversation with you. Thank you.
Guerra: Wonderful. Okay, let’s talk a little bit about Henry Ford. I know you’re pretty new but what can you tell us about the organization — the moving parts that you’re going to be responsible for making all move together.
Annecharico: Henry Ford, in my mind, is the pinnacle of an integrated delivery system from the mentation of the whole leadership team all the way through the 23,000 employees of this organization. I was very impressed in the interview cycle with the clinical integration theme that everyone spoke about, and most of the questions that represent my skills, my background, and my experiences were pointed in the direction of how I can help them be where they need to be. Henry Ford is known in the industry for the development of its electronic medical record and the highly customized focus of its billing and scheduling system that represents a single point of reference for the patient population in a single bill.
But they realized in the development cycles that they were beginning to fall behind what the industry was requiring from a regulatory and legislative perspective as the healthcare reform agenda is unfolding. A number of years ago, they were looking at what the industry had to offer in the way of the electronic health record orientation. And at the time, they looked at Epic and it was so underdeveloped compared to where it is in its state-of-the-art functionality today that they felt that they would be better served by continuing on the journey of their own implementation. But in the last two years, they began realizing the footprint was quickly on the walls that they couldn’t keep up with what was being required. And with the HITECH Act and the requirements for using the system meaningfully and having providers participate in a CPOE component, they began looking again at the industry and quickly narrowed down their desire to move into a partnership relationship with Epic to transform both the revenue cycle as well as the clinical environment into an integrated delivery system across its flagship hospital, the Henry Ford Hospital, and the five community facilities.
Guerra: How many beds are there, approximately, in the main hospital?
Annecharico: In the main hospital there are about 800 beds, and then representing up to 1700 beds total across the landscape of the organization.
Guerra: And there are a lot of owned ambulatory sites, physician practices, and practice clinics — that type of thing?
Annecharico: That’s right. One of the other things that distinguishes Henry Ford is its Health Alliance Plan that is basically an insurance arm of the organization and provides health insurance services to business and industry as well as to the population here.
Guerra: So is it a system like Kaiser where all the incentives are lined up — where the same entity is providing the care as well as the insurance, or is it not exactly the same?
Annecharico: Not quite the same. It is a service offering for each one of the entities but it doesn’t have the same dynamic.
Guerra: As you were saying, the EMR software business now is not something you can do part-time; you either do that or you’re a health system, and I think Partners may be pretty soon announcing some thing about getting out of the software business to a certain degree.
Annecharico: Yes. Partners, because of the changes there in its leadership, is really taking a step back. It’s very similar to what is going on here, when you are spending a significant amount of your time in development mode and not able to pay attention to the agility that the industry is requiring. Let me take a step back and just give you a little bit more background on the Health Alliance Plan (HAP).
Annecharico: Right now it’s serving about 3,000 employer groups and has over half a million members and it’s a non-profit managed care organization that facilitates the coverage in both the commercial space and government programs, with significant footprint. And again, I think that’s probably a better description of that for you.
Guerra: Sure. Okay, let’s talk a little bit more about you going over there. On our site, healthsystemCIO.com, we really like to look at the CIO as an individual, as a person. There are a lot of interesting things in switching from one organization to another. It’s certainly not a small step; it’s a big career step and a big decision. You were at University Hospitals for between three and four years, is that correct?
Annecharico: Yeah, about three and a half years. It was an opportunity for me to move back into healthcare since I was at the University of Pennsylvania School of Medicine as its CIO for 10 years. In their academic and research space integrated with their health system, I played a liaison role to the health system that had a counterpart on the health system side. And as a clinician, I was very thirsty to get back into healthcare directly. So, the opportunity three years ago that was offered to me by University Hospitals was a very natural flow of my experience and my desire to get back into a footprint that was very similar to the organization of University of Pennsylvania Health System. Partially, it was outsourced — the same as at Penn, and had similar systems that were going in.
During my consulting career that spanned the 12 years prior to Penn, I had tremendous opportunities to work with large academic environments and help create these strategic plans and the footprints for those clinical and business systems. So I felt like I was moving back into a sphere of familiarity and that I could add value there. At the time that I joined University Hospitals, they were in the midst of their launch of a major upgrade and full deployment of their Eclipsys product and that relatively completed after the three years of my being there, which made me feel like we had accomplished what we were attempting to accomplish. And at the same time, I was becoming restless in terms of being able to be a dynamic change agent when the recruiters for Henry Ford contacted me and asked if I would just talk with Henry Ford about the feasibility of their plan and what I might be able to offer. And again, as I have stated before, once I met the team and realized that there was this single-minded purpose and focus of the leadership team, I became very excited about an opportunity that I could explore further with them.
Guerra: Is it fair to say that you are someone who likes big change and a big project to tackle on and what happened was you kind of had done a big project and it was a question of incremental improvements and refining, and you were looking for that next big project?
Annecharico: Absolutely. I think I would characterize it by saying that the dynamic change is something that does excite me; it keeps me fresh. And realizing that although I hadn’t planned to make a career change from one large, very well respected organization to another, the allure of this opportunity and the aggressive timeframe of the implementation of Epic to replace multiple systems and create this clinical integration was very appealing to me.
Guerra: We’ll get into sort of where they are in the Epic implementation in a moment, but I actually went to MapQuest, and unless I’m incorrect, it’s about a three-hour drive between where you work and where you’re going to work. Is that correct?
Annecharico: It’s a little bit less than that — about two-and-a-half hours.
Guerra: I mean that’s a tremendous opportunity because you didn’t have to move. And usually, for a CIO who wants to get into another prominent role, you’re going to have to move geographically. You’re going to have to maybe uproot your family. You didn’t have to do that, so that’s a tremendous opportunity, correct?
Annecharico: It is, and yet I view this as a total commitment, and therefore, it’s not having to uproot my family, because my family is established. But I will be relocating permanently to the Detroit market once my home sells in Cleveland. I will tell you that Cleveland is an extremely gracious city and I was very, very comfortable there, so selling a home and the creature comforts that I established there — it’s part of the business decision to make.
Guerra: So it’s a change, but it’s not like moving from New York to the Deep South.
Annecharico: Anthony, that’s a good point. When I met this team for the very first time, there was a wholesomeness — that Midwestern wholesomeness that represents for me one of the distinguishing characteristics of Cleveland and why I chose that. So it was not a significant cultural change, but it gave me access to the kinds of roots that I’m familiar with. I was born in New York and when I was very young, my family moved to Denver. And that environment is very similar to this Midwestern culture — the work ethic and the demeanor of the residents of this state are very similar to how I grow up, and that’s a comfort for me. But it was one of those remarkable coincidences when I went through the interview process that the team spirit is the same throughout the organization in that regard.
Guerra: And it looks like you really just swung around Lake Erie, from one side to the other.
Annecharico: I did. I swung around Lake Erie, and I moved from what I didn’t realize was the lake-effect snowbelt of Cleveland on the east side to the less severe winter environment up here.
Guerra: Even though you’ve gone north, a little bit.
Annecharico: Even if I’ve gone north, yes. I think the Detroit area seems a little more buffeted from some of that lake effect. But I have spent my entire career in health care. I am a nurse by profession. The passion that drove me into nursing was a lifelong desire to be a nurse, and that was accomplished when I went to school in Manhattan and was, in my clinical career, a critical care nurse and director of a large academic medical center’s critical care services when I was approached by a vice president of finance and member of the leadership team to consider putting computers on the clinical division so that the orders for pharmacy and lab and radiology would electronically flow to those departments and the results would come back and the charges would flow to finance. And I quickly realized that being the vice president of finance, Mike wanted the charges to flow to finance, and I said, ‘I understand where you’re coming from. It sounds like you’re looking for efficiency there.’ And he said, ‘well, you’re quick study, but I really want a nurse to help represent what this could mean. I need somebody to build a division and move us in that direction. I’d like you to consider it.’ And at the time, I didn’t realize that he was asking me to take a step aside from my clinical role and become a businesswoman as well as a clinician in helping excite the organization toward that change.
Once that was accomplished, I was then squired away by the consulting environment to help other organizations do this. This was back in the mid 80s, so I spent 12 years with PricewaterhouseCoopers and with First Consulting Group helping to build clinical informatics in the clinical division within the consulting groups and had a wonderful 12 years of experience in managing in that environment and helping the organization do what I had successfully done back in New Jersey when I was there.
It was when I was at the University of Pennsylvania that the CIO at the time, Ward Keever, said, ‘We have a new dean and I’d like you to use your velvet hammer and go down and find out what he wants.’ He wants to change the role that IT plays because, according to him, they’re in green eye shade and stubby pencil mode and don’t have the systems and applications that they need to manage the footprint of academic medicine and research. So I went down, and again, it was like a repeat of the conversation I’d had years before with the vice president of finance. In the conversation, I said, ‘You understand what we need to do. Could you help us find a CIO and create a strategic plan and start moving us in the right direction? We need to move with alacrity.’ The three-month engagement that I had assumed on behalf of the firm, First Consulting Group, turned into an extended three months, and by the sixth month, I was hooked. They actually had their CIO who had been producing and was now part of the landscape and that was, for me, a nice departure from being on the road and having that connection with a healthcare academic environment.
So I feel like I am in my element back in the healthcare and that I have both the credentials and the credibility because of the successes that I’ve had. I’ve been given incredible opportunities. I feel very blessed and honored to have worked in a number of very distinguished organizations, and this is for me, I would tell you from the outset, the most positive environment in which I have worked and the most collegial of hardworking peers and cohorts to help get a massive job done.
Guerra: Did you always have an interest in technology to the same degree that you had an interest in being a nurse?
Annecharico: No, Anthony. It was a shock and surprise back in that day when Mike indicated to me that he thought I would be the perfect person to help computerize what the clinicians did in this organization. I mentioned to him that I knew two words about computers: one was hardware and one was software, and I had no idea what either one of them meant. It’s very true. He laughed like you did, and I said, ‘No, I’m very serious. I’m curious because you think I can do this, but I’m serious. I’m at zero; the starting line.’ So for the first several years, Anthony, I took courses. I stayed one step ahead of what I needed to teach and what I needed to plan and execute, and year by year and experience by experience, I acquired the acumen and the delivery style to help organizations do what I’m doing here.
Guerra: How would you describe your feelings toward technology? You can’t be good and make your life’s work something that you find irritating or boring. So does it fascinate you? Do you find it interesting or is it just a challenge to get your arms around it, and that’s what’s fun?
Annecharico: It’s fascinating to me. I am very, very thirsty. I enjoy working and existing around very, very bright people. Those who are fascinated by and create the accomplishments in the technology space are the people that I work with on a day-to-day basis there — those that report directly to me. But they’re also my business colleagues and my clinical colleagues. So I think we learn from one another, and it’s really the business of technology that drives change within organizations rather than the technology itself. And if we can purpose technology to answer the business questions, then that’s where we gain our efficiencies and our effectiveness. I am tantalized by the changes in technology.
I will tell you I am not technology proficient; that’s why I have very bright people working around me, and yet I can be the broker for the conversations with leadership and with clinicians and break it down into the manageable segments that they need. I can vision with the leadership team to talk about where technology can take us; how it can enable change and support the footprint of the dynamic changes that are being required of us in the landscape of healthcare reform.
This is a very technology-savvy organization. The innovative space in which they have existed for so many years is largely why they are who they are, and it brings them together. The Henry Ford Health System recently was awarded the very distinguished Baldrige Award for Clinical Excellence and Integration, as well as the opportunity to demonstrate its progressive improvement and enhancement of both the clinical space, and also the environment in which its workforce lives and breathes on a daily basis. They are very excited about this. The announcement of the award was on the very same day that I was being made the offer to join them, and so it was highly exciting and very innovative and energizing for me as well as this organization. They apparently moved through the process of the Baldrige application, which was a seven-year journey, with solid commitment, and that was so impressive to me as well as to others that I felt like this is an unstoppable organization and I am excited to be made the offer to join them.
The selection was very competitive; like the selection at University Hospitals in Cleveland, I was competing against six very competent males, all of whom at University Hospitals were seated CIOs in healthcare, and I was seated CIO in an academic research environment. So it made it even more competitive for me. Here, again, I think there were some very distinguished candidates against whom I competed, and I’m again blessed and very pleased with the opportunity to work with this leadership team.
As a nurse, I am also representing an extended footprint of several nurses who are in leadership roles at the president level for community facilities as well as the chief nursing officer and chief operating officer for the flagship hospital and president of a very innovative new hospital that just became active three years ago, so the clinical presence and a female presence is also a remarkable distinction. The chief executive officer, Nancy Schlichting, is by far the most positive and motivating executive for whom I’ve ever worked and she inspires confidence as well as supporting good decisions, whether they’re the right decisions from which you have to retract, or they’re less good decisions. She is very supportive and helps to create the positive change that the environment needs to keep going forward.