With an ever-growing number of projects on their plate, many CIOs are struggling with prioritization challenges. And what often happens, according to Rick Schooler, CIO at Orlando Health, is that tasks that are deemed urgent take precedence over projects that are essential to an organization’s growth. As his organization continues to expand, Schooler is working to balance immediate IT needs with Orlando’s long-term strategy to deliver a clinically integrated model of care, which is no simple task. In this interview, he talks about his concerns with the proposed MU stage 2 rules, why CIOs will need to put pressure on vendors, the importance of being plugged into the executive team, why enterprise analytics can’t be put on the back burner, and the skillset that today’s CIO must have.
- The skillset that today’s CIOs must have
- “The stakes are higher now on all fronts”
- Establishing a single source of truth
- Enterprise-level analytics
- Tyranny of the urgent
- Being plugged into the executive team
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It’s balancing that tyranny of the urgent; balancing that prioritization. Because somebody always has something that’s just on fire and has to be addressed. ‘I’ve got a need that you got to fix right now. If you don’t, we’re going to hurt patients,’ or ‘we’re going to jeopardize the organization’s financial stability.’
If you’re not a competent CIO, this will be the worst of times you could imagine. For people who really don’t believe in what we’re doing and really don’t have the interpersonal as well as the technical and professional skills and leadership skills to get it done, it’s going to be tough.
The best way to do that is to develop an enterprise-wide data warehouse platform that you can build and grow working with different vendors who are accomplished in this area of healthcare. It’s something we all agree we really ought to do, because then we’ve got one source of truth from which we can data-mine, we can query, and we can run reports.
When you want comparative data, you often find yourself having to send data out to an external source, but the more vendors you have, the wider you have to cast the net when you think about where is all the data that I need to get into this platform. And it makes it harder.
If you’re a CIO and you haven’t done a good job of effectively managing expectations, then when things don’t go well that are in any way related to the need of information, you’re squarely in the cross hairs. And quite frankly, you should be.
Gamble: It really amazes me how much CIOs have to deal with right now and how you’re able to prioritize. That, to me, seems like that would be one of the toughest parts.
Schooler: It is; it’s the number one challenge. People ask me, ‘what is your biggest challenge?’ The biggest challenge is ensuring that we’re doing what we’re doing. I gave a quote in one of the articles for Healthcare IT News — the HIMSS newspaper did a whole page on the interview, and one of the things I said is that we continue to respond to the tyranny of the urgent. The tyranny of the urgent compels you to do the things that you believe you have to do in the moment and takes your focus and attention away from the things you should be doing for the future, both near- and long-term. So it’s balancing that tyranny of the urgent; balancing that prioritization. Because somebody always has something that’s just on fire and has to be addressed. ‘I’ve got a need that you got to fix right now. If you don’t, we’re going to kill patients or we’re going to hurt patients.’ Or ‘we’re going to jeopardize the organization’s financial stability.’
You’ve got to figure out a way with limited resources — and everything’s relevant. I may have hundreds of resources where somebody else may have tens of resources but it’s all relative to an organization’s size. So you’ve got to figure out how to deal with the tyranny of the urgent; how to deal with the immediate needs and concerns and ‘gotta-do’s,’ many of which end up being not necessarily ‘have to do’s,’ but in the moment, with the emotions involved and the stress involved, people are like, ‘hey, I have to have this now and we’ve got to do this right now.’ You have to balance that with demand management — I guess that’s the management term — but prioritization and demand management are by far the biggest challenges that most of us would say we have.
There’s also the timing of getting some of these initiatives done, working with our vendors—in organizations like ours where we have hundreds of vendors and hundreds of platforms, orchestrating all of that to get to a point where everyone is compliant at the same time; for example, ICD-10, or to get the right releases installed for Meaningful Use, or the new Windows upgrade, what have you. It just comes in from all angles, so that’s a big skill, and it’s a big challenge to effectively prioritize and manage all of the application stuff as well as all of the infrastructure and technology stuff, while maintaining the relationships and aligning your IT initiatives; keeping everyone aligned with business priorities and keeping that communicated to the executive team. Those are the big things that CIOs have to be good at. We’re at a stage, I think, in our industry’s evolution where these skill sets are now paramount. And if you don’t have them, along with a lot of other traditional IT skills as well as leadership skills and personality skills — the ability to blend and to fit with the organization and to be able to read situations and respond to someone’s agenda when it conflicts with someone’s else — that’s all part of the game. If you’re going to be a competent CIO, that’s part of what you have to do. The stakes are higher now on all fronts for CIOs.
Schooler: I was briefly talking at the CHIME Forum — they recognized me and Rich Correll asked me just to say something quick, and I said, ‘You know, I really think there’s never been a better time to be a competent CIO. If you’re not a competent CIO, this will be the worst of times you could imagine. For people who really don’t believe in what we’re doing and really don’t have the interpersonal as well as the technical and professional skills and leadership skills to get it done, it’s going to be tough. It already is; even for those who have skills and have the ability and are proven to be thought leaders as well as accomplished leaders in the organization, it’s really hard.
Gamble: I can imagine. You were saying before that a few years from now, you’re be looking back at this time and everything you had going on and you’ll probably be saying, ‘how on earth did we get through all of that — dealing with not just everything that’s coming down form the federal initiatives but everything you have going on in your organization now and in the future?’ And like you said, not losing sight of all the planning that you have to be doing.
Schooler: Here’s a great example of something that an organization should be doing but gets distracted in the moment and never quite seems to get there. Let’s just take this whole subject, and this is a key enabler for the future of healthcare — to thrive in healthcare, you’re going to have to be effective at enterprise level analytics. And when I say enterprise level, I mean financial, clinical, operational, quality, clinical performance, physician performance, productivity, efficiency, you name it. So everyone would sit in a room and say, ‘You know what? The best way to do that is to develop an enterprise-wide data warehouse platform that you can build and grow working with different vendors who are accomplished in this area of healthcare.’ It’s something we all agree we really ought to do, because then we’ve got one source of truth from which we can data-mine, we can query, and we can run reports. We can also transmit data outside of the organization from this one trusted single source of truth. Why don’t we do it? Why don’t all of us do it? First of all, it has to be planned; it has to be a strategy. And it is expensive, but it’s not as expensive as putting in an EMR system. But it has to be something that is agreed upon; consensus has to be obtained and maintained as a strategic priority.
Well, what pulls us away from doing that often is, let’s say that the financial folks or the revenue cycle folks or the quality folks — just take those three areas — need information, and they need it now. And if you’ve got a research team that does any kind of clinical research or clinical trials, they need information as well. And all of our specialties have these databases that we have to contribute data to. So going back to that idea of the tyranny of the urgent, let’s just call it the urgent needs people have that run these different parts of the business. So at the same time, when you should be working on something that’s strategic that solves all of these problems with multiple sources of truth, and multiple business intelligence (BI) and analytics platforms, and we just can’t quite seem to get our hands around data that’s good regardless of who’s looking at it, we end up pursuing the individual initiatives. Why? Because we have to have information to run the business.
Most organizations fall prey to losing focus on building that platform of the future and they stay stuck in the platforms of today. We, just two years ago, put that in our strategic plan; with our organization strategic plan, the capital is essentially all IT except for the acquisition of physician practices and that kind of thing, which are kind of looked at as a separate investment. But we said, ‘We’ve got to start building this platform. If we start it within three to five years, we’ll be where we need to be, but if we don’t start it, we’ll never get there.’ And that’s a good example of what I mean when the tyranny of the urgent pulls away from the focus of building platforms that will allow us to survive in the future.
Gamble: It seems like data warehousing and analytics is one of those things where a lot of people say, ‘Yeah, that’s something we know we need to do,’ but somehow it keeps getting pushed back. And from what you’re saying, this doesn’t seem like something that can get pushed back.
Schooler: Well I think it depends on how you believe you’re going to be playing in the future. So if you think that you’re going to get consolidated into some other larger entity, and you’re stand-alone community hospital, then okay, you can probably dump your data to an external source and get a lot of what you need for today, assuming that tomorrow you’re not going to try to be the accountable care organization, or you’re not going to be the bigger dog, if you will, that controls and manages and leaves the health system. Then I would say it just depends on what you expect out of your future — what role do you want to play as a provider in the future in a larger health system or in some collaboration with other providers? But eventually you’re going to have to produce good data, and the problem with data is that it comes from multiple sources, and people do different things to it to make it look how they want it to look, so that’s a great example.
Gamble: And being in organization that does deal, like you said, with hundreds of vendors, does it kind of put a little more pressure on you to really make sure that you are able to get that single source of data?
Schooler: Yeah, and some of these databases, for example, we’ll keep. There’s a certain amount of BI that we dump data to on the outside that we’re going to keep. There’s no reason to get rid of it, because I cannot recreate the data massaging that’s done to that data for at least two, three, or four years. So we’ll continue to have that stuff, but over time, it all migrates into this bigger platform. And when you want comparative data, you often find yourself having to send data out to an external source if you want the benchmarks and so forth, but the more vendors you have, the wider you have to cast the net when you think about where is all the data that I need to get into this platform? And it makes it harder.
Gamble: Sure. It’s interesting, before you touched a little bit on being CIO at a large organization, where you might have more resources, but there are challenges that you face that are different from CIOs at community hospitals. For some of them who are feeling overwhelmed right now, do you have any kind of words of wisdom for getting through all of these requirements, getting through all of these projects when they do have a smaller budget?
Schooler: Well I would say, again, it goes back to the notion of things being relative. Relatively speaking, yes, there are differences. A large health system has got a lot more balls in the air and there are different kinds of things that you have to manage and different kinds of needs you have to meet, but when you boil it all down, it has to start with executive consensus on what’s important. And if you’re CIO in any sized organization, and you don’t believe that the things you’re involved in doing and your teams are doing are effectively aligned with the priorities and the agenda of the organization — and by that, I mean the executive council or the executive cabinet, those five, seven, or 10 leaders who are mapping the course for the organization; if you sense that you’re not aligned with them, or you’re not one of them, then you better get there as quickly as you can. Because in the end, you’re going to be staring down the barrel of someone saying, ‘Wait a minute, why don’t we have these things that we need? Why are we now going down this road with strategy and we don’t have the enabling technologies or information models to support it?’ So that’s why it’s so critical. And not to mention all the politics and all the interpersonal relationships and things that have to go on day-to-day to make things work. To be an effective CIO, you have to have those relationships, but if you’re not aligned — if your IT initiatives are not squared up with where the organization believes its priorities are, then you’re headed for real rough road, and in many cases, you’ll be looking for a job.
And again, that’s easier said than done, believe me, because there are a lot of things that can get in a way of that happening. Organizations where CIOs are not plugged into the executive team or the executive council — whatever your organization might call it — if you’re not plugged in to that directly, you better be plugged into it indirectly. Because people are going to make decisions for you, or you’re going to be missing decisions that were made that are vital to your success and you get that ‘outside looking in’ feeling, and it can happen very easily.
Gamble: Sure, and you end up being held accountable for what went wrong.
Schooler: I would say you will be. If you’re a CIO and you haven’t done a good job of effectively managing expectations, then when things don’t go well that are in any way related to the need of information, you’re squarely in the cross hairs. And quite frankly, you should be, because it’s our job as CIO to ensure that doesn’t happen and that’s kind of how it is. But that’s one of those things where again, that’s easier said than done. It takes a lot of energy and a lot of effort, and you have to have a great management team under you in IT.
I’m fortunate to be able to manage other areas. I have a vice president responsibility for supply chain and I have clinical informatics and enterprise analytics and biomedical, and so I get involved with other things. On the supply chain side, I’ve got two industry-renowned executives that run our supply chain. I get to be involved in the strategy and the fun part of supply chain, and they work with me on that; they’re the experts. But they make things happen day-to-day. We have our own GPO that we wholly own, which is going to be key for us going forward as we address supply chain costs. We’ve had it now for six or seven years and it’s putting millions on the bottom line that we would not otherwise have, even working through a national GPO. And we’ve taken back distribution of medical-surgical and we’re going to be doing other things, possibly pharmaceutical packaging, which will make us more efficient. But that’s millions of dollars on the bottom line.