Despite the fact that many health system CIOs sit on the executive board and play a key role in shaping an organization’s long-term strategy, the perception of the CIO as basically a “mechanic” is still a common one. And it’s one that Karen Marhefka wants to see change, particularly as more hospital functions and departments fall under the IT umbrella. In this interview, Marhefka talks about what it takes to operate a best-of-breed shop in today’s complex environment, the importance of staying abreast of vendor mergers and acquisitions, and the challenges in establishing a strategy that is solid enough to guide an organization but flexible enough to accommodate shifting priorities. She also discusses what it has been like to work with George Brenckle and how the CIO role has evolved and will continue to change going forward.
- The HIT workforce shortage and staff management
- Working with consultants, Encore Health Resources
- Working for George Brenckle
- HIT and Eddie Money
- The changing role of the CIO
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We looked within and we decided that the best staff for these implementations that are ongoing and additional functionality rollouts would actually be the folks from within the operational areas that the applications serve.
They are not a staff augmentation firm; they employ folks who have worked in the industry for a long time. These are mature professionals and we needed someone who was going to be head-down, very focused, very project management-oriented for the revenue cycle for Soarian Financials.
You have to continually weigh that partnership, that expertise, and that help with what you can afford from a budget standpoint. And we were also very careful to make sure that the projects that we entrusted to our consultant colleagues — specifically Encore in this case — were things that had a definite start and end date, and where we were not going to push a lot of knowledge out the door with them.
For the most part, he’s an unstructured kind of leader and I think that is very much the reason why we’ve been able to come as far as we have with our IS platform and the complexity that we have here — which, for the end user, doesn’t feel that complex. It feels quite seamless, and the brainchild behind a lot of that is George Brenckle.
The evolution into that new role is happening right now and there are a lot of folks certainly in the HIM profession that need to jump on that bandwagon, because there’s a skillset there that is just insanely needed and there a lot of opportunity for folks to grow professionally.
Guerra: One of those ingredients is having the IT staff to get it all done. We spoke a little bit at the HIMSS session that I moderated and one of the issues that was most talked about was staff management and just having the proper staff. We talked about issues of burnout and finding qualified people, which is not easy these days. Is that one of your major challenges, like everyone else?
Marhefka: It is, and if you recall, we at UMass approached the staffing issue for all of these changes that we’re making with our information system platform a little bit differently. We continue to have pretty good partnerships with our vendors who obviously have some very smart people on their staff that they supplied to us during key implementation points. But we looked within and we decided that the best staff for these implementations that are ongoing and additional functionality rollouts would actually be the folks from within the operational areas that the applications serve. We were very surprised at the interest we saw when we first went to HR department and initiated this. We said, ‘Why don’t we just do the ask? We’re not going to lose folks from the organization, and we’re not necessarily adding folks to the organization in a time when that’s fiscally hard to do,’ and it worked really well for us. We actually hired from within three to four nurses, we had a couple of docs that joined the IT staff and from the revenue cycle, we had at least eight people that for two-plus years, they’re duties were reassigned to be on the Soarian implementation.
We had great success building from within. Yes, we did have outside help in the form of what I call ‘a la carte’ consulting help. I think I used that term at HIMSS as well. We did not go for the big program engagements offered by the Deloittes and CSCs and Accentures. What we did is that as we got into our implementation, we found areas where we needed to supplement folks for different needs, and so we called it the ‘a la carte’ approach and that helped. It also helped watch our money and our budget. But for the most part, we recruited from within and a lot of that recruitment was permanent. Now they’re here as part of the information technology department or they were assigned to us for a period of two to three years and then with the anticipation that they would go back to their homebase.
Guerra: I know you work with Encore. What kind of work did you bring them in for?
Marhefka: Encore actually came in for a couple of reasons. One, we used them for our Meaningful Use on the eligible provider side for stage 1. The other thing that we used Encore for was project management for Soarian Financials. They are not a staff augmentation firm; they employ folks who have worked in the industry for a long time. These are mature professionals and we needed someone who was going to be head-down, very focused, very project management-oriented for the revenue cycle for Soarian Financials. So we brought someone in from Encore to fill that role, and then supplemented some other team leaders with Encore for specific things like reports taking; we have over 800 reports in our Meditech system that needed to be compared to reports that were necessary to be built on Soarian. That’s a very specific role there, so again, ‘a la carte’ — finding those particular projects that needed really direct focus in management, and once they are completed, we had dinner and said goodbye.
Guerra: When you find someone such as an organization consultant that really comes in and performs, that’s worth its weight in gold, isn’t it? You almost want to keep giving them stuff — ‘how about this now?’
Marhefka: Yes it is, and we have done that. But budget is everything, so you have to continually weigh that partnership, that expertise, and that help with what you can afford from a budget standpoint. And we were also very, very careful to make sure that the projects that we entrusted to our consultant colleagues — specifically Encore in this case — were things that had a definite start and end date, and where we were not going to push a lot of knowledge out the door with them. That was very important if there was something that we needed to have leadership where the content of that particular thing required someone to learn, whether it be a lot more about Soarian or a lot more about the workflow, and then apply the implementation steps to get them from point A to point B — if that included a lot of knowledge building that we didn’t want to have walk out of the door, we made sure that we had an internal person assigned to that versus an Encore person assigned to that.
Guerra: Right, and so you’ve looked around and used different consultancies for different projects based on expertise and things like that?
Marhefka: Yes, we have. We had CSC in there and we had one individual who was very well-versed in go-live planning and she was phenomenal and had a lot of expertise with go-live planning for a large organization as well as — and I use this word a lot — the mechanics of setting up support centers; for example, how many for multiple hospital going live at once, that sort of thing. She had a lot of expertise in how to do all of that set-up. So again, a start and end, and that was certainly not something that we needed to maintain a knowledge stream of going forward. Go-live setup is something we only have to do once every 10 years or so, so we didn’t mind bringing that expertise in and then saying goodbye to it when it was finished.
Guerra: So you’ve worked for George Brenckle for about three years?
Marhefka: Yes, three-and-a-half years.
Guerra: Tell me what it’s like working for him.
Marhefka: I think the thing that’s most interesting about George that differentiates him from a lot of CIOs, especially the CIOs who work in an organization as large and complex as ours, is that his favorite expression is ‘backyards without fences’. And that applies to his management style as well as his vision of how an IT department in an organization should work. He is very non-hierarchical, so at any point in time, especially within our department, and we’re 250-plus at our IT department at UMass, everyone is sometimes not quite sure who approves their time off, and I’m using this as an example, because they’re not 100 percent sure who their boss is. We have a team approach in almost everything that we do and so much of our work is program initiatives versus necessarily project initiatives, because program personifies the fact that you’re definitely dealing with not only application technology, but certainly workflow. So his vision is that to really feel that you can really enjoy your job and that you like working here at UMass and that you feel that you’re getting the most out of your experience here, you certainly need to feel like you can not quite pick and choose the things that you want to work on, but that you certainly have the ability to overlap a lot of things so that you can gain a lot of experience and a lot of knowledge and just have a well-rounded approach to your career and to your skill set. So that is wonderful 90 percent of the time. The other 10 percent it becomes a bit infuriating — and he knows I speak the truth — because there are times when you do need structure, and he leaves that up to myself and my associate CIO colleagues to provide that structure when it’s necessary. But for the most part, he’s an unstructured kind of leader and I think that is very much the reason why we’ve been able to come as far as we have with our information system platform and the complexity that we have here — which, for the end user, doesn’t feel that complex. It feels quite seamless, and the brainchild behind a lot of that is George Brenckle.
Guerra: I’m going to run a few other things by you before I let you go. As I told you before we started, I found some interesting facts about you on the Internet which, if you recognize them, you’ll know exactly where they came from — otherwise you’ll be completely puzzled. Three songs that are currently on your iPad play list: Chicago’s ‘25 or 6 to 4’ is a good song, and the Eagles’ I Can’t Tell You Why’ is a great song. My favorite here though has to be Eddie Money. You don’t see Eddie Money thrown out there a lot — ‘Two Tickets to Paradise’ is good stuff.
Marhefka: Yes, it is. I have a musician husband and I have children that are into old-school music and so there’s not a whole lot of anything after 1995 played in our house. You go back to places where you feel safe and that put you in a good mood and 70s music does that for me. So yeah, you found that on the Facebook thing for UMass.
Guerra: I’ve got all those songs, so we definitely could listen to the same music. And you mentioned your husband is a musician?
Guerra: And from the Q&A, I also see that he’s a gourmet cook. This is quite a score.
Marhefka: Yes, he is. I married well. And he’s also an IT guy, so there are a lot of benefits for me, for sure, but it also makes for great dinner conversation in our house because we happen to work in the same industry, which is pretty nice actually.
Guerra: And you enjoy Skyping with your three grown children. Where are they? Are they around the country?
Marhefka: My oldest son and intended wife are in Boca Raton, Florida.
Guerra: Nice place to visit.
Marhefka: Yes, and my middle son and his bride live not too far from us; they live about 20 minutes away. They gave us our first grandchild this year. And our daughter is finishing up her junior year at the University of Rhode Island. So we’re a very close family; even though our son is in Florida, we actually are able to get together, other than Skype, quite frequently, so I am a very blessed Mama, grandma, and professional person.
Guerra: You have full days, let’s put it that way.
Marhefka: I do.
Guerra: You’re not sitting around wondering what to do with the next hour
Marhefka: No, I’m not.
Guerra: Well this was wonderful. Before we go, I just want to open it up to you. Is there anything you wanted to touch on that we didn’t cover?
Marhefka: We covered a lot and your questions were great, thanks. It really gave me an opportunity to get a lot of stuff out that you can tell I’m passionate about. I think the thing that I do want to start talking more about in different forms — and I certainly want to make sure that you heard as part of this interview — is the changing role of a CIO. I don’t know if you noticed this in my credentials, but I am also a registered health information administrator. And in the old days, that is the person who ran your medical records department, so I have an HIM background. I also did a lot of work in the performance improvement arena with workflow redesign and part of the revenue cycle — the clinical side.
A CIO’s role today is moving again from being the chief of mechanics to something that an organization really relies on to help them strategize about data and where it’s going to take the organization. So the role is changing and I see out there all the time the different head hunters and the different forums where folks are looking for people to do that and do this, and even in the recruiting industry, there is still a demarcation with traditional CIOs — we’re looking for somebody and we don’t know what to call it yet. So the evolution into that new role is happening right now and there are a lot of folks certainly in the HIM profession that need to jump on that bandwagon, because there’s a skillset there that is just insanely needed and there a lot of opportunity for folks to grow professionally and to get into this new arena.
The whole role is changing and there’s just a whole lot of opportunity for folks who wanted to get into this arena; they can get into it now. And I’m going to follow it. I’m going to be a part of it and an advocate of that change certainly, but it’s something that I really wanted to make sure that I stress in my conversation with you, and it’s something I know everybody’s out there thinking about and maybe it hasn’t mainstreamed itself, but I certainly think that it’s going to.
Guerra: All right, Karen, that was a wonderful interview. I want to thank you so much for your time.
Marhefka: Thank you, Anthony.
Guerra: I hope to talk to you again. Have a great day.
Marhefka: Thanks a lot.