Ron Strachan, CIO, Community Health Network, Chapter 1

When Ron Strachan accepted the role of CIO at Community Health Network last spring, the organization had just selected a vendor for a major IT implementation — a project that was not going to be led by IT. It’s not exactly the scenario most CIOs envision when starting a new position, but Strachan viewed it as an opportunity. A year later, the rollout has begun at the constantly-expanding 7-hospital system, and Strachan is enjoying every minute of his job. In this interview, he talks about what it’s like to take on a non-traditional CIO role, having to repair IT’s reputation after a failed implementation, and the importance of setting the right expectations and not overcommitting yourself or your team. He also discusses the organization’s big push for business intelligence, what he’s learned from working different roles, and how being a CIO is a constant education.

Chapter 1

• About Community Health Network
• Starting a major migration to Epic — and pushing back certain projects
• Taking on the CIO role during a big rollout
• “I was happy they selected Epic”
• Repairing IT’s damaged reputation
• When clinical leads a project, not IT — “What I was being asked to do was quite different”
• Reaching out to colleagues who have rolled out Epic

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Bold Statements

He’s not new to the organization, but his view of our mission and how we’re going to grow is a bit different than our former leadership. We’re really focusing more on providing better access such as same-day appointments where we can.

Although I had some fairly strong feelings about what I was hoping they would select, I was very careful in the interview process not to taint their process one way or the other. So I very respectfully deferred a lot of answers for questions that were asked between their two finalist vendors because I really didn’t think that was a fair thing to do for either company.

I’ve been doing this for a long time and it’s kind of like, ‘if I’ve got the ball, I’ve got the ball, and off we go.’ And what I was being asked to do is quite a bit different, which was part of what was appealing about taking this job in that while it might be uncomfortable as I adapt to what’s being asked, it’s really an opportunity to develop a new set of skills.

When you have such a large project, and typically the accountability sits front and center with the CIO and maybe another business partner from within the organization, it is quite a bit different. But it’s been everything that I had hoped for and certainly it’s been a lot of fun and it has taught me a different skill set — a new set skill.

So we’re still in the mode of learning, but come September, we’re going to roll up our sleeves and figure out what it’s really going to look like, and then present and recommend that to our senior leadership team and let them react to it.

Gamble:  Hi Ron, thank you so much for taking the time to speak with us today.

Strachan:  Sure, Kate.

Gamble:  Why don’t you start off by telling us a little bit about Community Health Network — what you have in the way of hospitals, clinics, things like that.

Strachan:  Sure, Community is based in the surrounding area of Indianapolis and we operate, either as a fully owned subsidiary or through joint ventures, approximately seven hospitals today, and we have just over 200 outpatient locations throughout central Indiana. We have roughly 11,300 employees throughout our network.

Gamble:  Are you pretty spread out, geographically speaking?

Strachan:  No, it’s pretty contained to greater Indianapolis because we’re essentially starting to move into different geographies within the Indianapolis area. Traditionally we have been in the southeast and north corridor, so from 12 o’clock down to 6 o’clock. Now we’re moving a bit to the west through one of our client ventures, a little bit more to the south through another joint venture, and then we have another pending acquisition that will take us about an hour north of our existing market.

Gamble:  It’s a lot to keep track of with the organization expanding so quickly. Is this something that’s been happening recently or is it just the last couple of years that the organization has been quickly growing?

Strachan:  The focus, I think, is changing a little bit for our organization. Traditionally we’ve done a lot of joint ventures; for example, we have surgery centers up in southeast Michigan and northwest Ohio that are jointly owned between us and the surgeons and investors, so they are for-profit ventures. We do have a for-profit part of our organization, but we have a relatively new CEO — Bryan [Mills] has been in the position now for three years, give or take a few months, and he’s not new to the organization, but his view of our mission and how we’re going to grow is a bit different than our former leadership. We’re really focusing more on providing better access such as same-day appointments where we can, and really focusing on primary care.

But in the year that I’ve been here, not only are we still doing the smaller joint ventures, but we’re also now adding more hospitals to our network. And these hospitals typically are 200 beds or less, and in some cases they’re as small as 50 beds. The idea is that we want the smaller, more general hospitals that are more community-based that really help support primary care, as opposed to having specialty hospitals like an orthopedic hospital or a heart hospital, which we do have. So I think it’s a little bit different, but as I’m saying that, I know that we’re fairly opportunistic too, so if an organization contacts us to kick the tires on either doing a joint venture or being acquired by us, we are very quick to say, ‘yes, come on in and let’s talk.’

Gamble:  That’s got to be pretty interesting from you position. It’s kind of like, what’s going to happen next?

Strachan:  Yeah, it really is, and especially since we’re in the throes of a fairly major implementation. We had our first go-live for our ambulatory site last week and we’ll have four more go-live events in ambulatory, and then we have two impatient go-live events later this year, and that’ll take us through November.  So as we’re doing these business deals and acquisitions, it’s very difficult for us to drop the additional practices or hospitals into this schedule. And in fact we’re beginning to push them out into 2013 now.

Gamble:  This is the deal with Epic?

Strachan:  Yes, it is.

Gamble:  You said that you had your first go-live in ambulatory last week and inpatient will go later this year. What was involved in the deal — obviously you have acute and ambulatory, but then were there other components of this as well?

Strachan:  We’ve essentially purchased everything that Epic has to offer. Some of those components we’re deferring until next year because we want the products to mature a little bit more; for example, the home healthcare module we’re not doing until 2013, and we pushed the oncology module out to 2013. And then we have quite a large build for behavioral care because we have a 300-bed inpatient behavioral care unit on one of our campuses and that’s turning out to be a little bit more complex than what we originally thought, so we deferred that to 2013 as well.

Gamble:  And in the meantime, you’re going to stagger the ambulatory go-lives and some of the inpatient areas as well?

Strachan:  That’s correct.

Gamble:  Alright. So I know you’ve been with the organization for about a year. Was this already in motion at that point? What phase was this in when you started?

Strachan:  It sure was. It was pretty interesting because the recruiting effort for the new CIO here at Community and the process to select a new core system vendor was parallel. So as I was interviewing, I knew that they were probably going to make a decision on the new system vendor prior to their decision of selecting a new CIO. It was about three, maybe four weeks at most apart, so I knew going into it that if I were fortunate enough to receive the offer, it was going to be a bigger project with a new vendor than what they currently had, and that was fine.

And although I had some fairly strong feelings about what I was hoping they would select, I was very careful in the interview process not to taint their process, if you will, one way or the other. So I very respectfully deferred a lot of answers for questions that were asked between their two finalist vendors because I really didn’t think that was a fair thing to do for either company. But I was pretty happy that they had selected Epic when they called and made me the job offer.

Gamble:  Okay, so you’re going through the interview process and you’re thinking, ‘If I back Epic or the other vendor too much, then if they don’t choose them, they’re going to associate me with that system.’

Strachan:  Right, exactly.

Gamble:  And so that also puts you in the position that when you did get hired, you knew right away that this was going to be a big project. They’ve just chosen this new system so you know right away that this is the biggest thing on your plate.

Strachan:  Yeah, and how we structured the project was pretty interesting because without naming vendor names from our history, we did have an attempted upgrade for one of our former core vendors at one of our hospitals and the upgrade didn’t go very well at all. In fact, we ended up having to back that out because it was so unsuccessful. And it turned out that, from everything I learned since I’ve started, it sounded like it was no better than alpha code — you really couldn’t even call it beta code.

That was the impetus for the organization to pick a new vendor, unfortunately, and how we’ve structured the project. IT got a little bit of a bum rap around that failed upgrade and also the relationship we had with our soon-to-be former primary IT vendors or system vendors, and the organization really wanted to set this up as not being an IT project per se. So we hired a program director that was our COO from our home health unit, and when we built our team, it predominantly was practitioners coming from our various business units, both inpatient and outpatient, with some IT help, of course, because each one of our teams is co-led between a person from a business unit or a clinical person and an IT counterpart. But we’re not leading with IT; we’re not leading with technology. We’re more leading with getting the platform in and really focusing on how we can transform processes and transform care. So IT really is, I would say, in the background.

And that’s been a little different for those of us in IT, and for me especially, because I’m the kind of person who doesn’t shy away from responsibility. I’ve been doing this for a long time and it’s kind of like, ‘if I’ve got the ball, I’ve got the ball, and off we go.’ And what I was being asked to do is quite a bit different, which was part of what was appealing about taking this job in that while it might be uncomfortable as I adapt to what’s being asked, it’s really an opportunity to develop a new set of skills. And really, the two guys that I report to — our chief physician executive and our acute care president, so it has a very clinical focus — as they describe it, it’s really different, it’s like leading from the rear, if you will. And that, for most if not all of my CIO colleagues, is almost an unnatural act. And it’s a little bit different because, of course, we all understand how to leverage the organization, process, and people to get to the desired goal, so that’s not necessarily a new thing. But when you have such a large project, and typically the accountability sits front and center with the CIO and maybe another business partner from within the organization, it is quite a bit different. But it’s been everything that I had hoped for and certainly it’s been a lot of fun and it has taught me a different skill set — a new set skill.

Gamble:  So as the whole implementation goes along, do you see IT’s role changing? Or is this something where they really are going to go keep going with this different model of IT being a little bit more in the background than what would be the traditional way?

Strachan:  That’s a great question, because even though we’re not leading with IT, of course the project will not be possible without the infrastructure that we provide and some of the process and services that we provide. And we’re very intentionally deferring the development of what the IT organization, ergo the project team and support structure, for Epic is going to look like until the latter part of this year, because this is a new environment for all of us and we’re learning what it takes to support it. I’m getting some guidance from Epic and I’m reaching out to a number of my colleagues who have implemented Epic and are a mature Epic shop, and really learning what they have had to do as far as their support structure.

So we’re still in the mode of learning, but come September, we’re going to roll up our sleeves and figure out what it’s really going to look like, and then present and recommend that to our senior leadership team and let them react to it. And they may have a different idea; they may want to take a part of this existing team and say, ‘okay, we’re going to keep this outside and keep it reporting up to operations, and this is the team that’s going to focus on constant process improvement working with our PI people,’ and that would be great, and then keep a core team back in IT that really does the usual care and feeding of the application. So we’re not quite sure what that will look like yet.

Chapter 2