Ron Strachan, CIO, Community Health Network, Chapter 2

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

Chapter 2

• The challenge of being on an EHR implementation that isn’t being led by IT
• Reporting to the COO & chief physician officer
• Extending Epic out to affiliated physicians (after taking care of owned docs)
• Waiting on the Epic rollout to attest to MU for ambulatory
• ICD-10: planning to stay on course

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BOLD STATEMENTS

Many times we’ve gotten to a better place through this process, make no mistake but it, but it does take a little bit of getting used to.

We’re deferring the implementation work until the fourth quarter because we want to get through the bulk of our own practices and really become pretty good at support and implementation before we go to the outside and say, “Okay, if you want to come along with us, we’ll make it happen.”

Gamble: It’s interesting to me because I think that certainly for some people, going into a situation like that might be a bit of a turn-off; did you just see it as a challenge?

Strachan: Yes, absolutely. To be completely honest and transparent, I’ve had plenty of moments where I’ve had to go home at the end of the day and just think through things over a decent glass of wine with my wife. I’ve had to really talk through it, and do it in a way that it’s safe, in the sense that I’m not going to make a misstep at the office and offend anyone. There’d even been times when I’d get a little frustrated, such as when I’d bring guidance and recommendations to bear, and they get set aside and it’s like, “Ok, that’s fine.” We’re not leading this thing and we’re just part of the team and what we’ve recommended isn’t always going to be adopted.

And when it comes to doing this kind of work, I think it’s fair to say that most of us have been doing this for a long time are pretty accustomed to — if you’re in a situation where you’re experiences are relevant — your recommendations are normally accepted, but that’s not always the case when IT isn’t necessarily leading the project. That’s not good or bad; many times we’ve gotten to a better place through this process, make no mistake but it, but it does take a little bit of getting used to.  The way I think of it is, if you’re sitting down and you join your hands together, most people will either put one hand or the other on the top; so if you’re predominantly right handed, usually your right hand is over your left hand; so the way it feels is that if you want to cup your hands and put your left hand over your right hand, and lock your fingers the same way, it gets the same thing accomplished but it’s just doesn’t feel quite like what you’re used to.

So that’s kind of what it’s been like, but it’s working. Like I said, at the end of this, I feel very fortunate to be able to have gone through it in a substantially different way, and I’m learning more than I’m contributing, and that’s okay, the organization expected that. We’ve had really healthy conversation around that going back to the interview process because they had an idea of what the new CIO’s role was going to be, so none of this was a surprise.

Gamble: Yes, it’s important to know everything before going in.

Strachan: Right.

Gamble: You started the job, and then a couple of months into it were hit with a new reporting structure.

Strachan: Surprise!

Gamble: You report to the Chief Physician Officer?

Strachan: Yes, I actually report to the CPO as do a number of others. We have what we call our clinical enterprise and it is our acute care hospital, our specialty hospital and most of our outpatient activities because the outpatient work that sits in our ‘for-profit’ organization sits outside of that, but it is a minority compared to what our physician network is. Then we have dedicated finance and HR people that are part of that team, and we all report up to our Network Chief Operating Officer and then our Network Chief Physician Officer.

Gamble: And just as far as the structure is concerned, the physician network consists of employed physicians?

Strachan: Yes they are.

Gamble: The idea is to get them on the Epic system as well.

Strachan: That’s correct.

Gamble: But then do you also have independent physicians that are part of the network?

Strachan: We do have physicians that are affiliated and practice within our organization that we do not own their practice, and we’re actually coming up with a program in order to extend Epic out to them if they’re interested.

Gamble: That’s a challenge because of the size of your physician network?

Strachan: Yes, it is because we have employed, we have I think, it’s about 510 providers somewhere around there; so it’s fairly sizable.

Gamble: Is it a gradual rollout process?

Strachan: Yes, and that’s why we have these five ways for them to adopt. We’re deferring the implementation work until the fourth quarter because we want to get through the bulk of our own practices and really become pretty good at support and implementation before we go to the outside and say, “Okay, if you want to come along with us, we’ll make it happen,”

Gamble: Right, it makes sense. So now, aside from Epic, I imagine that there’s some other projects on your plate right now?

Strachan: I would say, we like everyone else, we have Meaningful Use requirements and we self certification requirements on the inpatient side, and have gone through the attestation process already and them on the outpatient side. That is dependent our Epic implementation; so we have a dedicated Meaningful Use team that will go behind each wave of go-live and make sure that those practices are capturing the data and using the system properly, and it will gauge and measure them as far as when we believe that a practice will be ready to attest and, of course, by the end of this year, we’re hoping that the majority of the practices will be ready.

So that’s kind of garden variety work for everyone right now. Preparation for ICD-10, even with the delay, is part of our upgrade that we have scheduled for next year. We’re probably not going to delay the work on ICD-10, that’s been the overall feeling in our network after the delay was announced; so we’re going to press ahead.

I would say that the single biggest thing that sits outside of this project that we’re working on is our work with business intelligence. Our organization is not much different than the average healthcare organization in that we’re able to harvest the data and make decisions, so we’re in a pretty good position. But as healthcare is really changing — especially with the advent of ACOs and more population management — we know that we don’t necessarily have the tools that will allow us to get really good at this and really move into a what I’d call a unified business intelligence platform, and then include predictive analytics with that, along with some self-service features, as well as really modernizing our entire BI platform; so that’s a pretty big area of focus right now, and it’s probably the number one thing I’m focusing on in addition to our Epic roll out.

Gamble: As far as ACOs, is that something that you’re dipping your toe into? Do you want to get to the next level with the business intelligence platform first?

Strachan: It’s really concurrent activity because we’re already putting ourselves into a pilot project, if you will, and with full intention to be fully ACO with the next 12-18 months.

Gamble: As far as HIEs, I know that you’re doing a lot within your own organization to get the physician connected; what are you doing outside HIE work with regional or state-wide exchanges?

Strachan: We are a founding member of the Indiana Health Information Exchange and that’s been part of the Epic project — replacing how we use what’s referred to as IHIE and how it integrates within our application sweep, and that’s taking a lot of attention within the Epic project right now in bringing IHIE and Epic together with our integration team to figure out how we’re going to retain the process for what we had before with our hybrid McKesson and GE environment versus being all Epic, and wanting to have that same level of patient integration, if you will, coming from IHIE.

Chapter 3