When one door closes another door (or window) hopefully opens. And that’s just what happened to John Kenagy when the door he’d been walking through at Providence closed. Just off interim status, Kenagy is now the CIO at Legacy Health, and loving every minute of it. That’s because the Ph.D. with an expertise in CPOE will be able to bring his research to bear right at the point of care. Being closer to the “rugby sport” that is healthcare IT has this veteran charged up again. To learn more about his plans for improving care by implementing clinical systems at Legacy, healthsystemCIO.com caught up with the long time West-coaster.
Chapter 1
- About Legacy
- From Providence to Legacy
- Going interim, then going full time
- Getting back to the clinical front lines
- CIO pressures
- CEO/CFO/CIO relationships
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BOLD STATEMENTS
I humorously say we played musical chairs and when the music stopped, I was standing. :)
I thought for a moment about not doing the kind of CIO rat race. It isn’t a job for the faint of heart. It is a lot of stress …
It’s healthy that I have an IT background, but I think that the muscle I use more frequently every day is as a business executive and not an IT person by any means.
Guerra: Good morning, John. Thanks for joining me to talk about your work at Legacy Health.
Kenagy: Yes, I’m glad to be here.
Guerra: Let’s start, if you would, by giving us an overview of the health system and then we’ll go from there – the facilities, open system, closed system, ambulatory components, that type of thing.
Kenagy: Legacy Health is celebrating well over 100 years in service to the Portland, Oregon region. We operate six hospitals in the Portland area and in Southwest Washington. Good Samaritan Hospital founded in the late 1800s, and then followed by Emanuel Hospital which is, this year, celebrating its 100th anniversary. We are an integrated health delivery network with the six hospitals, around 300 employed physicians in our Legacy Medical Group. We operate an outpatient home health hospice program and just a complex number of services. We have a children’s hospital – one of two in the metro area – and we are the burn center for the entire region. There isn’t another significant burn center between Seattle and San Francisco, and we have a very complex high level trauma program as well. We’re a big system, about $1.3 billion in revenue, and strategically really focused on affiliated physicians. I’m sure we’ll get into that in our conversation.
Guerra: So certainly an open system where you have the independent physicians referring.
Kenagy: Yes. Very strategically, which kind of differentiates us in the marketplace.
Guerra: Right and you do have a lot of employed docs. Some places don’t have quite that many.
Kenagy: Yeah, hospitalists, the hospital-based intensivists and a number of primary care physicians.
Guerra: So you’ve got the mix there.
Kenagy: Yes.
Guerra: Let me ask you, are you still interim or are you now the full time CIO?
Kenagy: Yes, I would say permanent but your CIO audience would know that doesn’t really mean anything :) A couple of months ago I converted from an interim appointment to a regular appointment.
Guerra: Tell me a little bit about that. I know you were at Providence Health for just over five years and then in March you became the interim at Legacy. Why take on an interim position?
Kenagy: I’ve actually done that successfully a couple of times ago, which I can talk about, but yes, I was at Providence for five years. Providence is a great organization, a very large organization, much larger than Legacy, with four regions going from Alaska down to California, and I served as the system CIO and had accountability for orchestrating the strategy for the organization working with my colleague CIOs in each of the regions. Each region had a CIO who reported, just like the CFO or the chief of human resources officer, to that regional executive. I worked at the system level working with that small junta :) of CIOs driving our strategy forward.
A couple of years ago, the organization decided to pursue Epic as an integrated electronic health record for the entire system and basically that decision kicked off a number of dominos that resulted in talking about how do we organize IS. Historically, what I had accountability for at the system level was the infrastructure, enterprise applications, our platform, email, the web, the intranet and also all the infrastructure services, so networking and servers and data centers. But the clinical applications, and really moving the strategic ball forward, was the accountability of each of the regional CIOs, and we had a significant number of deployments of McKesson and Meditech and then Epic up in Alaska. And with that decision to do Epic across the enterprise, the organization first made the decision to centralize revenue cycle, to organize revenue cycle and then IS. The five of us, as the CIOs, worked together on that design – a great design – for how that would be. Basically at the end of that run, obviously, the organization needs one CIO – and I humorously say we played musical chairs and when the music stopped, I was standing. :)
A dear friend of mine, a colleague and actually the person who encouraged me to come work for Providence, Laureen O’Brien, who’s been there now probably about 13 years, became that enterprise CIO, and she’s great. She’s doing a great job there. Really, the organization needed one CIO, and not two or five, and so I took the opportunity, which happens in people’s careers, to kind of rethink what I was doing.
Actually, interestingly, I thought for a moment about not doing the kind of CIO rat race. It isn’t a job for the faint of heart. It is a lot of stress, and I had been a CIO for 16 years across three different organizations and was kind of just contemplating what to do. I love Portland, I’d lived here before when I was CIO at Oregon Health and Science University and literally, coincidentally, this opportunity came up. Literally, the very next day after Laureen was announced as the new CIO for Providence – as a door closes, a window opens; fortunately that window opened and I wasn’t on the 40th floor. :)
Guerra: Was it a recruiter – and I don’t want to get more specific than you’re comfortable, but was it a recruiter who gave you a call about the opportunity?
Kenagy: No, I knew people. Portland is a small community and actually there are a lot of IS folks who have moved from all the organizations. I sort of say my tour of Portland-area healthcare has now finally full circled because I was at OHSU and then Providence (which has a large hospital system here in Oregon), and then now at Legacy, and we found out that the job became open. I literally drove down that next weekend and on Monday morning had a cover letter and my résumé and sat in the lobby of the Legacy headquarters waiting to hand it to the CEO and, ultimately, did hand it to the receptionist and got a call. No headhunter. There’s an expression within Providence that Providence will provide, and it’s kind of prophetic.
Guerra: At any point, when you’re driving down there with your résumé, you’re thinking, “I’ve been a CIO 16 years, and I’m about to hand someone a cover letter and a résumé. When are we going to get beyond this stuff?”
Kenagy: I know. Exactly.
Guerra: That’s pretty amazing that an opportunity in a region fairly close came up, and, for us on the East Coast, Oregon and Washington are essentially the same place. :)
Kenagy: Well, thank you. Yes, for us on the West Coast anything east of the Rockies just kind of molds together. :)
Guerra: Right. But I mean it’s a place you were comfortable with. It sounds like a great opportunity, so it’s just unbelievable that that worked out so well.
Kenagy: Yes, I am incredibly grateful for the time I spent at Providence and the time that I’m here at Legacy. I love being at Legacy. Both organizations are phenomenal. I am energized. In 16 years I wasn’t exhausted too much.
Although I am envious; I’ve met a number of people working in interim positions. There’s an interim working at Peace Health just across the river in Vancouver and just a wonderful career he’s had and retired, I think, from the telecommunications industry. He then puts his shingle up and basically selects/chooses these interim gigs where he’s a transition person between the last CIO and the next. There’ll be a time in my career that, as I’m closer to retiring, that may be attractive. But does a CIO ever really retire?
Guerra: I don’t know :) It was a little premature in your career to do the hopping around thing? It just didn’t feel right at this point?
Kenagy: It didn’t. I have kids (10 and 7), so it was more kind of family considerations that prevented me. Actually, given Legacy is all headquartered here, or all geographically centered in Portland, I’m doing far less travel. So actually, from a personal life point of view, it’s better. At Providence, I was flying to Anchorage or California, sort of across the whole west. Well, it was all on the west, but there was a significant amount of travel.
Guerra: It’s a big west, right?
Kenagy: It’s a big west. Yeah, come visit. Bring your tourist dollars. :)
Guerra: Are there pros that come to mind? You mentioned it’s a smaller health system. You’re now closer to the front-line clinicians.
Kenagy: That’s a great pro, and it’s a fabulous question, and a very insightful question. One of the things I hadn’t realized until I came back here is how much I missed the rugby sport of healthcare IT, the contact sport that it is. Legacy is a smaller organization, but it’s a much more horizontal position than the one I had at Providence, and I love that. I’ve been in this field 25 years, always in healthcare, and pursued my Master’s and studied my PhD in healthcare information technology, and so it’s great to be back. It’s nice to feel it.
Now, the expectations are high, the patience is low, and so it’s a new level of discourse, but it’s really around what are we doing to enhance our care to patients, versus at Providence a lot of my discussions were with my CIO colleagues: why is infrastructure so expensive? I’m having different conversations and am more connected to the mission of our organization which makes me proud.
Guerra: You mentioned your doctoral research specifically focused on CPOE. Perhaps that was a bit on the shelf at Legacy and now you’ll bring it to bear?
Kenagy: Yes, I think that’s accurate.
Guerra: That sounds like it’s going to be exciting. Of course the first time you get screamed at by a physician, then it becomes less exciting.
Kenagy: Yeah, I’ve been here five months, so it’s now happened at least 30 times. :)
Guerra: What was the honeymoon period, about two weeks?
Kenagy: It was longer than that. I told my boss… I think all CIOs get a good honeymoon period and when things are going well, that’s wonderful. It’s how you all respond when I really piss you off the first time, or deflate your expectations, that we then won’t be on a pedestal :) I actually think it’s a very tough job. You see so much turmoil in the industry. There clearly are high expectations.
I would love, actually, to do research as I get closer to retirement on that expectation gap, because I think the relationship CEO and/or CFO to CIO is a critical relationship and often a difficult one because, I think CEOs are promoted to that position because they know a lot and make good decisions and are on top of things, and I think that many self select not to really engage in IS because they think it’s going to be confused and they don’t want to look stupid, so it almost creates an artificial wedge between the CIO and the CEO.
I think, if you have a good IT operation, anyone with healthcare business savvy can be a phenomenal CIO. You need to be a little bit BS proof from your own staff and from vendors but, other than that, I think that, at the beginning of the day and the end of the day, my role is really as a healthcare executive and not an IT person.
It’s healthy that I have an IT background, but I think that the muscle I use more frequently every day is as a business executive and not an IT person by any means.
So I think that expectations are high for the CIO to perform, make it cheaper, make it better, deal with questions like, “Why does it cost so much and we get so little?”
Guerra: Based on what we’re talking about here, I wonder if a lot of CEOs don’t even realize what a CIO could bring to the table.
Kenagy: I agree with that. I think that’s too bad for our industry, and I think you’re on to something there. I think a couple of things on that. One, every CIO knows the horrible feeling if you’re in a boardroom or something and the PowerPoint on the projector doesn’t work, because all eyes go to you, and it’s like, “You know, I don’t know this stuff either;” I better just go fake it and, miraculously, things start working again and you look like the hero. It’s like, “Yeah, I’m not the senior IT geek for the organization.”
I think search firms reinforce this by recommending the same molds. There’s a lot of turmoil. The life expectancy of the CIO is what… two years? Three years? So someone comes in and the organization thinks, “Oh my God, now, here, this one is, this is the real one. This is Neo from the Matrix. Here’s the one that’s going to solve all of our problems.” It’s inflated expectations, but the person gets along well with everybody and then things just… it’s a tough field, it’s just tough work. Inflated expectations go by and the organization kind of moves on to the next CIO and then they call the search firm; the search firm looks for the same mold – a person cut from that same cloth – and I think that is a problem.
One of the things I would love to do — and I did start talking to a couple of the Gartners or Advisory Boards, both extremely respected think tanks in our industry — is tap the PhD. side of my work and less the health administration side and do some research and do some programs geared towards CEOs on the very thing you said – what makes a good CIO.
I think the thing I’d say next on this topic is I remember being at OHSU and feeling good relationships, great rapport with folks, but it wasn’t really measurable, and so in terms of good benchmarking, customer satisfaction, costs, I do think that while we are supposed to be the chief information officer and therefore, familiar with data and information, using metrics and benchmarking on ourselves still is more art than science, and so I think a lot of CIOs that I’ve talked to, and in my own role in the last four organizations, I’m viewed in terms of: “Oh yeah, I like John. He’s a really nice guy. He’s got a great sense of humor and we enjoy working with him.” I’d like the perceptions of me and our department to be a lot more measurable so that when something goes wrong, as it invariably does, it’s less on this personal front of interpersonal skills and more measurable – less art, more science.
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