Think you’ve got a heavy workload as CIO of your one- or two-hospital health system? Try 76 on for size. Of course, it’s not an apples-to-apples comparison, as Michael O’Rourke does have a bevy of regional CIOs and other support staff reporting up to him, but that doesn’t mean his post is without its challenges. To learn more about what it takes to make one of the nation’s largest health systems run, healthsystemCIO.com recently caught up with the Colorado-based CIO.
- Conferring with industry colleagues
- Working with Orion
- Governance best practices
- Leaving open an avenue for special cases to be heard
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I think, for the next 10-20 years, we’re going to be a pretty diverse industry, as far as IT is concerned.
Then it really is about what are the clinicians’ and the physicians’ experiences here, and we let them drive, if all things are equal regarding the technology and the cost and such.
One thing we always allow is a process by which if there is a special situation/special case, you have an avenue to be heard. Because sometimes they do arise, and you have to be open enough and transparent enough to say, “Let’s hear this special case.”
Guerra: We spoke about the size of your organization and how you have a small peer group. Do you have a small set of CIOs from those organizations that you talk to, like Phil Fasano from Kaiser? Obviously they’re one of Epic’s biggest clients – do you ever consult with him. I think you mentioned Tenet or HCA.
O’Rourke: Well, you know, there’s a couple of outreach avenues I have with my peers. One of the larger ones – one that I work with is called Catholic Health Association which is association of all the Catholic organizations – Dignity Health in the West Coast, Partners and CHI, and Trinity – a very large group of folks and CIOs that we collaborate with. And it’s an interesting thing because it is a melting pot. Trinity, as an example, is a large organization that has Cerner throughout. Other organizations have put in Epic. So you actually get some firsthand experience there. And then there are other organizations that, through conferences, we get to talk with about their solutions and why they selected them.
Kaiser is so very unique. I was on the West Coast for many years and Kaiser was always considered the model of clinically integrated networks with hospitals, Permanente, with their physicians, and, of course, their insurance capability, and if you think about accountable care, it’s almost the same model.
O’Rourke: So we do have some outreach with folks. But if you take even the Catholics as a microcosm of what’s going on across the United States, it’s all over the place – from groups that are just solid Meditech, groups that have gone to Epic, others have gone to Cerner, some are using NextGen, AllScripts. So I think, for the next 10-20 years, we’re going to be a pretty diverse industry, as far as IT is concerned.
Guerra: And exchange is the key to that. And I believe you’re using Orion Health as your HIE engine?
O’Rourke: Yes. We just recently, about 6 months ago or so, signed a contract with Orion. We looked at a number of different organizations, and Orion really just seems to have the right products, the right simplicity to how to support it and clients.
It’s one of those decisions too where we looked at this and said, “We do have a product we’re looking at at the same time, which is integrated with another product we have, and it was like, ‘Well, should we try to just stay with some integrated products, or should we try to really focus our attention on the uniqueness of this product, and where it can take us, and the capabilities it will give us?’” You always balance those things but we did, in the end, decide to go with Orion.
Guerra: You use the term ‘we’ when you’re talking about making these decisions. I’m picturing you’re sitting in a room with 5-6 people who report to you. Is that how it works? Give me a little bit of a better idea of the decision-making process that goes on.
O’Rourke: I would love it if it worked like that. J I would love that. If I could rule the world I would, obviously but…
Guerra: Well, with a little input…
O’Rourke: Right. Very little input and a lot of decision-making. No. It isn’t quite that straightforward. We actually had a number of teams. And since we have such a diverse organization across the country, we have to make sure in the best interest that we have input from a diverse group across the country. Now, you can’t have 77 folks come together every time you want to do something.
O’Rourke: But what we did do is make sure we had a technology team looking at the technology. Certainly, we had finance teams and such. But really important, we had a team of physicians and clinicians who worked with us looking at the product to look, to feel how it operates, how you pull information in, how you push information out. And they were major players in really understanding which of these products has a functionality that you think is really going to enhance your full experience with electronic health records.
There might have been, in the end, maybe 40 people that participated, which is rather large, but it was segmented into more functional groups. And pretty much, in the end, all the groups came together, and through the normal scoring and objective and intuitive reviews found the Orion product to be the one. But it was really important. One of the things we do try to do is to say we evaluate technology from the standpoint of the technology, where it is, how sturdy it is, the security of the systems — all things being equal as we look at products, and many of them are strong in those areas and they come out pretty equal. Then it really is about what are the clinicians’ and the physicians’ experiences here, and we let them drive, if all things are equal regarding the technology and the cost and such. And with that particular comparison of our few suppliers, it was like that, and the clinicians really drove to say, “This really feels like it works smoothly and seamlessly for us.”
Guerra: And governance becomes everything at an organization where you reach any kind of size. Obviously, for a very large organization – it’s life or death in terms of picking the right product and then getting acceptance for it. I wonder if when it’s so important it becomes a study in and of itself, if you have anyone in an organization like yours who’s in charge of governance processes or something like that, to continually look at them, refine them, and make sure they’re structured right for different types of decisions.
O’Rourke: Well, we do. We may have a few more layers in our organizations from the governance standpoint. But in CHI, we have these very specific markets, and in those markets, from an IT standpoint, we have steering committees.
Example, I’ll use Tacoma again because I just used them before. There’s 5 hospitals, a number of clinics up there. We have a regional CIO in that market and he has a steering committee. On that steering committee, he has representatives from the CEOs of the particular hospital, physician, nursing, etc., that populate his steering committee to help drive decisions. Now the relationship of that is that we have a national program, we have national standards. So the markets look at their particular strategies, where they’re going; for example, the recent business decision on Epic, that all correlates and connects with the national structure.
But each of those markets – those (maybe we’ve got 5-6 if you say macro markets) have a structure like that which usually reports into the senior vice president of operations of the market. So for all the decisions and the continuity and even helping break decisions, if they get locked up in maybe clinical disputes, there is a structure. That structure connects back into Catholic Health Initiatives national in Denver where we also have an IT steering committee. It’s made up of senior vice presidents from those markets. In Tacoma, we have a senior vice president for the Northwest. He sits on my steering committee along with his peers from other parts of the country, along with my chief operating officer whom I report to, the CFO, the chief strategist – so all of the key executives at national. We tie together those processes and even those decisions to make sure (1) we have continuity so folks aren’t saying, “Oh, yeah. I’m going to go buy IDX now.” Well, you can’t do that.
But if things do, from a governance structure, get tossed onto the rocks because a decision can’t be made in a market, it will come up through usually the senior vice president of the op saying, “I’m bringing this here. I want to understand this, have a conversation about it.” And even further along, we have the President’s Council that my steering committee, if we get thrown on the rocks because we have indifference or indecisiveness, I’ll go to the President’s Council, which is the CEO and some of his folks, a small council, and that’s where we’ll try to bring the governance in and try to get things clarified.
So obviously you try to do things on in the lowest common denominator, down in the markets, let them make decisions, give them the guidelines, give them the standards, give them the national agenda. And, for the most part as organizations mature, (and we’re still in a maturity stage, we’re still maturing as a business), those things start to align, there is less intervention, there’s less confusion, there’s less confrontation about it because it is the agreed upon through these various governance structures – it’s the way we’re going to do things.
It’s really hard, in the end, for our market to come back and say, “I don’t want to do this because I like something else,” when their macro market, IT steering committee and the national IT steering committee have all agreed — this is the way we’re going to go.
Guerra: So there’s a lot of principles and points that people can pick out of your answer that can help them touch up their own governance programs. Is there anything else you want to add in terms of the overarching principles?
O’Rourke: The principles that we use from an IT standpoint are really to try to think and see through the optics of the business. To develop your standards, to get buy-in to the standards, sometimes it takes a while. And then just live by the standards and move those forward.
One thing we always allow is a process by which if there is a special situation/special case, you have an avenue to be heard. Because sometimes they do arise, and you have to be open enough and transparent enough to say, “Let’s hear this special case.” And sometimes they resonate, and sometimes they don’t.
Governance is just an evolutionary structure. It’s organic, and you have to see what the make-up of your company is and what’s the best fit. I’ve worked for publicly traded systems where the governance was very, very small and very precise. There were 5 people at a table. You brought the decision, they said, “That’s how it is” and that was it. Other organizations are much more consensus-driven. So you have to live out your governance through the culture of your organization.
Guerra: Interesting. You talked about the route for exceptions. I just read an article by CIO Rick Schooler down at Orlando Health, and he talked about how going forward, CIOs are going to really need to draw inspiration and information and ideas about new technology, especially stuff that’s coming up on the consumers’ side, from the organization, not just in IT but throughout the organization because things are developing so fast that it’s impossible for just the IT group to make sure they’re tapping into everything that could be beneficial. Does that make sense to you?
O’Rourke: Oh, yes. Obviously we are not the end all, be all on technology and intellectual knowledge on these things. I know a number of folks in our facilities and some of them are innovation officers and such that have such a great handle on the vision of what’s happening in their market, what’s happening in the industry, and how some of the pieces with technology and other things can snap together – really grow their market and move things along. I think we have to tap into some of that knowledge and we have to be a part of that knowledge in those markets.
In some of our rural markets, we have a very large footprint – in North Dakota and Minnesota of critical access hospitals. Their primary focus – and rightfully so – is telehealth. They have a few folks in those markets who know the market, know the value that they have to seek. So pharmacy, and teleradiology and teleconsults, – those are all really the main focus for them.
I think CIOs are pretty broad in understanding technology, understanding the business they work in, understanding the finances of business, maybe having a broader span than most senior executives because of what they have to do. But at the same time, we really have to depend on those folks in the market, folks who really know the business and can see beyond what we can see and how things will fit together.
I utilize those folks in North Dakota and Minnesota to help me to really understand that the market in Tacoma is different. I need them to help me understand what’s in their market and how I need to address their needs.
So I think he was right on. Gosh, I wish I had that intellectual capital that I could be that smart to have the answers for folks.
Chapter 4 Coming Soon …
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