When he started as CIO at Flagler in 2010, Bill Rieger found himself in an interesting situation. Not only was it his first CIO role, but it was the first time the hospital had named a CIO. Instead of having big shoes to fill, Rieger had “a blank slate,” and he has leveraged that opportunity to help strengthen Flagler’s IT presence. In this interview, he talks about the challenges in migrating from one major system to another, what it was like to take over a department that was lacking in governance, the importance of having a strong CMIO in place, and why communication is absolutely critical. He also discusses his ACO plans, why he’s avoiding HIEs — for now, his social media strategy, and what he’s doing to keep his staff engaged.
Chapter 3
- HIE hesitancy
- Becoming Flagler’s first CIO
- From no IT governance to rolling out an EMR — “We had to use tools at the same time we were building them.”
- Challenges with change management
- The CIO network
- Making the case for a CMIO
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Bold Statements
When you start talking about collaboration and HIE, it may begin with trading information, but where does it end? How do these organizations really align with each other? I think, at least from my perspective, there’s some hesitancy there.
It takes great leadership to break through that barrier and get beyond the competitive nature and understand that there are enough patients in this country right now to keep all the hospitals full, and there will be for the next 20 years.
They did not have one Excel spreadsheet of projects they were working on. No process; no change control; no ‘this is how we get our work in here and this is how we decide what work gets done at what point.’ There was zero. No IT governance at all.
I think that if I had a preconceived notion about how it should work based on my experience at other places, that would have just added to the challenge. Here, I had a blank slate and no preconceived notions.
I started planting seeds right away saying, ‘If we’re going to do this change, we’re going to need a CMIO. We’re going to need a physician champion full-time on this project’.
Gamble: Are you involved in any HIEs right now? I know that in Florida there’s an interesting HIE landscape.
Rieger: We are not right now. The Harris Company has been calling. I know they’re doing work, but my understanding of the work they’re doing is they’re just connecting HIEs. They’re trying to get a statewide HIE network going, and in some pockets of Florida I think it’s going better than in others. But they really rely on the local areas to create their own HIE, and then they would come in and partner with it. If that understanding is wrong, it’s probably not a surprise. I think the communication about that has been a little bit sketchy, at least from my perspective.
In northeast Florida, there are several health systems up here — Ascension Health, HCA, and Baptist Health in Jacksonville, and then of course we’re not too far really from Orlando. There are several there. But I think if there was going to be one, we would focus on northeast Florida. There was one that tried to get off the ground a few years ago, but it didn’t happen. I think there are some small discussions going on now.
One of the things I think we have to get past, and I’ve been in northeast Florida here now for a little while, is the very competitive this landscape. I think that’s a barrier for most cities and regions — the competitive nature of healthcare. Everyone knows their market share numbers. And when you start talking about collaboration and HIE, it may begin with trading information, but where does it end? How do these organizations really align with each other? I think, at least from my perspective, there’s some hesitancy there.
But I know that’s not true in all areas. Some people have broken through that barrier. It takes great leadership to break through that barrier and get beyond the competitive nature and understand that there are enough patients in this country right now to keep all the hospitals full, and there will be for the next 20 years. So let’s get beyond the competition struggle and find a way to be more collaborative. The only way really that we’ll be able to sustain the healthcare model that we have is if we can do something like that. So I do think that it will change, even here northeast Florida, and we will become more collaborative. I know there are discussions going on right now at a high level to make sure that happens and we will certainly support that when it comes time for that. But it’s just not there, at least here in northeast Florida right now.
Gamble: Yeah. I’m sure you know we’re hearing the same thing from a lot of people in a lot of different areas. Everyone knows it needs to happen; it’s just a matter of how on earth it’s going to happen.
Rieger: I know.
Gamble: Okay, so you started as CIO at Flagler in 2010. You were hired as CIO, right? And you were at Baptist Health prior to that?
Rieger: I was in IT leadership at Baptist Health. I was not the CIO there. Roland Garcia was the CIO there, and he still is. As a matter of fact, I have an email in my inbox from him. We want to get together for breakfast and talk about financial systems. We still have a real good working relationship. But actually, when I came here, there was no CIO. I’m the first CIO of this organization, and before that, they had an IT administrator who was here about 30 years. He started out in accounting and worked his way up to be comptroller. Then all of the sudden they had a lot of computers and they said, ‘oh boy, we need to focus on these computers.’ And so he spent half the time being a comptroller and half the time between being the IT director, and then he went full-time. For about the last five years, he was here as just a full-time IT director just trying to keep Meditech up and running.
When they started talking about bringing in a new system and doing all these changes, he told them that he would not take the organization through that and that he would retire. So they decided to hire somebody who they would call a CIO. Actually, my first title here for about the first month and a half was IT administrator. Once that transition was complete, the other guy was moved over to the CIO role, but it was a very interesting transition. It was the second organization I’ve been to where I had vendor demos for a large EMR implementation in my first week. So that was a lot of fun.
Gamble: Welcome to your new job.
Rieger: Yeah, I know. The interesting thing about here — and really I’ve just grown by leaps and bounds because of the challenges — but when I first got here I was talking to that guy and I said to him while we were in our transition, ‘Why don’t you just send me an email of all the projects you have and your processes for how you get your work so I can start getting my arms wrapped around it?’ And he just started rattling it off the top of his head. I said, ‘I’m not going to remember this. Just send me the email with the documents.’ And again, he just started rattling. So I said, ‘You don’t have any documents, do you?’ And he said, ‘No.’
They did not have one Excel spreadsheet of projects they were working on. No process; no change control; no ‘this is how we get our work in here and this is how we decide what work gets done at what point.’ There was zero. No IT governance at all. So we had to go from zero IT governance — and I mean nothing; not even an IT committee to talk to people — to putting in a multimillion dollar EMR system. We had to use tools at the same time we’re building them. This whole process has been a challenge. We’re a little over two years into it and it’s still not challenge-free. People are still not used to this heavy governance structure. So while we have change control issues from an EMR perspective, we have change control issues from many avenues with regard to just change control itself as a process of change.
So it’s been a challenge here in every respect, and one of the things I really do appreciate — not to be a commercial for healthsystemCIO, but I really have listened to those podcasts and they’ve really helped me. I’ve listened to a lot of guys talk about their experiences and what they’ve done. I’ve followed up with phone calls. I’ve connected with them on LinkedIn and have really gotten help from a lot of those people that I have followed up with. Obviously not all of them, but some of them have been really compelling. And they’ve all been very willing to share their experience with me — ‘Oh yeah, I’ve been through that. This is what you can expect here. This is what you might want to do here.’ I’ve talked to them about how to engage and deal with physicians, and it’s been very, very helpful. And again, without sounding like a commercial, thank you guys for doing what you do because it is very helpful.
Gamble: It’s always really nice to hear that. And I can imagine being in your shoes and having to deal with all this; in some ways, I’m thinking it might even be an advantage that you weren’t a CIO previously, because you would have been maybe used to stepping into a certain environment. The fact that you had to establish IT governance — maybe in some ways do you think it was an advantage going in fresh?
Rieger: It probably was. I had no preconceived notions, so from that perspective it may have been an advantage. One of the things they let me do was hire people. I started to explain, ‘I’m going to need this and I’m going to need that,’ and the CEO has been nothing but 100 percent supportive from that perspective. The first person I hired was what I call a senior program manager who’s been helping me, through the last two years, put governance in place. And then I was able to hire a couple of other leaders to join the team here and help with process and things like that. I think that if I had a preconceived notion about how it should work based on my experience at other places, that would have just added to the challenge. Here, I had a blank slate and no preconceived notions. It was kind of like an artist with a canvas, and it’s worked out pretty well.
Gamble: It must seem like you’ve been there for about 10 years just because of everything you’ve gone through in two-plus years.
Rieger: Yeah, it does. I went to the CEOs office in September and I said, ‘I’ve been here two years.’ And he said, ‘No way.’ We’re just both amazed at what we’ve been able to accomplish in the last two years. It’s been pretty awesome.
Gamble: You mentioned the CMIO before. That was a new position as well?
Rieger: Yes. That position is probably a year old now. Actually, in my interview with the CEO and the president of the medical staff, I talked to them about the CMIO role and they didn’t have one. They had one physician who was the IT champion, if you will, but wasn’t even part-time at the hospital. So I started talking to the CEO. I started planting seeds right away saying, ‘If we’re going to do this change, we’re going to need a CMIO. We’re going to need a physician champion full-time on this project’. I would send them articles about CMIOs and what they can offer. So he started slowly seeing the benefits of that and we talked to a couple of local physicians. Of course I didn’t know all of them, but the CEO knew them all very well. He’s been here 30 years in the community. We found this guy Dr. Michael Sanders — he had a private practice and was a family practitioner but before he was a family practitioner, he was a computer programmer. He programmed for Amtrak Railroad and a bank while he was going to medical school. And then when he got out of medical school and got into his private practice here in St. Augustine, he actually wrote his own EMR and sold it. He was selling it even as of last year. He just sold off the company. It’s not really big and he’s going to probably disband it because he didn’t have enough resources to do all the programming necessary for Meaningful Use, but that kind of background came with this guy. So he really has a great head, and he’s just a wonderful man and really has had a positive impact on my life. We’ve been blessed to have that guy.
If there’s any person that could be credited with the success of this project and where we’re at specifically with the physician group, it would definitely be him. It brings me great pleasure to support him and take a backseat to him when he’s dealing with these physicians. Because when you see him up there dealing with them, he’s a master — very well respected. They obviously have a lot of faith and trust in him. Again, I just step back and I helped him in the background. I help him in one-to-one meetings; we review things and we talk about things — ‘this could be good, this might be good. Let’s try this, let’s try that.’ And I just let him go and do that. If I had to when I first got here, paint a picture of how I wanted it, I wouldn’t have painted it this good. It’s really good.
Gamble: It’s a really good thing and obviously one of the keys to success with any project is having good people around you.
Rieger: Yeah.
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