With all of the preparation Frank DiSanzo’s team did before rolling out an EHR, the one thing they didn’t factor in was revenue loss. It was a tough pill to swallow, and one DiSanzo hopes to help others avoid. In this interview, he talks about why organizations need to anticipate a decrease in patient volume during an implementation, the “awkward” position he was put in when McKesson announced it was sunsetting Horizon in the middle of St. Peters’ inpatient rollout, and why he believes it’s important to keep patients informed of major initiatives. DiSanzo also discusses the McKesson CIO meetings, his role as chief strategy and business development officer, and the secret to Jersey Health Connect’s success.
- ACO work — “It’s like making the 12 clocks chime at the same time.”
- McKesson’s BI tools
- Looking to finance for help with big data
- From business background to CIO — “They saw my non-healthcare experience as a positive.”
- Embracing the role of chief strategy officer
- Advice for new CIOs
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You have all the other IT needs that come with running any other 400 to 500 million or billion dollar institution, whether that’s accounts payable, receivable, inventory management, CRM, you name it. We have it all in healthcare.
The collaboration that’s required in running a successful ACO means that reams of data have to pass seamlessly between the clinician in the field and the hospital or healthcare system. So it’s a daunting task.
When you look at the tools that are available in the finance industry to analyze data and do modeling, they far exceed anything that’s available from any of the main healthcare software vendors today. So as a CIO, I’ve been keeping an eye on some of those products.
They really wanted someone to come in with a business background to run the IT department of the hospital more like you would run the IT department of a successful business organization. And that was the hook for me.
It was really the push — first by ARRA, and then healthcare reform — that accelerated this adoption of IT in hospitals to the point now where I think it’s really hard for hospitals and vendors to even keep up.
Gamble: As far as some of the other IT projects on your plate, what else are you looking at in the near future? Are there any other big projects on the horizon?
DiSanzo: I think the EHR implementations are going to stay big for the next several years. You have stage 2. You have stage 3. You have beyond that — whatever is coming, who knows. As we move out and establish ACOs and things like that, I think the CIOs are going to be pressed to integrate these provider organizations into the healthcare system’s electronic infrastructure. I think connectivity will be big. Data mining and business analytics are going to continue to grow as we move from a pay system that’s based on episodic care to a pay system that is based on treating chronic care over the continuum of the patient’s healthcare needs.
You have ICD10 — obviously many organizations are struggling with right now. That has a huge impact to revenue cycle and almost everything else that takes place at the hospital relative to care and billing. And then you have all the other IT needs that come with running any other 400 to 500 million or billion dollar institution, whether that’s accounts payable, receivable, inventory management, CRM, you name it. We have it all in healthcare.
Gamble: Do you have any plans in place at this time for accountable care, or is that something that you’ve already begun?
DiSanzo: We’ve already begun establishing an ACO for St. Peter’s. Right now what we’re doing is we’re putting together the IT infrastructure map for how that will be linked and how the providers that are part of that ACO will share data with the institution, and how we will report back on the kind of care that’s given and the quality of care that’s given and the cost of that care relative to what we expect the cost of that care to be. The collaboration that’s required in running a successful ACO means that reams of data have to pass seamlessly between the clinician in the field and the hospital or healthcare system. It’s a daunting task.
It’s something we’re working on right now in so far as how we map that out and what that looks like, what products we’ll be using, and how they’ll integrate, because I think the real challenge there is that it’s like making the 12 clocks chime at the same time. Our strategy at St. Peter’s is to offer a variety of solutions to our ACO partners relative to how they connect and share data with us. That’s a little bit different than what other people are doing where they’re insisting that everybody be on the same EMR or the same decision support system. We’re not sure that’s the right way to go.
Gamble: Obviously in some ways it would be easier if everybody was on the same system, but it’s just not practical for some organizations.
DiSanzo: That’s true, at least not over the short term.
Gamble: And kind of hand-in-hand with that, you talked a little bit about analytics before. Is that something that you’ve dived into yet?
DiSanzo: We actually use Horizon Business Analytics, a product that’s nicknamed HBI. It seems really flexible relative to the data that it’s able to accept, and relative to the kind of dashboards and modeling and reports that we need to generate — not only to run our own organization efficiently, but ultimately to run an ACO efficiently. It’s very highly rated in KLAS. What we’re looking at now are ways to port data from disparate systems into HPI so that we can manage our businesses more effectively.
Gamble: It’s one of the things you keep hearing about — ‘big data.’
DiSanzo: Yeah, I’m wondering quite frankly if we in healthcare may have to adopt some of the tools that other industries use out there to manage big data going forward. Healthcare software vendors have not, to say the least, been on the cutting edge when it comes to performance analytics, reporting, database scaling, etc. And I think that this may be an opportunity for other vendors in the business world like banking and finance, for instance, to come in and maybe offer some exciting turns on these types of products as healthcare comes to rely on big data more and more to manage care.
Gamble: Yeah, that makes sense. There might not be a need to reinvent the wheel if you can take some of what they’re doing successfully in other industries.
DiSanzo: When you look at the tools that are available in the finance industry, for example, to analyze data and do modeling, they far exceed anything that’s available from any of the main healthcare software vendors today. So as a CIO, I’ve been keeping an eye on some of those products saying, is that something I can bring in to help us run our business as we move to bundled payment models of reimbursement rather than the fee-for-service model that we have today.
Gamble: That’s going to be interesting to watch. You’re probably not the only CIO who sees it that way.
DiSanzo: No, I’m sure I’m not.
Gamble: There’s a lot to be learned from other industries.
DiSanzo: Absolutely. I couldn’t agree more.
Gamble: The last thing I wanted to talk about is your background. You mentioned North Shore-LIJ and you were CIO there for a couple of years, and before that, I see that you had various roles on the vendor side. I wanted to talk about what made you want to make the move to the provider side and how your experience on the vendor side has helped shaped your role today.
DiSanzo: Well, I was the CIO at Staten Island University Hospital for over eight years, and that is part of the North Shore-LIJ system. Prior to that, I worked on the vendor side and also in the pharmaceutical industry. The thing that really got me involved in healthcare was the fact that someone brought to my attention that North Shore was looking for a CIO for what was, at the time, an affiliated hospital — not an owned hospital. They had a contact there who I spoke to, and what intrigued me was the fact that they were looking for a non-healthcare CIO. They felt at that point in time that they had exhausted the healthcare CIOs that were kind of making the rounds, going from job to job at local hospitals, and they really wanted someone to come in with what they felt was a business background to run the IT department of the hospital more like you would run the IT department of a successful business organization. And that was the hook for me. That really intrigued me. The fact that they looked at my non-hospital, non-healthcare experience as a positive rather than a negative really made me want to roll up my sleeves and get involved and see what could be done in the healthcare arena, how much could it be run like a business, and what kind of efficiencies I could bring from the vendor side and from the non-healthcare side into that situation.
That was a very successful run for me, and I’ve been a healthcare CIO ever since. I’ve now spent over five years at Saint Peter’s, where I actually have a dual role. I also function as the chief strategy and business development officer. And that’s because strategy, as far as the healthcare system or hospitals are concerned, is so closely tied to the IT initiatives in so far what IT can or can’t deliver, that the senior leadership at Saint Peter’s thought it would be a natural fit to put the two together.
Gamble: That certainly makes sense, especially as we see IT playing such a large role in the health system strategy and how these projects or transformations — like people say — are not IT projects, but organizational projects. It makes sense to me having that dual role.
DiSanzo: It’s been very interesting. Now I’m not only responsible for coming up with new business ideas, but ultimately, I’ve become responsible for how to integrate them from an IT and technology standpoint into the healthcare system as well.
Gamble: That was an interesting time for you to come to the provider side. The last decade or so has just been constant change, and it’s probably unrecognizable from when you first took the CIO role at Staten.
DiSanzo: That’s absolutely true. It has changed so much as a result of healthcare reform. The process of change itself has been just super accelerated. I think, to a certain extent, information technology in healthcare systems was always the stepchild when it came to capital budgets and things like, that because you were always competing with a new piece of clinical equipment. And so the pace of change in healthcare IT moved very slowly.
Take barcoding, for example. How long have we seen barcoding in our local supermarket as opposed to now the barcoded meds administration systems that are common in most electronic hospitals? It was really the push — first by ARRA, and then healthcare reform — that accelerated this adoption of IT in hospitals to the point now where I think it’s really hard for hospitals and vendors to even keep up. McKesson likes to say that their head of product development is now the federal government. They say, we used to pay people to do that, and now the federal government does it for us. It’s a very exciting time to be in healthcare; challenging, but very exciting.
Gamble: I can imagine.
DiSanzo: You certainly can’t let grass grow under your feet.
Gamble: No. So you have any words of wisdom or advice for people who are just beginning CIO roles or are early into the position, just as far as managing all the things that you have to balance right now?
DiSanzo: I think my advice for any healthcare CIOs today, particularly new ones, is to first avail yourself of the advice and counsel of your peers. I have found fellow healthcare CIOs to be a very inclusive and helpful group. So don’t be afraid to reach out, and particularly ask questions if you don’t know the answers. There are a great many tools out there, whether it’s through CHIME or HIMSS or SIM or other organizations that CIOs can use to brush up on the latest technology or find out what’s going on. Gartner is another great source of information.
I think you have to constantly educate yourself. You have to participate in as many of these groups and forums as you can, particularly those around whatever vendor products you’re using, and reach out to your fellow CIOs. I think they’ll be more than happy to lend a hand, and you won’t get a more honest opinion than you will from another CIO.
Gamble: That’s a really valuable thing, just being able to speak to people who have been through the same thing you’re going through or about to go through. That’s about the best advice you can get.
DiSanzo: And I want to encourage more people to get into it. It’s an exciting time, and we need all the bright people we can in this field.
Gamble: It would be interesting to see if there’s more interest in the field, just based on the fact that health IT has gone more into the mainstream than it has been in the past.
DiSanzo: You’re right, it has gone more into the mainstream, and I think that we will see an uptake in individuals looking to get into the field. There are a lot of clinicians that are looking to get into the field right now as well. You see a lot of physicians moving from the CMIO role into the CIO role, and I think that’s going to continue as well.
Gamble: Not just talking about people coming out of school, but people who are already in different facets of healthcare. Okay, we’ve touched on a lot, and I really appreciate your time. So unless there’s anything else that we missed, I figure I should probably let you go and take care of your many priorities.
DiSanzo: No, that’s great. Thank you very much for the opportunity. I’ve really enjoyed it.
Gamble: Sure thing, thank you. And I hope to touch base with you again in the future.
DiSanzo: Absolutely. Have a great day.