Shafiq Rab, MD, VP & CIO, Hackensack University Medical Center, Chapter 1

There are very few CIOs who call themselves “useless,” but that’s precisely the term used by Shafiq Rab of Hackensack University Medical Center, who says his top priority as CIO is “to make sure everybody else becomes useful.” In this interview, Rab talks about his eventful first year in the new role, during which he has focused on optimizing the Epic EMR, enhancing the infrastructure, getting predictive analytics into place, and most importantly, building relationships. He also discusses the work he’s done to obtain clinician buy-in — which involves creating “hoopla,” and talks about his plans for genomics, the technologies that are game-changers, the organization’s ACO work, and how he thinks the CIO role will evolve.

Chapter 1

• About HUMC
• Reflections on year one
• Prioritization and governance
• “My job is to make sure everybody else becomes useful”
• Managing mobility
• Relationships are the key to effectiveness
• Managing up, getting the votes

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Bold Statements

The first step is to get the information in the right format and get all the players together so we can effectively use that information to make the right decision at the right time for the right person in the right format every time.

I focused on my internal team, motivating them and at the same time giving them the opportunity to flourish, because without a good workforce, nothing happens and without a good educated workforce, nothing happens.

The line was so big from 8 a.m. to 5 p.m. that my CEO called me and said, ‘What the hell is happening? Why are all the doctors and surgeons standing in a line? I’ve never seen surgeons standing in a line.’

I believe in my own heart of hearts that the relationship is key. As CIOs, our job is to build relationships and then build a trust with all of our constituents, and at the same time, try to understand where the other people are coming from.

We failed a couple of times not to provide things immediately, but since we partnered with them and we had given them the initial low-hanging fruits and the relationship was there, it’s a give and take, and that allowed us to still have that relationship.

Guerra:  Good morning, Shafiq. Thanks for joining me to talk about your work at Hackensack University Medical Center.

Rab:  Good morning, Anthony.  Thank you for having me.

Guerra:  You’re very welcome. This is actually my health system in my neck of the woods. Why don’t you tell the readers and the listeners a little bit about Hackensack University Medical Center, and we’ll go from there.

Rab:  Hackensack University Medical Center is a medical center in Bergen County, New Jersey, and is among the top 50 hospitals in the country and the top four in the New York and New Jersey area. It is a pioneer in leading the charge of bringing effective change in healthcare. We have been awarded many accolades by US News and Healthgrades, but what really matters is that Hackensack University Medical Center is trying its best to support and to bring effective change in healthcare in the community that it serves and also to be a pioneer in research and academia in the state as well as the country.

Guerra:  You’ve been there just over a year, correct?

Rab:  Yeah, I’ve been fortunate to be here for about 14 months.

Guerra:  What can you tell me about your first year? How would you describe it in terms of surprises and lessons learned? What’s the first year been like?

Rab:  Very typical as it’s going in the journey of healthcare. It’s been very challenging and dynamic. The ever-changing landscape of healthcare is what has dominated us; the ever-continuing journey to get to the point where we can get the patients engaged and interactive with us. So to get our act together, the very first year has been very challenging. From making our electronic health record right, to get to stage 6 of Meaningful Use, which we achieved, and now we are going to stage 7. At the same time, getting predictive analytics in place, building our cloud infrastructure, which is going live next month, getting into the mobility — all those are the first steps in journey of healthcare as I call it, same as Leif Ericson did when the Vikings came to this part of the world.

In healthcare, we are far behind as compared to the finance industry and other industries, because the first step is to get the information in the right format and get all the players together so we can effectively use that information to make the right decision at the right time for the right person in the right format every time. The first 14 months that I’ve spent here was to make sure that also we went live with our financial system with the Epic. Fortunately, we were one of the very few people who after going live we made three million dollars more than we should have, so evidently we did something good.

Guerra:  Yeah, because we’re hearing certainly some other situations, which we can talk about a little later. You mentioned a number of things — analytics, mobility, patient engagement, and obviously, getting the EMR system up and running. And there’s physician engagement. What that made me think — and this is a typical issue that every organization has to deal with — is when you have so many things to do, the real challenge becomes prioritization, governance and not getting distracted by things that don’t matter. Tell me how you’ve worked to come up with a system that helps you focus on the most important things.

Rab:  Anthony, you and I have known each other for so many years so we are friends too. One of the things that I have realized as a CIO is that I’m useless. It’s true. My job is to make sure that everybody else becomes useful, and so using that technique, one of the things that I know is to partner. First of all, you have to have a good team. If you don’t have a good team, nothing works. So I focused on my internal team, motivating them and at the same time giving them the opportunity to flourish, because without a good workforce, nothing happens and without a good educated workforce, nothing happens, so that was my first priority.

The second thing I did was to partner with people who have power — the CEO, the CFO, the CNO, and all of the C‑suite — and make them understand, and at the same time make myself available for them so that information technology is at their service so that they can use us at their beckon and call.

The third thing I did was to partner with the medical staff, because without understanding the aspirations and the needs of what the physician really wants, it’s very different what CIOs think and what IT people think, so we got them engaged to a level. You’ll be happy to hear that we have 55 physicians who got trained in Epic and 10 of them are physician builders. They actually build a system for us. How can I put it in a mild way — I emotionally blackmailed everybody to support IT? Or a different way of saying it is that I’m useless and everybody else is useful.

So based on that, we set our priorities on what is number one and what is number two. Not only that, but we also partnered with our marketing and planning division, who understand the pulse of the community better than a CIO does, and understand what the patients want. In fact, we interviewed a couple of people who came as patients here to understand what they need. Based on that, what we did is that we went to the basic step.  The basic step is that we need to have an agile workforce. Second is to have basic infrastructure which means servers and routers, and to change that to the cloud and then put in mobility.

Now with mobility, I’ll tell you how we set the priorities. Mostly people go and tell the doctors and the nurses that we need to put our MDM, which is mobile data management, on top of it. Instead of that, what we did is we said hey, bring what have at home. Whether it’s an iPhone or an iPad, Android, anything you have in your office — even if it’s an old Apple. Bring it in and we’ll hook it up. But here’s the following things you need to do. Be ready when you come in that we have to put something on it so that we can control it. Second, if it’s a laptop we’ll put an antivirus on it and all the control that IT does. At the same time, when you’re there, if you have any IT questions, we have a table on the side so you can ask them that question. And the last thing is to sign your charts, because if the physician doesn’t sign the chart, we don’t get paid. The line was so big from 8 a.m. to 5 p.m. that my CEO called me and said, ‘What the hell is happening? Why are all the doctors and surgeons standing in a line? I’ve never seen surgeons standing in a line.’

That trick again — the emotional blackmail trick, as I call it — has worked out and then the physicians saw that they could use their phones and their iPads and other things. But before doing that we had to make sure that the infrastructure worked. What that really means is that we made ourselves available to all our constituents and made them understand that without them, we will not succeed. At the same time, we made their priority our priority. And the moment that happened, we picked out the low-hanging fruits, and lo and behold, I had an IT department of 12,000 people instead of the 400 that we usually have.

Guerra:  Have you had some tough situations where you had to say no to requests from very prominent physicians who wanted to do this or that? Everyone says try to turn a no into a ‘yes’ or say ‘no, but’ — how do you handle those situations?

Rab:  You’re right on the money. There have been many situations like that. I’m not a funny guy, but I believe that it’s like when you see a girl for the first time, like when I saw my wife and I wanted to marry her, you want a relationship. And to do that, I wanted to carry her books. I was thinking there’s some possibility and there could be some opportunity to change my behavior, which can help me to build our relationship. I believe in my own heart of hearts that the relationship is key. As CIOs, our job is to build relationships and then build a trust with all of our constituents, and at the same time, try to understand where the other people are coming from. Sometimes you have to explain it, sometimes it works, and sometimes it does not.

Case in point, we have Epic and there’s a big group that wanted to implement some other system in the institution. It took us a whole year to go through the process of coming to the conclusion that we should go for that project also with Epic. Sometimes what happens is that people need things immediately. We failed a couple of times not to provide things immediately, but since we partnered with them and we had given them the initial low-hanging fruits and the relationship was there, it’s a give and take, and that allowed us to still have that relationship. Especially working with the medical executive committee and each individual individually, and making them the leaders and making them set the priorities for us — that has helped us a lot.

Guerra:  It sounds like if you build the relationship, then it makes it a lot easier to have these tough conversations.

Rab:  Yeah, and the most important thing is that everybody says, if you built it, they will come. I say, if they are building it with you, they’re already in it.

Guerra:  That’s good. That’s a very nice quote. I like that. Let’s talk a little bit more about partnering with the people who have power. We talked first about the board — the CEO, CFO, COO, these types of people. Ed Marx is CIO down at Texas Health Resources.

Rab:  Oh, I love him.

Guerra:  Yeah, he’s really right in line with what you’re saying. He even talks about having votes on the board through his relationship building efforts. He’s got votes, almost like a senator going around and getting the votes. It sounds like you’re right in line with that type of thinking. Tell me more about that relationship building at that high level managing up, if you will.

Rab:  So one of the things is as a CIO, for example, why wouldn’t the CEO and the board support me? This is just an IT thing. So the first thing is that as CIOs, we have to create ‘the hoopla’, as I call it, or the need. Some people call it education. Some people call it information sharing, but the Hackensack board is very smart. They’re very involved, and they always want the best. We have a very committed board, but the relationship with board comes to the CEO and the CFO and the C-suite. In my first speech in front of the board, I said that your salvation lies in IT — you should have seen the face of everybody when the CIO made that statement. Nobody understood a single word that I was trying to make them understand, and me, the idiot, I should not have said that, but I don’t hold back. I say what it is.

Guerra:  That’s true, you don’t hold back.

Rab:  I believe that if we fail, our next generation is not going to forgive us. We have a unique opportunity to change healthcare, and it’s a journey. Having said that, coming back to the point, what I did was that I created the hoopla of achieving stage 7. They asked what is stage 7, and what stage are we at? So I said, we are at stage 4. They said, ‘What? How is that possible? This is Hackensack.’ So the moment that intriguing question comes in, they wanted me to explain what stage 7 was and how do you get there. I said, let me explain the journey. You need to have barcoding. You need to have no paper. You need to have 90 percent CPOE. So they said, okay, tell us how do we get there? Then the conversation starts and you talk about security with the compliance person and then it’s okay, how do we get there?

You have to have some cause for people to rally around. I used that approach to get a cause to rally around. We have a very smart board. All of the sudden, everybody’s interested in IT, and then of course, the physicians support you in every board meeting. ‘Thank you, Dr. Rab,’ and ‘We got this quality done.’

I’ll give you a simple example: palliative care. Nobody talks about palliative care. At Hackensack we have the top two people in the state of New Jersey who have achieved awards for palliative care. And early understanding of palliative care, there’s a best practice alert that comes up through Epic — we got that done and all of the sudden now everybody’s talking about palliative care because palliative care can happen from pediatrics to geriatrics. People think it’s only about end of life. These kinds of conversations start and people get engaged in it.

Chapter 2