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.
- Fostering internal goals using industry-standard measures
- “I may be an MD, but I’m also the CIO. I’m a service department, and I have to be humble.”
- ‘It’s never the people, it’s always the process.”
- Getting ready for genomics
- The art and science of visioning
- The game changers are cloud, mobility and the smart phone
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We look at the numbers, and if we are falling behind, we scream bloody murder and start talking as loud as we can, and then everybody goes after everybody and it’s ‘Oh my God, we’re going to die.’ Then we have a laugh about it.
As the CIO, I’m the catalyst. I have to tell the story every time. So it really tells me who I am. I can say that I have become the greatest storyteller and the glue that brings people together. That’s it. That’s my role.
That was my biggest weapon, because everybody thought that I’m this big, high and mighty powerful CIO coming in, and I’m going to shove it down their throat and tell them what to do. That’s what the culture was.
Our job is to live in 2015 and 2016. If I live in this moment, I should not be the CIO. I should be fired immediately and sent home, because I’m not the CIO. I’m just a guy who does this mundane thing — what the government wants you to do, and what everybody else does.
You don’t have to go on top of a mountain and meet an old man and drink a cup of tea. That’s not how you do visioning. Every six months, go back to what you thought and see how the world has changed and how the world will change. Talk to your friends and find out what they are thinking.
Guerra: You’re talking about HIMSS Analytics Stage 7 — and by the way, I think that’s a great technique. You have a board that you know wants to be the best, and you’re able to show them ‘hey, we’re at stage 4. We should be at stage 7 if you want to be the best,’ and that gets them motivated and they say, ‘why aren’t we stage 7?’ So that’s a great motivator. Now you have the stages of HIMSS Analytics then you have Meaningful Use 1, 2, and 3. Have you used both of those in the same way or in different ways?
Rab: I’ll answer that in one second. Here’s what I did. When you get to stage 6, HIMSS sends you a pin that you put on your lapel. I sent one for each board member so now they have a pin.
Guerra: Very nice.
Rab: One other thing we did for the Meaningful Use — and this is very strange, but we were in such a rush to get to Meaningful Use as a nation because you need to get the electronic health record and other things, so one of the things we did is that we partnered with our chief quality officer. Hackensack takes quality very seriously because we are number 22 in something and number 29 in something and number four in something with all the different categories. So while the quality people are trying to get their numbers together, with Meaningful Use stage 1 and 2, stage 1 we already achieved and two we’ll achieve by September or October — they had a cross path. Then you have value-based purchasing, which is the third thing that Medicare is trying to introduce. And then the fourth one, of course, is stage 7 of HIMSS.
What we did as a team together is we sat down and said, hey, do we have a cross path? I’m a lazy person. I shouldn’t say ‘lazy,’ but if we can kill three birds in one shot, let’s get five birds in one shot. So we sat with the quality team and our BI team and tried to do as much cross-work as we could, and then based on that, we selected certain things that we could achieve in a timely fashion. Of course Epic is a great company. That also helps you a lot with Meaningful Use to get there.
So that helps us, but more so it’s the physician staff and the nursing staff who actually help us to get there, because this is not only doing the IT stuff. People actually have to do the stuff, like pharmacy people. So we partner with our pharmacy person. We partner with our CNO. We partner with our chief quality officer, and together, they helped us to get there. There’s a team that meets every week. We look at the numbers, and if we are falling behind, we scream bloody murder and start talking as loud as we can, and then everybody goes after everybody and it’s ‘Oh my God, we’re going to die. The world will come to an end.’ Then we have a laugh about it.
Guerra: That’s very good. Now you’re an MD, so has that helped you partner with the medical staff? Has that helped them engage with you?
Rab: It always does. That helps me to get job interviews at least. When I send an email, then they say you’re not good enough. But yes, it does. What it does, Anthony, is it brings some credibility. I’m good at what I do. I’ve made my career over the last four different times, but what it does is, first it gives you credibility, plus the CEOs and the CFOs will introduce me to people. That also gives them the little bit of an edge, but I think the most important thing is that I have to always remember that I may be an MD, but I’m also the CIO, and I’m a service department. I have to be humble and I have to also understand that in the field of healthcare, it’s not only just the physicians; it’s also the transporter. It’s also the person who moves the dietary. It’s the person who actually cleans, who helps with C. difficile, because if the cleaning doesn’t happen, you will have C. diff.
How do I connect everybody together? And as the CIO, I’m the catalyst. I have to tell the story every time. So it really tells me who I am. I can say that I have become the greatest storyteller and the glue that brings people together. That’s it. That’s my role, I think. Maybe I should take Jay Leno’s job.
Guerra: Right, Jay Leno. I think he’s out anyway — didn’t they replace him? You talked about humility. I would imagine that showing humility, especially for a new person coming in as a VP and a CIO at a place like Hackensack, is tough. In my experiences in different companies with IT, humility was not the strong suit. I would imagine it’s very disarming, in a good way. When somebody comes to you, they expect you not to be humble, and so to be humble is so probably pleasantly shocking to them. Have you seen people actually change when first meeting with you, and because you’re being humble, it changed their attitude?
Rab: Anthony, you are a genius. You have hit it on the spot. That was my biggest weapon, because everybody thought that I’m this big, high and mighty powerful CIO coming in, and I’m going to shove it down their throat and tell them what to do. That’s what the culture was. You should have seen their jaws. I was like, ‘Okay, so how may I serve you?’ They were like, ‘What?’ I’d say, ‘Absolutely, you want it now? Hold on a second, let me text somebody. I texted, and by the time we finished the conversation, whatever they needed was already done.
It threw people off their game, because mostly what happens in the healthcare industry is we talk a lot. The healthcare providers do their job and we’re trying to get ourselves organized, but we’re not there yet. We’re not data-driven yet. We are, but we’re not. There are a lot of anecdotes, and I think what’s happening to us as an industry is we’re trying to get people together, to think together, to work together, and to understand each component. I’m Lean, Six Sigma Certified. I understand it’s never the people; it’s always the process, and until we change the process and the workflows, things will not change. But that does not happen until your heart and mind change, because as you know, the paradigm of healthcare will change 18 months from today. I predict that healthcare will not be the same as it is, because when genomics become available for a hundred bucks, when you can get your entire genome sequencing done for a hundred bucks, then all of a sudden all this healthcare game that we are playing will totally change. And if we are not ready for predictive analytics and if we are not doing cloud computing, data centers will be history. Nobody will need to see their data centers in place and for that to happen, healthcare has to become agile. Healthcare has to change processes and people who are in power now have to be ready for that.
Guerra: So you’re going to have a world where people show up in the ED and they’re able to hand the clinician their smartphone with an app that’s got their genome fully sequenced and say, ‘Here you go. Make sure you treat me based on my genetic sequence.’
Rab: Better than that. What I’m envisioning and what we are working toward maybe next year when you and I talk, and I hope I’m not selling myself before I’ve done it, is something better. My children sit at home and they try to buy something from Amazon. I have little kids. You have a young infant at home, too, and they all know what the choices are, how to buy, and what to do. If you sit at home and you have an app that can not only schedule you, but get your blood test and your reports, and not only that, but also see the directions and send it to your GPS directly to your car, and when you come, by that time the parking pass has already been sent to your iPhone, which you wave at the door, and it opens up and the light tells you which way to go. By the time you go to the doctor, the doctor already has your symptoms already sent by you. They already have your gene sequencing, and are understanding it and working on personal healthcare you require. That all will happen in two to three years, and the hospitals and health systems that are gearing themselves up for that, they will be the leaders in the paradigm shift.
Guerra: Most people, I would imagine, are so mired in the day-to-day, and just doing what the government’s telling them to do, because that’s got their plates full — Meaningful Use stage 2, whatever stage 3 comes out to be — that they don’t have time to craft this vision that you just described. And if you never create the vision, you’re never going to be ready for it, right?
Rab: Like I said, brother, you’re 100 percent right. This is what happens to people like me who have no life. I get to drive an hour and a half each way to my home, so that’s where the most creative thinking happens — in the carbon dioxide polluted roads of New Jersey. As CIOs, our job is to live in 2015 and 2016. If I live in this moment, I should not be the CIO. I should be fired immediately and sent home, because I’m not the CIO. I’m just a guy who does this mundane thing — what the government wants you to do, and what everybody else does. If we cannot see forward, that’s very important to figure out.
We have a big cancer center here. We have the fifth largest in the country now, and everybody’s coming for a miracle cure, but a miracle cure is not coming. People are talking about diabetes. People are talking about obesity, all these things. Everybody’s forgetting only one thing. You know what everybody is forgetting? It’s the patient. Without the patient being accountable, without the patient interacting and without the patient engaging, how are you going to make effective healthcare change? It’s never going to happen. The only way it can happen if we step outside our healthcare and understand.
And I’m going to say this very clearly so you can tape it, whatever you want to do. Healthcare is divided into so many types. Number one is catastrophic care. That means you’ve got a nail in your head. You’ve got to go to a place where they can take the nail out of your eye socket. For that, you’ll need tertiary care. Then comes acute care. That means you got appendicitis, so you can go to any ED and any general surgeon who can take it out. Then comes your chronic care, which means somebody’s got diabetes or congestive heart failure, so long-term care and ACOs take care of those things. Then comes wellness or preventative care where somebody exercises and does all those things trying to prevent diseases. ‘I’m going to live to 94 and be mean, old, crotchety, and healthy.’ Preventative care can help to get there and to understand my health.
But to get to all those four or five stages, the most important thing is, for me, Dr. Rab Rab, what do I know about my health right now? I have no clue what my blood pressure is. I have no clue what my gene sequencing is. I have no idea when I’m going to get a stroke. I have no idea who in my family has had cancer and what to do to prevent it. Do you know that of the people who get heart attacks in this country, only 20 percent try to change their lifestyle? The other 80 percent don’t give a damn. As CIOs, we have to be smart enough to engage them, and the game changer is the cloud and the mobility and the smartphone, because you can now get to them. You can get to them and make them play a video game. I don’t care what you have to play to come get your check-up done.
Guerra: How do you put some process around visioning? How many years out is it important to have a vision — three years? Five years? When you get too far out, it just becomes silly because things change so much. Do you need to have a vision that’s actually written down and that you update every month or every quarter, or is it just something in your head that you have to think about? Is there any way to put structure around visioning?
Rab: You’re asking a very valuable question. Here’s what it is. In the olden days, which is about three years ago in IT, people used to write stuff down, like their three-year strategy. Then you put in résumé, and you get a job. Here is my three-year strategy. Well, the world is ever-changing, so that means you have to be agile. The way I am doing things nowadays is that everyday between four to five, my team sits around my desk and I do the preaching, as I call it — this is how life should be and we talk about life and things like that. But that’s not visioning. You don’t have to go on top of a mountain and meet an old man and drink a cup of tea. That’s not how you do visioning. To answer your question, every six months you have to go back to what you thought and see how the world has changed and how the world will change. Talk to your friends like Ed Marx, like Martin Harris or Dave Levine up in Cleveland Clinic. Talk to your friends and find out what they are thinking.
The other thing that has helped me is to talk to the CIOs who are not in healthcare, like JP Morgan Chase or companies that doing the Princess Cruise line. I met somebody who’s into telecom. Then I met the CIO of Wal-Mart — half a trillion dollar man. See what they are thinking and how they are tackling different things. We are talking about barcoding 2D and 3D; well, barcoding is a joke for CIOs of Wal-Mart and other places. They do it for a living. That also helps you every six months. So to answer your question, go outside your comfort zone, and again, there’s humbleness. Tell them straightforward, hey listen, I don’t know about it. What do you think about it? Sometimes law enforcement also can be helpful. What keeps me awake every night is bloody cyber security, and I am not good at it. I am not good at it. That’s one of my weaknesses and I’m trying to make myself understand how to keep myself secure. I am so worried about it.
Guerra: Yeah, a lot of great stuff in there about CIOs from other industries. That’s another thing Ed Marx preaches. Do you find that they’re generous with their time? Do you just ping them through LinkedIn? What’s a good strategy for getting in touch with them?
Rab: There are three or four strategies that I have. One, LinkedIn is a good way, but it does not help that much. I go to conferences, like when EMC or Intel or McAfee would throw a CIO conference, so I’d pick and choose and then I make connections there and just straightforward ask, like the guy who runs the stock exchange. Two stock exchanges are merging now — the one in Atlanta and the one in New York City so I just talk to the CTO and I say, ‘Listen guys, you’re merging stock exchanges. Oh my God, what is it like?’ Sometimes you get lucky that your CEO, when he goes to ACHE and other places, they are your ambassadors too. So you can say, ‘Hey, if you meet other CEOs of different industries, can you hook me up with their CIO?’ And when it comes from the CEO to the CIO, that also helps. Those are the two or three cheap shots that I got.