Ralph Johnson, CIO, Franklin Community Health Network
They’re the words every CIO dreams of hearing: “Thank goodness we had an EMR.” When a new building sustained fire damage a few years ago, it could’ve been devastating. But because Franklin Community Health Network’s last clinic had just gone live, not a single record was lost, and CIO Ralph Johnson was given an opportunity to assess the organization’s disaster recovery plan and to revisit his device management strategy. In this interview, Johnson talks about leveraging partnerships with large health systems while remaining a standalone, why a CIO’s best strategy is to make a recommendation — and then step back, the risk small organizations take on with ACOs, his work with the ConnectME Authority, and why he has no regrets.
Chapter 3
- Preparing for MU audits — “Everything is documented.”
- Increasing broadband access in Maine
- The push for patient engagement
- From “former geek” to CIO
- Seizing the right opportunity — “It was a quality of life issue”
- Smaller organizations are “much more nimble”
- New England HIMSS
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Bold Statements
Every step of the way, he has kept minutes and documentation; every one of the reports he has archived, including our security audit that we had from an outside vendor. Everything is documented.
The goal is to get broadband to every home in the state of Maine. The more rural you get, the more expensive and harder it is, especially when you have traditional providers saying it has to be 15 homes per mile in order for us to run the lines down that street.
The next big steps in improving quality in health care are going to be through consumer engagement. We can tweak right now with making adjustments to refine medication reconciliation and getting just a little bit better, but those are going to be very minor increments.
At a smaller organization, it’s much more nimble. We can turn quicker. We can get things accomplished. Decisions can be made much faster.
It was never my ambition to be a CIO. If you had asked me 30 years ago if I was going to be a CIO, I would have said, ‘No, that’s not for me.’ I really liked writing code.
Gamble: One issue that comes up with Meaningful Use, when you do get funding, is the chance of being audited. I don’t know if that’s something that you’ve had to deal with, but what have you done or what do you plan to do to make sure that you’re prepared in the event that that would happen?
Johnson: I assigned a project manager to oversee that process, and he has been a great historian. Every step of the way, he has kept minutes and documentation; every one of the reports he has archived, including our security audit that we had from an outside vendor. Everything is documented in a binder for the chance that that might happen. We feel pretty comfortable that we can basically hand over a three-ring binder that says, ‘here’s our documentation.’
Gamble: Have you spoken to CIOs or others who have dealt with being audited, just to see what the experience was like?
Johnson: No, but I’m also a member of CHIME. I’ve seen some of the chatter in our listserv, and so I know that around the country that’s been happening. People are sharing what they’ve seen and what they’ve experienced.
Gamble: It’s a scary thing. Any time you hear the word ‘audit,’ it’s scary.
Johnson: It is, absolutely.
Gamble: Being prepared is the best thing you can do. I also wanted to ask you about the ConnectME Authority, the initiative to increase broadband access throughout the state. You were appointed to serve as a board member?
Johnson: Yes.
Gamble: Can you tell me a little bit about that?
Johnson: Sure. In Maine, it was recognized under a prior administration that broadband was really key to economic development of the state. I think this was during the time when Verizon was selling all of their land assets in Maine, New Hampshire and Vermont to FairPoint, and the ConnectME Authority was established. They received a fund similar to the FCC rural connection fund in the state of Maine from all of the internet providers and telecom providers. There’s a tax that goes into the fund for the ConnectME Authority, which then offers matching grants in rounds. Right now, I think we’re in round eight of choosing grant applications, and they award those funds based on a pointing system.
The goal is to get broadband to every home in the state of Maine. The more rural you get, the more expensive and harder it is, especially when you have traditional providers like a Time Warner or a FairPoint saying it has to be 15 homes per mile in order for us to run the lines down that street. In rural Maine, there are a lot of places that just don’t have that density. There could be one home every mile. This assistance is out there to encourage innovation and encourage the expansion of broadband. We’re starting to see some areas of fiber to the home. We’re seeing, in very rural areas, high-speed wireless technology and point-to-point wireless being offered, especially in the down east communities.
It’s interesting; I got connected with it — no pun intended — because we received one of the FCC rural broadband grants six years ago in cooperation with Central Maine Medical Center. We received a $3.5 million grant from the FCC to run a high-speed connection for 10 health care organizations, and I got the matching funds that the FCC required from the ConnectME Authority. That was my introduction to them. We were very successful in our project. They really recognized that health care is one of the driving forces, and so I was asked to be on that board.
Gamble: I can certainly see the benefits of a program like that, not only for patients who might be able to participate in some kind of telemedicine initiative, but also in having that connectivity so that they can become a little more engaged in their health. It helps having access to high-speed internet access.
Johnson: Right. When I wear my quality hat, I say that the next big steps in improving quality in health care are going to be through consumer engagement. We can tweak right now with making adjustments to refine medication reconciliation and get just a little bit better, or with DVT prophylaxis protocols on the floor, but those are going to be very minor increments. It’s when the patients become engaged and really participate in their own health care that’s going to be the next big step.
Gamble: That’s a huge focus — the idea of keeping patients out of the hospital, especially chronic care patients.
Johnson: Exactly, and we’ve also got to remember our physicians. By getting this out into the community, it brings high-speed internet to the physicians’ homes, so that they have access when they’re on-call to their electronic records. I have three physicians on staff who do not have broadband available where they live, and that’s a challenge.
Gamble: Yeah, sure. It’s hard to imagine it as someone who lives in New Jersey, but this is a reality in a lot of areas in the country. I’m sure that that’s something you want to address — just making sure physicians can get access to patient information anytime they need to.
Johnson: Exactly.
Gamble: I wanted to talk a little bit about your own experience. I know you said you had an interim CIO role at a larger organization, and I also saw that you spent quite a bit of time as a director of IS — where was that?
Johnson: I started at Mid-Maine Medical, which is now MaineGeneral. I was the lead IT person. That was before the title of CIO was really in vogue. When I left there, I actually went to Portsmouth Regional Hospital in Portsmouth, New Hampshire and worked for HCA for three years. But my heart was really in Maine. I was recruited at Maine Med to be the director of computer technology — it was primarily an infrastructure role, but I also over saw the financial applications there.
When my boss — the CIO — retired, I was tapped to be the interim, and I did that for a year and a half. Maine Health decided they were going to bring the CIO position to the system level and that it would be a physician, and so I knew I was not in the running for that role. I was happy to stay there as a second-in-command, but I had a quality of life opportunity. We had grandchildren on the way in this area, and the opportunity fell out of the sky for my wife and I to move closer to where our grandchildren were and participate in seeing them grow up, and it’s been fantastic.
Gamble: That’s great. It’s so important to have balance in your life. Being able to be close to family is a huge factor.
Johnson: I never looked back on it. I don’t look back at all. I’m very happy.
Gamble: But I’m sure it’s interesting having had that perspective. Having been at such a large organization, I’m sure that there are lessons learned that you can apply being at a smaller organization with different needs.
Johnson: Absolutely. One of the things I really enjoy is that being at a smaller organization, it’s much more nimble. We can turn quicker. We can get things accomplished. Decisions can be made much faster. We’ve been named most wired the last two years, which is something my staff is really proud of.
Gamble: I can imagine that’s a nice motivating factor for the staff, or just an acknowledgement of the hard work that’s been put in.
Johnson: Exactly.
Gamble: One of the things I noticed on your LinkedIn page was that you’re a ‘self-proclaimed former geek,’ which I love. You also talked about how you found more reward being in a leadership position. I think that that’s interesting. Can you talk a little bit about why you like being in the position where you are now?
Johnson: It’s funny; it was never my ambition to be a CIO. If you had asked me 30 years ago if I was going to be a CIO, I would have said, ‘No, that’s not for me.’ I really liked writing code, and I go back to the IBM mainframe base. I was given an opportunity one time. Our computer room manager had resigned where I was at Mid-Maine Medical, and my boss, the director of IT at the time, had said, ‘Those guys really get along with you, Ralph. I think you’d do great. Would you take on managing the computer room?’ That’s where I learned that I found rewards in supervising and managing people, and then I sort of fell into rest of it. It was never my intention, but I have no regrets at all. And now, here I am in this role. I’m the incoming president of the New England HIMSS Chapter. Again, I didn’t seek that opportunity, but it found me.
Gamble: You were the New England HIMSS CIO of the year, right?
Johnson: Last year, yes.
Gamble: Congratulations. That’s great.
Johnson: Thank you.
Gamble: That’s certainly a really nice validation that taking the CIO path was the right thing for you.
Johnson: That’s right.
Gamble: Having that leadership position with New England HIMSS, do you find yourself talking a lot to some of the younger, less experienced CIOs just about what to expect or just telling them about your experience?
Johnson: Not so much yet, but you actually touched on something that we’re hoping to start in the next year, which is a mentorship program. It’s going to be something unique, I think. The chapter is going to offer a program where some of the experienced people in various roles — consulting roles, hospital IT practice roles, etc. — offer to be mentors to some of the younger up-and-coming people. We’re going to tie that with our student liaison role.
Gamble: That’s great. It’s such a valuable resource to be able to hear from people who have been in this field and seen the transformation over the past few years. All right, well we’ve touched on a lot. I wanted to make sure there wasn’t anything we missed that you wanted to talk about.
Johnson: We actually went down a few paths I didn’t anticipate. This has been fun, Kate.
Gamble: Okay, great. Thank you so much for your time. I appreciate it, and I hope we can catch up again in the future.
Johnson: Thank you.
Gamble: Thank you.
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