Mitzi Cardenas, SVP & CIO, Truman Medical Centers, Chapter 3

When it comes to population health management, Truman Medical Centers is “thinking outside the bed.” What that means is looking beyond the care provided within the four halls of the hospital and relying on strong community outreach programs to increase patient engagement and improve health. In this interview, Mitzi Cardenas talks about the work her organization is doing to target chronic disease management — whether it’s through IT tools like portals, or more rudimentary vehicles like mobile farmer’s markets. She also discusses the organization’s EHR journey, why they’re opting for a “build-your-own” ACO, the governance team she helped put together, and why her team views achievements such as Stage 7 “as a barometer.”

Chapter 1

Chapter 2

Chapter 3

• Marketing IT successes
• IT’s seat at the governance table
• Added job title — “It’s like getting recognition for things you’re already doing.
• Addressing the workforce shortage
• The Stage 7 curse
• CIO job security
• “Work and life become the same thing.”

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Bold Statements

The organization didn’t have a specific governance group that really helps drive priorities. And so we built that. We have everybody on there from our foundation executive director to our VP of marketing and PR, because we really want the organization to have input into what IT does.

I have always been very involved in the strategy of the organization, because I was fortunate enough to have a CEO that really looks at technology as a very important and strategic asset.

When we achieved Stage 7, it was like putting a flashing beacon on the top of the hospital. Other organizations were working very hard to recruit our good folks away because they knew they had been a part of that.

If I had 100 people looking at creating different ways to present information to the clinicians, and also working behind the scenes to provide the data for all these different programs that we have, I’d need 110. There’s just never enough to fill all those needs.

It’s just like any other job; as long as you have a passion for it — and I think there are a lot of very passionate people in the industry — you don’t really see it as a challenge. Work and life become the same thing.

Gamble:  You talked a little bit before about achieving Stage 7 and the Most Wired designation. I imagine things like this are really big to be able to market to the organization and the community as a validation of all the hard work and investment that goes into these projects.

Cardenas:  It is, particularly on the Stage 7 side. It’s really about adoption, so it not only shows that we’ve got the technology out there, but also that our clinicians are using it to take advantage of all the quality and patient safety and other good things that having an EMR brings. What’s also been interesting is that when we’re applying for a grant, they usually have a component that wants to know about your technology. We find that when you say that you’re HIMSS Stage 7, people understand where you are in your EMR journey without having to go into so much detail, as we used to have to do. We still do provide the detail, but it is really a threshold I think that’s recognized across the industry, same thing with Most Wired.

Gamble:  Do you market these achievements to the community as well?

Cardenas:  We do. We were the second in Missouri to achieve Stage 7 and the first in the Kansas City market, so we have certainly touted those to the community. When we were going through all these exercises, we certainly shared those with our patients too, because it does show an advanced use of technology that hopefully they can understand benefits them as well.

Gamble:  You talked about some of the governance changes a few years ago, what specifically did that entail?

Cardenas:  We have a board subcommittee that is focused on technology. It really looks at capital expenditures of all kinds, which of course technology can be a large one. But the organization didn’t have a specific governance group that really helps drive priorities. And so we built that. We have everybody on there from our foundation executive director to our VP of marketing and public relations, because we really want the organization to have input into what IT does.

One of their primary responsibilities is to review status of efforts of projects and programs and give us guidance on whether we’re on track, how the end-users are reacting to the changes that are being made, and most importantly, to prioritize our work. IT has a seat on that governance group. It’s led by the chief operating officer of Lakewood Campus, and it’s really focused on having the organization tell us what they want us to be doing.

Gamble:  In terms of your own role, you started out as VP and CIO at Truman 2008, and then your title expanded a few years ago. Tell us about that.

Cardenas:  About two years ago, the vice president of strategy and business development was moving into a different role and getting ready to retire. One of the things that our CEO has appreciated with IT was our ability to execute. He had pulled me in on a number of broader organizational things over the period of time that we were having challenges in executing. And so when this role became open, he created a combined role. So my work now is around strategy and business development as well as what we call performance integration.

So I work on all kinds of things. I have always been very involved in the strategy work of the organization, because I was fortunate enough to have a CEO that really looks at technology as a very important and strategic asset for the organization. And so it was kind of a logical next step, and I’ve really been able to bring the strong project management skills and technology as well as just the ability to execute to this role, and it’s been very exciting. I still am very engaged in IT — not as much as I was, but obviously that’s still a passion of mine.

Gamble:  It really does make sense when you think about how CIOs are so heavily involved in strategy and are crossing over from IT to organizational leadership.

Cardenas:  When I went through the transition, I realized that there really wasn’t anything in the organization that I wasn’t already involved in. When people realize what IT does and can do, and you have a senior leader that imparts that up on the organization, it becomes really clear that IT or an IT representative needs to be really in any conversation that we have. There was no strategic initiative and there really wasn’t any major organizational priority that I or one of my team was not involved in, so transitioning was kind of almost logical.

Gamble:  I would imagine that it was a validation to have this new role, but also to say, ‘I’m kind of already involved in X, X and X.’

Cardenas:  That’s absolutely true. It’s like getting recognition for the things that you’re already doing. For me it was kind of like, well, this just sort of makes sense. And I really hadn’t ever thought about it much, but certainly it was an interest that I’ve always had. It’s really been pretty exciting to merge those two things, and I think that CIOs have a great opportunity to move into those kinds of roles if they’re interested in doing that.

Gamble:  Now more than ever, CIOs seem to be increasingly involved in advocacy efforts. Is this something that you still have been able to keep up with despite having more responsibilities?

Cardenas:  I still do, but it’s a little bit different. Back early in Meaningful Use days, I had opportunities to testify before the implementation work group about the impact of Meaningful Use on organizations of all sizes and shapes. That was in early 2010, and as I said, I’ve been very active in promoting health information exchange for a long time across the state and in the community. I’ve had opportunities to speak at a number of vendor events. I’ve spoken to the America’s Essential Hospitals group which used to be the NAPH, and I’ve have spoken at HIMSS, both locally and nationally, on different panels.

Recently, I’ve had a lot of opportunity to work with IT workforce groups talking about the need for the IT workforce and how we are changing in the skills that we need, and so I’ve been very involved in that. Organizationally we’re extremely involved in groups like the American Hospital Association and Missouri Hospital Association in terms of supporting their efforts on where we’re trying to go as an industry with a lot of the IT things.

Gamble:  I’m glad you brought up IT workforce initiatives. We just hear so often that the demand is only growing and that there really is a need to create the right programs to help kind of build the next generation of leaders.

Cardenas:  That’s absolutely correct, and it’s challenging because the entry level skills that someone needs to go in the healthcare IT are much different that they were a few years ago. It’s really hard to hire people without some kind of experience, whether it be healthcare or at least some technology — preferably the two. It’s also challenging for those of us who build great people. I always say that when we achieved HIMSS Stage 7, it was like putting a flashing beacon on the top of the hospital. Other organizations were working very hard to recruit our good folks away because they knew they had been a part of that, and because it’s such a symbol of not only of what you’ve rolled out, but also how it’s been adopted. It certainly takes really strong IT leadership and workers to make that happen.

The workforce continues to be a challenge for us. There just aren’t enough good people, and I think the need continues to grow every day. I always say that if I had 100 people looking at creating different ways to present information to the clinicians, and also working behind the scenes to provide the data for all these different programs that we have, I’d need 110. There’s just never enough to fill all those needs, because the more we give people, the more they need. And that’s a great thing, but again, it’s challenging from a workforce standpoint.

Gamble:  Sure. In a way it’s almost a curse being Stage 7. Everybody’s looking for really skilled IT leaders and staff and seeing something like that, they say, ‘Wow, this is what they’ve been able to do. How can we kind of poach them?’ That’s a challenge and we hear a lot about that. It’s amazing that in so many areas of the country people are going through the same thing; there really is a shortage of skilled people on this field.

Cardenas:  I think the colleges and universities and schools are getting more focused on really how to grow and build those people. It’s really about aligning and partnering with healthcare organizations like ours as well as the vendors. I think it’s going to take a really collaborative effort to be able to continue to grow and build a workforce that’s going to have to come out and hit the ground running with the higher skillset than perhaps what they had to have in the past.

Gamble:  Right. And like you said, it just keeps evolving, so the job descriptions can get stale pretty quickly.

Cardenas:  That’s absolutely true.

Gamble:  You talked a little bit before about the job security that CIOs have now, and I can certainly understand that, with having so much on your plate. But how are you able to get away from that and maintain some kind of work-life balance? I know that this is something that a lot of CIOs are struggling with right now.

Cardenas:  Well, I wouldn’t say it’s complete job security, but when we go to some of these things where technology becomes a big part of the conversation, I always joke with my IT leaders and I say, ‘Check that box for job security,’ but work-life balance is challenging. We’re involved in everything, and just like with the organization, healthcare is 24/7 and we have to be able to support our providers 24/7. And so it’s really challenging.

For me, I just really love what I do. It took me a while to figure out that I wanted to be in healthcare IT. I always had a strong interest in healthcare but I knew I didn’t think I could be a very direct caregiver. I felt like this was a way for me to contribute. Most of the people that have been in healthcare IT for a period share the same passion. And so work-life balance can be challenging, but it’s just like any other job; as long as you have a passion for it — and I think there are a lot of very passionate people in the industry — you don’t really see it as a challenge. Work and life become the same thing.

Gamble:  That’s true. They say that if you really love your work, then it isn’t work.

Cardenas:  That’s true. I wouldn’t say that’s true every day, but I think we know that we’re making an impact on people’s lives, and we know that with the work that we do is making an impact on people’s health and state of wellness. That’s important. Like I said, we’re not direct caregivers, but the work we do to support the direct caregivers makes us feel good when we come to work every day, knowing that we’re making a difference.

Gamble:  We’ve touched on a lot and I know that I had a lot to throw at you. I really appreciate your time, and unless there’s anything else you wanted to cover, I figure I should let you go.

Cardenas:  Thanks Gamble. This has been a great opportunity. I love to talk about some of the great things that we’re doing at Truman Medical Centers. We’re doing some really innovative things. And I always like to talk about what’s going on in the industry, because these are exciting times and have been for a while, and I think it’s going to continue. I appreciate the opportunity

Gamble:  I agree. Thanks so much, and I hope to connect with you again down the road.

Cardenas:  That sounds great.

Gamble:  All right, thank you so much.