There are few tasks that can better prepare one for the CIO role than leading an Epic rollout at organization like the University of Michigan Health System. It was the path that Dan Waltz took, and it has helped him enormously at MidMichigan, where he has held the CIO post since January. One of the most valuable lessons he learned? Letting physicians vent and not taking it personally. In this interview, Waltz talks about the importance of clinician engagement, how his leadership philosophy has evolved, his long-term goal of getting to one integrated system, the benefits of using consultants, and what he believes is the toughest part of being a CIO today.
- ACO work with University of Michigan
- MU 2 struggles
- Creating governance committees
- Physician frustrations — “You’ve got to let them vent, and you can’t take it personally.”
- From U-Mich to MidMichigan
- Coveting the CIO role — “I felt I had something to offer.”
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What we’re finding is to make Meaningful Use meaningful is going to take a lot more time. We can get measures in, but are they meaningful? Maybe, maybe not. It’s just too much, too fast.
The easy way out is let’s just put an alert in the system, and that’ll fix their bad process. But it really isn’t. You really have to look at the processes behind the alerts and say okay, what should we really be doing here?
You’ve got to let them vent, and you can’t take it personally. You just need to let them know that you’re listening to them. You’re doing the best you can of putting people on the projects and things that make the biggest impact for them.
I was very happy doing the Epic implementation. That’s something that I love to do — large scale implementations, but I still wanted to be the head person and felt that I have something to offer in that role.
Gamble: What about accountable care? Do you have something set up right now or are there plans with the University of Michigan or other organizations to do that in the future?
Waltz: My understanding is we’re in talks with the University of Michigan, which is already doing fairly cutting edge ACO work, and so we’re learning from their experience and talking to them. I believe we’re looking at some work around the area too with some of our independent physician groups. I really don’t know if I can discuss it much further than that, but we are definitely looking at it.
Gamble: It’s interesting because you have organizations that are involved in what are technically defined as ACOs, and then you have a whole lot of organizations doing things with that same idea, but maybe it doesn’t have quite that tag just yet.
Waltz: Correct. There’s a lot of collaboration. We’re talking to a lot of independent physicians about working together. There’s no doubt about that. We’re working really hard at that. We want to provide better care to our community members — that’s the whole point.
Gamble: Absolutely. You talked a little bit before about how Meaningful Use is what drove a lot of the EHR strategy or at least it had an impact on it. Where do you stand right now with Meaningful Use?
Waltz: In our organization we’re struggling with stage 2, and so this recent CMS piece that came out where they potentially may delay all or part of Meaningful Use 2 is very welcome. What we’re finding is to make Meaningful Use meaningful is going to take a lot more time. We can get measures in, but are they meaningful? Maybe, maybe not. It’s just too much, too fast, and we don’t have the staff to really do the full-blown, let each physician practice pick their own quality measures. Even Michigan is not doing that. They’re just trying to get up with the basic measures and then more forward in the long run to get the measures per physician or per physician practice so that they do have things that are meaningful for their service line. But that takes time; a lot of time. I think many of our physicians are really upset by the fact that this is moving so quickly forward, because they can’t keep up.
Gamble: Is that something that they expressed to you and to the hospital?
Waltz: Absolutely. Almost every week I’ll talk to a physician about their disdain for the pace of this change and whether it’s really good for patients or not.
Gamble: In what type of settings do you usually talk to them? Is it in meetings or sometimes just informal discussions?
Waltz: I’ve been here since January, and we’ve set up some formal governance committees and are really leveraging them to have the physicians take control of the EMR system. I think a lot of times in the past — and it’s not just this hospital, it’s most hospital or IT shops — the decisions were made more in IT. We just don’t have IT projects anymore, and that’s what I’ve been telling our staff. We have business projects and clinical projects that require IT. And in saying that, you are giving the power to the software that these physicians have to use every day, as well as nursing and all the other clinicians. When they have an error and it’s happening every day, that’s got to be really frustrating. So we want to get their involvement and their input on how to fix and what to fix on the system so that we can provide them a better experience, and they can also pass that experience on to the patients. We hear this in our governance committees. We have a nursing governance committee or a clinician governance committee and a physician governance committee, and we’re setting up an interdisciplinary governance committee as well.
The other thing that drives physicians nuts is when you put alerts in the system without their input, and so we’ve frozen all alerts. We take all alerts and we run them through the physician and nursing staff. Maybe we have a bad process, and usually the easy way out is let’s just put an alert in the system, and that’ll fix their bad process. But it really isn’t. You really have to look at the processes behind the alerts and say okay, what should we really be doing here, and do we really need an alert — a hard stop? Those are really difficult for physicians.
Gamble: I’m sure the feeling that certain things are being done to them is something you always want to avoid ideally, and make them part of the process.
Waltz: We’ve had really good engagement. Our CMIO, Dr. Jandwani, and I have been partners in trying to improve the engagement of the physicians and these governance committees, and we do feel like we’re getting some traction.
Gamble: I’m sure that those are some interesting meetings. It has to be challenging sometimes letting doctors air out their frustrations because at some points you must start to feel like saying Meaningful Use isn’t my decision, but it helps to let them vent the things that they’re feeling.
Waltz: Sure. I developed some very thick skin while I was running the Epic project at University of Michigan. And by the way, I wish them good luck to them as the last phase of that rollout is this weekend, and they just put the inpatient system in. I just got a text a few minutes ago from John McFall saying things are going well.
Gamble: That’s good.
Waltz: When I was there, we had four go-lives and one was the ambulatory system. The scope of that was huge. We went to lot of physician meetings where physicians who weren’t involved in the implementation weren’t happy. And yeah, you’re right. You’ve got to let them vent, and you can’t take it personally. You just need to let them know that you’re listening to them. You’re doing the best you can of putting people on the projects and things that make the biggest impact for them and trying to get them to work through their physician champions and their governance committees to bring the specifics of things we can actually help them with.
Gamble: It would be interesting to be a fly on the wall, maybe not in your shoes but maybe for me.
Gamble: Okay, so you said you’ve been CIO in Mid-Michigan since January of this year.
Gamble: How did it happen as far as going from University of Michigan to MidMichigan?
Waltz: It was a very interesting set of circumstances. When I was the project director and executive director at Michigan and running the Epic project, I had Deloitte in there as our vendor of choice for helping do the PMO work. They did a terrific job, by the way. But anyway, I met a number of Deloitte people while I was at Michigan, and one of the people that I met was hired by MidMichigan to be the CIO, a former Deloitte employee.
Well, I got a call from that employee saying, ‘Hey, I’ve decided to move on at MidMichigan and I’m going to rejoin Deloitte and move back to Vancouver.’ And so he put a word in for me to the CEO here at the organization. She gave me a call, and that’s how I got the interview. I was recommended by the current CIO at this organization. That was really nice to get that kind of recognition. Deloitte knew the job I was doing at Michigan and I was happy that they felt good about that.
Gamble: That’s a great validation. Did you have reservations about taking the role, or was it something where you were working toward or wanted to have a CIO position?
Waltz: I had been looking for a CIO position for several years. In the meantime, I was very happy doing the Epic implementation. That’s something that I love to do — large scale implementations, but I still wanted to be the head person and felt that I have something to offer in that role.
Gamble: I’m sure that experience alone is something that’s very valuable to have under your belt.
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