Kyle Johnson, SVP & CIO, Eastern Maine Healthcare, Chapter 3

After spending 16 years at Trinity Health — which had just merged with Catholic Health East, graduating from being a large organization to a mega system — Kyle Johnson knew it was time for a change. Several hundred miles away, Eastern Maine was looking for a leader with experience in data management and analytics, and a match was made. In this interview, Johnson talks about building a foundation for population health, the organization-wide effort to restructure, EMHS’ homegrown umbrella portal, and her thoughts on the growing M&A trend in healthcare IT. She also talks about what it’s like to go through the merger process as a CIO, and when she knew it was time to move on.

Chapter 1

Chapter 2

Chapter 3

• Major M&A at CHE Trinity — “When is large too large?”
• Data management as a differentiator in mergers
• Acquiring Mercy — “There’s a lot of heavy lifting that has to go on.”
• When it’s time for a change — “You have to be really ready, and I was.”
• Size versus agility
• Cultural fit — “If you pick wrong, it can be pretty miserable”

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Bold Statements

There’s a lot to be learned by these mega-mergers that are happening and what should the new organization really look like to be efficient, and if can they function in the same way that they always did.

This is no longer a mom and pop organization — we need to act like a system, and so we know we’re having a system growing pains too as well.

I think it does challenge organizations, because a lot of times the merger activity trumps or supersede some of the other things going on. That happened here at EMHS too.

In some ways, I’m getting to shape the organization from the ground up, and I’m just having a blast. It’s the best thing I’ve done in a long time.

If you pick wrong it can be pretty miserable, and so figuring out the cultural fit during the interview process is really important.

Gamble:  You were with Trinity when they merged with CHE. I can imagine that was an interesting thing to go through because such a large organization was created. Was there anything in that process that you took as a lesson learned, or any advice you can offer to your peers? There are so many mergers and acquisitions going on — any takeaways from going through that experience?

Johnson:  I have a few takeaways, actually. I think one of them is the question of, when is large too large? And what I mean by that is Trinity was 50 hospitals on their own; when they acquired CHE — or when the two organizations merged — Trinity became 85 hospitals overnight. Three years later, they’re still reeling with how do they function now as an organization that’s a third bigger than what they were. I think that’s a real struggle. Even though they were both Catholic health organizations, culturally that was probably the only thing the two organizations had in common, and I think when you’re trying to really bridge cultures that are really quite different, that takes special work around the two. I think that as folks are looking at all these mergers around the country, you can’t underestimate how much time that really takes away from getting back to a new operation for the new organization and really what you’re about.

Trinity still doesn’t have all the senior leaders in place. They’ve been really slow to get a new CEO. I think when that merger happened, they didn’t expect Joe Swedish to leave and go to WellPoint. That was a big change. It’s really turbulent times, and there’s going to be a lot more of it happening in the healthcare industry. I think there’s a lot to be learned by these mega-mergers that are happening and what should the new organization really look like to be efficient, and if can they function in the same way that they always did.

Gamble:  Absolutely. To go from being big to even that much bigger, I think it’s easy to underestimate just how much it’s going to take for the merger to go through from so many different angles.

Johnson:  I think if you just look at IS as an example, on the opportunity side, it was one large IS organization consolidated, centralized — really serving all of Trinity. I think actually that really wasn’t working very well as you added CHE in, and it had gotten so big that it probably needed to break into some regional clusters, but they’re still working through that. I think it’s because things were still a mess when it was Trinity to get decisions made and really get things rolled out once you decided on a solution rolling that out across 50-hospital organization, but then to have 85, it almost became just daunting to think about the task and the years literally it would take to roll some things out.

I think it’s that kind of thing that really challenges the core of what these organizations are about if these mergers occur. And we’re starting to see it even a much smaller scale here; as we’re acquiring, this is no longer a mom and pop organization — we need to act like a system, and so we know we’re having a system growing pains too as well. 

Gamble:  You’ve touched on some of those things that need to happen when you are going to make that move to a system organization; for example, data management has to be a bigger priority, and there has to be enough resources put into that, because you’re talking about more hospitals and more data that does need to be managed and then utilized.

Johnson:  Sometimes the whole data management function could really be a differentiator in a merger because you might decide to come together at first by just bringing data together and really understanding the business through data before even any operations are consolidated. If you manage that way, you could do that for some period of time before you even have to think about touching your transaction system.

Gamble:  From the point of view of somebody who was in a leadership role when you were going through the merger — especially a merger of that size — does it enter into your mind that you’re going to have reprioritize, and that focusing on doing everything it takes to merge is going to take over some of your priorities? Does that enter your mind at all?

Johnson:  Yeah, it very much does. One of the first things you bring together is the general ledger and the financials so you can close your monthly books together as a single organization. You actually usually try to have that happen as close to day 1 of the signing as you can. And then oftentimes you are making plans for supply chain systems, the HR system, and then maybe clinicals and revenue after that, either what’s going to merge in or how you’re going to merge data together.

Actually, IS usually gets involved pretty early on in that merger process, and you’re absolutely right — I think it does challenge organizations, because a lot of times the merger activity trumps or supersede some of the other things going on. That happened here at EMHS too. When Mercy came on board, we pretty much stopped everything here to bring them live on Cerner. I think the lesson learned there was that we really can’t do that; there are other things that we have to keep going. So we’re actually looking at doing more data integration; I talked about it as a first step, and we may partner with Cerner or one of our vendor partners to bring a new merged partner on board rather than taking the internal resources to do that work. Because we realize in the next three to five years, there’s really a lot of heavy lifting that has to go on with all this change — health reform change that we can’t really afford to take our eyes off of either. So there are very interesting times.

Gamble:  And you started at Eastern Maine earlier this year, right?

Johnson:  I did at the end of March.

Gamble:  What was that transition like? You said you had 16 years at Trinity. That’s a long time, especially nowadays. It’s a good number of years to spend at one organization. What was is it like making that change?

Johnson:  For one thing, I think you have to be really ready for the change, and I was. I knew that I had gotten to that point where I needed to be doing something different. So I think that’s one thing, and then I think it’s picking the right place to be. Trinity had been a great place, but I think I had done everything I could do there, and I still wanted to do more. I really had the appetite to have the very top CIO spot. So when I got the offer to come here and do that, I really wanted to do that in my career.

This is a great organization. I have been welcomed since day. It’s very exciting to have folks from other places that have seen and done different things, to bring that to Maine. And it’s really fun. In some ways, I’m getting to shape the organization from the ground up, and I’m just having a blast. It’s the best thing I’ve done in a long time; making this change and coming here.

Gamble:  It wasn’t a difficult adjustment to go from an organization that had become very large to one that’s not exactly small, but smaller?

Johnson:  No. It’s interesting enough, what I’m really enjoying about Eastern Maine is the fact that we actually can get things done more quickly. I think one of the things I had become inpatient with is the amount of time it was taking at Trinity to make decisions and get things underway. We’d gotten into rhythm in Trinity over the years in implementing an EMR across 50 hospitals, and I was part of all that. And then having a new organization, some of that was like starting all over from scratch, and I sort of decided I’m going to do that — maybe I’ll do that someplace else in a different role, and that was a lot of what went into that for me. It felt like I could reach out and do something, and I do like the ability to be more agile here. We’re just big enough that there’s some size that you can utilize the scale from, but we’re not too big that we can’t still be agile in what we’re doing, so I really like that part of it.

Gamble:  One of thing I imagine can be a little scary is that you can visit a place, you can talk to the people there and think, okay, I think this is a fit, but then sometimes you get there, and after a couple of weeks, you’re not sure. I would think it’s something where you have to give it a few weeks before you really can tell whether or not it’s going to be a fit. Was that the case for you or was it pretty much, ‘okay, this feels right.’

Johnson:  I thought it felt pretty right, and you know, you’re right. It’s funny, even when I went to Trinity, I remembered this happening. I was only there two weeks, and I felt like it was coming home, but I felt like this here too. I was here a couple of weeks and I met some people here, but it’s interesting — the CMIO at Trinity came from Eastern Maine. He had been there only a couple of years and then we almost swapped and I came here. I knew Eric Hartz really well, and I knew people here through Eric; I was close to this organization anyway. So it was nice coming in and knowing some folks and knowing I had some trusted colleagues already, even coming in. But it’s been really good. There is something about that though, and you’re right. I think if you pick wrong it can be pretty miserable, and so figuring out the cultural fit during the interview process is really important.

Gamble:  I’m sure it helps too that Maine is absolutely beautiful, so that’s a nice perk.

Johnson:  Yes it is. You should see the view I have out my window. I’m looking at all these reds, oranges, yellows and greens. It’s so pretty, and I think we’re getting the tail end of a tropical storm for the next two days, and it’s going to be really windy and rainy. It’s probably going to bring all the beautiful leaves down, but it’s been a magnificent fall.

Gamble:  Great. Well it definitely sounds like you’re in the right place, and that there’s a lot to do, but you feel equipped and ready. That’s a good place to be in.

Johnson:  I have a great team. I was blessed to walk into a really, really good team here, and so that’s been very enjoyable as well. I’ve been really well embraced by everybody here — not only my team, but all of my colleagues — and my boss is a fabulous person.

Gamble:  Okay, well we’ve covered a lot, so I should let you go. I really appreciate you taking the time to speak with us. It sounds like you have a lot of great things going on, and I definitely hope to speak with you again down the road.

Johnson:  Thanks, Kate. Have a great day.

Gamble:  Thank you, you too.