It’s amazing how much a single conversation can influence one’s career. Years ago, Dave Lundal asked a chief operating officer what he looks for in a CIO. The answer? Someone who understands the healthcare business. Lundal took those words to heart, and now, as CIO at Presence Health, his leadership strategy is built around the idea of applying technology to the healthcare business. In this interview, Lundal talks about what drew him to Presence, the challenge of having two EHR systems — on multiple databases, and implementing an IT governance process. He also discusses what he learned going through the M&A process, and how healthcare has evolved in the past 20 years.
- The “huge challenge” for CIOs
- Staff appreciation — “Everyone is overworked.”
- IT governance & “black holes”
- From idea to business case to decision
- “We have a lot of different initiatives, but not a coherent strategy.”
- Managing multiple portals
- Clinical integration platform for HIE
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One of my huge challenges as a CIO is just managing the sheer volume of work coming our way. There is almost no initiative across the health system that doesn’t require some form of information technology and support from us.
You have a place to say ‘here’s what the health system is requesting. Here’s what we’re recommending. Here’s the resources required,’ and make some decisions about what’s in and what’s out. Because without that process, it literally becomes a ‘who’s screaming the loudest’ type of scenario.
Saying no is not the option. That’s not going to last, and that’s not a good management technique.
We have to make sure investments work really well to achieve the goals that we need. So I think it’s a critical and necessary component, just as much as it is making sure we have people that can manage the technology we have.
Patient engagement is a critical component for population health. We need to get that right, so there’s some strategy effort that will be taking place there.
Gamble: It’s interesting when you talked about moving to this different care model and how you don’t really have to sell it because you’re in this position of being able to say, ‘all this hard work we’re putting in? This is what’s going to come out of it.’ I imagine it’s really a good thing to be able to do that and to show the staff and all the people in IT and other departments that this is the end goal, and we’re really playing a key role in improving care quality.
Lundal: I think it’s a good thing. It’s a great thing, but it’s also a required thing. One of my huge challenges as a CIO is just managing the sheer volume of work that’s coming our way. There is almost no initiative across the health system that doesn’t require some form of information technology and support from us.
When you put that on top of a time where revenues are flat or declining, that presents a huge challenge, and so we’re all overworked and overstressed. So when a requirement comes in, trying to tie that back into ‘here’s what we’re for’ and getting that intrinsic value out of your work, I think that can be a good thing. And just reminding everyone of just how critically important we are, because sometimes you don’t feel it. You just feel like everyone needs a piece of you. Everyone needs you to do something. There’s emails flying in and voicemails and meetings, and sometimes you don’t feel that.
Part of my job, I think, is to try and make sure people realize just how important they are and how appreciated they are, because they truly are appreciated. It’s not just us in IT that are overworked. Everyone is overworked. So that makes it harder to find the time to pause and do those thank you’s.
Gamble: Whereas a clinician might be able to physically see a patient improving and care improving, that’s a bigger challenge on the IT side.
Lundal: That line of sight to the patient is a challenge, but I think it’s one that can be overcome.
Gamble: You touched on how much is going on and how much of a challenge that can be with so many demands being placed on IT. Are there things you try to do to just make sure that the staff is not overworked or make sure that there are benefits to make sure that you’re able to hold on to good people?
Lundal: One of the big things we’re going to do here is we really need to implement the structures and the processes to help us manage the work and that comes in the form of — at the high level — a governance process. You have a place to say ‘look, here’s what the health system is requesting. Here’s what we’re recommending. Here’s the resources required,’ and make some decisions about what’s in and what’s out. Because without that process, it literally becomes a ‘who’s screaming the loudest’ type of scenario and all work is good and expected.
So we’re going to implement a governance process. We’ve started on that, but we have a long way to go in that as well. We want to put some structures in place to help with these like portfolio management and time tracking — a very small set of people within our organization just devoted to this task of managing the portfolio, managing the priorities, helping to quantify what the capacity is for us to do things, and make sure we have a process where we say, ‘what are we going to do,’ and then report on its value and maintain tight communications with the organization. Because often where IS organizations are left is being that black hole stereotype; and that’s not a function of people wanting to be a black hole. That’s a function of there’s just so much there and you’re just responding to the work that’s in front of you that creates the space where you can’t get back; you can’t respond to everybody that’s calling you. We want to create that.
As I talk with my leadership team, I say, ‘look, this is an imperative for us. Saying no is not the option. That’s not going to last, and that’s not a good management technique.’ But putting these things in place, we really owe that to our team so we can have rational decisions made about the investment that the organization is making in us and how that is spent. That’s critical.
Gamble: With a health system the size of Presence, which is fairly large, how does it work in terms of the governance setup with IT? Are there regional director positions that report to you? How does that work in terms of being able to look at the whole picture of the organization and its needs?
Lundal: We have a slightly different structure; it’s not broken up into IS folks that are in charge of regions. It’s much more from a leadership level in our IS organization based on function, whether that’s technology or clinical technology or ERP-type systems. That’s how we do it. We are adding one piece to the organization that’s going to be a system director level role around strategy and planning and finance and governance — I forget the exact title, but at least three of those four words are mixed up in there. That person is going to have a small staff of four people, and they’re the ones that are going to help us make sure we have a single intake process. So we’ll have people that don’t have any task other than to help manage this portfolio of ideas and take them from idea to business case to decision, those types of things. That’s how we’re going to approach it. I think that’s a critical piece.
When I look at the investment that we have to do and will be spending it’s daunting, but you know that if we did everything that people were asking us to do the investment would be two or three times what actually will be spent. We have to devote some resources to say ‘look, this is just the job to help manage and make sure we’re investing where we need to.’ Otherwise, we’ll only get the right outcomes for technology out of sheer luck.
In the population health world, it’s not just about are we capturing enough to produce a clean bill — those days are going away, if not already gone. We have to make sure investments work really well to achieve the goals that we need. So I think it’s a critical and necessary component, just as much as it is making sure we have people that can manage the technology we have.
Gamble: Looking into 2015, what are some of the other bigger priorities on your plate?
Lundal: We have to sort out from a strategy standpoint what we’re doing with health information exchange. We have a lot of different initiatives and technologies, but not a coherent strategy right now. We have some good things, but I need to know what technology and what programs we push, which ones we de-emphasize, which ones we talk to this group and use with this group, and which ones we use with other groups, etc. We need to close that out, and based on that, we have some implementation of technology to do in that space as well. We need to know how that feeds into a clinical data repository and into a data warehouse so that we can make sure all the analytics are fed properly. We need to take some good work we’ve done with telehealth and close that out and make sure we have a full rollout plan for population health, whether that be home monitoring or teleconsults or synchronous patient-doctor visits. We do need to make our decision around the number of patient databases we have between Epic and Meditech, so we have to do some planning around that. Those are the kinds of things that we have as priority.
Gamble: The whole decision as far as the number of patient databases, as we touched on a little bit before, is a very big decision, and it’s not one that can be rushed into especially when you said you’re talking about several different versions of Meditech, right?
Lundal: I think it’s one version, but six different databases.
Gamble: Okay. And then what about as far as patient engagement, what type of adoption are you seeing and are there multiple portals?
Lundal: Yeah. We’ve got a lot of multiple everything, but portals is one place where we have multiples. We have one with Meditech, we have one with Epic, and we also have one available — not rolled out — for our clinically-integrated network. That’s an example of, okay, how do we get one? And as we’re going at risk — with not just Presence but with many, many partners who will never be on one electronic medical record — how do we do that? Is it possible to create a place where you could interact with Presence in a broader context and through one portal? And so whether it be that physician partner that you go to as your primary care and that physician is in partnership with Presence through Presence Health Partners and in contracts to be at risk, is that something that we can offer? Or do we just narrow it down and say that for the Presence organization itself there is going to be one portal — how do we do that across the two and does it have to be connected with the electronic medical records or can that flow more off like, say, the clinical data repository? Patient engagement is a critical component for population health. We need to get that right, so there’s some strategy effort that will be taking place there.
Gamble: You talked about the clinical integration platform. What do you have in place? Is it something that can connect the different clinical systems like from different vendors, things like that?
Lundal: Yeah. We have a captured technology that can go out to physician practices and grab their data essentially and bring it back. We have a private HIE strategy with the technology in place that is acting as our clinical data repository that we our Epic and Meditech systems are feeding. So we do have the technology that we can go about that. We’ve also been an early supporter of the Metropolitan Chicago Health Commission’s Health Information Exchange, so we’d like to see how we can fit that in to the broader picture as well.