David Bensema, MD, CIO, Baptist Health, Chapter 3

As an internal medicine physician, one of the most important lessons David Bensema learned was that if he was going truly engage with a patient, he first needed to establish trust. As CIO, he employs that same strategy to engage with physicians — something that doesn’t always come easy, even for an MD. In this interview, Bensema talks about what has surprised him most during his first year as CIO; the tough part when it comes to creating a task force of the “best and brightest”; and the strategy his team is using to roll out Epic across 7 hospitals. He also discusses why he doesn’t like the word ‘optimization,’ how he keeps the end user’s needs as top priority, and the one thing that needs to change when it comes to CIOs and project planning.

Chapter 1

Chapter 2

Chapter 3

• Physician engagement
• “We don’t get relationships sitting in offices. You have to get out.”
• Lessons learned in change management
• Biggest surprises about becoming a CIO
• Anticipatory staffing — “It’s not a sustainable model.”
• Learning project management as an executive medical director
• Coming to Baptist in 2001 — “I knew I’d found home.”

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Bold Statements

They’re not upset really with you — they’re upset with change. They’re upset with the disruption they’re seeing in multiple levels in their practices. And you have to just let them go through it.

Their concern for patient safety and the quality of care that our patients experience I would say rivals that of anyone at the bedside. I am just overwhelmed by the commitment of the staff.

Anticipatory staffing is lacking in the IT world. We just keep getting projects thrown in without increment in staff. That’s not a sustainable model.

Just because you found the perfect practice to acquire or just because you found the perfect site to put some people, doesn’t mean you’re there. Negotiating the lease is just the beginning.

On my first day, I said, ‘You all have to understand, I’m a kindergartener. I don’t know much. Please teach me. Every day, teach me.  If you start to use a term assume I don’t know what it means.’

Gamble:  With the work you did with physician engagement, was there anything that kind of sticks out to you that could be helpful to CIOs just as far as maybe some of the lessons you learned or just any takeaways from that as far as just what it took to get through that change management piece with physicians.

Bensema:  I go right back to being an internal medicine physician and when I walked in a room with a new patient I knew what the priority was. It was that patient; developing a relationship of trust was the priority to make sure that patient was well taken care of. It’s the same with my physician colleagues. To engage the physicians you need a relationship, and we don’t get relationship sitting in offices. In a system like ours, I don’t get a relationship sitting in Louisville at the headquarters. You’ve got to get out, and that’s really hard.

To your point about CIOs having a lot on their plate, it is really hard, but if you don’t make that effort, they’re not going to assume it’s that important. So I get around to the physician staff meetings. I get around out on the floors. I make sure that people know me face-to-face if they want to chew on me, because my physician colleagues do when you go out and you represent IT. My wife’s a practicing pathologist and she said when I went into administrative roles, I went to the dark side. You’ve heard that one before. But when I went to IT, I went to black ops. And she’s representative of my physician colleagues. They’re not that trusting of the IT efforts, and so you’ve got to have relationships, remain cordial, and understand that they’re not upset really with you — they’re upset with change. They’re upset with the disruption they’re seeing in multiple levels in their practices. And you have to just let them go through it, and then when they see that you stand in and you’ve stood through whatever they want to throw at you, then they begin to trust you for answers and they come looking for answers. My job is much easier now than it was nine months ago, just because of the number of relationships I’ve been able to develop.

Gamble:  That’s interesting. I’m sure that even though there’s some level of added credibility for your background, it wasn’t necessarily an instant sell.

Bensema:  No. I’ve been called some pretty impressive names standing in front of groups of even 100 physicians, and so if a physician colleague doesn’t have qualms about calling me something, then I’m sure my CIO colleagues are hearing some worse things if they don’t have that MD after their name. And, again, you just you tolerate it and you know it’s not you. My wife who is also brilliant and much smarter than me says to me all the time, ‘it’s business, it’s not personal. Blame the government.’ Those three things will get you through a lot.

Gamble:  Yeah. So certainly there have been challenges stepping into the CIO role, but what has really kind of stood out to you? Is there anything that surprised you about it?

Bensema:  One thing was a very, very pleasant surprise — and it shouldn’t have been, but it was a surprise to me, and so it’s something I try to tell everyone about — was the level of commitment and caring of the IT staff. Their concern for patient safety and the quality of care that our patients experience I would say rivals that of anyone at the bedside. I am just overwhelmed by the commitment of the staff, so that was a very pleasant surprise.

On the unpleasant side, how unnecessarily arcane and complex some of the products are. I would broad brush it enough to say that all of them are arcane and complex, unnecessarily, to some degree. We’ll say it because you can’t have an interview without saying ‘interoperability,’ but interoperability stinks. And I think that was a surprise. The lack of interoperability, even within some of the systems and some of the products, is amazing. Epic is much nicer that way in terms of interoperability with itself, and really even in transmitting outside and receiving from outside, but there’s still effort in that transmission and receipt. More effort than I think is necessary and long-term appropriate for the care of our patients across the country. You’re hearing that from Congress now. You’re hearing it from everyone else. I think CMS and Congress have to look in the mirror and say, ‘Can we really be surprised that we didn’t get interoperability when we paid for everything but?’ They set measures that had nothing to do with interoperability. So you get what you pay for. People were focusing on Meaningful Use.

And the last surprise on the roll is how granular the involvement of IT is in every aspect of the patient care experience and in every aspect of running hospitals and clinics. There’s not a project that goes on that doesn’t need a pass by IT before it goes forward. We’d like to get in earlier on that. I think every CIO would like to be in on the planning stages earlier so they can anticipate need and help people to budget in for the necessary IT lift. You have an IT department of X number of people that has capacity for X number of projects. You usually budget for what you’re currently doing. We’ve got to get the vision to start budgeting for what we need to do, what we’ll need for growth. Anticipatory staffing is always hard, because you don’t want to spend money ahead of time, but anticipatory staffing is lacking in the IT world. We just keep getting projects thrown in without increment in staff. That’s not a sustainable model. And it’s no different than my physician colleagues getting more and more documentation and other requirements thrown on a regulatory requirements. Healthcare is going to find itself in a real pinch if we don’t solve that anticipatory process.

Gamble:  Right. Another thing I wanted to ask about was the experience you had in the executive medical director role in setting up practices and developing clinics, and how that has shaped your role, because I would think that’s an interesting thing to have experience with.

Bensema:  I think two things. One is it taught me a lot of project management skills. It also taught me to really respect the professionals in project management. I’m very open to and appreciative of those folks who have those skills. So I think that’s one thing that came from it.

The other is from an IT standpoint, it helps me to understand again just how granular the involvement of IT is. When I first started putting together practices, I can remember putting together a building in 2007. We built an 11,000-square-foot, two-story, two-elevator building in 92 days from a break ground to being in the building. In that time, of course, we expected IT to do all of the data drops, to do all the phone lines, to make sure we were up and running with our printer network and wireless, and that all of it worked flawlessly on day one. That’s ridiculous. I now know that. What I did to people was just abusive. But I wouldn’t have that depth of understanding if I hadn’t been through it and been the one with the unrealistic expectations and demands.

So now I know how to look at those projects and explain to those who are coming forward with them why a different timeline is more doable, more approachable, and more appropriate, and also to get with my executive colleagues and help them to understand why advance notice is so important. Just because you found the perfect practice to acquire or just because you found the perfect site to put some people, doesn’t mean you’re there. Negotiating the lease is just the beginning. I think a lot of times executives don’t really have that insight or that feedback, and I can provide it with some credibility because of all the sites I’ve put together.

Gamble:  Right. That’s really interesting. You and I had talked a little bit offline about the different paths people take to the CIO role. With your path being a physician and then the medical director experience, you have that that where some CIOs are lacking, but I would imagine there were some aspects that when you did take on the CIO role you had to lean on people a little more for other areas of expertise that maybe you didn’t have the strongest background in.

Bensema:  Yeah. I still have to lean very heavily on my team for technical aspects. I understand what my interface analysts do, but I couldn’t create an interface. I recognize my shortcomings and in fact I told my executive team — I have my three executive directors, Tricia Julian, Mike Brown, and Michael Erickson, who’s executive director of infrastructure and security. I told them on my first day, I said, ‘You all have to understand, I’m a kindergartener. I’m a smart kindergartner, but I’m a kindergartner. I don’t know much. Please teach me. Every day, teach me.  If you start to use a term assume I don’t know what it means.’ And they’ve been wonderful about that. On April 24, I went into our meeting with them and I said, ‘today’s my first anniversary. I’ve now matriculated. I’m a first grader.’ I still don’t know a whole lot. I still need to be taught, and I’m still willing to learn, and I think that’s really a pretty apt analogy of where I am. I am just a first grader when it comes to being a technical CIO. I think I have other skill sets, but from the technical aspect I learn every single day.

Gamble:  Would you do it all over again?

Bensema:  Absolutely.  I am helping our system move to a brighter future. I originally took the CMIO role to help my physician colleagues work through the requirements of Meaningful Use and come out of that as unscathed as possible and help the system achieve it. And then when I was asked to add CIO, by then I already knew about Epic; I knew that we were going to be putting it in, and I wanted to get our system to that point. I wanted to help Baptist Health get to where I know it can be in terms of being an integrated system. It’s always been a tremendous place. It’s always been a great place to take care of patients, whether it’s our hospitals in Louisville, Paducah, Lexington, Corbin, La Grange, our new additions in Richmond and Madisonville. It’s a tremendous place. My wife started working here right out of her pathology residency, and I spent the first 11 years in my practice with my wife saying, ‘I work at a great hospital, how about you?’ And in 2001 this Baptist wannabe became a Baptist physician, practicing for five years as an internal medicine private physician, and the day I started working in Baptist Health Lexington, I knew I’d found home.

Gamble:  That’s great. That’s what it all comes down to is feeling like you’re at the right place and it’s a good thing you do feel that way because you couldn’t have picked a busier time to get into this industry.

Bensema:  It’s a busy time. I’m blessed to be of use. I tell people that I may be totally crazy, but I enter every situation in every room assuming that I can do something to help. I think that comes from being a physician. You walk into a lot of hopeless situations if all you’re looking for is to completely solve it, but if you’re looking to help, you can always help.

Gamble:  That’s a great perspective. Well I’m sure I could talk to you a lot more, but I think that that’s all I wanted to cover for now.  I’d certainly like to check back with you down the road to see how everything’s going.

Bensema:  Absolutely. I’ll talk to you again.

Gamble:  Okay, great. I really appreciate your time. Thanks so much, and I think that these insights are going to be really beneficial for our readers.

Bensema:  Kate, thank you so much. Appreciate the chance and look forward to talking to you in the future.

Gamble:  Alright, that sounds great. Thank you so much.