If Chuck Christian had one message for CIOs, it’s this: get out of your office. The 2015 CHIME Board of Trustees Chair, who is also VP and of Technology and Engagement at the Indiana Health Information Exchange, believes the best way for leaders to truly understand what the organization needs is by getting out and talking to end users. In fact, he preaches a method called Management By Wandering Around (MBWA) when teaching CHIME Boot Camp. And as health systems continue to expand, it’s become more critical than ever for CIOs to be out in the field. Christian discusses his philosophies in this interview, along with CHIME’s new vision statement, why the “O” in CIO should stand for optimism, and why today’s leaders must be willing to “walk into the storm.”
- New CHIME vision statement — “Healthcare is changing, and so our role had to change.”
- Emulating Wayne Gretzky
- Getting docs the right data at the right time
- CIO 3.0: “Running the servers is not a core competency.”
- Management By Wandering Around
- “You have to be willing to walk into the storm.”
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We found that it’s been very helpful to the folks in Washington, D.C., to listen to the people who are actually having to implement the regulations. We found that they’re very much willing to listen. So we wanted to craft a vision statement and mission statement that is far more fitting to what the organization really is.
We’re not just talking about what the next network is going to look like or if we need wireless and that kind of stuff. We’re in the boardroom talking about business. How do we leverage the technology to have a positive impact upon the organization?
If you find somebody that has a great best practice, take it and use it. There’s no reason for us to keep paving the same roads in different counties that others have done and done well. Let’s learn from what they’ve done.
Running the servers, as far as I’m concerned, is not a core competency that the CIO has to have. He needs to have the management skills and the wherewithal and the knowledge to understand the business implications of that.
Building those relationships is an extremely powerful thing, because once you can build that rapport with those folks and you’re a known entity to them, you’re just not this person that they see at the boardrooms or happen to run across in the physicians’ lounge. If they know who you are and they’ve had some time to have a conversation with you, they will bring issues to you.
Gamble: One of the things I wanted to talk about was the new vision statement for CHIME. First of all, what was the motivation for changing it?
Christian: The vision statement we had had been around for a while. The organization is changing because health care is changing. And so our role, in order to provide the services we need to the membership, had to change. We felt like we needed to have a little bit different vision statement that spoke more about what we’re currently doing with education — not only for the CIOs but just the industry in general, because we have such a bigger part in advocacy now than we ever had before.
I came on board back in 2002. Our role in advocacy was very, very small at that point in time. Over the last several years, we’ve ramped it up a little bit. We found that it’s been very helpful to the folks in Washington, D.C., to listen to the people who are actually having to implement the regulations that are pouring out of the hill. We found that they’re very much willing to listen. So we wanted to craft a vision statement and mission statement that is far more fitting to what the organization really is.
If you look back a couple of years ago, this organization is very much different than it was before. We’re still focused on our membership. We’ll never take our focus off the membership. I’m the one that waves that flag a lot because we are a membership organization. It’s like I said yesterday morning, everything we do we always check against that list. Is this something that our members are going to benefit from, and what’s the next thing that we’re going to be looking at and worried about with this next iteration of either regulatory or reimbursement rules that are going to be carried out?
Gamble: I can’t imagine it’s that tough to get pretty good honest feedback from the members if they’re not getting enough of something.
Christian: The really interesting thing is we have over 1,700 members, but it’s like everything else. Trying to get everybody to participate is not going to happen because some people join the organization because they want access to the information; to that stream of consciousness that’s coming out from those. Then you’re going to have the thought leaders that are going to be willing to offer an opinion even when it’s not asked for. And so there’s a variety. I’m sure you could bell-curve the membership interaction. I’ve gotten emails from some folks while I’m here about what they like, what they don’t like, and I’ve have some meaningful conversations in the hallway. They’re very willing to offer an opinion. The other nice thing is many of us have been in the organization from the very beginning and these are friendships we’ve had for years. Friends tell friends things that they won’t tell anybody else. So we take it in confidence and just go on.
Gamble: What about the overall mood of the show. Are there any themes that you see coming up a lot? It seems like there’s just a good bit of optimism, which is nice, but I guess that’s all that relative.
Christian: The O in CIO sometimes I think has to be for optimism, because if you’re not optimistic, there’s nowhere that you can look into the future of where we have to look. It’s like Wayne Gretzky. We’re not trying to skate to where the puck is; we’re going to try go where the puck’s going to be. And the regulators are moving the goal, so we have to figure out where that’s going to be so we can skate to that. Sometimes we guess well, sometimes we don’t.
I use the word ‘guess,’ but it’s an informed opinion. It’s not that we’re seeing a light at the end of the tunnel. It’s that many of us in the industry have advocated for the use of health information technology to have a very positive impact upon patient care and the delivery of care in the healthcare delivery system as a whole. And I think now we’re seeing that as professionals, we’re not just talking about what the next network is going to look like or if we need wireless and that kind of stuff. We’re in the boardroom talking about business. How do we leverage the technology to have a positive impact upon the organization? How do we help it meet the demands of these new reimbursement models like ACOs or other at-risk programs? And the other thing is how do we use the data that we’re collecting in these EMRs that we’ve spend so much time and money on, and to actually do the analysis on it so we can have an impact upon population health and other things that are coming down the pike.
I think that as we continue to go through this iterative process, we’re going to learn more about how we can engage the patients at another level and get them more involved in their care and provide the tools that they need. It’s kind of like, ‘I’m going to tell you that you need this tool — you may not know you need it, but here’s how it’s going to help you, particularly, if you have COPD or you have congestive failure, diabetes, or some other chronic malady. You’re not in this alone; with mobile apps, I can put your caregivers as far away as the palm of your hand. The other thing with some of the new remote monitoring technologies is that it’s not about the technology; it’s how do we create those connections and relationships to help them better manage what they’re going through at that point in time?
Gamble: It’s really interesting seeing the next wave.
Christian: In conferences like this, we’re doing track sessions right now and we did track sessions yesterday, then we’ll do some repeats. We have the CPI Institute, where we have some best practices where we’re able to put educational material out that are real honest-to-goodness real-world white papers and studies of people in their organizations along with their vendors have been successful. I’m getting that out there and see if we can share that knowledge of what they’ve done, because if you go back and look at the Baldrige Criteria, one of the things they do tell you is to steal shamelessly. If you find somebody that has a great best practice, take it and use it. There’s no reason for us to keep paving the same roads in different counties that others have done and done well. Let’s learn from what they’ve done.
We already have a great lag in medicine. From the time good medical evidence occurs, it takes 17 years for that to actually wind up in the physician’s office. Guess what? It’s just too long. We can’t wait that long; the volume of medical knowledge is growing at such a quick a pace. I read a stat that if a physician read a peer-reviewed article each night for one night, in about three months, he’d be 400 years behind.
Gamble: Wow. That’s overwhelming.
Christian: Yeah, it’s terrible. You can’t keep up the way that we used to. When I started in health care 40-something years ago, that’s how you did it; but there are some really good tools and techniques that are coming out there that can help. I’m not suggesting that we replace physicians, but we augment their ability to treat their patients.
The whole thing with genomics and proteomics is that I think we all know now based upon the readings and the publications, is that if you have prostate cancer, it may not be the same kind genetically that somebody else has. That’s where a lot of the treatments that oncology is predicated upon statistics — ‘here’s the probability this treatment is going to be good for you.’ Let’s see if we can do better than that. Let’s come up with the tools and the techniques to say, ‘Okay, based upon your genome, other people that have genomes like you do better with this treatment than that one.’ For me, that increases my probability of successful treatment. Those are the things we need to do, but to sequence everybody’s genes is expensive and, man, it’s a mass of data.
I was talking to a gentleman at a research hospital and they were trying to do a better job with security and they were moving things over. They had one researcher that had 4 petabytes of genomic data that he needed stored safely, and I guess he just assumed that the hospital was just going to take it and drop it in their new data center. Well, storing that much data is not cheap. It has to be backed up. It has to be recoverable, and it adds to the cost of that. And so I think that the volume of data that we’re going to generate over time is going to get really much larger than it is right now.
The other issue is how do we address that? How do we deal with it? I work for the Indiana Health Information Exchange now, and we have about 30 years of clinical data in our warehouse that we’ve been building over this time. It came out of research and came out of the Regenstrief Institute and now it’s moved over to us and we’ve actually commercialized it. It’s not that they had a bad code; it’s that when you are writing code, to do research and that kind of stuff, you’re not as careful with it as if you would if you were going to commercialize it. What we’ve done is we’ve hardened the code. And we’re servicing the same population we always had. but it’s a little different. If you test it, it doesn’t break, because we want it there all the time.
One of the things that physicians will tell us is that it’s not enough to present them with a mass of data over a course of a lifetime of a patient. They need to have that back in their quiver, but they’re looking more for arrows. And I’ll use this as an example. If in they’re in the emergency room and they’ve walked through the door because they’re having chest pain, you really don’t care if they had a broken leg three years ago. You want to know what other related symptomatology they have. Have they had an echo done? What was their last injection fraction? What medications related to cardiac are they doing? Are they diabetic? Those types of things.
Being able to reach in and get that data and bring it to them upfront so it percolates to the top of the pile, is going to be really important, because they just truly don’t have time to wade through that and go hunt this stuff. That last echo may have been three years ago. Well, they don’t have time to wade through the record and go look for it. You would think it’s just as easy as going and looking in cardiology echo studies and there you go. That’s not really how the data is always stored. It could be under imaging. It depends on which facility you had it in because echo in some areas are in cardiology; in other areas they’re in imaging, or they may be in cardiovascular. It’s named differently. We have to normalize that data and put it out there.
Gamble: Just a little task.
Christian: Just a little bit, absolutely.
Gamble: The last thing I wanted to touch on is that I definitely see some of the emphasis here on the CIO role and how that’s evolving. That’s always an interesting thing. One of the sessions yesterday focused on the need for CIOs to really be collaborating with other members of the C-Suite team. And I know that that’s not a new message, but maybe it’s something that seems to be even more important now.
Christian: That’s the evolution of CHIME and the evolution of the CIO. One of the things we’re doing in the LEAD forums is CIO 3.0, which started out with CIO back in the late to middle 90s advocating for the role of the CIO within the organization, because the role of the CIO was mostly keep the bits and bytes flowing through the network. CIO 2.0 was get yourself out of the IT shop and elevate yourself as a business person, and 3.0 even says that more so, because running the servers, as far as I’m concerned, is not a core competency that the CIO has to have. He needs to have the management skills and the wherewithal and the knowledge to understand the business implications of that, and making sure that they’re backed up and they’re secure and those types of things, but he or she has staff to do that that are highly competent, and they very well should have more skills than the CIO in those technical areas. That’s what they do. The CIO should be more of a business partner working with the other operational pieces in the organization; working with the CNO, the CMO, and the CMIO on this thing called clinical transformation. How do we apply the technology to improve care without creating an undue data entry burden on the physicians or the nursing staff? How do we do that? These are process reengineering type of things.
It’s not implementing software. You have PMOs and others who are very good that are credentialed in project management. They need to know enough about oversight and how to manage those processes and understand what the implications financially are of the organization. They need to be working with the CFO on ‘this is how much this is going to cost. Help me figure out through the value that we bring back in the organization how do we make these things pay for themselves, or actually, maybe even if we’re lucky, cut enough cost that we actually add to the bottom line rather than just continue to spend money, because these things are not cheap. The acquisition cost on the technology is only the tip of the iceberg because then you have to buy it again over the course of the next five to six years.
When we did Boot Camp , I asked for a show of hands among the folks in the audience — many of these were sitting CIOs and others are aspiring to be CIOs — I asked, ‘how often do you get out of your office and go into your physician practices that I know everyone in your organizations are purchasing?’ It was a few. I said, ‘I will tell you from a personal experience, get yourself up and get out in their practices, and make sure three people see you when you walk in the door: the business practice manager, the physician’s nurse, and the doc. If you build a relationship with the business practice manager, she will make sure you see the other two, and she will make sure they know you’re there.’
I said, ‘If you don’t believe that just your presence in their practice is powerful, go try it, because they do not typically see someone from the executive team in their practice and with no agenda whatsoever. Just say, ‘I want to come over and see how things are going? How can I help you? We’ve got a couple of things that at some point in time I want to sit down and talk about.’ And who in the practice has more time to have that conversation than the doctor or nurse, unless they’re down for whatever reason — maybe it’s their afternoon to do charts or whatever.
Building those relationships is an extremely powerful thing, because once you can build that rapport with those folks and you’re a known entity to them, you’re just not this person that they see at the boardrooms or happen to run across in the physicians’ lounge. If they know who you are and they’ve had some time to have a conversation with you, the really nice thing is they will bring issues to you and help you fix things. That’s where the collaboration comes in — how do we do this together? I don’t think that just because we may have a CMIO in the building, it’s not that we will say, ‘Okay, we’ll delegate this authority to you and I’ll go do something else.’ I don’t think that’s the way. There’s a partnership that has to be created to get stuff accomplished.
A lot of CIOs don’t necessarily have a lens and a body of experience to understand when somebody’s talking to them, what do they mean? It takes a little while to learn how to actively listen; to listen carefully about what they’re saying and what they’re not saying, rather than trying to formulate a response. There are techniques that we, as CIOs, really need to learn in order to actively listen. I don’t care if somebody’s mad; actively listen. Unless they’re going to ball up their fist and hit you, which they won’t, you need to actively listen to what they’re telling you.
Because I’ve learned over the course of years that even physicians who are very angry because something has happened that they believe that has incurred liability for them or impacted their workflows — if you listen very carefully, they’ll give you the answer. Somewhere in that stream of consciousness that is emanating from their mouth, they’re going to give you the answer. What you have to do is be smart enough to listen for it and not take what they’re saying personally even though they may be personal. Listen to what they’re saying.
I had two physicians that I’ve dealt with, one was an ER physician and the other one was a cardiologist. It always felt like I was like going in a movie when the movie has already started. That conversation started with them in their head 45 minutes before I showed up, then the dam busted and I got it. I’ve created two really good friends because I just sit and listen to them. And I’ve said to them, ‘Okay, here’s what I hear you say, and here’s what I’m hearing you think we can do to accomplish this,’ and they started to believe I was willing to listen to them.
We didn’t always agree, but one of them, the ER physician, became a good enough friend that we agreed we could say anything to each other we wanted to — good, bad, and indifferent — and when we got up, we were still friends. It’s an extremely powerful thing to not have to be guarded in what you say. Because you know that politically, the other one doesn’t care, but if we get into a situation then we’re going to have each other’s back, we’re going to tell you. Building those relationships, I think, is absolutely the key.
The other thing is getting out and doing what I call MBWA, which is Management by Wandering Around, which means get out into the organizations and go to the nursing aides. Go to the OR, go to the ER. When I was at Good Samaritan, I’d work shifts in the emergency room. I’m an old x-ray tech, so I like the clinical setting — you can’t make me sick, and I’m not squeamish. But I also understand that that’s where not only good quality care takes place, but the compassion for the person also occurs.
We have a tendency sometimes to forget in health care that this disease or this malady actually has a person attached to it. I think we have to be reminded that health care is not about fixing people when they’re broken. It’s about taking care of them as a whole. I think we need to be reminded of that. And the fact that CIOs live in this world of technology, the more of an aspect of a business leader that they can take on, the more valuable they’re going to be their organization and to themselves.
Gamble: That’s really interesting. I like what you said about the physicians. I remember talking to a CIO pretty recently, David Bensema, and said that because he was coming in as an MD, he didn’t think it was going to be so rough. I think he underestimated what it would be like, because the physicians just really were very, very honest.
Christian: Right. He went to the dark side.
Gamble: Yeah, but he had said to them after he listened to them, things started to change because a little bit of trust had been built.
Christian: I had one physician in Columbus, a long-time physician who had a great practice. I wound up having to be the CPOE police because it was ‘you do it.’ So I had to tell the physicians. And the medical staff had put a new policy in place if you’re not at this level, you’re going to lose your privileges at this hospital. Well, he found some technical issues with the policy — it was put in place before I got there. I heard through the grapevine that Glenn had put together a PowerPoint presentation to illustrate all the errors in that judgment. And rather than focus upon the medical staff exec committee, he focused on me, because I was policeman. I heard about it so I went down one day at lunch and sat down with him. I said, ‘Glenn, I understand that you found some things that you need to share about the policy.’ I said, ‘Keep in mind, I didn’t write it. Your peers did, but I’d like to know what these are.’ So he pulled out his iPad and went through his presentation. We walked through every point and I saw exactly what he was talking about. From a physician standpoint, from that side of the street, yeah, I absolutely agreed. It was written in a way that it could be very punitive, and so, I said, ‘I’ll tell you what. If you want to bring this up with the med execs, which is going to meet this evening,’ I said, ‘I’ll support you in your request.’ Med exec came, and he never mentioned it. He was ready. He was loaded. But he never mentioned it. I said, ‘Glenn, I thought we were going to talk about it.’ He said, ‘I’ve already talked to the chair. He’ll fix it.’
And so I guess you have to be present and willing to walk into the storm. You have to do that, and sometimes it’s going to be like a hurricane — you’re going to have all the limbs off your tree ripped off. But they grow back, and you just go on. But I think in doing that, you build a level of respect with the physicians that you’re just not a stuffed shirt that’s just about implementing technology and forcing everybody to do it, but you’re truly interested in what the impact is going to be on how they get work done and how well they take care of their patients.
Gamble: Good stuff.
Gamble: Thank you very much.