Most would agree that in order to be successful, CIOs need to have true partnerships with their vendors — where there is some dissent is what that actually entails. To Joey Sudomir, it means being providing constructive feedback while also being honest about what the organization can commit to. In this interview, he talks about his team’s strategy in rolling out Epic across the system, the population health partnership that could be a game-changer, and the principles that guide him in his role. Sudomir also discusses the challenge in knowing when to accelerate and when to brake — particularly when leading a large organization, and what qualities he values most in staff members.
- Ultimate goals as CIO
- IT & the “black box”
- Guiding principles: transparency collaboration & trust.”
- THR’s Epic plans — “We’ve got a lot of catching up to do.”
- Moving into more robust data centers
- “We needed to make a risk aversion play.”
- Importance of organizational support
- Making “non-emotional decisions”
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What we do in IT is very much a black box to people who aren’t in IT. And it’s our responsibility to present any new initiatives or spending requirements in the most robust manner possible. But the reality of the situation is many people don’t quite fully understood what we do.
As we’ve become more dependent upon technology, our risk portfolio in those data centers has grown, and so it finally reached the point where as an organization, we decided we needed to make a risk aversion play and move to more robust data centers.
We made it a non-emotional decision for both us and our leadership by basically saying, ‘Here’s a simulation if we had a single data center loss. Here’s a simulation if we had a dual data center loss. Here’s what insurance would cover. Here’s what we would be on the hook for financially.’ Then it just became a cost benefit analysis.
I’m not really inclined to chase things just to create work for IT or because industry trends say you should do something. Hopefully, what that’s done over time — even prior to me being in this role — is build up the credibility that when we approach our leadership about any type of initiative, we’re bringing that based on a real need.
Gamble: As some background, you’ve been in your current role since summer of 2015 but with the organization for quite a few years longer?
Sudomir: Correct. I just passed nine years in January.
Gamble: When you took over the CIO role at Texas Health Resources (THR), when you think about that time, what were the big projects you wanted to look at, or the primary goals you had in mind?
Sudomir: Obviously, being an internal candidate is a little bit different in terms of the viewpoint you step into the role with. My goals then and now really are the same, and they’re not so much project-focused. It’s about creating a service delivery organization within THR that is based on transparency and collaboration and trust. At the end of the day, what we do in IT is very much a black box to people who aren’t in IT. And it’s our responsibility to present any new initiatives or spending requirements in the most robust manner possible. But the reality of the situation is many people don’t quite fully understood what we do, and so much of the success in any organization comes down to trust between the leadership and the department and CIO who’s serving in that role.
For me, it’s very important to continue to earn that credibility within our organization, and I think being collaborative and very transparent in everything we do and everywhere we spend our money is really the foundation for that. Those will always be my high level goals for our department in my time in this role that aren’t specific to any project or initiative because those obviously come and go, but fundamental lasts forever.
Gamble: That’s a good point. When you think about projects, that’s really just a way of meeting those overall goals.
Sudomir: That’s correct. Every project or initiative is just another opportunity for us to prove that we’re living to those fundamentals that I mentioned. It’s like life — you’re always judged on your latest performance. And so it’s important that we don’t rest on our laurels over time and that we continue to view every new project or initiative as an opportunity to live up to that foundation.
Gamble: As far as the EHR, is Epic in place in all the hospitals at this point?
Sudomir: Yes, partially. We have the clinical portion of Epic installed at all of our wholly-owned hospitals and three of our managed joint venture hospitals. We have the clinical side installed at about 75 percent of our physician practices, but we actually have two major projects that are underway right now to accomplish a couple of goals.
On the inpatient side, we are in the process of migrating to Epic’s Revenue Cycle System and Patient Logistics System. Four of the hospitals that are currently on clinicals, depending on where they fit in the schedule over the next couple of years, they will be on Epic stem to stern. For our physician clinics, we are doing the same and rolling out the Epic Practice Management Suite and Billing Suite. And then the remaining 25 percent or so of clinics that aren’t on Epic HER are migrating to that.
By the end of 2019, which is when all our wholly-owned efforts complete on both those projects, our wholly-owned hospitals, those three joint ventures, and all of our physician practices, in effect, will be full deployed on it, both clinicals and financials.
Gamble: Obviously, that takes up a lot of time and resources, but you can see what the end goal is there.
Sudomir: Yes, a very big project. Candidly, we were very early adopters of Epic. We were one of the first to attest to Meaningful Use in the country when the program first started. What’s been ironic is, if you view us now, most people think of us as a big Epic shop — and we are on the clinical side, but the fact that we’re just moving to Epic Financials, whereas most organizations who have gone Epic in the last five years have done the so-called ‘big bang approach,’ means we’ve got a little bit of catching up to do from our Epic deployment.
Gamble: What was behind the rationale for doing it this way?
Sudomir: It was a combination of factors. On the inpatient side, our current system was acquired and the new vendor was intending to sunset that product, which was really just the catalyst we used for change. I think organizationally, we knew we needed to come to support what really the drivers are, and that is consumerism, convenience, and population health — moving all of that data away from disparate systems. And with all the magic we have to do to integrate and pull data out for analytics, we needed to streamline all of that in order to meet what really is the new paradigm of health care and consumerism in health care.
I would say the acquisition is what pushed us to make the leap, but we’ve known for quite some time it was a leap we needed to make, and we’re just trying to evaluate expending that money along the way versus other priorities in the health system; and so, the timing just turned out to be right now.
Gamble: With the hospitals migrate first to revenue cycle, do you plan to take some of the lessons learned and apply them to other rollouts?
Sudomir: Yes, absolutely. Having done a large clinical deployment starting 10 or 11 years ago, we checked those lessons learned around our enterprise-wide implementation. We’re utilizing the same best practices that we found from our clinical deployment. We have a very conservative early rollout schedule. We are actually taking the first hospital live on the revenue cycle system that we took live on our revenue cycle system 20 years ago. They’ve been a good partner for the financial implementation.
And then we’re definitely going into a settling-in period after that first hospital before we move on to our next hospital, which then will be one of our larger flagship institutions. We’re going to do that one by itself to make sure we give proper attention to the amount of revenue and patient volume that’s flowing through that entity. Then we’ll take another pause and some reflection time, and we’ll start on a little bit more of an aggressive rollout schedule towards the backend of the timeline.
Gamble: Okay, so certainly not a big bang.
Sudomir: No. And on the practice management side, we’ve got waves of clinics that are staggered between now and the end of 2018. The clinic side will actually be complete with the revenue cycle system and the remaining EHR migration by the end of next year.
Gamble: I imagine with those clinics there’s a decent variety as far as the size and type of clinic.
Sudomir: That’s correct — different clinic size, different number of physicians, different specialties. It will be the entire gamut of our physician practice portfolio.
Gamble: Now, as far as data management, I read about a data center migration. First, at what point is that right now?
Sudomir: We are essentially in month two of what is a one calendar-year project. Although we started signing in 2016, execution really began January 1. Our goal and expectation is that we’ll be about 95 percent complete with that migration by the end of the year.
Gamble: What have been some of the challenges in doing this type of project?
Sudomir: The first challenge, obviously, is that resources are finite — both financial and human capital. This has been many years in the evaluation and discussion stage of our executive leadership. As a little bit of background, our ‘data centers’ today basically have been in the basements of our two largest hospitals, and we’ve known for some time that’s not an optimal situation. As we’ve become more dependent upon technology, our risk portfolio in those data centers has grown, and so it finally reached the point where as an organization, we decided we needed to make a risk aversion play and move to more robust data centers. Getting over that hump and collaborating with leadership to ensure the amount of risk matched the value of commitment we had to make financially as an organization was probably one of the first hurdles.
Within the execution this year, I think the biggest two hurdles are planning appropriately and really managing all the pieces of the puzzle and the timing, especially amidst everything else we have going on. Just in the three projects we’ve talked about, that’s a great deal of organizational change happening at one time. And so, the data center execution and the timing of each move and getting that 95 percent completion goal this year is really critical to the ongoing success of the other projects I mentioned, plus others we haven’t talked about.
Gamble: Right. As far is pushing it forward, was it a challenge to justify it and push it through to the final level?
Sudomir: No. Our organization has always been very supportive of IT and I think our responsibility along that multi-year setup journey has been determining how best to quantify the risk. It’s difficult to help people to understand the potential risk of what if. We’ve got probably one of the best chief information security officers in the industry and he’s very adept at quantifying risk and playing out game theory type scenarios, which is what we did this year. We made it a non-emotional decision for both us and our leadership by basically saying, ‘Here’s a simulation if we had a single data center loss. Here’s a simulation if we had a dual data center loss. Here’s what insurance would cover. Here’s what we would be on the hook for financially.’ Then it just became a cost benefit analysis.
I’m incredibly grateful for the support Texas Health Resources non-IT executives have always given IT. This multi-year journey of building up to determining the right timing and when that risk level surpasses cost has been an enjoyable journey.
Gamble: Right, and it goes along with what you were talking about as far as transparency and communication.
Sudomir: I would agree. I’m not really inclined to chase things just to create work for IT or because industry trends say you should do something. Hopefully, what that’s done over time — even prior to me being in this role — is build up the credibility that when we approach our leadership about any type of initiative, we’re bringing that based on a real need.
Ultimately, I tried very hard to make things non-emotional, certainly not personal so that any decision becomes, ‘these are the positives and outcomes of option A and these are the positives and outcomes of option B,’ and we just need to weigh that against every other thing we need to do to advance our organization.