When University of Vermont Medical Center brought Adam Buckley on board in 2012, it was because they believed his focus wouldn’t be on what technology could do, but rather, how it could improve patient care. They were right. Two years later, he was named CIO of the medical center (and eventually the health network, when it was formed), and Buckley’s attention is still on how IS can be leveraged to provide better care.
In this interview, he talks about how being a rural organization affects his strategy, what it took to sell Epic to the board (and get through the state’s red tape), and his team’s plans for becoming an integrated system. Buckley also discusses the need to leverage the experience of others, why he refuses to believe that a CIO needs to be “a CISO and CTO rolled into one,” and what it was like to go from the hustle and bustle of NYC to cow country.
- Having other CIOs on call
- “Leveraging expertise is critical to anyone’s success”
- 5-year plan with annual updates
- The upside of having limited resources: “We’ve gotten much better at saying no.”
- Prioritization & the “continued struggle”
- Clinician burnout — “We’re the bearer of bad news.”
- From NYC to Vermont: “There’s a lot to love.”
You need to have a very open-minded approach about seeking expertise, finding best practices, and leveraging knowledge wherever you can get it, because no one can know it all in this space.
We still have a ways to go. The organization still struggles with limited capacity, and so there’s always a natural tension point that exists. That being said, there’s good buy-in at all levels of the organization.
IS tries not to say no or yes. We try to make sure it’s leadership saying no or yes. And we’re trying to get them to buy in to what we’ve prioritized.
The sheer volume of change that’s being asked of physicians has had nothing to do with either internal leadership or IS, and yet, we’re the bearer of the bad news.
Gamble: What we’ve seen in the past few years is that there are so many different paths to the CIO role, which makes it even more important that CIOs reach out to each other to share best practices. Is that something you do?
Buckley: Absolutely. Today, IS literally touches every piece of care. From RFID on medical carts to dispense blood products, to the way we communicate, there is literally nothing that isn’t touched by IS. And so you need to have a very open-minded approach about seeking expertise, finding best practices, and leveraging knowledge wherever you can get it, because no one can know it all in this space. I don’t think it’s any different than a CEO needing a CFO and a COO. Even though that’s different in terms of the realms of the things they need to understand. Leveraging expertise is critical to anyone’s success, and so I make no compunction about finding it and using it.
To your point, there are quite a few CIOs I text with on a regular basis to bounce things off of, along with friends in other realms of healthcare leadership. I’m often in meetings on the operations end or the finance end, and so it’s important for me to be able to leverage expertise beyond IS.
Gamble: Along those lines, one of the key aspects of the CIO role is to make sure what IT is doing aligns with the organization’s overall strategy. What has been your approach to this?
Buckley: I really believe in strategic management. I’ve been fortunate enough to join an organization that takes the formalization of organizational strategy very seriously. We have a five-year framework that I helped build three years ago, and we do an annual refresh. The health network strategy informs the affiliate strategy, which then informs the tactical side. We’ve had two IS network strategic retreats, and we’ll have another where we take the strategies established by the health network and affiliate, and use that to inform the areas that IS will focus on. That’s at a larger level.
From a project-based perspective, we’ve done a lot of work specifically at UVM Medical Center, which has a much larger project queue because of its resource pool. The other affiliates are leaner and tend to focus mostly on keeping the lights on. And so we’ve asked UVM Medical Center to make sure any project-based work links to an organizational and network strategy, and that has reduced the number of project requests dramatically.
We do that for a very specific reason. We did with tracking hours and efforts to be able to determine what our capacity is for project-based work, and we need to manage that as a precious resource. We need to make sure any project that requires significant resources in terms of hours or financial outlay is tied to our strategy. And we’ve done that by making sure the overall IS strategy generally adheres to health network and affiliate strategies, and that all business plans that are approved at the IT governance level are linked to a network strategy as well.
We’ve really tried to carry that theme throughout all the work we do that’s not regulatory-related or doesn’t involve keeping the lights on. We still have a ways to go. The organization still struggles with limited capacity, and so there’s always a natural tension point that exists. That being said, there’s good buy-in at all levels of the organization of the idea that linkage to strategies is non-negotiable.
Gamble: Right. Another issue is prioritization, which I can imagine is a challenge. You have this big Epic project that uses a lot of resources, but it’s by no means the only project.
Buckley: I would say that in terms of maturity, that’s an area where we’re still really struggling. We’ve gotten much better at saying no — and by ‘us,’ I mean the organization. Because from my perspective, IS only tries to say ‘no’ if it’s a security issue or it’s a technology we can’t support. But for the most part, IS tries not to say no or yes. We try to make sure it’s leadership saying no or yes. And we’re trying to get them to buy in to what we’ve prioritized. Our queue has outstripped our capacity, and we’ve been working for the last few months to get them to refresh the queue.
I think the Epic project is helping bring some pressure to bear because they recognize that once the CON (Certified of Need) is approved, the work will most likely stop, other than regulatory and keep-the-lights-on activities. With our capacity, we know that for three years, nothing else will get done unless it’s a new rule from CMS or regular updates from our vendors. So yes, it’s going to be a challenge. Prioritization has been a continued struggle for us.
Gamble: And of course there’s the burnout factor, both with IS and clinicians, which needs to be taken into account.
Buckley: Yes. That’s another area where we’ve done a lot of benchmarking with staffing. They understand that we’re pretty lean across all the affiliates and we have limited capacity, but I think there’s a struggle between want versus need.
It’s been tough. Where we did risk some burnout and we were able to move the needle in terms of enhancing capacity was on the infrastructure side. Our desktop support and engineering teams were really burning the midnight oil, and that led to a change in our infrastructure staffing in the last 18 months. It was because of the capacity work we had done to demonstrate that risk.
On the physician side, the point of change saturation occurred for them years ago. Unfortunately, what often happens is that IS or leadership are blamed for the changes that have occurred in their roles. And so we worked with the Green Mountain Care Board to inform them that a lot of the significant changes we’ve asked of physicians — at least half, if not two-thirds — have been driven by federal regulations. It’s not IS deciding one day to start measuring specific quality indicators out of the EHR. It’s the federal government, the state government, or CMS deciding they want us to start doing 20 new quality measurements, which requires a new build and different inputting. The sheer volume of change that’s being asked of physicians has had nothing to do with either internal leadership or IS, and yet, we’re the bearer of the bad news.
The classic example is the Joint Commission’s Two-Midnight rule. That was a major disruptor. We had about 30 days to produce. Everyone was like, ‘we have to do what?!’ So I don’t blame them for reaching that saturation point of change, but it’s a challenge that we’re not the ones driving it — nor is the organization, more often than not.
Gamble: That’s definitely a tough spot. Now, the last thing I wanted to talk about was the adjustment you and your family made in moving from New York City to Vermont. That’s a big change.
Buckley: It definitely was, but I grew up in a small town in Massachusetts and I went to college in a small town in New York State, so I’ve certainly done small towns. And it’s great to be in a college town. We have UVM here, as well as a few other colleges, including Saint Michael’s College and Champlain College. So it has nice vibe to it. But we’re still a little freaked out that there are more cows than people.
Gamble: I’m sure.
Buckley: It’s just some of the little things. We miss really good sushi restaurants. And I’ve spent most of my life around the ocean, and I definitely miss that. But it’s beautiful up here. The people are fantastic. And upstate New York is beautiful as well. We’re taking advantage of the Adirondacks more and more. So there’s a lot to love, for sure.
The other thing is the rhythm of life. The kids up here seem to stay kids longer. We see kids who live in the city, and it’s just a very different experience. I just have to get used to the long winters.
Gamble: That would be a tough one for me. But on the whole, it seems like you found a home there.
Buckley: Absolutely. It’s been a great ride so far. It’s so fascinating to think about how much IS has changed over the years. It used to be scheduling and billing, but it’s so far beyond that. When I tell people what I do, they still say, ‘Oh, do you do the help desk or make sure the PCs run?’ And I say, ‘Well, it’s a little bit more than that now.’
Gamble: Just a little bit. Well, I’ve taken up a lot of your time, so I want to thank you so much for speaking with us. It sounds like your team is doing some great work.
Buckley: Sure, I’m happy to do it any time.