Jim Noga, CIO, Partners HealthCare, Chapter 3

“Change is hard. It’s always hard.”

One of the most important lessons Jim Noga has learned during his 17 years in health IT leadership is that no matter how much education and planning go into a project, there will be a period of adjustment — and there’s no way leaders can avoid it. What they can do, however, is take steps to ease the burden. When Partners embarked on a five-year initiative to implement Epic across the system, Noga made sure that various stakeholders were at the table, providing input. The goal was to have a system that didn’t just meet the needs of clinicians, but all users — including patients.

In this interview, he talks how Partners viewed the Epic project as a “foundation” on which to build future functionalities, why innovation can never take a backseat, and why data governance is “necessary for the sustainability of the entire organization.” He also speaks about the key challenges in transitioning from Mass General CIO to Partners CIO, why it’s time to stop viewing IT as a component of the organization’s strategy, and how something as simple as wayfinding can have a huge impact on patient care.

Chapter 1

Chapter 2

Chapter 3

• From Mass General to Partners CIO
• Bringing “empathy” to the role
• Planning for change management
• “Cloud is not a strategy. It’s an opportunity for anything that you do.”
• First IS budget decrease in 20 years
• Evolving CIO role — “You need to be able to express the return on value of capital investments.”
• Patient engagement & showing value

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Bold Statements

The key to the transition was probably bringing a slightly different perspective and having empathy for what may be simple from a decision perspective at Partners, isn’t necessarily so simple to execute at the sites.

We’ve come to the conclusion that cloud is not a strategy. It’s really an opportunity for anything that you do. Sometimes the cloud makes sense and sometimes, honestly, it doesn’t make sense.

Any time that you can have an application or an infrastructure managed by an outside provider at equal or lower cost, that potentially frees up valuable resources that can focus on innovation.

Five to six years ago, people talked about IT being an enabler of an enterprise strategy. Now I think IT actually is a component of the strategy. Especially when you talk about digital health in terms of competitors and being best in class in a region.

It’s something that seems fairly simple, but if you think of the stress of going to a clinical appointment, especially when it is in an urban area, it’s a lot. And so we want to focus on what we can do to reduce that.

Gamble:  You’ve been in your current role for about six years now, right?

Noga:  Correct.

Gamble:  And before that you were CIO at Massachusetts General Hospital.

Noga:  Yes.

Gamble:  Can you talk a little bit about what it was like to make that move, and how you approached that different role?

Noga:  Yeah, so I’ve been CIO at Mass General for 17 years, and part of the Partners IS senior leadership team. I think the key to the transition was probably bringing a slightly different perspective and having empathy for what may be simple from a decision perspective at Partners, isn’t necessarily so simple to execute at the sites. Even in my role today, when I think of our rollout of Office 365 and Exchange Online, it sounds simple, but I know how difficult that can be at a site just in terms of change management, attention to detail, and making certain you don’t have an interruption in services. That as you move people to new applications — as you go from, let’s say, Windows 7 to Windows 10, you’re aware of the amount of regression testing and the number of applications. Because we still have hundreds of other niche applications of things that Epic doesn’t do that are still in place. That’s a pretty heavy lift at the site. I think I probably brought that to the position — the need to plan in terms of education in change management as you undertake any of these initiatives, because they can be fairly disruptive to the user base.

It’s also being sensitive as to how much change can the community absorb at once. With Epic, that was a fairly massive change where we really held back on other things or they moved probably much more slowly than we would have outside of the Epic implementation time frame. So we’re doing some catch-up on things like Office 365 and Exchange Online. Last month, we finally upgraded our PeopleSoft to version 9.2. And, as a mentioned, we’re getting back to thinking about innovation.

Now, during that timeframe, I will say that we made a lot of progress in terms of opportunities in the cloud, whether that’s software as a service, or whether that’s moving some of our storage or some of our compute into the cloud. We’ve come to the conclusion that cloud is not a strategy. It’s really an opportunity for anything that you do. Sometimes the cloud makes sense and sometimes, honestly, it doesn’t make sense. And I think there’s been a real shift with a lot of the hardware and software providers in terms of really moving toward a subscription model — not just in the cloud but on premises, and the same thing in terms of a usage model of only paying for what you use. With that shift, it makes the on-prem versus off-prem discussion more meaningful. Obviously, any time you can have an application or an infrastructure managed by an outside provider at equal or lower cost, that potentially frees up valuable resources that can focus on innovation.

A lot of our efforts have been driving our cost down. This was the first year in the 20 years of Partners that the IS budget dropped year to year. Our FY18 budget is 4 percent less than it was in FY17, yet we’re delivering the same services, and at a larger scale. We feel that’s important, because if we want to focus on innovation, we can’t necessarily grow the budget exponentially. What we need to do is bring down the cost of run and builds, so that we can focus on innovation and exploitation.

Gamble:  Right. That’s a really interesting statement on how the industry has progressed, and how different the CIO role has become where there’s such a huge focus on making sure certain investments are bringing value while keeping that focus on innovation. I’m sure that from your perspective, it’s been interesting to see that evolution in the role.

Noga:  It is a focus, because everybody within an organization competes for capital, and so you really need to be able to express the return on value of capital investments to understand where you want to make those investments. I think the other shift too was probably five to six years ago, people talked about IT being an enabler of an enterprise strategy. Now I think IT actually is a component of the strategy. Especially when you talk about digital health in terms of competitors and being best in class in a region, I think a lot of that is going to be who does digital health better in terms of that patient experience, that clinician experience, and the convenience factor for millennials in terms of where do they seek care.

And again, it’s looking for innovations, both from a clinical perspective as well as from a convenience perspective, whether that be virtual visits, whether that be eVisits, whether that be how do I effectively stand-up urgent care centers. All that is going to play into an overall strategy of delivering care to a population that you’re responsible for in terms of at-risk contracts, how best to manage a population.  And I think the really good news is that everything we talk about in terms of digital health and population health management not only lowers cost, it’s actually providing better and more convenient care to the patient and that would be, ultimately, what we want to do.

Gamble:  Even things like wayfinding can really, I think, go a long way toward improving the patient experience, and it’s not a huge outlay to try to make that happen.

Noga:  It’s interesting because we actually had a discussion at our IS board committee meeting on wayfinding and how you measure the value. One of the board members said there’s literature out there suggesting when you have specific directives — and this wasn’t necessary specific to wayfinding, but wayfinding can be one way — how it can substantially reduce stress.

So if you have a patient coming into Boston from outside the city, gnarled in traffic, not sure where they’re going to park, and you think about the kind of stress they’re experiencing, the vision we have potentially for wayfinding is that patient drives in, we know where they are, we’ve reserved the parking space for them, and we tell them where to park. They park the car, and they obviously have their wayfinding to get to the clinic. But the clinic could be running behind, and so we notify them that they’re running behind. We send them an eCoupon so they can go get a cup of coffee and a snack in the cafeteria rather than sitting in the waiting room.

There are just so many opportunities. It’s something that seems fairly simple, but if you think of the stress of going to a clinical appointment — and we’ve all been through it — especially when it is in an urban area, it’s a lot. And so we want to focus on what we can do to reduce that. Or, because we are a system, we want to give people options. Speaking for myself, I live on the North Shore in Massachusetts, and so I’d much rather go to North Shore Medical Center and have an x-ray because it’s closer to my home. Well, with Epic we’re able to do that, because we have one record now. Patients can go to what’s convenient for them for, let’s say, diagnostic testing. Yes, they may need to visit their PCP whether they’re on the North Shore or at Mass General or the Brigham or one of our other community hospitals, but you would hope you can provide what’s most convenient for the patient when it comes to diagnostic testing or other aspects. Or if we’re talking about physical therapy, because people like to have physical therapy near their home if possible. If you’re 30 miles from the hospital, you don’t want to have to do a 60-mile round trip two times a week per PT. All these convenience factors lead better patient care and probably reduce stress — not just on the patient, but the family that’s involved too.

Gamble:  Really interesting. The big focus for Partners really seems to be taking those next steps and leveraging all the data and technologies you have in place to deliver a better patient experience. Very cool stuff.

Noga:  That really is our focus. We have the building blocks in place, now we need to leverage those assets to really take the next steps in our journey.

Gamble:  Okay, well this has been really interesting, so thanks so much for your time. I appreciate it.

Noga:  Great. You have a good day.