“The most exciting part of healthcare right now is the disruptors who are entering the market.” It’s not exactly a shocking sentiment; for quite some time, analysts have predicted that companies like Google and Apple could shake things up considerably. In this case, however, the statement was made by Debbie Cancilla, a CIO with 25 years of healthcare experience. She believes that by underestimating these disruptors, the industry could miss out on tremendous partnership opportunities, particularly when it comes to improving the consumer experience. On the other hand, those who are willing to keep an open mind can help move their organizations in the right direction.
Recently, healthsystemCIO spoke with Cancilla, who was named CIO at NJ-based Atlantic Health in 2017, about the Epic task her team faces, why she was hesitant to take on another major EHR rollout – but eventually accepted the challenge, and why culture really is king. Cancilla also talks about what she considers to be the most valuable leadership qualities, and what excites her most about the future of healthcare.
- Learning from CIOs outside of healthcare – “There are so many parallels.”
- Atlantic Health’s Epic migration
- EHR rollouts: “They’re hugely rewarding, but also very exhausting.”
- Big-bang vs phased approach – “One size doesn’t fit all.”
- Assessing user readiness
- Previous experience w/ Epic: “You learn about the cycles & trends”
- The “unglamourous work” of dealing with legacy systems
- Shared services through HTC
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We’re all focused on trying to make the experience for whoever we serve more convenient and more transparent, and to get engagement from that population. When you look at those things from a different lens, your mind starts to get incredibly creative about some of the things you can do.
Without having data that is centralized, and not in disparate systems; without having a model you know is sustainable and a team that can support you, you can’t really be innovative. You can’t innovate without having all that in place. So it became a no-brainer; we said, ‘yes. Let’s get this done.’ And we did.
Clinicians are incredibly smart. They know what’s going on across the country and in other facilities, and they understand. If you’re behind a bit in the direction that things are moving, you’re going to question why your organization isn’t there as well. So I think that definitely contributed to readiness.
There are cyclical things that happen. One organization might say, ‘we need to change this,’ but you have a calmness associated with it where you understand that these things happen in waves after an implementation, and that the organization will work through it.
Gamble: For some background, Atlantic Health is a large system with six hospitals based in northern New Jersey. Because it’s a very densely populated area, with quite a few health systems, do you feel like you really have to stay on top of things and communicate often with other CIOs?
Cancilla: I’ve actually found a lot of value coming out of discussions with CIOs from other industries. I find that to really tap into something different or try to help support the system in more unique ways, you need some creativity, and I often find that comes from discussions with CIOs from other industries.
Gamble: Are there any particular industries you tend to work with more often?
Cancilla: Being in the market that we’re in, I’ve had the opportunity over the past year to talk with folks from a multitude of different industries. There’s a CIO in the cosmetics industry that I’ve spent time talking with. You’d think our worlds are miles apart, simply based on the nature of what our industry does and that space, but we have so much in common. There are so many parallels; whereas we talk about creating a digital patient experience and converting our records and make our processes easier for patients, they talk about the digital consumer experience. Is that vastly different? No. It’s absolutely in parallel.
We also talk about cybersecurity. Is that vastly different? No. We’ve got all the same challenges we’re working through. There are so many parallels between folks in other industries. When you talk to recruiters or placement firms, they tend to focus more on the industry than the transferability and parallels that exist. There really is a great pool of learning opportunity from those who are in other industries.
Gamble: That’s really interesting. I know some CIOs reach out to leaders in the tech sector, but it seems there’s really so much to be learned from other industries, especially when you’re talking about consumer experience, which has become a big factor.
Cancilla: It doesn’t matter what industry you’re in — we’re all focused on trying to make the experience for whoever we serve more convenient and more transparent, and to get engagement from that population. When you look at those things from a different lens, your mind starts to get incredibly creative about some of the things you can do.
Gamble: In terms of your role, you’ve been with the organization for about two years?
Cancilla: Yes. I’ve been in Atlantic for two years and was with three different organizations prior to that.
Gamble: So you’ve held the CIO role before?
Cancilla: Yes. In Buffalo, New York; in Atlanta, Georgia; in Harrisburg, Pennsylvania; and now here. I have 25-plus years in the CIO role.
Gamble: I would imagine each role is different.
Cancilla: What’s different, actually, is the culture. The culture drives a lot of your capabilities within an organization.
Gamble: I definitely want to get into that, but first, let’s get a little bit more information about Atlantic Health. As far as the EHR system, are all of the hospitals on Epic at this point?
Cancilla: Yes. We just finished bringing up our last hospital on Epic in October of last year, but the platform is relatively new for the health system. Atlantic was a little bit behind the curve in terms of standardizing on an enterprise solution, but we absolutely hit it out of the park. We got an award from Epic for being the second best install ever. And so I’ve done this a few times before, but I’d say the third time was definitely the charm.
Gamble: When you came to the organization, had Epic been selected at that point?
Cancilla: It’s interesting, I was originally recruited to do more innovative work, which was incredibly attractive to me, because EHR implementations are really quite taxing. They’re hugely rewarding but they’re also very exhausting. You realize the personal commitment you need to put into making these things successful, and I wasn’t sure I was up for round three. And so I came here in the CIO role, but it was largely supposed to be focused on innovation — not the EHR implementation. They actually had another CIO on board who was doing that in an interim capacity, but as the tide changed, that person was rolled off, and they asked me to lead the implementation.
And so, knowing that it’s so incredibly important to have that enterprise EHR foundation, I knew we had to get this done. Because without having data that is centralized, and not in disparate systems; without having a model you know is sustainable and a team that can support you, you can’t really be innovative. You can’t innovate without having all that in place. So it became a no-brainer; we said, ‘yes. Let’s get this done.’ And we did. Now we’re starting our journey into the more exciting part of IT.
Gamble: What do you think made the implementation successful? Rolling out Epic certainly isn’t easy; a lot of organizations have run into roadblocks.
Cancilla: I think there are multiple factors associated with it. We talked about culture — clearly the organization has to be ready for change. I think that’s foundation number one. Foundation number two is you have to have the right team in place. Foundation number three is having leadership’s support through the challenging times. You have to have that operational support. In my case, I was fortunate to bring that experience to Atlantic Health to help them achieve success with the implementation.
Gamble: I would imagine a big factor in all of this is readiness, which you touched on before. How did you work to gauge that level of readiness across the organization?
Cancilla: These implementations are actually an amazing time to bring everybody together for hard discussions that really haven’t occurred before, especially when you’re a multi-facility health system where workflows may be handled differently at each of the various organizations. It’s an amazing, transformational time to bring everybody to the table and gain consensus on how you’re going to do things in a standardized format. Standardization is required so that you can get the expected data outcomes and then do the fun and innovative stuff with data as you go forward as a business.
Gamble: What was the strategy as far as rolling that out — was it done in stages?
Cancilla: There are two fundamental approaches. One is to do it all at once, which is the big-bang approach, and the other is the phased approach. Sometimes the phased approach, depending on how the workflows differ across facilities, can be incredibly complicated, and can cause you to have to put interim workflows in place. We found it was most manageable to handle this with a phased approach, and so we had two hospitals go live at the end of February, we had the flagship hospital in June, and then the last two facilities go live in the beginning of October.
But again, one size doesn’t fit all. You have to look at what you’re workflows are between facilities, and you have to look at whether the organization is ready. Or maybe you need to do a trial first — handle a piece of it and see how it goes, remediate, and get ready for the bigger part of the organization later. It’s understanding the organization and the people that helps you determine how to approach the implementation. Epic has been a very good partner for us. They’ve done these thousands of times across the country, and they’ve been really good in terms of being a partner and helping to answer some of the more challenging questions, or tell you what’s worked well with other complicated systems across the country. And so a good partnership is also an important thing.
Gamble: Now, you mentioned that Atlantic Health had been somewhat behind the curve when it comes to having an integrated system. Was that a hurdle or perhaps something that worked in your favor somewhat?
Cancilla: Clinicians are incredibly smart. They know what’s going on across the country and in other facilities, and they understand. If you’re behind a bit in the direction that things are moving, you’re going to question why your organization isn’t there as well. So I think that definitely contributed to readiness — the intuitiveness and brightness of the workforce and knowing that this is something you have to do.
Gamble: In terms of your own experience with Epic, was that something you’ve able to draw upon in this role?
Cancilla: It definitely helps, because you learn what the cycles and trends are with an EHR implementation. First you have the initial discomfort and getting folks settled into the workflow. The next phase is helping them understand the system well enough to know that it’s not exactly what they want. They want optimizations done. And then comes the realization that, ‘I’m putting all this data in; I really need this data out of the system to help me run my business.’ That’s the widget data.
Then it evolves into, ‘I need my widget data, but I also need more.’ So you start to talk about data warehouses and development of that. Each of these things goes through various cycles. After you start the data warehouse and data lakes discussion, you realize that data needs to be normalized so that, for example, block time for one OR has to be the same as the definition for block time for another OR. If it isn’t, maybe we need to go back and change a workflow to make that happen.
In my mind, there are cyclical things that happen. One organization might say, ‘we need to change this,’ but you have a calmness associated with it where you understand that these things happen in waves after an implementation, and that the organization will work through it. And you’re mentally prepared, because you know exactly what the next wave is that will hit, so you try to plan or remediate to be able to handle that when the organization is ready to deal with it. You don’t want to try to force these discussions or issues before readiness. In other words, you don’t start to talk about optimization the week of implementation. We’re not there yet — I’m trying to figure out what value I need to put in what field, and how I find lab results or enter blood pressure. It’s a maturity cycle.
Gamble: What are some of the other key priorities on your plate right now?
Cancilla: There are a few areas. We started this conversation by talking about the enterprise system, and how you just need to do it. Once you’ve done that it’s awesome, but now you have a whole book of legacy systems that have to be decommissioned, and you have to figure out what to do with all that old data. It’s unglamorous work, but it needs to be attended to, because if you don’t have plans and you don’t continue to drive that book of business, your IT costs aren’t sustainable, because now you’re carrying redundant expenses.
The other part of this is that Atlantic has improved as far as the community knowing that we’re a strong player or a strong partner. An entity called HTC (Healthcare Transformation Consortium) was developed. Within HIT, there’s a lot of discussion around how we can leverage the system, the data, and the tools we’re creating, and help support other organizations and create perhaps a more cost-effective model. It also opens up a whole other discussion about shared services.
Those are some things we’ve started working on at this point. And obviously, we’re focused on continued growth within the network. We’ve put in a platform, and now we have the ability to collect and manage data and use it to say, how do we help our partners? How do we grow our business? Those are some of the other things that we’re looking at on a day-to-day basis.
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