There’s nothing “easy” about being a healthcare IT leader. But what many have begun to realize is that implementing the actual software that’s meant to change the game was the “easier” part. What has proven more difficult, of course, is the operationalization phase.
Now, it’s about taking the next step: “How do you innovate? What slice of your time or your team’s bandwidth can you put toward that?” Like many CIOs, Tom Barnett is dealing with these precise questions. And although there are no simple answers, there are ways to begin to focus more on transformation itself, and less on the building blocks.
Recently, healthsystemCIO spoke with Barnett about how his team at University of Rochester Medical Center is approaching their core objectives, how they’re organizing teams while maintaining collaboration, and the challenge of prioritization. He also talks about what he learned from previous roles, and what it takes to get IT to the table – really.
- Previous roles with NorthShore & Henry Ford – “I knew a lot of the processes.”
- Going on a “listening tour”
- Revamping governance: “It was a lot of awareness and communication.”
- 4 advisory councils: clinical, provider, revenue cycle & analytics/data
- URMC’s “metrics-driven” perspective
- 5-year IT strategic plan with “periodic touchpoints”
- Working w/ CMIO & CNIO to triage project requests and manage pipeline
- “There’s no healthcare event without an IT response.”
LISTEN NOW USING THE PLAYER BELOW OR CLICK HERE TO SUBSCRIBE TO OUR iTUNES PODCAST FEED
It’s easy to come in from the outside and say, ‘I know exactly what needs to be done. Here is the prescription for success.’ But every organization is different, and getting that perspective is so important.
They’re focused on things like, ‘Are we working on the right priorities? What new functionality is either available from Epic or will soon be available? How do our metrics look? How is our throughput? How do work queues look in terms of throughput?’ We’re getting very metrics-driven from that perspective.
We need to make sure we have a harmonizing layer on top that cross-communicates what’s going on within each of those advisory councils, while also making sure we cross-pollinate membership of those governance boards.
IT doesn’t get introduced into the environment or released into the wild on its own. It’s always tied to an operational workflow or requirement. It’s no different than what the optimization team does; it’s making sure technology supports the workflow, it doesn’t drive it.
Gamble: Those are three pretty big priorities. What was the mindset you had coming in as far as breaking this down and looking at how to approach them?
Barnett: I was extremely fortunate to work for NorthShore University Health System in Chicago prior to this, and before that I was with Henry Ford Health System in Detroit. From a size perspective, Henry Ford is very comparable to the University of Rochester Medical Center, and so I knew a lot of the processes and a lot about how an organization of that size optimally operated.
When I arrived here my priority, first and foremost, was to go on a listening tour, and that’s from two perspectives. First, it was listening to my customers. Any meeting that would have me, I was happy to attend, and do an introduction. I sat down and met with absolutely every department chair in order to determine, on behalf of the IT division, what was working well, and what could improve or wasn’t meeting their needs.
During my first year, we divided everybody in the division and randomly chose groups of eight IT employees. The only rule was they couldn’t be from the same team. I would then sit down and meet with the group to explain my thoughts and overall vision for the division, but most importantly, to hear their thoughts on what we should start doing, what should we stop, what should we continue doing as a department. Those conversations were great.
Hearing from my customers and from my operational leadership team about what their expectations were and what they were looking for, as well as meeting absolutely everybody in a 500-person division, helped formulate a strategy. Because it’s easy to come in from the outside and say, ‘I know exactly what needs to be done. Here is the prescription for success.’ But every organization is different, and getting that perspective is so important. We’re very fortunate here to have some longer tenure IT folks here who’ve been with us a while and have seen some great things at work and can add to the strong culture here. I was able to take all those different feedback points and perspectives and sit down and meld that through those questions: ‘Where do I think the organization needs to be? Where does operations need to be? What are the current challenges?’ Once that’s done, we were able to put a roadmap together that can support what the CEO is looking for, and support organizationally what we need to do, in addition to driving that change, and chartering the new governance structure that we put into place.
Gamble: How did you go about developing that governance structure? I would imagine that can be met with some resistance at first.
Barnett: Anytime you change something, there can be resistance. But in our case, it’s not widespread. It’s more about what was wrong with the old way we did things. A lot of it is awareness and going on a communications tour to get that message out there. We put in place a governance structure that was very similar, I assume, to what the original 13 colonies went through as they were storming between, ‘What’s my state responsibility,’ and ‘what do you mean a federal government? I don’t know what that is.’
So we created four primary boards. We have a clinical advisory council, a provider advisory council, a revenue cycle advisory council, and an analytics and data advisory council. From those perspectives, my clinical advisory council, which is chaired by two C-level executives, oversees our hospital operations. So if we’re looking to implement something within the Epic clinical space, that group as well as all of its representative membership of all the hospitals, will weigh those priorities and determine the clinical impact. Is there something we should be doing that drives length of stay? If we’re looking at readmission rates, what different options are out there? There’s a great dialogue that occurs within that group.
The provider advisory council was originally put together to work almost exclusively with the new optimization team we built. We are also extremely fortunate here in that we have about 24 physicians who became certified Epic builders, and they’re from all different specialties. We have almost everybody covered. They’re all members of the provider advisory council, so that’s become a great group. It’s chaired by our chief medical information officer as well as the chief operating officer of the entire medical group, and they focus on hearing from providers what works, what doesn’t, and how we can make the experience better at the end of the day.
That optimization team only works with this provider advisory council, and it’s worked really well. Our goal is to morph that over time. That that will become the group that deals with our broader ambulatory network, whether it’s system choices, integration, standardized workflow, or standardized content. A lot of things will be handled there.
The revenue cycle advisory committee is chaired by the CFO of Strong Memorial Hospital and the CFO of our medical group. They’re focused on things like, ‘Are we working on the right priorities? What new functionality is either available from Epic or will soon be available? How do our metrics look? How is our throughput? How do work queues look in terms of throughput?’ We’re getting very metric-driven from that perspective; having a representative body from a revenue cycle perspective has worked really well.
The last group is our analytics and data advisory council. As we started to roll out this and, in effect, build out some of the Caboodle functionality from within Epic, we realized we needed a group that represents our biggest constituencies, which is operations, because there are operational reports. We have strategic reports that are necessary, as well as making sure we have input from the research community. What is the proper order, and what kind of use cases from a reporting perspective need to be driven by the build we do next? And so we make sure we have operational and research buy-in to that, and the team works from those prioritizations appropriately.
Inevitably, there’s going to be a difference of opinions between the provider advisory council and maybe revenue cycle advisory council. And so we need to make sure we have a harmonizing layer on top that cross-communicates what’s going on within each of those advisory councils, while also making sure we cross-pollinate membership of those governance boards onto at least one other board.
For example, the provider advisory council has two or three members that attend the revenue cycle committee. They also have members who attend the hospital or the clinical advisory council and vice versa so we can make sure that — and this is hypothetical, not a real-world example — if there’s a revenue cycle change scheduled that may potentially add nine extra clicks to the provider workflow, we’re facilitating that dialogue so that operations is on the same page with why something is being done, and everybody has input on how it’s implemented.
Gamble: Right. I would think having these advisory councils can be very empowering for those groups, but it’s also important to make sure you have that layer on top to make sure everyone’s needs are being considered.
Barnett: Absolutely. What’s also important are periodic touchpoints back to the overall five-year IT strategic plan to protect capacity within the IT team to make sure that we’re dealing with the today issues and the today opportunities, as well as making sure we don’t take our eye off the ball in terms of working toward the five-year strategic vision.
Gamble: I can’t imagine that’s easy to do, especially when there are so many different priorities. Do you find it challenging to have all these different objectives that are in different phases and keep that all together?
Barnett: I think the challenging part — which we’re addressing — is with transparency and communication. Any initiative or project by itself can seem like a fantastic idea, but we don’t have unlimited resources. We’re enthusiastic and happy to support any initiatives, but given the limited resources we have, we need to vet everything through those governance advisory councils to make sure it hits on enough of the criteria that those groups deem important. If we get the blessing from the appropriate groups, then yes, we can move forward; but I’d say the key is definitely communication. In an organization this size, it’s so easy for projects, initiatives, efforts, or even new functionality from vendors to slip through, and so we have to make sure that our operational counterparts understand what it is, what’s the value of it, and most importantly, the timing.
Gamble: Right. You mentioned project management before; I would think that experience plays into your strategy quite a bit in this role.
Barnett: Absolutely. We get project requests that come in on a daily basis. Each one of those advisory councils has a smaller workgroup that helps us, along with our CMIO and CNIOs, to triage these requests so we can quickly ascertain which ones the advisory councils should have on their radar, which are a few years out, and the ones where you might say, ‘Other departments have solved the problem we’re trying to solve with this project. Let me take this and go speak to my colleagues on behalf of IT.’ It gives us that insight into the pipeline.
One of my favorite phrases is, ‘There’s no healthcare event without an IT response.’ If you think about it, IT doesn’t get introduced into the environment or released into the wild on its own. It’s always tied to an operational workflow or requirement. It’s no different than what the optimization team does; it’s making sure technology supports the workflow, it doesn’t drive it. And so we want to make sure we’re having those proper conversations from a workflow and an operational perspective before we can bring technology to bear.
healthsystemCIO’s Interviews and Podcasts are sponsored by: