It almost didn’t happen. Lee Milligan seriously contemplated texting the CEO in the middle of the night to say he had changed his mind about taking the CIO role at Asante. His doubts were completely understandable; not only did it mean leaving the CMIO position, which is a significant change, but it also meant filling the shoes of his predecessor, who had resigned after more than 20 years at the helm.
If that wasn’t daunting enough, a new CEO had just taken over.
Fortunately, Milligan never sent the text, having decided that the rewards outweighed the risks. But it hasn’t been an easy adjustment. “I had to be more honest with myself than I’ve ever been in my professional career in sizing up what I do well and in what areas I’m lacking,” he said in a recent interview, during which he opened up about how he was able to grasp the CIO responsibilities, what surprised him most during the first 6 months, the goals he has established for his team, and why he never takes metrics at face value.
- Leveraging Arch Collaborative data to measure user experience – “Not doing that is a mistake.”
- Process improvement framework
- Finding “more automated and more efficient” methods
- High reliability: “It’s not just for network and storage folks.”
- Lessons learned as CIO: “People really want face time.”
- His open-door policy
- Vendor relationships
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My thinking was, if we’re going to ask folks to spend 20 minutes of their day filling out a survey, I had better be willing to sit down and read every word they wrote.
We have to find a way to do more with the same amount of resources — not less, but the same. And so, in order to widen our bandwidth, we’re going to have to do what we currently do, in a more automated fashion and a more efficient fashion.
Ultimately, if we can look internally and make improvements, our bandwidth is going to expand exponentially.
This concept of high reliability isn’t just for network folks and storage folks; this is for everyone to do their job reliably.
We depend heavily on the Internet to be able to get our jobs done. If Epic or the network goes down in one area, it’s going to affect everything.
Gamble: You have experience as a physician builder — I can imagine that has been really helpful in this role.
Milligan: That piece has been big. When we received our KLAS Arch Collaborative survey results, we were a bit nervous first, because we had never really taken our temperature in an objective way. We thought we had done a good job delivering a decent EHR for our folks, but we weren’t 100 percent sure.
As it turned out, the Arch Collaborative scores were really positive. I think it surprised some of us that it was quite that good. KLAS is known for slicing and dicing information dozens of different ways; the initial PowerPoint had something like 220 slides.
One of the slides that really stood out was where they broke down satisfaction based on specialty, and compared your results are compared with the rest of the Arch Collaborative findings. It showed that there were five or six specialties that were way above the average — in some cases, it was literally twice the satisfaction rate. In our system, each of those specialties has a physician builder. The ones that scored average (or close to it) do not.
It was really fascinating. We invested in these specialties. We put a point person there to help navigate that, and it is clearly delivering results. My successor, Peter Canning, MD, is now taking that to the next level. He’s developing a more advanced version of the builder program that will provide more clarity around the goals and objectives. On top of that, he’s also developing a program for ongoing training.
Gamble: I can imagine it’s really important get the pulse of your user through initiatives like the Arch Collaborative — even if you’re not sure what to expect.
Milligan: I think not doing something like that is a mistake. We really relied on anecdotal evidence of how people are using the EHR. And of course, you have to keep in mind that the loudest voices aren’t necessarily representative of the experience of the whole organization.
So it was great to get that feedback. They also provide a written narrative of the comments received, which I printed it out and read over a weekend. It was 110 pages (single-spaced) of feedback, and some comments were certainly easier to read than others. But my thinking was, if we’re going to ask folks to spend 20 minutes of their day filling out a survey, I had better be willing to sit down and read every word they wrote.
Gamble: Sure. I would think that as you go through this process, you’re able to draw from your experience as a physician and as a user of the system. It goes back to the point you made earlier about customer experience being a key priority.
Gamble: Looking at where things stand now, what do you consider to be your top priorities?
Milligan: Given the fiscal constraints most health systems experience, we have to find a way to do more with the same amount of resources — not less, but the same. And so, in order to widen our bandwidth, we’re going to have to do what we currently do, in a more automated fashion and a more efficient fashion.
That comes back to the internal process improvement framework we have in place. We’re building out a separate SharePoint site in which we will showcase what we’re working on, what we’ve effectively executed on, and how that impacts IT from an operational standpoint. For example, our Epic analysts are building out queues so that the HIM chart correction folks can work on those. Basically, if a physician documents the wrong patient, it falls into a queue, and someone is assigned to work that queue and correct the errors in the medical record.
When we followed them around, we noticed that the queue frequently contained charts that were not erroneous. And so the manager, as part of this OKR framework, was able to work with the HIM Epic analyst to improve the filter by which these charts make their way into the queue. When he measured it, he found that there were three analysts working the queue, and each was spending about a quarter of their time erroneously working on charts that shouldn’t be there. It was fixed on the frontend so that the queue only includes charts that are incorrect. In the process, he freed up 0.75 FTEs, simply by making one correction. That’s an example of the type of internal process improvement work we can do, in order to meet that goal of doing more with the same resource pool.
Gamble: Right. It seems like it’s really important to have something like that in place.
Milligan: It is. I think when the culture shifts, people begin to realize that there needs to be a framework in place so that when there are problems, we can fix them. It’s important to our CIO that we do so, and that we’re recognized for having done so.
One of the most controversial things I’ve done was to tell our executives that my team is going to be doing 10 percent less over the next couple years in terms of productivity. I asked folks to put aside four hours of their week to work on internal process improvement, and that corresponds to less output of reports or builds of whatever it might be. That was difficult for some folks to digest; fortunately, my CEO was very supportive.
Ultimately, if we can look internally and make improvements, our bandwidth is going to expand exponentially.
Gamble: I’m guessing it was a big selling point to be able to focus right away on doing things like process improvement that could have a big impact.
Milligan: Yes. If the team has clarity about the ultimate objectives of this exceptional customer experience, it makes a big difference. It’s funny; when I first came up with these, our technical services team — the people who take care of the hard drive, storage, and networks — was on board with the idea of being a high reliability organization. But some of the people working on Epic felt it wasn’t in their job description.
And so I said, ‘Let’s define high reliability.’ Let’s say I’m doing chart review in the EHR and I see an icon that says, ‘EKG.’ When I clicked on it, instead of having an EKG, it’s a single-lead rhythm strip. Is that reliable?
Another example — and this is something I experienced multiple times as a clinician — is where you see an icon that says pulse oximetry, which is a measurement of how much oxygen is in your blood. A few years ago, we ran into a situation where for when you clicked on, you get a pulmonary function test instead. And so, this concept of high reliability isn’t just for network folks and storage folks; this is for everyone to do their job reliably.
Gamble: When you think about your experience so far, is there anything that really surprised you about the CIO role?
Milligan: To me, the biggest surprise was that people really want face time with you when you’re the CIO. In the beginning, I almost felt like I was butting in. I was doing it because I wanted to learn, but I was surprised how much face time people really want. We put out a monthly newsletter and we have department meetings every other month, during which I always remind my team that I have an open-door policy. No matter what’s going on — if you find yourself in a strange situation, or whatever the case may be — I’m always available. I’ve had no fewer than 20 people take me up on that.
Sometimes it’s to vent about a particular situation, and sometimes it’s something they’re hesitant to discuss with their direct supervisor. In that case, I can help them navigate that conversation. But I’ve really been amazed by how much face time folks want. With this OKR framework in place, it’s helpful for me because I can review their OKRs beforehand, and we can talk about it.
Gamble: You talked about some of the things you did to prepare for the role, but is there anything we didn’t touch on, or any advice you can offer to someone who’s starting their first CIO role?
Milligan: One thing that’s really important is to carve out some time and make a list of your core vendors. Create a strategy to develop a strong working relationship with them.
During my second month in the role, I made a list of our core vendors: Microsoft, Cisco, Kronos, Epic, and a few others. I set up meetings with each of them to dive into what products we’re using, which ones we aren’t using, where there may be overlap, where the relationship has been solid, and where it has been shaky.
Here’s one example. Obviously, we depend heavily on the Internet to be able to get our jobs done. If Epic or the network goes down in one area, it’s going to affect everything. If the Internet goes down, we have redundancy. It’s really important that it’s up and running.
We actually have two separate service providers. Recently, we had a problem with one of them that persisted for a long time. My staff had to work an entire weekend; one individual was up for 24 hours trying to navigate this thing, and I didn’t have an escalation pathway. This was one vendor I hadn’t contacted. And so, after that died down, I reached out to our account rep and said I wanted to set up a meeting with the regional VP so we could have a conversation.
They did a great job. They brought together a number of people from both organizations, and we had a terrific conversation. The vendor provided me with an escalation pathway that went all the way up to the corporate VP. It was one of those things I should have done on the frontend, but it was a valuable lesson to learn. I’ve done something similar with each of our core vendors as I’ve gotten to know them, and it’s been really helpful.
And actually, Epic recently held its User Group Meeting; for the first time, Asante send its chief executive officer to the event. It’s going to go a long way toward building a solid relationship with your core vendors, which I think is critical.
Gamble: I’m glad you brought that up. I’m sure it can be very challenging to manage those relationships with vendors as effectively as possible.
Milligan: It is. If you can build and sustain a good working relationship with your core vendors, I feel like that’s 70 percent of the issues you’re going to face.
Gamble: Sure. Well, this has been great. We covered a lot of really valuable topics. I think it’s going to be very helpful for those who are new to the CIO role. We appreciate it, and I’d definitely like to touch base again down the road.
Milligan: Thank you, Kate. It’s great to have the opportunity to share the lessons learned so far in this journey.