There are few things more daunting than dealing with a natural disaster; especially when you’re new to the organization, and the storm headed your way is a category 5 hurricane. It’s the type of news that would send any leader into a panic — unless the individual in question has quite a bit of experience with disasters. Like, say, being in a submarine during a tsunami. Or providing relief after a devastating earthquake. Or, perhaps most terrifying, having to testify before Congress.
Once you’ve weathered those types of storms — as William Walders has — it’s hard to be rattled. And so when Hurricane Dorian threatened the Florida coast (and ended up veering in another direction), he was ready. And Health First, which impressed him with its high level of disaster preparedness, was ready to focus on building a framework to enable better care, and a better overall experience.
Recently, healthsystemCIO spoke with Walders about his team’s core objectives, why effective communication is the basis for pretty much everything, his approach to professional development, and how his military career prepared him for the CIO role.
- Health First’s 4-hospital system
- Joint venture with AdventHealth
- Dealing with Hurricane Dorian – “I was ridiculously impressed.”
- IT representation in the command center
- Working w/ CEO Steve Johnson – “He’s big on digital culture.”
- The Amazon/Uber/Starbucks experience
- Privia/athenahealth EHR’s “seamless go-live”
- Interview questions: “I asked the board & leadership a lot of questions.”
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One of the first things I did when I got here was to sit down with the six-inch binder we have, which feels more like a phonebook. But I went through it and immediately saw that there was a lot of rigor and a lot of processes in place.
We have tools in place that provide us with a network monitoring perspective, and let us know long before our peers in facilities and clinical engineering when things are down.
Now we have a road map as to how we’re going to enable consumers to drive their own healthcare, to improve access, and to provide ease and convenience for our customer.
We were all in awe that there weren’t any major issues. Nothing failed. No one hinted that they wanted to go back to the legacy EHR. It was incredibly seamless, and that’s a testament to the preparation of our vendor partners, the staff, and most notably, the providers.
Gamble: Let’s start with an overview of Health First: number of hospitals, what you have in the way of clinics, and where you’re located.
Walders: Health First is a $2 billion integrated delivery network. We’re a not-for-profit system with four hospitals and around 900 beds. We have four existing lines of business: outpatient wellness services, hospital services, a medical group, and our own health insurance plans, which has about 164,000 members. There’s a lot of changes and a lot of growth happening. It’s a really exciting time to be at Health First.
Gamble: And you’re located in central Florida?
Walders: Yes, we’re predominantly in Brevard County, which is located along the coast, about 45 minutes west of Orlando. We’ve recently entered some partnerships that are going to help us grow across the state, but right now that area is our focus.
Gamble: And you’re independent, correct?
Walders: We are locally owned, yes. We recently entered a joint venture in which AdventHealth purchased a minority share of our organization. Our board has made a commitment to remain locally owned, and so there’s no option to buy Health First wholly, or even to buy a majority share.
Gamble: So the idea is to remain independent while gaining access to more resources?
Walders: Absolutely. We’ve got some great growth strategies to partner with them and share each other’s strengths.
Gamble: Very interesting. Now, you started with the organization this summer, and very quickly had to deal with the threat of Hurricane Dorian. Can you talk about how the organization approached the situation, and what were some of the challenges?
Walders: Sure. I have to say, I’ve been in every natural disaster imaginable, with the exception of a volcanic eruption. I’ve been in 800 feet underwater in a submarine during a tsunami. I’ve been in wildfires. I’ve been in earthquakes, including the one that hit Haiti nine years ago. Plus, I grew up in Florida; so frankly, it didn’t bother me that much.
Having been in the seat for roughly three months when it occurred, I was ridiculously impressed with the level of preparation and the amount of rigor the organization at large has when it comes to natural disasters. One of the first things I did when I got here was to sit down with the six-inch binder we have, which feels more like a phonebook. But I went through it and immediately saw that there was a lot of rigor and a lot of processes in place. Thankfully, we had very minor issues resulting from this hurricane. As you might know, it turned north and then, regrettably, had a significant impact on the Bahamas.
It did, however, give us an opportunity to have a live-fire, three-day drill where we did everything we’d normally do in the event of a hurricane. We learned a lot from that.
Tangential to that, this organization has had a very steep learning curve when it comes to resiliency. Now, we have tools in place that provide us with a network monitoring perspective, and let us know long before our peers in facilities and clinical engineering when things are down. And so we knew right away that a physician clinic was going offline. We watched our helicopter hangar come offline, and IT was at the table contributing, and providing a strategic and tactical element.
So yes, Health First has made significant investments in IT. There’s a level of understanding as to how important it is to do what we do and continue to make significant investments. We expect about a 20 percent growth in all things resources for FY20, including both capital upgrading and staff.
Gamble: I would imagine a disaster plan can’t be static, but instead is more of a living document. Did you make changes or add to it after this particular event?
Walders: We definitely added to it. We learned a lot from some of the storms last year and did some tabletop exercises. One of those lessons was to have a senior leader from IT in the command center driving a lot of the decision making. In the past, it was more of an omnidirectional conversation where IT was there to do a quick report-out, as opposed to having a collaborative, strategic role, and working hand-in-hand with other senior leaders across the organization.
Gamble: What about staffing up for something like a hurricane? I’m sure it’s tricky, because you don’t know exactly what’s going to happen, but you want to make sure there are enough people available.
Walders: We do a very mature thing here where we have pre-storm, during storm, and post-storm processes. Everyone knows their roles, including response time to return back. Nearly all of the senior leaders are present making these decisions on when to transition the staff. If the hurricane would have been as bad as we thought, we would have wanted as few people around as possible, so that they could be with their families.
It’s a really interesting dynamic. I was impressed by two things: first, by the level of rigor and preparedness we had, and second, by how well people followed it. We did the pre-storm plan at about three days out; at that time, it was a Category 5 hurricane coming right at us, meaning that if you live in Brevard County, you were being told your house and family might not be there when you return. It was really interesting to see everybody coming together and all the needs being met. Having been in the command center, I can attest that we had zero issues when it came to personnel, either in term of accountability or responsibility.
Gamble: Let’s talk about the plans for 2020. I imagine they were already in place, but did you have the opportunity to make any changes?
Walders: Absolutely. Thankfully, the incumbent CIO and I had about a month of overlap, and so I was able to get an understanding of why the priorities were there, do assessment of my own, and modify accordingly. I had the opportunity to shape our Fiscal Year 2020 priorities, and get a bolus of additional resources from that assessment to ensure IT matches up to where Health First is going in FY20.
Gamble: What are the key strategic objectives for 2020?
Walders: For IT specifically, or for the IDN?
Gamble: I would say the IDN, because I imagine they’re closely aligned.
Walders: They are aligned; IT has some very tactical ways of doing the high-level things that the IDN wants to do. For example, our CEO Steve Johnson wants us to get into the digital space, and so we’re doing what we call a pivot.
What we’re seeing in the cities near — Orlando, Jacksonville and Miami — and even across the nation, is healthcare becoming a more digital-centric environment. It’s more consumer-centric, and the tools in the hands of providers and patients are drastically different from what they were five or 10 years ago.
And we’re the first to concede that Health First is behind in the consumerization movement. We don’t have a prolific set of tools to do portals — or anything digital. So we had an external entity come here and do an assessment. Now we have a road map as to how we’re going to enable consumers to drive their own healthcare, to improve access, and to provide ease and convenience for our customer.
Our CEO is really big on digital culture. He follows Amazon, Uber, Starbucks and other disruptive companies — not just in healthcare. We want to be like those companies. Right now, a Starbucks customer can order a latte and walk in and pick it up, with minimal interaction if that’s the desire. We would like to do the same thing with labs, rads, ancillaries, appointment and scheduling, and we will.
Gamble: Right. Of course, there’s a lot that needs to happen to enable that. What do you have in terms of the EHR system(s) in the hospitals and clinics?
Walders: We have many hospital systems — something in the magnitude of hundreds of different applications. On the ambulatory side, we just transitioned from GE Centricity to Privia, which sits on top athenahealth’s platform. It’s an entirely managed service from Privia for all things ambulatory, and then we use Allscripts for most of non-ambulatory.
However, having just transitioned from GE, we do still have some legacy instances. You’re never really fully transitioned, right? And so we’ll continue to support GE Centricity until the last user is transitioned to Privia.
But I have to say, when we went live with Privia, which was in late August, it was one of the most seamless go-lives I’ve ever experienced. I’ve been part of a few, most recently deploying Cerner with the Defense Health Agency in the Pacific Northwest, but this one really stood out. We were all in awe that there weren’t any major issues. Nothing failed. No one hinted that they wanted to go back to the legacy EHR. It was incredibly seamless, and that’s a testament to the preparation of our vendor partners, the staff, and most notably, the providers.
Gamble: I’m sure that was an interesting position to be in with this implementation, where the wheels were already in motion. How did you approach that?
Walders: I had two overarching questions when I was interviewing for this position in the spring. One was around the partnership with AdventHealth; because no CIO wants to come to an organization that’s potentially being bought or merged, because things tend to go in one direction or another. I had full assurance that wasn’t the case; that the direction was independent of any acquisition, and I would have the scope of responsibility and authority to do what Health First needed me to do.
The second was to learn why the decision was made to select Athena/Privia as the EHR. I asked the board a lot of questions. I asked leadership a lot of questions, and was ecstatic with the answers, which goes back to that consumerism approach to healthcare. To have something that’s almost turnkey from an ambulatory perspective on all the things we need to do as a health system, whether it’s providing online scheduling, enabling patients to message providers, or providing a single portal for the PHR. I was very happy with the requirements that were set forth.