Q&A with Tom Andriola, Part 2: “We’ve adopted almost a wartime mentality.”

As technology becomes more strategic to the mission of an organization — especially in the areas of research, education, and patient care — information technology needs to be represented at the cabinet level. In fact, discussions about data-driven innovations that can transform care delivery must involve CIOs from the start, said Tom Andriola. That was precisely the thinking at UC Irvine, where last fall he was named Vice Chancellor of IT and Data, after having served as CIO for both UC Irvine Health and the University of California system for six years. Now, the CIOs of UC’s six health systems report up to Andriola, who likens his role to that of a conductor whose focus is to “get the band to play together,” even though they have their own instruments.

Never has it been so important for the different sections of UC Health to harmonize than in the past few weeks, as the organization has banded together to create and implement a COVID-19 response. During a recent interview, Andriola talked about how the “dynamic environment” has shifted his priorities, why he believes virtual care should become “the new norm,” and the incredible opportunity organizations have to help educate the community.

Part 1

Part 2

• Adopting a “wartime mentality”
• Daily huddles to manage the “dynamic environment”
• Dramatic increase in remote workers – “It’s created some instability.”
• COVID-19’s long-term impact on care delivery
• Cybersecurity concerns – “It’s easy not think about it.”
• Sharing knowledge throughout UC’s network through “a combination of technology & human coordination.”
• His role as “Impresario” for the 6 CIOs

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Bold Statements

The fact that there is so much dynamic information requires us as leaders to really have that daily huddle type of approach, which we’re now doing twice a day, just so we can deal with the broad implications of this.

In a lot of cases, especially in healthcare, where we’re trying to do a better job of matching the right model of care for the right patient in the right situation, and move that to the lowest cost care interaction, we may find that this new norm can create a more effective healthcare system.

We’ve been trying to think about that — when we take steps to do things, to stop and say, have we thought through the cyber implications of this? Have we thought about that it’s going to force us to open new ports and that may make us more vulnerable? Is there something in the messaging around this that the bad actors out there may take advantage of with phishing campaigns?

Being able to connect and share information — ‘We just saw this, everyone else should be aware of this’ — can really shorten the time span between when we recognize something and when we’re able to respond to something. That’s been a huge focus of our cyber risk program over the last four years.

We’re sharing those because it helps everyone think about what we could be putting together to show our executive team to give them a comfort level that we’re doing the right things.

Gamble:  From the leadership standpoint, this situation presents a challenge for leaders who are trying to manage their staff appropriately. I feel like that ability to think on the fly — and that might not be the right expression — highlights some of the really important criteria of leaders, especially in this industry.

Andriola:  Thinking on the fly isn’t the term I would use. I would say we have adopted almost a wartime mentality. We have a couple of stand-up meetings every day where we get together as leaders, because it is a dynamic environment, and we need to share the information we’re getting, whether it’s about the spread of the disease or information that the local government organization has passed a new ordinance or announced a public health emergency, or in the case of the Bay Area, a shelter in place designation. The fact that there is so much dynamic information requires us as leaders to really have that daily huddle type of approach, which we’re now doing twice a day, just so we can deal with the broad implications of this.

It’s not thinking on the fly as much as it is dealing with the fact that the environment is literally changing every day, with new understandings and new situations we have to adapt to, and then trying to figure out how do we respond to what’s right in front of us, while at the same time thinking a little bit down the road.

Here’s one example. In addition to trying to send our residential student population home — as high a percentage as possible — we’re also designating our employees as essential and non-essential. Essential meaning you have to be at your place of work, and non-essential meaning can work remotely, and be part of the self-isolation. We’ve gone through that exercise as an organization.

But along with that, we’re seeing that the number of people who are trying to connect through the virtual private network to get access to resources was four times the typical number. And we haven’t even gone full blown, so we may see 10 times that number. It’s created some instability within the system where we had to then figure out how to scale the service. We’re also seeing this with some of the core systems which are being used by many more people who are hitting it remotely, and how do we measure that.

We’re really thinking about scalability of some of our services. We’re all using Zoom now; the entire world is going to Zoom, and that has made us think about how we can scale it. Because we want people to use it, but at the same time, we can’t have every professor teaching a class at 9 a.m. on Monday, with synchronous interaction with students all over the state — that’s not going to go well. And so, how do we train professors to do a lecture capture host and move their courses into an asynchronous mode?

That one example of technology scaling that I think every CIO, regardless of industry, is dealing with in dimensions that they haven’t necessarily had to before this all started.

 

Gamble:  There are probably going to be so many lessons learned from this, because of the unique nature of the situation.

Andriola:  Right. I think for CIOs, the pandemic is going to force us to accelerate the use of technologies to enable things that have traditionally been done face to face, and think about how to make this the new norm. If we don’t think about this strategically, it’ll be too easy to just assume everything will go back to normal when the pandemic ends. What we’re looking at is, does it make sense to adopt the new normal? In some cases the answer may be no. But in a lot of cases, especially in healthcare, where we’re trying to do a better job of matching the right model of care for the right patient in the right situation, and move that to the lowest cost care interaction, we may find that this new norm can create a more effective healthcare system for us that balances cost and quality.

 

Gamble:  Another issue is cybersecurity. We’re seeing vulnerabilities exposed, and it goes to show that it can never take a backseat.

Andriola:  In times like this, when everyone’s rushing to the crisis, it’s easy not to think about the implications; not do the same cyber hygiene activities we’ve been training our organizations to do. We’ve been trying to think about that — when we take steps to do things, to stop and say, have we thought through the cyber implications of this? Have we thought about that it’s going to force us to open new ports and that may make us more vulnerable? Is there something in the messaging around this that the bad actors out there may take advantage of with phishing campaigns? We’re already seeing some of that.

We’ve got a pretty robust network across the University of California with our campuses and medical centers where we share information pretty quickly when we see these type of phishing campaigns pop up. And we have some technology partners who help us isolate these websites. For example, they helped us identify one website that was coming in a few weeks ago, and we blacklisted it across all of our locations, because they had some early success spoofing some messages coming from the CDC.

 

Gamble:  That’s scary. I would think that’s where we’re having the infrastructure and having that ability to share data quickly comes into play.

Andriola:  It’s a combination of technology and human coordination. Those human networks of being able to connect and share information — ‘We just saw this, everyone else should be aware of this’ — can really shorten the time span between when we recognize something and when we’re able to respond to something. That’s been a huge focus of our cyber risk program over the last four years.

 

Gamble:  In terms of your role, you sit on top of the six health system CIOs — how does that work? Can you give some background on that?

Andriola:  I have my vice chancellor role at UC Irvine, but I still maintain a UC-wide role as the Chief Information Officer of UC Health, which is the umbrella of the six health systems: UC San Francisco, UC Davis Health, UCLA Health, UC Irvine Health, UC San Diego Health, and UC Riverside Health. I convene the CIOs of each of those sites on a monthly basis. We have a program called Leverage Scale for Value, which is includes everything from buying things together to reduce costs, to deploying cyber capabilities together, to the way we’re doing virtual care enabled through Zoom and MyChart. We’re implementing that in similar ways because we have a blueprint being copied by each of the UC Health systems, and I’m the coordinator. I hold that second title to coordinate the activities across the system. It’s something we’ve been doing for four-plus years now, and it has generated tens of millions of dollars of cost savings and cost avoidance for the health systems, at a time where managing the cost of care and the cost of organization is important in the US healthcare market. It’s also becoming increasingly strategic. Under that program is where we developed our patient data repository, which represents all patients within the University of California and 16 million unique patient identifiers that have been treated at one of our six health systems.

 

Gamble:  When you talk about your role as really being able to add strategic input to the table as CIO, I imagine part of that is having a finger on the pulse of what these six systems are doing and what they need. Would you say it’s like being their representative?

Tom:  I would put it two ways. One term I use is impresario. I’m like the conductor getting the band members to play together. They all have their own instruments, and they’re all a little different. UCLA is different than UC Davis. The patient populations are different, the sizes and scales of the organizations are different.  UCLA has a lot more primary care in its network than UC Davis does, whereas UC Davis affiliates for a lot of its primary care activity. They’re different, and so the coordination between them is really important to figure out where we can actually learn from each other, share capability, and even share resources.

The other part of it is also getting us to link what we’re working on to the larger enterprise strategies for the university. We’re all trying to cascade down things that we’re doing around COVID-19 to the individual health systems, and so one of the big things is everyone is trying to build a COVID dashboard, and they all look a little bit different. Everyone’s grabbing a different set of metrics. Maybe some are prioritizing testing as the primary thing, or they’re looking at what ICU bed utilization and isolation looks like. We’re sharing those because it helps everyone think about what we could be putting together to show our executive team to give them a comfort level that we’re doing the right things, and we’re doing enough of those right things to respond to the biggest areas of need. It’s keeping a pulse on what the executive suite is looking for and then figuring out how we can scale the good things that we’re doing so that all five could be doing them as quickly as possible.

 

Gamble:  That makes a lot of sense. Well, I want to thank you so much for your time; we really appreciate it. I’d really like to follow up again in the future to talk about some of your other priorities

Tom:  Not a problem. Anytime.

 

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