Podcast Interview with CTO Chuck Christian, Part 1: “We’ve Learned Together.”

As healthcare IT leaders grapple with the day-to-day challenges brought on by the COVID-19 pandemic, while keeping a close eye on the strategic goals established by the organization, it’s important to ask this question: “How much change can an organization consume at one time?”

For Chuck Christian, who is VP of Technology at Franciscan Health, it’s become clear that some initiatives need to be put on hold — or at least, decelerated — to enable the IT staff to focus on what matters most: responding to the needs of providers. Recently, healthsystemCIO spoke with Christian about how the leadership team at Franciscan, a 12-hospital system based in Indiana, is prioritizing to ensure patient care is front and center, while also keeping the trains running. He also talks about his core objectives as VP of Technology, what it takes to lead during a crisis, and the lasting effect COVID-19 will have on the industry.

Part 1

• About Franciscan (12-hospital, faith-based system providing care in Indiana, Illinois & Michigan)
• Reorganizing the IT department
• Main priorities: lead technology & structure the department for success
• Bringing in VPs of innovation and analytics to “do things we’ve never done.”
• Dividing and conquering during COVID-19: “It was the perfect storm of expertise and experience we needed.”
• Limited downtown during Epic upgrade
• Managed services through Virtustream – “It’s more of a tango than a waltz.”
• Focus on remote work

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We’re doing architect and design work a little bit differently than I’ve done before, and so I’ve taken on more of a consulting role to work with those folks.

There was a lot of conversation and debate, but because of the way we orchestrated it, the only downtime our end users experienced was about two hours and 40 minutes. That’s pretty good.

Our instances of ServiceNow are integrated so that if we put in a ticket on our side that should go to them, it goes right to them. It’s like a dance, but it’s more of a well-done tango than a waltz.

How do we do that better? How do we leverage the tools Epic has and our own workflow expertise in order to limit some of the work and actually let the tools do the work themselves?

That’s what we’re looking at: how do we care for our patients and how do we look at what services are going to be essential? What do we need to do? What do we need not to do?

Gamble:  Since the last time we spoke, you took on a new role as CTO at Franciscan. Can you tell us a bit about the organization?

Christian:  Sure. Franciscan is a Catholic organization. It was started by the Sisters of St. Francis of Perpetual Adoration about 150 years ago. Our corporate office is in Mishawaka, Indiana, which is right next to South Bend. We have 12 hospitals and more than 400 locations, including imaging centers, lab draws and physician practices located mostly west side of Indiana, all the way to south Chicago and into southern Michigan.

We have two data centers: one in Beech Grove, where my office is, and one in Lafayette. We’ve done some outsourcing. When I got here last year, one of the first things I did was move our Epic instance to Virtustream, which is a Dell company. That was the last gift that Bill Aker, who was the CIO before Charles Wagner, gave to Franciscan. Before he retired, he signed the agreement to host Epic remotely. We did that in May or June of last year.

Our primary data is in Sterling, Va., with the second in Las Vegas. Our IT division has grown — not because we hired more people, but because we restructured the organization to include clinical informatics and IT education into our groups as well. Now we have about 500 members in the IT department.

My responsibility as chief technical officer is all of the infrastructure, networking, phone systems, and end user technical support, as well as being part of the senior leadership team of the IT organization.

 

Gamble:  Is it somewhat similar to your last role because of that technology focus?

Christian:  When I was at IHIE [Indiana Health Information Exchange], I was the CIO/CTO and CISO, and I did a lot of customer relationship management with CIOs around the state of Indiana. With an organization the size of Franciscan, the role of senior vice president and CIO takes on a more strategic function, whereas my role as the CTO has more operational. I spent 30 years being a CIO in smaller facilities, and so I was doing a lot of this work anyway. I had to wear many hats as we were figuring out architecture.

The good news is that in this organization I have three enterprise architects that report to me. We also have a desktop architect and a few others as well. We’re doing architect and design work a little bit differently than I’ve done before, and so I’ve taken on more of a consulting role to work with those folks on design.

Actually, I’ve just finished reorganizing our department. I have about 100 or so people underneath me, including a director and several managers that report directly to me.

 

Gamble:  What was it that appealed to you about this particular organization?

Christian:  A couple of things. I’m retired clergy from the Episcopal church, and so from the religious standpoint I can very well relate to the mission of the organization. I’ve been in healthcare most of my life with a couple stints of doing some other things, and was doing some consulting work as well.

I got to know Charles through my executive management duties at IHIE. He mentioned at lunch one day that he was looking for a chief technical officer. I knew the organization, and so I thought I’d throw my hat in the ring just to see. They had an interim set up through Chartis, but Charles was looking for somebody to do a couple of things: to lead technology, and to structure the department in a way that it could be successful in the future. After consulting with Charles as well as some of the Chartis folks, I think we’ve done that. Is it exactly the way it needs to be? No. Will we get there? I have faith that we will. There’s a lot of organizational change. Charles has just gotten his senior leadership in place. We just brought in Sri Bharadwaj as VP of digital innovation, and we brought in Mohamed Humaidi as vice president of analytics. As a result, we’re able to do things we’ve never done before.

When the COVID-19 outbreak hit, all of us really hustled. I was working to move our workforce to remote, and Mohamed was pulling together an analytics and reporting infrastructure unlike anything we’ve ever seen before to rapidly move thing out. Sri has been working on the virtual health front, and I’ve been right there with him trying to help stand up a very robust virtual health platform in a very short period of time. It was the perfect storm of expertise and experience we needed in order to make all of that happen.

 

Gamble:  In terms of the remote hosting strategy, how has that factored in to what you’re doing?

Christian:  Actually, we just recently dropped in the August 2019 version of Epic. We upgraded in the middle of all of this. There was a lot of conversation and debate, but because of the way we orchestrated it, the only downtime our end users experienced was about two hours and 40 minutes. That’s pretty good for a system this size; every physician practice, all of our home healthcare agencies, and all of our hospitals were all upgraded at one time.

Not only did we go with the hosting solution, but they’re also managing our Citrix environment for Epic as well as the cache environment. We have managed services along with them hosting everything, which has been beneficial. Has it been without issue? No. Because, like I said, we were one of the first sites that signed on for it. Covenant was first, but they’re just doing hosting; they’re not doing any kind of managed services.

So we’ve learned together. We have some dedicated folks at Virtustream and we’ve got a good management team. And, like I said, it’s not been without issue, but it’s been really good as far as the organization goes. We still have teams of people dealing with applications at a deep level, and I’ve got people on my infrastructure team managing Virtustream our Epic environment. We have conversations with Virtustream every day. Our instances of ServiceNow are integrated so that if we put in a ticket on our side that should go to them, it goes right to them. It’s like a dance, but it’s more of a well-done tango than a waltz.

 

Gamble:  I like that. Now, regarding the Epic update, was there anything particular you were focused on, or was it just improvements in general?

Christian:  We were just dropping in the August 2019 package and everything that goes with it. We’ve been doing quite a bit of what we called Epic 2.0. It’s not going back to model, but it’s similar to that. Everybody gets the same software now, so when we do one upgrade, we upgrade everybody. There’s quite a bit of coordination, education, and communication to make that happen.

We have a few projects going on, such as clinical documentation enhancement. We’ve been part of the Arch Collaborative with KLAS for quite a few years looking at workflows and how we can have an impact. You hear a lot in conversation with physicians about the overhead we’re putting on their practice with all the requirements for documentation — how do we do that better? How do we leverage the tools Epic has and our own workflow expertise in order to limit some of the work and actually let the tools do the work themselves?

We have a lot of features in Epic we haven’t turned on yet that we continue to roll out throughout the organization. But it’s like everything else — how much change can any organization consume at any one given time? Right now, we have a massive amount of change related to the COVID-19 response. We’ve had to slow several things down in so we could concentrate on taking care of our patients and not have it impact our ability to respond in the way that we need to.

 

Gamble:  I can imagine that’s a difficult balance. In terms of the COVID-19, what would you say were the first priorities?

Christian:  There’s been so much activity, particularly on the clinical side, so I can’t answer to all of that. But from a corporate standpoint and a senior leadership standpoint, we immediately stood up a command center, and started looking at how we can get as many people working from home as possible. We have an ambulatory and an acute billing center; one is in Hammond and the other is in Indianapolis. And so we started immediately taking inventory: how many laptops do we actually have on hand? How many other devices do we have?

We were rolling out Rover and looking at MyChart Bedside. We have a lot of iPhone 8s on hand; we have not ordered the iPads yet for MyChart Bedside. We refresh about a quarter of our laptops each year and we had just placed an order to start that process for the first quarter, and so we had those laptops on hand and we immediately froze the refresh so we could keep those back.

The other thing we started doing is looking at our licenses, particularly for remote connections. We run Palo Alto Networks, and we were just starting to stand up a new VPN solution called GlobalProtect. We were just starting to test it; we went from testing to full-blown deployment in about a week. We started looking at how we can orchestrate that with remote workers, and what the requirements are to stand up virtual health.

We have people coming into the hospitals and people going into our physician practices. How do we protect patients and how do we protect clinicians? We were already working on a virtual health strategy, just not quite at the volume we’re looking at today.

I was speaking with John Kravitz at Geisinger about some of the things they’re doing. They hit the peak before us, and so Charles asked me to schedule a call with some folks in New England. He and I, along with Sri, got on a call with John to learn how they’re preparing for that surge of patients and ramping up telehealth.

I got some great notes from a cardiology group thanking us for how quickly we were able to pull the environments together to make that happen. That’s what we’re looking at: how do we care for our patients and how do we look at what services are going to be essential? What do we need to do? What do we need not to do? It’s been an interesting month, to tell you the truth.

Part 2