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.
- Phishing campaigns – “We have to be on guard.”
- Managing updates through VPN connections
- Leadership during a crisis – “You have to literally over-communicate.”
- Installing VoIP throughout the enterprise
- Telecommuting & virtual visits – “I don’t think it’s going to change.”
- Transitioning to Franciscan
- “I’ve got an awesome team.”
- Indiana’s network of health IT leaders
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We’ve shared with everybody to be cautious — overly cautious — about what you click. If you don’t know the source and don’t understand it, don’t click on it.
I’m always having meetings with my teams. We meet with site directors and our business relationship managers for each one of those facilities and other key business units of the organization to try to understand what their needs are and how we can meet them.
I don’t think we’re ever going to get back to where we were, because we’ve learned some things about how we can provide care to patients and how we can work.
The only thing I don’t get to do is to see people’s faces. I don’t get to interact with them, and that’s tough. We’re built as humans to interact with individuals, and to have the collegiality that goes along with it.
It was never, ‘We can’t do that.’ It was, ‘how do we figure out how to do it?’ We spent a lot of late nights finding solutions for virtual visits and virtual rounding in the nursing homes. Some of our physician leaders are in nursing homes, and we needed to figure out, how can they round without physically being there? How can we find a solution?
Gamble: The timing of all this is pretty incredible, because we had the final rule released about a month ago, which has all kinds of implications for virtual care.
Christian: It does, and the fact is, at the same time they were rolling those out, OCR was relaxing requirements around patient privacy, and HIPAA was starting to release some information where appropriate so we could take care of the public health issue as well. We still have to be on our guard and cautious.
The other thing we’ve had to do is ramp up security because there have been so many different phishing campaigns that have come at everybody. They’ll take advantage of any crisis to make you think you’re clicking on a link that’s going to give you some salient information, when really it’s loading malware onto your PC. We’ve shared with everybody to be cautious — overly cautious — about what you click. If you don’t know the source and don’t understand it, don’t click on it.
Gamble: There are so many security implications when things like remote work and telehealth ramp up so quickly. How are you addressing those concerns?
Christian: We actually have a few people that didn’t have internet service in their homes. Fortunately, we had just had some conversations with AT&T about their FirstNet program, and we were able to acquire some of the hotspots and send them home with folks who didn’t have internet. That’s worked out fabulously. It’s like I’ve always said, I’d rather be lucky than good looking. We got lucky with that, and with the go-live on the new VPN.
One thing I’ve found in rolling out updates is that I don’t have to be connected to the VPN all day long. I connect when I need to get to systems behind the firewalls. We just recently rolled out Office 365, which is another lucky thing. We’ve leveraged the Teams platform for a variety of things internally for the organization. We have ServiceNow. We have so many things in the cloud that there were only certain things I needed to do. I could just log in, connect, and then drop off. But in doing so, I didn’t get all the updates that I needed. And so we asked everybody to be on for four or five hours a day so we could make sure we get all the updates to those machines.
We’ve had a remote workforce for quite a few years. Now we’re running between 600 and 800 people every day, including our home healthcare agencies and visiting nurse associations. We were ramping up another remote worker policy just as this was hitting; working with HR and the rest of senior leadership to allow individuals to work from home either two or three days a week or on a routine basis, just from a cubicle and office space standpoint.
Like most states, the schools in Indiana are closed. And so, having the ability to let people work from home — those who can — gives them the opportunity to be with their kids and not have to worry about daycare, especially since most of those are closed as well. This whole thing has created challenges far beyond just a regular flu season.
Gamble: Absolutely. That’s a really nice segue into one of the other things I wanted to talk about, which is leading through crisis. What are your thoughts, based on your experience?
Christian: Really and truly, you literally have to over-communicate. We stood up groups very quickly, and some of us have daily check-ins. I’ll have phone calls running until 7:30 or 8 o’clock at night, starting at 7 or 7:30 in the morning, just because we need to make decisions.
These are management principles. I’m always having meetings with my teams. We meet with site directors and our business relationship managers for each one of those facilities and other key business units of the organization to try to understand what their needs are and how we can meet them.
Charles Wagner, our CIO, has an all-hands-on-deck meeting at least once a quarter. During the summer, time we’ll have cookouts. Last week, we had an all-hands meeting with 432 people, where he provided updates about the organization and talked about how impressed he was with how quickly we were able to come together, team appropriately with the different groups, and provide solutions very rapidly. We’ve sent out broadcast emails. We set up team sites for communication. Actually, at different times, we’ve been able to merge work streams because people are working on the same things, and so we’ve been able to step away and let the appropriate people work on those things, particularly around virtual health.
The other thing I’m doing is having an all hands on deck meeting for my squad, which is a little over 100 people, just to give them updates. That includes folks on the service team and the desktop team, and the architects. They’re still doing what they’ve always done. Sometimes they don’t respond as rapidly as everybody else because their immediacy is not at the same level — we’re not standing up new hardware and network fabric and that kind of stuff.
Our telecom team has been deeply involved with moving people home, standing up softphones and all of that. I’m so happy and so impressed with the decisions we’re making about virtualizing things; for example, putting in a VoIP system through Cisco throughout the entire enterprise. It’s not done yet, but we’re getting there. We have Avaya phone switches that allow us to run softphones and other things, and we were able to very quickly pull those tools together to meet the demand.
I was talking with one of our physician leaders about virtual visits, we were talking about virtual visits and what it’s going to look like once this is done. I think it’s going to change. I don’t think we’re ever going to get back to where we were, because we’ve learned some things about how we can provide care to patients and how we can work. I’ve worked for some folks who believe you need to be in the office every day. I was never in the office every day, even when he wanted me to, because I was at the physician practices or I was at one of the other facilities. Now that we can work virtually in order to get a lot of work done and do a lot of collaboration using those tools we’ve stood up, I think we’re going to learn how to work differently.
The other thing we’ve learned is how important it is that we take care of each other and ourselves. Because if we don’t, our careers will be short lived in a couple different ways. I know that my wife is tired of me being at home every day.
Gamble: It’s a big change.
Christian: It is a big change. I was doing consulting work before I took this job. I had my office setup upstairs, and so I’ve added some enhancements that makes it a little more convenient for me to work in this space every day. The only thing I don’t get to do is to see people’s faces. I don’t get to interact with them, and that’s tough. We’re built as humans to interact with individuals, and to have the collegiality that goes along with it.
Gamble: Right. So you’ve been at Franciscan for about a year, but for those who are new to an organization, especially those in a leadership role, it has to be really challenging.
Christian: The good thing for me is that I already knew a lot of people in the organization. I’ve known Bill Aker, the previous CIO, for almost 30 years. I knew the organization, and a lot of people in the IT organization knew me. In fact, for one of our administrative directors, I was faculty at the CHIME Boot Camp she attended. I’ve interacted with Dr. Jonathan Roskam, our CMIO, for years around interoperability issues in the state of Indiana. There were a lot of people I already knew, or they knew me, and I think that made it a nice transition. There were established processes that we needed to look at. But I’ve got an awesome team. I can’t begin to brag enough about how well they came together and how all of senior leadership worked together to ramp up to meet this challenge.
It was never, ‘We can’t do that.’ It was, ‘how do we figure out how to do it?’ We spent a lot of late nights finding solutions for virtual visits and virtual rounding in the nursing homes. Some of our physicians leaders are in nursing homes, and we needed to figure out, how can they round without physically being there? How can we find a solution that will allow the patients and their families to visit if they can’t come into the building? These are things we were figuring out on the fly. We had some difficulties with our virtual health platform and got those worked out. We actually had some calls this weekend with senior leadership at Geisinger, since we’re using the same platform, and so I have no doubt that we’re going to get there.
Gamble: It’s encouraging to hear that you’re reaching out to people either who are in the same spot or maybe are a bit ahead of where you are. It just makes so much sense to do that, especially now.
Christian: Absolutely. That’s the way my career has been all along. When I worked in community hospitals, I had to pick the brains of folks that were way ahead of me as far as technology and process. Through relationships, and through professional associations like CHIME and HIMSS, I was able to leverage those friendships and stand on the shoulders of giants. I’m still doing that today.
That’s one thing I’m seeing with all the CIOs and CTOs I know; we’re sharing information. I have a friend who’s a CTO at one of the other large health systems in Indianapolis, and we’re sharing all the time. We’re trying to solve the same problems, and at the end of the day, our missions are the same — to take care of patients.
That’s an interesting thing about Indiana. About 15 years or so ago at the Indiana Hospital Association’s IT work group meeting, the hospitals decided not to compete on data. We’ll compete on quality of care and services, but we’re going to share the data, because that’s what we need to do. The patients need to be able to get care wherever they want to. That’s one of the reasons that we have interoperability platforms we have in Indiana that are unique and different from what others have. But everybody else is catching up, so that’s a good thing.
Gamble: That’s something we really hope to see continue. For some people, it’s not their instinct to reach out. Hopefully going forward, those individuals are going to be more likely to share and to reach out.
Christian: I learned a long time ago that I’m just a dumb old country boy from Alabama. I tell my team, if I walk in the room and I’m the smartest guy in it, I need to find another room. I’m there not only to offer what little knowledge I have, but to learn as well. I’ve got a lot of smart people on my teams. I’m very pleased to be able to contribute whatever little I can in order to make this organization successful.