Q&A with CIO Will Walders, Part 2: “You Have to Get Your Technical Debt in Order.”

Will Walders believes one of the most important things an organization can do, especially now, is to become “brilliant at the basics.” At its core, it means making sure clinical systems are functioning properly and users can access their email without issues. In doing so, teams can create “an excellent foundation” to accomplish the more complex tasks.

This philosophy has served him well at Health First, where Walders has served as CIO since June of 2019. Since that time, the organization has cut $16 million in waste and significantly reduced the number of applications in use, and he doesn’t plan to stop there.

Recently, Walders spoke with Kate Gamble, Managing Editor at healthsystemCIO, about how his team is leveraging visibility and shared accountability to decrease legacy debt; the “holistic, predictive approach” he has taken to IT business management; and why capturing “low value work” is so critical. He also talked about how they’re working with partners like RelayOne to create a “frictionless experience” and what he believes healthcare can learn from the Domino’s Pizza Tracker.

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Key Takeaways

• By adopting a “holistic, predictive approach to what IT services management looks like,” Health First is able to see determine the IT spend on a broad level, while examining things like service tickets at a tactical level.
• For IT departments, retiring legacy systems — especially those that are no longer fully supported — is a victory that should be celebrated.
• When a team is “brilliant at the basics,” it doesn’t get noticed when email works and clinical systems are functioning. It gets noticed “when that happens the same way over and over again, and they pick their head up and realize they haven’t had an issue.”
• One way to increase efficiency in the perioperative space? With “a frictionless PHI-less solution that allows you to see the entire environment with a simple click.”
• “We don’t need heroes; we need normal people doing normal things well all day, every day. If everybody just did their job all day every day, we would be great.

Q&A with CIO Will Walders, Part 2 [Click here to view Part 1]

Gamble:  And IT service management falls under your purview as well, right?

Walders:  It does, yes.

 

30,000-foot view of IT

Gamble:  That’s another area where I’m sure you found a lot of room for improvement.

Walders:  Yes. There’s a lot of range as you look at the maturity of IT business management, from true incident management to problem management to taking a holistic, predictive approach to what IT service management looks like.

I feel like I’ve gone through this journey everywhere I’ve been. At Health First, were 2.5 years into understanding all the services we provide and what they cost, and adding time required maintain with service level agreements. It’s establishing the administrative baseline for IT service management and finding an audit proof way to communicate that back to stakeholders.

Our clinics aren’t terribly different. They were roughly at the same level of productivity; being able to show that one consumes more IT resources than another is a powerful statement, particularly if one is more or less productive than others. You can start to take a holistic approach — a 30,000-foot view of where the IT spend is and why, and tune it to what’s best for the organization. Then you take that to the tactical level of incidents and service tickets, etc. It’s a force multiplier. On a scale of 1 to 5, we’re at about a 3, meaning that people are using knowledge management to solve the problems, but we’re not quite to the point where we’re seeing the problem before it develops and cutting it off before it becomes an issue. We’re still at the rationalization stage of getting as lean as possible.

Marking “a significant milestone”

In fact, we’re about to celebrate a significant milestone. We have one server left from our legacy Windows product. It’s the last supported server we have. And of course, as a legacy system, it was based off pagers and fax machines. But our clinicians fought hard against it. They said, ‘if you turn this system off, it will kill patients.’ Generationally, there have been 7 improvements on how this is done, but it’s the way we’ve always done it, and it’s hard to disrupt the system and processes people use all day that works.

So we’re celebrating that. It gives us a level of maturity. We’re getting off our last unsupported system. That’s a victory for most of the CIOs out there. I talk with some of my peers and they say, ‘We’re never going to get off that Windows XP system that runs the $3 million microscope’ because the OS isn’t going to drive the replacement of an electron microscope that’s still good and doesn’t need to be replaced for another decade. Those are some of the things that we inherit as CIOs and supply chain leaders. But it’s our last one and we’re going to have a cake cutting and a party to celebrate the final transition.

 

Removing legacy debt

Gamble:  That’s a big accomplishment. You have to celebrate those things.

Walders:  Absolutely. I do this intentionally everywhere I’ve been. We make a cake with the name of the application on it, cut it, and consumer it. It’s very cathartic.

I have the physical server out in the conference room. I like to joke with the system administrator and a lot of the platform team who supported it and tell them that every day someone from the team has to hold the server over their head and do a lap around the office until we could finally sunset this thing. That’s how important it is to remove legacy debt and to have that visibility with IT business management or IT service management to know those things are there. And moreover, to take that approach where we know what it truly costs; how much you pay out of cycle for Windows support. When it’s no longer supported, you have to pay a hefty sum to have it patched and supported. It’s that legacy debt of having to maintain all these systems.

That’s where we are in terms of maturity. It’s so important. I think people underinvest in this because it’s not sexy stuff. It’s not glamorous to do that work. The team doesn’t get a ton of recognition for what they do. You have people solving problems every day and getting customer feedback on how awesome they are, and the IT service management team is making sure that the administrative services from an IT perspective are lined up, documented, and measured. I don’t envy that team.

 

Gamble:  It’s interesting; we’ve heard so many times about telehealth being the silver lining with Covid, but it seems like the ability to identify inefficiencies and blind spots is just as important.

Walders:  That’s exactly correct. There were a few cartoons circulating around during the pandemic. One has people sitting in a boardroom saying, ‘Digital transformation is coming, but we’re in no rush. We’ve got years to do it.’ And there’s a wrecking ball aimed at the boardroom that says ‘Covid-19’ on it.

There’s another with a few construction workers in front of this ramshackle of a house that’s pieced together with a hole in the roof. Someone is holding an umbrella over the hole and two people are standing in front of it saying, ‘why does it takes so long to put in a new window?’ On the bottom it says, ‘Technical debt.’

New window on an old house

The end user is thinking, ‘I just want a new window.’ They need to look at the house. It’s not that simple. The ‘new window’ might be a new virtual solution or, as a lot of us did, implement asynchronous registration and virtual waiting rooms to prevent consults so that doctors don’t have to put on and take off PPE to go in and out of patient rooms. We did a lot of that as a result of COVID.

But if you had a ramshackle environment that wouldn’t support this innovation and was dependent on either the expertise or the infrastructure that you hadn’t quite been able to do because of all that technical debt, you weren’t going to do it. You had to get your technical debt in order. You can’t build a new house on a crappy foundation.

 

“Brilliant at the basics”

Gamble:  Right. Which is why the non-sexy stuff is so important.

Walders:  It was an excellent time to focus on what I call being brilliant at the basics. If you’re brilliant at the basics, and you do basic things well every day, that’s expected as support services and as a commodity of an organization. People don’t applaud when their email works and they can log in every morning and clinical systems are functioning. They applaud when that stuff happens the same way over and over again, and they pick their head up and realize they haven’t had an issue. If you do those things well, it gives you an excellent foundation for all the rest of the things that are expected of you.

 

Gamble:  So clearly you have a lot going on.

Walders:  We do. We’re at an impasse when it comes to clinical consumerism — how we can deliver a relentlessly consumer centric approach to our customers. And those customers can touch us in many ways: as a health plan member, as a customer at our retail pharmacy, etc. Even if you’ve only interacted with Health First by buying crutches at one of our durable medical equipment locations, we want to take a consumer centric approach to that. That’s what our focus is.

We’ve partnered with a few start-ups. We’ve been a part of two of them going public this year — Oscar and Privia Health, which have been great success stories for us. Using Privia on our ambulatory platform, we’re delivering consumer-centric care in ways we never were able to before. We’re doing the same thing on the health plan side with Oscar by providing consumer platform and reducing friction.

Our focus in 2022 is to do that on the acute care side. We hope to continue the success we’ve on the ambulatory side by being brilliant at the basics. We’re doing everything we need to do from the payer side with open enrollment, advertising and getting the message out there. We’ve been able to offer a truly consumer centric platform on the health plan side, and now I want to do it on the acute side.

Partnering with startups

What’s notable there is that we’re doing this with Oscar and Privia, companies no one has heard of before. Privia’s platform sits on athenahealth; not Epic or Cerner. We’re not leveraging the traditional players to provide a consumer-centric experience, and there’s a reason for that. I think many of us agree there are certainly pockets where those solutions are implemented well, but healthcare at large hasn’t figured this out. We want to be one of the firsts.  We’re taking a physical approach to this as well in building health villages — a true destination of wellness that can be experienced physically.

I want to do the logical version of that and build an acute version of what this could look like. We’ve partnered with a start-up there as well to truly transform what the acute experience looks like from a consumer centricity perspective and incorporate all of that based off your persona.

That’s my focus for 2022 on the acute side. The perioperative space is our number one focus for reducing the amount of friction folks experience when they go in for care, as well as the care team. We have some really exciting partnerships there, including a company called RelayOne that uses a PHI-less solution. We’ve fallen into a pattern of doing security to our staff: you need multifactor authentication. You need to enter a code every time you log in. You have an anesthesiologist who has credentials at seven hospitals in a community and who struggles with managing all the disparate systems we’ve forced on them.  How about a frictionless PHI-less solution that allows you to see the entire environment with a simple click? We’re looking at things like in the perioperative world.

Never-ending security battle

And then there’s security. You’re never done with the security battle. For us, we’re looking at how do we continue to modernize our security posture, focus on areas where we have the biggest bang for the buck on improvement.

We spoke to our audit subcommittee recently, they’re very happy with where we are, what processed we’ve made and where we’re going to focus resources.

Security is always going to be tough. When I worked in government, I joked that we had $50 million to spend on a $500 million problem. Now I have $5 million to spend on a $500 million problem. But we have figured out how to prioritize and not reach diminishing returns.

Those are my big focuses for 2022.

 

Gamble:  You’ve got your hands full, obviously. But I’m sure it makes a difference when you start to see the wins and the improvements.

Walders:  I have a pretty big team, and we now have the resources to handle all of this using IT business and IT service management. I’ve articulated what we do, how we do it with the resources we have, and what it will look like if we want to add a little more or a little less. We’ve reached an audit-proof state when it comes to people, time, and money to understand what we have in terms of people, how much time we have to do it, and what it costs.

It goes back to the IT business management construct. We know what we get. We’re no longer the black hole.  We’re no longer the passion plea of, ‘give us another 5 million for this security tool or the ransomware guys are going to get us.’ We know through good discipline, being brilliant at the basics and documenting everything we do from a people, time, and money perspective, that when we’re given a resource of any type, we can perform. We then provide milestone updates to show what we’ve done. We’ve gained that credibility in IT, and I’m doing the same thing with supply chain. We’re going to continue that momentum through 2022 and beyond.

 

Gamble:  I really like the term, ‘brilliant at the basics.’ That’s a great goal to have.

Walders:  It comes down to this: we don’t need heroes; we need normal people doing normal things well all day, every day. If everybody just did their job all day every day, we would be great.  That’s just a different way of saying it.

I’ve got a pretty simple construct: when you’re brilliant at the basics, you build partnerships and business relationships. You create a positive perception of what IT does, as opposed to what many people erroneously think it is. Once you have that partnership in place, you can then do whatever you need to do. I always build these things in pyramids. Basics are at the foundation, partnerships are in the middle, and your mission is at the top. They drive each other. That’s why it’s important.