When you’re the organization’s new – or, as is often the case, first – chief information and digital officer, the temptation to make a splash can be quite overwhelming. However, doing so without taking a property inventory will all but ensure a short tenure, according to Joel Vengco. “You don’t want to go in and say, ‘I’m going to build generative AI capabilities’ when the foundation isn’t being addressed,” he said during an interview with Kate Gamble, Managing Editor and Director of Social Media. Rather than being mesmerized by shiny objects, leaders need to “make sure we do absolutely everything we need to do for the foundation.”
For Vengco, who joined Hartford Healthcare in March of 2022, that meant devoting time to “understand the culture, the environment, and the capacity and capability for change, and from there, figuring out what we need to bring forward.” One of those needs was developing a data and digital platform focused on “delivering data as a product to the enterprise,” he said.
During the conversation, Vengco also talked about Hartford Healthcare’s long-term growth strategy; the organization’s ultimate goal of improving patient access; the partnerships they’ve built to achieve that goal; and how transforming an organization is like fixing up a classic car.
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- The goal of Hartford Healthcare’s ITS 2.0 is “not so much about implementing the EHR — it’s about realizing the vision of personalization and coordination across the enterprise.
- Personalization requires more than having data about patients; it’s figuring out how to harness the data and create liquidity, and leveraging digital technology “in a more intelligent way bring together assets that could provide what they’re looking for.”
- Three main components in developing a solid ITS strategy: focus on the foundation, commit to optimization, and become leaders of transformation.
- Driving change isn’t about focusing on shiny objects. It’s “making sure we do absolutely all we need to do for the foundation.”
- As CIDO, “you have to understand the business and be creative in terms of creating solutions and understanding how to lift up the car and put in a new engine that optimizes the care. It’s a beautiful car… but you need to update the engine.”
Q&A with Joel Vengco, CIDO, Hartford Healthcare
Gamble: Hi Joel, as always, it’s great to speak with you. The last we time talked, you were with BayState Medical Center, and you’ve since transitioned to Hartford Healthcare. Can you share a bit about the organization?
Vengco: Hartford Healthcare is an 8-hospital health system with roughly 400 sites across Connecticut. We’ve grown rapidly over the last decade; there’s a deliberate focus on being within 10 miles of every resident in Connecticut. It’s a great strategy. And it’s proliferated in that manner through not just putting up primary care sites or acquiring primary care sites and other medical practices, but also through joint ventures.
We have joint ventures with GoHealth and Amazon One Medical, to name a few. There’s a big focus on ambulatory-based care or home care, keeping folks local, and keeping an eye on value-based care. When I was at Baystate, we had been on that journey for quite some time. Connecticut is just starting on that journey in many ways, really coming off of a hot fee-for-service market. Now, we’re really focused on value-based care, taking risks, and moving care toward the ambulatory setting as opposed to just in-patient. It’s really a terrific journey.
As with many other organizations, there’s a huge focus on going big with digital and figuring out how to really transform one’s organization toward providing care and engagement and access in that manner. That’s primarily why I’m here.
Gamble: When did you actually start with Hartford?
Vengco: I started mid-March of last year, and I have to say, it’s been quite a year. And it’s been quite a journey so far.
Gamble: I want to talk about some of those strategic partnerships, as well as the other work you’re doing. I’m not sure where you want to start — there’s a lot to cover.
Vengco: When I started, it was a matter of figuring out what we have and what we need to achieve that digital strategy. Our vision at Hartford Healthcare is to be the most trusted provider of personalized, coordinated care. What’s very cool about the history of Hartford Healthcare is that they had really focused on one EHR system, one registration system, one scheduling system, and one ERP. There was a deliberate focus on making sure we had a unified platform; the prior administration did a great job at achieving that.
HHC ITS 2.0
Hartford Healthcare ITS 2.0 is not so much about implementing the EHR; it’s about trying to realize that vision of personalization and coordination across our enterprise. Personalization, to me, means we know the person we’re providing a service to; we have to have data about them. We have to figure out how to harness the data and create data liquidity.
To coordinate our services, we obviously have to have a great set of standard processes. But we can also leverage digital technology to begin to bring together, in a more intelligent way, the assets that could provide patients and family members what they’re looking for, whether it’s access or education.
Assessing the environment: “What do we have & what’s missing”
With that in mind, I asked some questions: what do we have and what’s missing? What’s that white space that ITS has can really fulfill? I did a lot of rounding, or going to the Gemba—as we like to call it here, because we’re a really big lean shop—to really try to understand the culture of the organization, the environment, the needs, and our capacity and capability for change, and then from there, figure out we need to bring forward.
To your earlier question, you can’t do it alone. You have to start to identify collaborators and partners who want to innovate and do so in a way that’s really beneficial to both us and to them. In finding that white space, I then started to identify who are the partners that we should connect with and go after to help us with this work. It’s not just me alone, obviously. I inherited a great team but also great partners around IT, folks in the informatics space, in the clinical business space, the administrative space. There was already this notion of innovation and partnership that Hartford Healthcare had begun to foster well before I got here, which is really exciting.
Gamble: I’m sure that was a big draw for you.
Vengco: For sure. Having the infrastructure to bring on partners and innovators is really a critical part of the process. All that said, I think really the first thing was to identify the problems we need to solve and how do we get there. And then when you figure out what the capability is that you need, the structure comes with that — form follows function. That form and function also creates the space to identify partners.
Creating a structure
I’ll give you a sense of the structure that I created from our IT shop, because, as we know, what got us to where we are in IT today is not going to get us to where we need to go. Not to say anything badly about the IT shops that got us to here to implementing the EHR and the ERP systems. but it’s a very different structure that you need to do what we’re going to do now—to focus on data and to focus on digital transformation.
Component #1: Foundation
As I started to generate our ITS strategy, I realized there were three things that I needed to make sure our IT shop could do. Number one, we need to be able to focus on the foundation. Things like being brilliant with the basics is really critical, and making sure we’ve got the fundamentals for operating a modern IT shop but also making sure we keep the lights on for this organization.
Component #2: Optimization
The second is to be able to focus on optimization; optimizing the systems that we have, optimizing the process with the systems we have, evolving our current applications into products and to make sure that those products can support new capabilities that our health system needs for the next wave of service delivery like care at home, for example, or home health. Those are in many ways new types of products that we need to be able to provide to our clinicians and our patients, and that sector is still pretty immature in many ways. How do we evolve or optimize the current systems that we have today to be able to support that service?
Component #3: Transformation
The third thing that I would say my IT shop needed to be able to do is really lead transformation. We are, in many ways, seen as the facilitators and the igniters of transformation and innovation, and we have to support it. It’s really important for us to think about what’s on the horizon and to be able to put together plans and vision and strategy to achieve that transformation. As an IT shop, it’s not just about keeping the lights on, it’s about foundation, optimization, and transformation.
Four Key Leaders
Creating that structure made me rethink what teams I need, and it turned out to be four teams and four key leaders. The first is the VP of IT Operations and Technology Platforms. That’s sort of what I call business of IT. That team is everything from security to services to dev-sec-ops to tech services and infrastructure and cloud, which we’re migrating to. That’s the first team.
The second team is led by a VP of Enterprise Applications and Products. It’s all of the traditional applications, but with this notion of product management rather than just project management.
Hartford’s data & digital platform (H2D2)
The third is Data and Digital Platforms. The focus there is data liquidity, creating what I call at Hartford Healthcare the data and digital platform, or H2D2 for short. It’s not the traditional analytics or reporting team; it’s in many ways focused on delivering data as a product to the enterprise, which is more important now than ever with this whole wave of generative AI. Who are the data experts to provide the data to those types of applications and ensure that we have good guard rails for that and a good platform to be able to give data to partners and to ensure we’re securing that data for that kind of use. And also, analytics and advance analytics that will reside in that team.
The final team and group is really digital transformation, which is where things like consumer platforms or patient platforms and technologies will reside, along with our CRM and human centered design. It’s more outward facing, but it’s also about transforming the way that we deliver care, and it starts in many ways with the digital platforms and digital capabilities we need to create.
Those are the four key areas, and that’s how we came to the partnerships we’re creating and seeking from those who are innovating in each of those spaces. Hopefully that gave you a little bit of sense of the fundamentals we’re trying to build and what I’m trying to accomplish here.
Gamble: Absolutely. Everybody wants to have strategic partnerships, but you really need to have all of this in place. I imagine that that was a big part of your focus for the first chunk of your time there.
Vengco: Totally. It really is essential, particularly when you’re the organization supporting the health system. I’m supporting and providing a service to know that we’re not just focusing on the shiny object. In fact, it’s far from the truth. We’re focusing on making sure we do absolutely all we need to do for the foundation on top of which we’re going to build these net new things or to build the transformation on top of.
You don’t want to go in there and say hey, I’m going to build all of this generative AI capability and advance analytics capability when the foundation isn’t being addressed appropriately or you’ve got a data center problem or a cybersecurity problem. We need to make sure that’s solid first. And once there’s a solid roadmap, you can start to focus on some of the other areas.
An ‘ecosystem of partners’
What’s really a blessing for us is that it became clear that the partnerships we needed at the beginning were really partnerships that could address, at the very least, the first three tiers, if not all four. We don’t believe, I don’t believe one partner can do it all, although many partners think that they can. To me, it’s an ecosystem of partners that’s needed and required to be able to do the many things that I think that we need to be doing as a health system.
We chose, first and foremost, a partner who could help us with going to the cloud, which is essential for all of the things that you need to be doing to get to digital. If you can’t, if you’re not in the cloud, it becomes a very expensive proposition to transform digitally. Imagine buying however many boxes you need to buy to get applications up and running—you can’t spin it up in an agile fashion. It just becomes really difficult if you don’t have the ability to spin up capacity and compute or acquire services with the push of a button.
Cloud is really essential for us and our partnership with Google. It was really founded on that first fundamental capability, which is that we need to lift and shift our 10 data centers up to the cloud. That’s really the first piece of our journey—to bring that to fruition. From there, it really becomes more of application, data, and then the digital phases where we start to really realize the use of that data through what we believe are essential use cases towards transformation.
Gamble: When you’re talking about that many data centers, what’s the strategy?
Vengco: As with all things, you have to figure out what’s the value proposition. In our case, we were just about to embark on a set of refreshes, or a full refresh in some way for many of those data centers. It was a ripe time for us to put together a strategy and a business plan to say instead of buying a box in a data center or in multiple data centers, let’s take that money and put it towards buying services in the cloud and then harvest those savings, because if you do it properly, you can rationalize applications.
Saving and investing back into the health system
You can certainly reduce a lot of overhead and right-size your use of capacity and compute. We modeled that and we found that we had the potential to save somewhere between 25 to 30 percent of what we thought we were going to spend over a 10-year period. We basically parlayed that into a way to harvest savings and we’re going to invest that back into transforming the health system instead of asking for more money, which I think would be the easiest route. I wish I could have done that, but we all know healthcare systems are at a very challenging moment in our existence, particularly with reimbursements, supply chain, and all of the economic challenges. We don’t have the opportunity or the luxury of just spending discretionary amounts of money.
We, as IT leaders, have to do a really diligent job at finding ways to reduce spend and really harvest sort of those dollars to invest into something that’s accretive for the organization. That really was the strategy; to reduce that expense and put those savings back into IT in a different way so that you can really begin to transform the organization through the new technologies without asking for more money.
The Evolving CIDO Role
Gamble: That’s really telling when you think about how the role of CIO or CIDO has changed, where so much of it is being able to have a value proposition. The way you’re approaching it seems like that’s really representative of the evolution of the role.
Vengco: I think that’s really the modern chief information digital officer. It’s not only bits and bytes; you really have to understand the business, you have to be creative. And not just creative fiscally, but creative in terms of creating solutions and understanding how to lift the car up and change the chassis and put a new chassis and a new engine that optimizes the car. It’s a beautiful car. It can actually do a lot of great things, but you need to update the engine.
Because everybody knows what the outside needs to look like and what it should look like, and it could still be beautiful, but there are so many other things that it needs to be doing and some of those things are absolutely necessary for healthcare to survive. We don’t have the luxury of hiring more doctors and nurses. There’s just not enough of them.
And even thinking about that particular problem, it can’t be solved by just putting in an EHR. You have to figure out how do you leverage data to support the technology that can reduce the administrative burden of a clinician or even a front desk person who doesn’t necessarily need to call a patient to let them know that they’ve got an appointment in a couple of weeks or ask them to fill out a form or scan a form. It’s all those things — how can you create more automation, more intelligent processing so that those folks can be doing other things that without that technology would have required another body.
As IT leaders, we really have to be creative in that regard and you have to know the business to be able to create something like that.
Gamble: Cloud is obviously a really big foundational piece. Can you talk about some of the other partnerships?
Vengco: From a technology perspective, we’ve partnered very deeply with Google both on the data and the digital side of the house. I touched on our partnerships already on the clinical side and with One Medical — we’re also working with Optum on the risk side.
Those bring challenges in terms of interoperability and integration because we all have our separate technologies, capabilities, and analytics. But we’re very much focused on clinical partnerships because we know that these entities are coming into the market. We need to make sure we either can compete with them or are cooperating with them. There’s a ‘co-opetition’ that has to happen there.
We also partner with academic institutions. In our case, we’ve partnered with Quinnipiac on the medical education side. We’ve also partnered with MIT on innovation work and research. We’re doing some work with AI on length of stay, staff augmentation, and staffing predictions that they’ve been working for the last couple of years, which is creating products or solutions that we’re using internally, but also creating net new products that we can license to other organizations. Those are some of the partnerships that we have.
We also have an innovation sort of channel that seeks partners or innovators outside of our organization; they can submit their solution through our website, and we look at the problem they’re trying to solve and see if we can match that to a problem we have internally. We’ve had some good partnerships come through that area.
Ultimately, we’ve created a platform to leverage our ecosystem at Hartford Healthcare for these partners to innovate, to pilot, and to expand on current products to develop them further. Our health system is pretty unique in this regard. We have all of these different capabilities and we’ve actually exposed that to these partners in such a way where they can speak to clinicians and they can observe operations to see if their solution applies to problems that we’re seeking to solve. That’s how we’re partnering with some of the start-ups specifically in our organization.
“You have to have good governance”
Gamble: I would imagine prioritization is a challenge. There are so many things that need to be addressed and attended to. What has been your strategy there?
Vengco: It is a challenge, especially with our budget challenges. Everyone has budget challenges. The mechanisms for prioritization are essential. You have to have good governance, starting with a good intake process, and a good operating model to make sure you’re executing once you’ve made those choices. For us, the last 10 years were focused heavily on growth. That strategy really dictated the choices we were making.
Now, our strategy is about focusing on personalizing and coordinating care for patients; on top of that, we have a lot of challenges with regard to operating margins and other fiscal challenges. That being said, the prioritization lens becomes, how do we continue to improve our ability to provide access to our patients, and how do we continue to grow and survive in this climate without cutting costs? There’s a saying: you can’t shrink to grow, or you can’t cut for growth. We have to figure out how to optimize what we have now to ensure we can support the foundation we’ve laid, and also continue to expand and grow our business.
Prioritization is absolutely essential. It’s tough because you also have to think about what you need to stop doing. If you have a good vision and strategy, which I believe we do at Hartford Healthcare, you can always point to it and say, that’s our North Star. Our North Star now, if you were to boil it down, is about access.
That speaks to the vision of personalized coordinated care. It also enables us to grow or sustain growth because you’re caring for patients. You’re keeping them healthy. You’re creating loyalty. You’re expanding reach, and if we focus on access, and everything that we decide is around access, we realize what it is we should stop doing and what we should continue to focus on to ensure that even in these tough times, we’re doing all the right things for the patient and for the organization. It’s essential for that.
Gamble: I like what you said about having a North Star. Access is central to everything, and you need to be able to leverage all these tools to improve it.
Vengco: We could be doing a whole host of things right now. There are a lot of directions for us to go, and so I think for us as an organization, it’s critical to have that North Star so that everyone of our 30,000 employees knows when they’re presented with a decision of what you should be doing, it should be very clear, hopefully, what choice to make. Because we do have a culture of giving folks autonomy and empowering them to make decisions. In order to do that correctly, at the leadership level, you have to provide clarity.
Gamble: Well said. That about wraps it up. I want to thank you so much. It’s great to talk to you again and hear about what you guys are doing.
Vengco: Thanks, Kate. I appreciate what you guys do. It’s always great to catch up with you.