Everyone has their number one.
Regardless of the size, scope or geographic location, every healthcare organization has one thing in common: competing priorities. Whether it’s clinical, revenue cycle, infection control, or any other area, “everyone has their number one.”
The challenge is that technology touches everything, and “IT can only have so many number one things they can work on at the same time,” said Teresa Andrea, CIO at Silver Cross Hospital. This is where solid governance and leadership can make an impact by “setting the rules of the road” and ensuring requests truly benefit the organization.
Recently, Andrea spoke with Kate Gamble, Managing Editor at healthsystemCIO, about the core objectives on her team’s roadmap, which is closely aligned to that of the business, and how they’re leveraging a “stair-step approach” to achieve them. Andrea, a nurse by training, also talked about why physician involvement is so critical, the keys to forming successful vendor partnerships, and her advice for aspiring CIOs.
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Key Takeaways:
- “Technology touches every single part of healthcare. Having a roadmap that runs in alignment with the organization’s strategic plan is really important to really ensure we are maintaining our true north.”
- One of the keys to a successful digital strategy is to “have a line of sight to the problem we’re trying to solve,” while also looking at the long term and having a stair-step approach. “You want to be able to stack your technologies so that they complement each other.”
- When it comes to clinicians, “being inclusive will fare you well, being exclusive will not,” said Andrea. “We’ve learned the hard way early on that as much as physicians will sometimes say, ‘I don’t have time, I don’t want to be bothered,’ you need to find the time and you need to bring them along.”
- The key to strong vendor partnerships is in “having clear expectations and communicating those expectations,” Andrea said. “Be transparent and honest. That way, we know where we stand.”
- “Success in the CIO role today is not about who has the biggest IT chops in the room. It’s about understanding the business need and being able to transcend the discussion such that the technology makes sense to executives.”
Q&A with Silver Cross Hospital CIO Teresa Andrea
Gamble: Thank you for putting aside some time to talk about the work you’re doing at Silver Cross. Can you start by giving a high-level overview of the organization?
Andrea: We are a 336-bed independent regional medical center. We used to be a community hospital, but we’re expanded our footprint. We have several outposts including a freestanding emergency room, urgent cares, and ambulatory sites for family practice and specialties.
We were recently awarded a 5-star CMS rating and a Leapfrog rating of A, which we’ve been successful in maintaining year over year. We’re very proud of that.
Gamble: And you’re located in Illinois. Is it a suburb of Chicago?
Andrea: Yes. We’re in New Lenox, Ill, which is a southwest suburb of Chicago.
Gamble: You’ve been with the organization for a while, but you came into the CIO role a bit more recently, in 2020, correct?
Andrea: Yeah, it was three years this past June.
Aligned IT-Business Roadmap
Gamble: I definitely want to get into that. But first, can you talk about what you consider to be your biggest priorities at this point?
Andrea: Sure. My priorities are aligned with the organization’s strategic goals and strategic plan. We have what I call an IT business aligned road map. That helps us set our focus on technologies, whether it be new implementations, optimizations, or expansions. There’s so much technology. Technology touches every single part of healthcare. Having an IT business aligned road map that runs in alignment with the organization’s strategic plan is really important to really ensure we are maintaining our true north and running in alignment with the direction in which the organization is going.
If we think about our current strategic plan, a lot of it has to do with patient access, ease of use, and giving people the ability to have healthcare accessible when they want it and where they want it. Part of our objectives and priorities within IT are to ensure that we have those represented through technology as we look at how we’re going to invest our IT capital in any given fiscal year.
Enabling online scheduling
Gamble: I can imagine that’s challenging because there are so many different areas where you could potentially spend those funds. Can you talk about some of the initiatives that are geared toward patient access?
Andrea: We have online scheduling, which has gone very well. However, we are looking to expand how we use our texting platform for things like reaching out to patients proactively. For example, if we receive an order, we can ask, ‘would you like to schedule an appointment’ and include the hyperlink to schedule it.
We’re also looking to move into online registration, which again allows for easier access, increased efficiency, and more convenience for patients. Rather than arrive on site and go through the registration process, they can do it on their own device. It allows them to upload their insurance cards and driver’s license. That’s one of the things we are going to be looking to institute, first at our ambulatory sites and then at the hospital for acute care services and outpatient testing services.
A “Stair-step vision”
Gamble: There’s so much focus now on patient access, which has been so challenging in the past. I imagine that a lot had to happen to set the foundation for that.
Andrea: Yes. And that’s where choosing scalable technology is so important, along with having a stair-step vision. Part of my role is to oversee our digital strategy. One of the things I am very passionate about is, first of all, always having a line of sight to the problem we’re trying to solve. But you have to look at the long term and have a stair-step approach, because you want to be able to stack your technologies so that they complement each other and make sense for the consumer.
Gamble: I like that premise. Can you talk a little bit more about how you to have that line of sight, as you talked about, while also using a stair-step approach?
Andrea: I’ll give you a perfect example. We were just starting our digital journey and investigating what we’re going to do first, and then along came Covid to throw a monkey wrench to the world. We had to very quickly be able to figure out how we were going to get massive amounts of people through testing and immunizations, because we were identified as a site in Will County.
Short-term and long-term needs
As we were vetting products, certainly in the short term it was important to meet acute-care needs, but we forced ourselves to say, ‘where will this be a year from now? How could we expand it?’ While it’s always advantageous to be nimble, and speed to stand up is important, these things are too expensive to have to rework.
Playing in the sandbox
The product that we chose not only met that short term goal but helped us as we transitioned to putting our outpatient services online, which we then expanded to include radiology modalities, lab, and now scheduling at our employed practices. We’ve been able to scale all that.
In addition, it’s having a vision to say, what else is it going to be able to talk to? Because if you have a texting platform and its functionality doesn’t play nice in the sandbox with the others, then you have a bunch of disparate systems. The consumer, unfortunately, is going to experience that because they’re going to be getting messaging in different redundancies from different platforms. And so, it’s important to have that line of sight to say, if I bring you into my world, are you going to play nice with others? That’s another piece when I talk about having a line of sight and having a stair-step approach. You start at the baseline step, and you want to build upon it. I always encourage people to take a pause and assess that. As quick as you want to get some things to market, it’s really worth it to have all the right people in the room and take a pause and have that long-term vision.
Find the ‘what’s it in for me’
Gamble: Right. Of course, the other big implication is the impact this will have on providers. I imagine that has to be top of mind when you look into different initiatives.
Andrea: Absolutely. You have to bring people along with you, and that includes physicians. When online scheduling came about, the physicians felt like, ‘I don’t want people controlling my scheduling. I don’t want you to tell me who I can see, when I could see, and whatnot.’ It’s about engaging them and bringing them along to understand the value add. Success, especially with providers, is in finding the, ‘what’s in it for me?’ The physician needs to understand what’s in it for him or her: why we want them to support this initiative, why we want them to be in alignment with online scheduling, and why we want their books to be open for business.
A “robust communication plan”
Gamble: How is that done? How do you work to instill that in them or communicate the value it holds?
Andrea: Part of any project is to have a robust communication plan and ensure that you’re casting the net wide at your key stakeholders — and that includes anybody who’s impacted. There’s immense value to having all the people at the table, whether it be the provider or somebody who is representing the provider or a champion. Having a champion is important. Your revenue cycle, scheduling, operations — those are stakeholders that need to be at the table as design decisions are made. We need to hear their concerns so we can address them and help bring them along. Being inclusive will fare you well; being exclusive will not.
We learned that the hard way early on with initiatives; as much as physicians might say, ‘I don’t have time’ or ‘I don’t want to be bothered,’ you need to find the time and you need to bring them along, even if it requires going to them. I’ve been to many quarterly physician group meetings to keep them in the know, let them know what’s coming, how it’s going to impact them, and what’s in it for them.
Gamble: So, you mentioned before you’re doing a lot in the digital front door arena. Are there other initiatives you’re looking at either for now or in the future?
Andrea: AI is all the buzz now. There’s a lot of technology coming out now and it’s the big buzz. But again, the value is in taking a pause to understand it. I think when we talk about artificial intelligence and algorithms and machine learning, how this plays out for healthcare is a little bit different than in industries where you’re not dealing with people’s lives. We’re treating this year as an opportunity to educate ourselves: the good, the bad, the ugly, what’s known, and what’s not known. While we’re going to go there — and we absolutely have to go there — we want to be smart about what’s the stair-step approach? Where’s the first place we want to dip our toe that we think will add value to the organization but with risk mitigated to a degree?
Gamble: That’s smart. As far as wanting to make sure that IT and other teams don’t have too much on their plates, how do you address that? How can leaders make sure the workload is workable?
Andrea: It’s a challenge. I think this is probably familiar to many IT shops, but anything and everything in healthcare now touches IT. That’s why you need to have a strong capital project plan and project roadmap. We have an IT steering committee that helps decide what those projects are going to be for a given fiscal year. Because we’re a hybrid shop, our analysts not only do projects, but also have break-fix and do service requests. We have to find that balance and ensure that we’re keeping that balance.
Anything that is not planned or has not gone through the regular planning process has to go through the IT steering committee as an on-plan project. It gets vetted by IT first so that we can get our mitts on it and understand what resources are going to be needed, whether it be monetary or labor wise. And then we go to the IT steering committee and say, ‘listen, this is what we have going on. If you want us to do this, this is when we can do it.’ We give them something to react to. You have to approach it this way because everybody — people in different areas of the hospital, whether it be clinical, infection control, or revenue cycle — everybody has their number one.
The rules of the road
IT can only have so many ‘number one things’ that they’re working on at the same time. Ensuring a solid supportive IT steering committee that really sets the foundation and the rules of the road, if you will, such that service requests and projects are coming through to ask, ‘does this make sense? Is this going to benefit the organization? Does this really need to be a priority this year? Maybe it’s a good idea but maybe it’s not for this fiscal year. Or is it important enough that it’s going to be a game changer and we push off something else to do this?
Keep in mind, one of the questions you have to ask yourself — and this goes back to why it’s important to have an IT business-aligned road map — is what they’re asking in alignment with your strategic plan and vision for the organization?
Let’s be better together
Gamble: That’s huge. Another area I wanted to talk about is working with vendor partners. What have you found to be some of the best practices in building and maintaining good relationships?
Andrea: Good communication is number one: having clear expectations and communicating those expectations. I always say I’d rather be transparent and honest, and this way they know where we stand. I believe in having good vendor partnerships. I always say, let’s be better together. While I absolutely believe in accountability and holding vendors accountable, I hold my own staff accountable too. Any given project is a partnership, and I think clear communication and expectation are key in a partnership.
Gamble: Communication is huge. Looking at your career background, you’ve been with the organization since 2009 in various roles. You stepped into the CIO role more than three years ago — can you talk about what it was like to take on the role? Especially in June of 2020, which was such a tumultuous time.
Andrea: I’ve actually had two tours at Silver Cross. I started in the cath lab back in the early 2000s. I left and then I came back. I’m a nurse by background. I dipped my toe into technology around 2011 when we were going to an EMR and they needed somebody who did not necessarily have a ton of technology experience but understood workflows and how to transcend those workflows. That’s how I got my interest. I went on to get my master’s in informatics and served as director of clinical informatics for 5 years. People have asked how I got into technology, and my first answer is, ‘I have no idea, but here I am. It works.’
It’s not about the biggest IT chops
I think the reason it works is that success in the CIO role today is not about who has the biggest IT chops in the room; it’s about understanding the business need and being able to transcend the discussion such that the technology makes sense to executives, board of directors, etc. Because if people don’t understand it, their gut check is to say ‘no, we don’t need it,’ or, ‘it’s not a priority.’ And so I think you have to be humble and you have to be open, and I’m not afraid to ask questions. I have also forced my team to transcend the discussion in terms and say, ‘I need you to explain this to the CEO. How is this board going to approve $3.5 million to redo our wireless wired infrastructure? I have to be able to transcend the discussion so that it makes sense to them.
I think that because I’m able to do that; to walk the walk of the provider or nurse and take care of the patient, I can home in on things. One of my first questions is, how is this going to pact the business? I’m then able to compile that with my informatics experience and my business acumen to create a wide-lens view and be a change agent. That’s what has helped me navigate across departments. I think those are all key things that led to my success in this role.
Gamble: It seems like it’s becoming more common to see CIOs who were nurses; it makes a lot of sense. Can you offer any advice to someone who is in nursing now and wants to eventually pursue the CIO role or something similar?
Andrea: I would say get involved. Be a champion for your unit. If there’s new technology coming to your unit, become a subject matter expert or super user. Offer to participate in projects and committees where you can help represent one of the key stakeholders.
Also, be open to asking questions. My path was not conventional. As I started to network, I noticed that a lot of people had technology backgrounds. I’d sit there and say, ‘I don’t really need to know how the server works; I need to know how the server supports the business.’
My advice is, don’t be afraid to ask questions and be willing to be vulnerable. You need to be willing to be a little bit uncomfortable and work in the gray. You have to be able to work in the gray. Technology is not necessarily black and white. They may sell it as black and white, but the way it plays out in healthcare, you have to be able to work in the gray, because there is a technical piece and there’s an adaptive piece. It’s often the adaptive piece that’s the hard work. You can throw technology in, but how people adapt and use it is hard work. If you’re looking to dip your toes into technology, the ability to come in as a change agent and bring people along with change with technology is a really good way to start for someone who has more of a clinical background.
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