Q&A with Health First VP and CIO Michael Carr: “Don’t Create Roadblocks.”

“Sometimes as technologists, we overplay the technology aspect.”

In today’s digitally driven world, one might think that statement was made in jest. But Michael Carr, CIO at Health First, is completely serious. During a recent conversation about his team’s core objectives at Health First – which include an Epic migration and planning new construction – he talked about the approach they’ve adopted and why he thinks it’s the best course.

“We wanted to find the right balance between cutting edge and fit for purpose,” he said, which means holding off on some promising solutions. “We’re trying to be budget-conscious while also offering a great experience.” The key, Carr noted, is being careful “not to overload it with technology.”

It’s a bold stance, but one that has served him well, both at Health First (where he became CIO in 2023 after spending three years as CTO/CISO), and in his prior experiences with Legacy Health and Providence Health. Throughout his career, his passion has been to help deliver the best possible tools and services, and doing so in a way that “really helps our clinicians do the right thing and is not a barrier.”

During the interview, Carr talked about how his team is able to achieve that balance while also striving to become a high-reliability organization; why it’s so important that initiatives are led primarily by clinicians rather than IT; the key difference between CIOs and CTOs; and the valuable lessons he learned while serving in the US Army.

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Bold Statements

‘Who’s going to make decisions for this workflow, this application, this position?’ We spent a lot of time thinking through who needs to be involved in those decisions, because we wanted those decisions to be made close to the work as possible

 ‘You’re the experts. You should be the ones to decide what the workflow looks like in the ED or in the OR.’ A lot of work has gone into the governance.

On the technology side, we’re looking at how do we modernize without having to get too creative? What is it going to look like when we have Epic there? What is it going to look like from the perspective of workflow and patient experience?

We want to find that right blend between cutting edge and fit for purpose. We want to be practical. We want it to be a great experience. Sometimes, I think as technologists, we overplay the technology aspect of that.

The realization was, we can do a lot. We can improve the experience for our patients and our members. We can provide better care. We can get in front of some of the things that tend to be dissatisfiers for patients or lead to poor outcomes.

My passion has always been around tools and services and creating an experience that helps our clinicians do the right thing and is not a barrier.

 

Q&A with Michael Carr, VP & CIO, Health First

Gamble:  Why don’t you give kind of a high-level overview of Health First — what you guys have in terms of hospitals, where you’re located, things like that?

Carr:  Sure. Health First is an integrated delivery network located in the space coast of Florida. We’re about an hour east of Orlando and primarily Brevard County. We have four hospitals. We have a 500-member physician group, and we have a health plan with a little more than 80,000 members. It’s starting to grow, not just in Brevard, but across central Florida and across the state.

 

Gamble:  Being located where you are, do you get a pretty decent seasonal population, or has it evened out somewhat?

Carr:  We definitely have our snowbird season. Most of the snowbirds head home in late April or early May, trying to avoid the hurricane season and try to get out before it gets too hot.

 

Gamble:  You’ve been there a couple of years — since January of 2020, so you had some time before things took a turn.

Carr:  Absolutely. I had a little time to get used to the community. The East Coast and West Coast are very different; not just in terms of geography and weather, but the healthcare environment.

 

“Very big rocks”

Gamble:  I’m sure. In terms of your objectives, I know you’re doing a lot with the Epic implementation – can you talk more about that?

Carr:  We look at our IDN strategy and the focus around customer centricity, around growth, around quality, and around being financially healthy. From the IT side, we look at what we’re doing to support the organization. There are a few areas.

One is what we call paving the road; it’s our application modernization. We’re working to implement Epic on the clinical side, as well as on the Health Plan side with Tapestry. It’s a major initiative that spans the entire organization, with a focus of improving our clinical and operational capabilities, streamlining the amount of manual work that we have to do, better integration of data, and most importantly, providing a platform that our clinicians, associates, members, and patients that creates the consumer centric experience that we’re aiming for. Those are two very big rocks.

Across the organization, we have a couple of other initiatives. We’re building a replacement hospital for our Cape Canaveral Hospital. That’s in progress now; the hospital will come online probably at the end of 2026. The other strategy that I talked about earlier is growing our health plan. That’s a big focus of the organization and our Tapestry initiative supports that as well as our ability to grow as we extend across the state.

And then finally, our Chief Clinical Officer, Cheyana Fischer, is pushing us toward becoming a high reliability organization. We see Epic and Tapestry being very aligned in terms of creating the discipline and the operating model but then also adding the supporting technologies and workflows to enable that.

 

A modern platform

Gamble:  Can you talk about what’s happening with the Epic implementation? Did you have a different EHR in place?

Carr:  We’re going live with Epic in the summer of 2025. In December of 2023, our board made the decision to go with Epic, and we started the project. We kicked it off in early March. Right now, we have 5 different EHRs on the clinical side, depending on how you count them. The push to get to a single, modernized EHR platform is about more than just the clinical and the documentation. That’s been a big push of ours in bringing the team together and aligning the organization. We’re in the design-build phase right now.

 

Gamble:  Okay so you’re very early in the process. very early.

Carr:  Yes, very early. We have about a year to go. We started the build phase a few weeks ago. The teams are going through training and certification. We stood up the program and we’re now into our second wave.

 

Led by operations and clinical, not IT

Gamble:  Let’s talk about the governance structure. What’s the strategy there?

Carr:  One of the big decisions the organization made, which I’m really thankful for, is that we talked a lot about these initiatives being operations clinically led, not IT led, and our organization took that to heart. One of the first things we did is ask Cheyana Fischer, our Chief Medical Officer, to be the executive sponsor. We created a steering committee and decided it would be clinical and operations leading it; it’s not going to be IT driving this.’

We started with building out our governance framework in terms of executive steering and then getting down to, ‘okay, who’s going to make decisions for this workflow, this application, this position?’ We spent a lot of time thinking through who needs to be involved in those decisions, because we wanted those decisions to be made close to the work as possible, with the understanding that there are some things that may be non-negotiable in terms of Epic first. We’re going to adopt as much of the Epic platform is possible, making decisions around what third party applications we keep or retire, data and reporting, those things.

“A really good framework”

Those are IDN standards that we’re locking down, but we’re really saying to frontline leaders, ‘you’re the experts. You should be the ones to decide what the workflow looks like in the ED or in the OR.’ A lot of work has gone into the governance. And it’s still early, but so far, we’ve had really good participation. People are excited. They want to be part of it. They understand that they’re going to have say in how things are done. I feel like we’ve got a really good framework to build on.

 

“We need to learn from them”

Gamble:  It certainly can make a difference making sure governance is clinically led, especially when you mention things like workflow and making sure it works for the people who use it every day.

Carr:  Absolutely. On the Tapestry side with Health Plan, it’s a very similar approach. We’ve got Jamie Forrest, the COO of Health Plan, leading the program. Matt Gerrell, the CEO of the Health Plan is the executive sponsor. Our IT team is there for support on both sides, trying to make sure that whether the member experience or patient experience, let’s have the experts decide what that needs to look like following Epic’s foundation and best practices, because they have the benefit of having implemented Epic in a bunch of different organizations, and we need to learn from them. The good news is we don’t have to start from scratch, but there’s still a lot of decisions to be made along the way.

 

Epic decision

Gamble:  Interesting. When you joined the organization, I would imagine that you knew that that was in the plans.

Carr:  I was hopeful. It wasn’t initially part of the plan. I started at Health First in January 2020 in my role as Chief Technology and Information Security Officer. We were working at the time really to try to integrate these multiple platforms. The question was, ‘can we create an experience that really delights our customers, create the efficiencies, creates the platform for our clinicians to continue to provide great care?’ We came to the realization that the answer was no. We couldn’t build it.

I became the CIO in April of last year and one of the first things our interim CEO and senior leadership said is, ‘what is our technology strategy?’ We started talking about Epic. I was hopeful. In my previous work experiences, I had been on Epic for a while. At one of them, we had moved from multiple EHRs to Epic across five states. I’ve seen the impact, seen the amount of effort and work, but I’ve also seen the value it brings to the organization. I was hopeful that we had come this way. If you asked me two years ago, I don’t think there was a lot of optimism. But I think senior leaders and our board realized that this is the best way for us to deliver our promise of a great platform for our clinicians, our members, and our patients.

 

Application rationalization

Gamble:  You talked about ‘paving the road’ and that being one of the key things. What were some of the other aspects?

Carr:  We have other areas we’re working on. One is our ERP modernization — there’s a lot of work there. We need to tackle that down the road in terms of maturing those back end processes and functions. It’s rationalizing our portfolio. One of the things we looked at as we’re going to Epic and then Tapestry on the Health Plan side is at how many of these third party or niche products do we really need to keep, and then simplifying.

We identified roughly 75 applications that will go away when we go to Epic. That’s a big — not just from a cost perspective, but in terms of the amount of effort it takes to manage and support them, and how many vendor agreement and contracts there are.

Part of that rationalization is as much as we can do on those standard platforms. Even if it’s not best in class in terms of every single niche product, we’re still valuing the integration and interoperability in having a single platform to work off of. That’s part of paving the road; simplify the portfolio, standardize, and then as we go down the road with ERP, to say that if Epic does it, we’re going to take it unless our clinicians say that it’s unsafe. We haven’t found that to be the case yet. But we’re pushing to take that integrated platform and then retire a lot of those secondary systems.

 

Gamble:  That is a lot; 75 is a big number. And is ERP something you’re looking at now?

Carr:  Yes. We’ve looked at it. From an organization perspective, we know that our current platform is dated. We’re in the process of updating it and moving to the cloud. We know that there’s value in moving to a modern ERP platform, but that’s still a few years out. First, we want to get to Epic. We want to get to some of our other strategic initiatives. But in the next couple of years, it will rise to the top.

 

Designing a replacement hospital

Gamble:  You mentioned the replacement hospital – what are you doing there?

Carr:  We’re really excited about this. Cape Canaveral has been a mainstay in the Brevard community for a number of years. It’s a beautiful location and there are a lot of expectations. We’re early in the design phase. We’re locking down the programming and what’s going to be at the location. We’re locking down a campus and then on the technology side, we’re looking at how do we modernize without having to get too creative? What is it going to look like when we have Epic there? What is it going to look like from the perspective of workflow and patient experience? Like I said, we’re in the early phases. Construction will start later this year. We’ll go live in our current Cape Canaveral hospital next year and then the following year we’ll cut that over and move that whole facility over to the new campus, which is about three miles west.

 

A good experience without tech overload

Gamble:  That’s something I would guess looks a lot different now than it did a few years ago, given everything we’re seeing in terms of digital transformation.

Carr:  It is. We’ve had a lot of conversations around how cutting edge we want to be and what does that experience need to look like. We want to find that right blend between cutting edge and fit for purpose. We want to be practical. We want it to be a great experience. Sometimes, I think as technologists, we overplay the technology aspect of that. We had a great conversation about wayfinding and things like that. We said, ‘are we going to deploy RTLS and these really advanced tools?’ And the response was, ‘no, we don’t really need that.’ We can provide a really good experience and help people navigate with more traditional capabilities. We’re trying to be very budget conscious in terms of the value to the consumer and the workflow. It’s going to be a very clean experience but we’re being really careful not to overload it with technology.

 

High-reliability organization

Gamble:  That makes a lot of sense. You also talked about the push to become a high reliability organization. That’s really interesting. Can you give some of your thoughts on that?

Carr:  Sure. I’m very thrilled that our clinical leadership and senior leadership has decided that this what is we want to become. I think at the end of the day, it’s as much as a mindset as it is a process. It’s not a technology enabled strategy. It really is, how do we make sure that at every step of a patient or member’s journey, regardless of where people are, direct patient care or not, that we’re highly reliable? That’s something that speaks to me as a technologist, and it speaks to my partners in HR and finance and in our Health Plan.

“We can do better”

I think the realization was, we can do a lot. We can improve the experience for our patients and our members. We can provide better care. We can get in front of some of the things that tend to be dissatisfiers for patients or lead to poor outcomes. Again, we’re early in the process. This really just started in the past few months.

At the end of the day, I think when you come into healthcare, it’s different than a lot of industries. I worked in transportation and logistics before joining healthcare and it was important that our packages just got there in time, but not as important as making sure that a patient has the right care or the right medicine. It’s a much different, much more tangible experience with much more at stake than a lot of other industries.

But yes, we’re excited that collectively everyone’s on board. We’re partnering with Press Ganey to help us through this journey. We’re doing an assessment right now to figure out where we are, where we need to go, and how do we start to move that dial around being highly reliable.

 

Career growth

Gamble:  Really interesting. So, earlier, you mentioned being on the West Coast. Which organization were you with before Health First?

Carr:  I started my healthcare career working at Providence for about 8.5 years, both in the Oregon region and then the corporate level. Then I worked at Legacy Health for about 4 years before coming here in 2020.

 

Gamble:  That’s a big move.

Carr:  It’s been good. People often ask why I made the move because I went about as far away as you could go. Part of it was the weather. It’s lovely further west and there are a lot of great things, but the weather in Florida is great. It’s warm and it’s an amazing place.

 

“Don’t create roadblocks”

Gamble:  And you previously held leadership roles in technology and security?

Carr:  Yes. When I started my career, I was on the applications services side and then moved into technology. In the last 7 or so years, a lot of my focus has been on technology and security. But my passion has always been around tools and services and creating an experience that helps our clinicians do the right thing and is not a barrier. The way I’ve always looked at it, whether you’re the CTO or CISO, you’ve got to balance the needs around security with the usability of our clinicians. I have peers who say one of our core jobs in IT is making sure that our services, our tools, do not become a barrier and impediment. Don’t create roadblocks. So yes, it’s been a passion of mine.

 

CIOs and CTOs

Gamble:  There are definitely similarities between the CTO and CIO. But do you think distinguishes the two roles?

Carr:  I will say CTO is one of those titles that really depends on the industry. In healthcare, a lot of times the CTO is really accountable for core technology and operations — those core IT services. Before healthcare, my background was in finance and operations. I’ve always looked at myself as a business technologist, but I didn’t grow up in the technical world. I’m not a software engineer, I’m not a developer. My primary responsibility is to understand the capabilities of technology and how do we match that with the business need.

As CIO, it’s very similar but a little different scale. A lot of my focus is around prioritization and planning. It’s around people and culture, making sure that we have the right talent and the right tools deployed to meet the needs of our clinicians. Instead of IT or technology leading the way, it’s saying, ‘what’s our business strategy? How do we come alongside that?’ People might ask for a technology strategy, but the truth is, you can’t have one without a business strategy. Unless you know where you’re going, you really can’t build an architecture or a platform around that.

I think the biggest thing around CIO versus CTO is that as a CIO, I’m less involved in the day-to-day technology and operations and whether it’s this application or that application. It’s more focused around, are we meeting the needs of our three business units? Are we staying ahead in terms of keeping pace with them as they grow and evolve? The biggest thing is making sure that we have the right culture; that we’re hiring the right people and bringing in the right skill sets. It’s making sure the people we bring in are empowered and enabled to do the work that’s required by the organization, and they have the support, training, and skillsets they need.

 

Learning from mentors

Gamble:  What do you consider to be the most important characteristics in people that you’re helping to advance? I’m sure maybe it changes too depending on the situation, but what are your thoughts?

Carr:  I had some great role models: my first CIO who I worked for, Laureen O’Brien (formerly of Providence) and my most recent CIO, William Walders (now CIO at BayCare Health System). They’re similar in a lot of ways. William used to say, ‘everyone in IT — we’re all customer service and we’re all cybersecurity.’ Lauren used to say, we can teach people the technical pieces. What’s harder to teach is the willingness to earn, the ability to get along with others, and the work ethic. I firmly believe those are some areas in which people need to be highly specialized.

Beyond technical acumen

In our industry, you need a fair amount of technical acumen but that is often outweighed by things like, can you collaborate across business units? Are you trusted? Do you follow through? Are you growing? A lot of times, you bring in somebody who is highly skilled, but they’re maxed out in terms of their ability to learn or to think outside the box or change their mind or opinion. Our job is to cultivate that — and not just with people young in their career, but also people who want to grow in their career. That’s the piece that we look at: do they have the right mindset, are they teachable, are they coachable, do they want to learn and do they want to be in healthcare? Because I think at the end of the day, you have to want to be in the industry. If you don’t, if you’re not passionate about it, then it’s not the right place for you.

 

“Our job is empowering people”

Gamble:  I like how there seems to be more emphasis now on IT’s role in patient care and connecting to that. It’s so important to be able to tie everything to that mission.

Carr:  I agree. That’s what our senior leadership team has been trying to do. At the end of the day, we’re all in patient care, and we’re all in member services, depending on whether you’re on the Health Plan or delivery side. That was one of the hardest things with Covid — that connection got lost for a lot of people. Because maybe they weren’t coming to the office; maybe they weren’t interacting. And so, a lot of our focus has been reintegrating people and making sure that at the end of the day, our clinicians can provide care and our Health Plan agents can service our members. Our job isn’t about turning the dials or pressing the buttons; it is about empowering those people.

 

Culture of security

Gamble:  Right. So, I’d like to talk a bit about your experience in security leadership and how that impacts your role, especially when it comes to balancing security and usability.

Carr:  I think one of the best things about my career is that I’ve had a chance to be on the application side, the technology side, the security side, and the data side. Having all those has really helped me in my current role. I’m not an expert in all those, but I’m pretty familiar with them.

As you mentioned, I’ve spent a lot of time on the security side. I think that as a CIO, one of our primary responsibilities is protecting our data and our systems. Part of that is educating my peers, the board, and others. It’s also making sure that our program is efficient, effective, and progressing, and making sure that culturally we understand that we don’t want to do security to people, but we want to be secure. What does that mean? What does that look like? How do we show that we’re making progress? There are rarely good stories in the news about cybersecurity. You can pretty much go in every day and read a story about something bad happening to an organization. And so, it’s got to be top of mind for all CIOs.

 

Gamble:  Do you have a dedicated CISO or security leader?

Carr:  I do. Kim Alkire is our Chief Information Security Officer. When I became CIO, Kim was part of my team, and she took on the CISO responsibility. She’s an incredible leader. I think one of the great things about her and the team is they’ve really created an ecosystem of security champions across the organization. Kim is also involved in the community and nationally around cybersecurity. I feel very confident in that team and the direction.

But having been in that role, it’s kind of hard to stay out of it. I’m pretty curious about what’s going on and how do I stay current on what they’re doing. It’s something that I don’t like it too far away from me because it’s incredibly important to the organization.

 

Miliary lessons

Gamble:  I don’t blame you. So, there’s one more topic I wanted to touch on, and that’s your military experience. Are there any experiences or lessons from that time that you’ve been able to draw from in your current role?

Carr:  That’s a good question. If I were to narrow it down to one thing, it’s that the military puts a lot of focus on knowing the role of the person to your left and to your right and knowing what your boss is doing, because you never know what’s going to happen and when you’re going to have to step in. I’ve been fortunate in that I’ve worked for leaders who believe in that as well. You can have people who are really good at one thing, but it’s still important to understand what the people on your left and right are doing. I think that willingness to learn and that openness — even if that’s not your role — was probably the best thing that I took away from the military. I want to learn. I want to understand what people are doing so that when an opportunity becomes available, you may not be fully prepared, but you’re willing to step in.

I’ve been fortunate in my career to get some of those opportunities where I was interested, I learned a little bit about it, and showed a desire to learn. That’s what I look for in younger leaders. Do you ask questions? Do you get involved in things? Do you want to just do your job and go home, or do you want to know what’s going on? Do you want to understand the mission at the end of the day? That’s one thing the military really excels at.

 

Gamble: Really interesting. You can ask that to so many different people and there’s a lot of really great responses.

Carr:  It’s hard to narrow it down to one. At the time I didn’t always appreciate it, but looking back, it’s been a blessing in my career.

 

Gamble:  For sure. Well, unfortunately I have to let you go, but I’ve really enjoyed speaking with you. Thanks so much your time.

Carr:  Absolutely. I appreciate you reaching out.