In Retrospect, Meaningful Use transformed healthcare

This evening I was reflecting on how much healthcare IT has changed over my career. I became a CIO the 90s, when our medical records were still largely on paper. My fellow executives would ask me when we would have fully electronic records. My answer would always be that we were 5 years away. In fact that was my answer for 10 years.

I have to admit that the tipping point was the HITECH Act and Meaningful Use. I was critical of that program at the time. I argued that there wasn’t evidence that showed the program objectives were the things that best furthered the goals of the US healthcare system (improved quality and reduced cost). In retrospect, that didn’t matter. The flood of money that Meaningful Use brought to healthcare IT resulted in providers not only meeting the objectives, but  making the changes necessary to finish the transition to fully electronic health records. Because of that, we have more actionable data at our finger tips. That data is used to better manage the care we provide and that patient experience.

The Skype Interview

I have been thinking about other CIOs and IT pros looking for new gigs. I thought I would follow-up my last post with another learning from my recent search. Video calls are now a standard part of executive interviews. I want to share a few tips I think make for a good result.

  1. Place your camera at eye level. For me this means simply stacking some books under my Macbook. If you simply put a laptop on a tabletop you get the upshot angle, including a look into your nostrils. Be sure to frame your entire face and shoulders.
  2. Invest in a decent USB microphone. Laptop microphones are surprisingly good, but a high quality USB microphone (~$100) adds some clarity to your voice and that is the most important part of the interview.
  3. Your tendency is to look at the middle of the monitor to see the other party. And you should be looking at them for visual cues. But, you will also want to look squarely into the webcam to create the illusion of eye contact. As you can see in the photo of my setup, I put a sticky on the screen to remind me to look at the camera.
  4. Have an interesting, but not distracting, background. Even a plain wall with a plant to the side creates a more visually welcoming setting.
  5. Dress the part, at least the parts the interviewers can see.

Good luck!

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Resources for Displaced Healthcare CIOs (and CIO seekers)

Even the best CIOs find themselves unemployed. After being displaced from my 17 year position in 2017 I started my search for my next gig. I found that these firms handle the majority of Healthcare CIO searches:

  1. Rudish Health Solutions [Nancy DeMoss]
  2. Kirby Partners [Judy Kirby]
  3. Witt/Kieffer [Nick Giannas]
  4. Korn Ferry [Doug Greenberg]
  5. B. E. Smith

Additionally, you may want to contact firms that place interim CIOs. During the year it took me to find my next gig I worked as a consultant and an interim CIO. I loved the work and I found it to be adventurous. I also found my permanent role through my interim work.

  1. Starbridge Advisors (good people!) [Sue Schade]
  2. B. E. Smith [Lori Reynolds]

My search experience is that I came very close, without luck, during my 15 month search. Part of success is a numbers game. A lot of it is luck.

Your CIO friends usually have a bunch of stuff happening and could use someone to lead an effort without a lot of direction. So, if you work your network you might find some consulting work while you are waiting for that next gig.

Good luck.

Some thoughts about Customer Experience

I read a lot about digital transformation (especially in the twitter feed of @dchou117). It is an important topic. But, I believe it should be viewed as a means by which we achieve great customer experience. When we flex our digital transformation muscles without thinking through the ideal customer experience we end up with things like patient portals with single digit adoption rates.

Make no mistake, creating an ideal customer experience in any industry is difficult. It is especially difficult in large healthcare systems. Besides being incredibly complex, we have a legacy of applications, workflows and organizational culture that are significant barriers.

So, here is a suggestion for healthcare IT leaders…start with creating ideal customer experiences for your internal customers. Show your organization that IT has the vision and the chops to do this work and create a model for the external customer (patient) experience.

What is your organization’s customer experience when onboarding a new employee? Is it an all digital experience that is quick and well thought out? Does it collect only the minimal information required, without duplication? Are you using well designed front-ends and a database on the back end? Is it connected to the hiring process so nobody slips through the cracks or shows up to work without the ability to do their job?

What Employees Want

I think the best management advice I ever received was a reminder that I, as a leader, accomplish all of my work through the people on my team.

Therefore, my goals as a leader are:

  1. to make sure that the team members I am privileged to lead are happy, engaged, productive and
  2. those team members are working within a system of work that is continually optimized to accomplish clearly articulated goals quickly, cost-effectively and without defect.

That first leadership goal raises the question: What makes employees happy, engaged and productive? Over the years I have observed that most employees want the same things:

  1. Employees want to feel like they are part of a something important, a mission that transcends the daily activities of their workplace. Healthcare leaders are lucky because we have a great story to tell about caring for the people in our communities that is easily embraced. Lately I have expanded our mission to include transforming the healthcare system to provide better, safer and less expensive care.
  2. Employees want to feel that they bring meaningful contributions to the mission. Employees do not want to be over-managed. My greatest management mistakes were micro-managing employees. My greatest frustration as an employee was being micro-managed, especially when the supervisor was less capable. Leaders need to provide employees the big picture, direction, and periodic feedback – then get out of the way.
  3. Employees want to be recognized for their contributions. Studer Group provides great guidance to leaders on how to recognize employees.
  4. Employees want their leaders to have their backs, and in turn they will have yours. When the division as a whole lets down their customers the leader needs to accept responsibility, never singling out anybody in the organization. We are imperfect people. Mistakes are made. Leaders need to create a culture where we treat mistakes as learning opportunities and not times to dole out punishment. Leaders need to lead by example and admit when they make mistakes and to vow to learn from that mistake in order to do better in the future.
  5. Employees want leaders that ask them what they need to do their job better and what are management’s misconceptions that negatively impact productivity and quality. Employees can accept constraints if they understand them.
  6. Employees want to know managers are concerned about their satisfaction and continually gauging what can be done to improve the workplace, even if it is already a highly regarded workplace.
  7. Employees want to be surrounded by other high performers that have the same passion achievement and good work. That means leaders need to address performance issues in a timely and candid manner.

What would you add?

Eliminating the Interoperability Question

I just finished reading Victoria Brock’s excellent post Stop! Just stop with the “Interoperability”. In it she expresses the frustrations with healthcare systems vendors that represent their products as “interoperable” to non-IT buyers, knowing that those people will assume the best of what interoperability could mean. This is a phenomenon of human nature that I blogged about 12 years ago!

I agree with Brock. We need to educate our colleagues involved in reviewing clinical IT systems to stop asking the Interoperability Question. It is too vague and gives the vendors a chance to say yes to a different question than what is truly being asked. We need to train our non-IT colleagues to think about what they mean when they say interoperability. We need to give them examples of alternative questions, such as:

  • How will the medication list in your system automatically reconcile with the medication list in our core EHR? Where have you done this?
  • How will the allergy list in your system automatically reconcile with the medication list in our core EHR?

Brock reminds us that these interoperability questions involve three parties, the two application vendors and the client. Because something is possible doesn’t mean it will happen of all three parties are not committed to the work. We need to educate our colleagues that these interoperability questions cannot be answered by one party alone.

Those of us that are very clear about the the problem we are trying to solve and the new problems we are trying to avoid will have the most success.

Lyft and Blue Cross

Healthcare leaders should take note of this new partnership between Lyft and Blue Cross.

As a consumer, I like what Blue Cross is doing. While Blue Cross presents this as a way to improve access and reduce missed appointments, the next logical step is to quite literally steer patients to lowest cost providers.

There have been numerous studies that show the primary criteria patients use to choose their doctor and hospital is convenient location. Healthgrades summarized that finding in an infographic.

Perhaps the only thing more convenient than driving to the doctor’s office down the block is having a car waiting for you at your front door. The average cost of a Lyft ride is $12.53. It is a no-brainer for an insurer to pay $25 to steer a patient to a provider with a more favorable contract. Especially for expensive services such as chemotherapy or a Remicade infusion, both of which can run between $5,000 and $25,000 per visit.