Don’t Hijack Physician Workflow

During my time off I have been meeting with folks to see what is new in the healthcare IT space. I got a quick demo of a product called IllumiCare. Their mission is to provide cost information to physicians so they can make informed, cost-effective decisions about plans of care and hospital orders.

To be clear, this is not an IllumiCare endorsement and IllumiCare did not ask me to post this. I just saw a demo. But, their offering is based on 2 principles that I completely agree with. I believe these should be guiding principles for all of us in healthcare IT:

1. Embed everything in the EHR

Illumicare’s information is presented as embedded panes in EHRs such as Cerner or Epic. Illumicare believes (and I agree) that having separate systems kills adoption. Physicians live in the EHR. They don’t want to login to separate systems; re-query their patients; nor deal with different user interfaces. Even if you have single sign-on and patient context management, there is significant inertia that keeps systems from logging into other systems.

2. Don’t hijack the physician workflow

Our attempts to build alerts into the physician online ordering workflow have been failures. Because these alerts are seldom relevant to the task at hand physicians clear these alerts before they are even observed. It is time to STOP using alerts except in the most critical safety situations.

Instead Illumicare presents cost information on review screens. The idea is that information is imparted when the physician is most open to receiving the information. Over time physicians come to understand the cost impacts of their behavior and modify that behavior over time.

Still Candid

This is a personal update.

For the last 16 years I have been the CIO at Affinity Health System and Ministry Health Care. That run comes to an end this month.

So, now I am going to take several weeks off. Initially I had grand ideas: backpack across Europe, bicycle across the US, or through hike the Appalachian Trail. But, after consultation with my wife, Pam, I have more grounded plans:

  1. Spend more time on my numerous community activities in downtown Appleton.
  2. Spend time reading about healthcare IT; blog; and network with interesting people in my field with whom I had lost contact (connect with me on LinkedIn and we can catch up).
  3. I have also been given a list of things to fix around the house.

When summer comes I will get serious about deciding what I will do next. While I love being a CIO, I also love living near my adult daughters: Amy (Chicago) and Mary (Appleton). So, I may be returning to my consulting roots and hitting the road. Either way, I am eager to share what I have learned in 22 years as a CIO.

Transitions are a time full of different emotions. I have been through them all. At this point I am mostly feeling satisfied with what I have accomplished and excited about starting a new life chapter.

The best thing about leaving an organization is the number of kind notes that you receive and how much insight others have about your strengths and contributions. I cherish the many emails and notes I have received.

For the last couple of years I have been transitioning our IT division to Ascension Information Systems (AIS). A move that is the natural outcome of Ministry’s acquisition by Ascension, the nation’s largest non-profit hospital chain. That transition is complete and the team I was privileged to lead is now following an exciting national strategy set by Ascension’s excellent CIO, Gerry Lewis. Those IT employees are in good hands and I thank AIS for taking such good care of those people and me.

More to come…

A Framework for IT Expense Reduction

February seems to reliably delivers Patriot Super Bowl wins and budget gaps to be closed. I have used these approaches, both as a CIO and a consultant, to manage challenging IT expense reduction efforts:

Get Organized

Every daunting task is more easily accomplished by breaking it up and delegating work into smaller streams of work. Here are the categories that I have historically used for large cost reduction efforts:

it-expense-management

IT Expense Management Framework

Here is a PowerPoint version that is more readable. In future blog posts I will write about successes I have had in these different categories.

Generally, I would be accountable for the entire effort, but I would assign a lead for each of the major categories (labor, sourcing, rationalization, and telecom). There is a lot of overlap, so the leaders need to regularly meet as a team.

Keep Score

All of these efforts require tracking tools to tally the planned savings. Smaller organizations can use a spreadsheet. Larger organizations need a mechanism that multiple people can contribute to at the same time; and enforces complex score keeping rules. Sharing the results frequently will build momentum and create the proper sense of urgency. I have some sample tools that I have used in the past, let me know if you would like to see them.

For a larger effort it is a good idea to have an audit role. The people that are good at generating creative IT ideas are not always the best accountants. They need help translating their ideas to actual projected savings.

Execution

Each IT expense initiative is a project. Without regular review and disciplined follow-through the savings will not be realized. Keep the structure in place until all of the ideas have been implemented. Create a dashboard to show leadership and the team their progress to the goal and changes to the expected savings total. Celebrate regularly.

Good luck. Remember, the money you save makes healthcare more affordable.

Shifting from IE to Chrome in the enterprise

If our experience at Ministry Health Care is an indicator, enterprises may be transitioning from Internet Explorer (IE) to Google Chrome as the browser of the future.

The problem for IE is not about being an inferior browser (although I am sure that will be argued in the comments). But, enterprises like ours have a lot of early generation web apps that were built to run specifically on older versions of IE. This has prevented us from upgrading IE to more recent versions.

At the same time we are implementing a lot of new web apps (like Workday) that demand a modern browser. Since we can’t upgrade IE without breaking the legacy web apps, we are introducing a second browser: Chrome.

Over time we will have fewer and fewer apps running on IE and more apps running on Chrome.

Suggestions for Marissa Mayer

Yammer is the internal social media platform we use in IT at Ministry Health Care. Recently there was a Yammer thread discussing the effectiveness of the communication surrounding the recent Yahoo email outage. Outage communication has been a focus for us and we like looking at what others are doing.

There were certainly a number of things that Yahoo did well. We thought that a communication from the CEO of the company set the right tone and it was written with a lot of authenticity. Sending an email from generic email accounts like the “IT help desk” would not have created the same level of goodwill.

But, I have two suggestions for Marissa Mayer:

  1. Don’t refer to your customers as users. Customers are valued. They are the reason you exist. Everyone has a mental model of good customer support. This Yammer post summarizes it better than I could: “Call me a customer, a client, an associate, a staff member, even just ‘you’ but ‘user’ sounds technical and impersonal.” Even if those receiving your service aren’t the ones paying I believe it is important to constantly remind associates they are the reason we are here and their satisfaction supersedes our own.
  2. A thank-you is better than an apology. There were a lot of apologies in the Yahoo communications. I believe it is a better approach to thank customers for their loyalty and patience while recognizing the inconvenience and letting customers know that you are working day and night until everything is fixed. When you thank someone you are recognizing them. When you apologize you are denigrating your performance. Save apologies for intentional acts, not mistakes.

ICD-10 Nervousness

So, our ICD10 effort isn’t entirely going as planned. I suspect that is the case for nearly every complex health system.

We started our effort by surveying our key IT partners (vendors). The surveys asked a lot of question but the key information we wanted to ascertain was Which version of your application can we count on being ICD10 ready?

I believe the vendors were responding with the best knowledge they had at the time. But, their responses are proving to be incorrect. As we tested the supposed ICD10-ready versions of the applications we found bugs that had to be fixed. Many of these fixes are requiring a later version of the software. The unplanned upgrades are adding months and thousands of hours to our ICD10 plans.

While the ICD10 transition date is over a year away, I am feeling a lot of pressure. When we sequence the tasks that need to be completed we are running out of slack.

Thoughts on Presentations

I believe the most important aspect of my role as a CIO is communication. A mediocre strategy well articulated will produce greater results than an excellent strategy that is not understood by those that must execute and support it.

There are many communication vehicles, but those of us at the senior management level must be able to stand in front of a room with a few hundred people and deliver a 30 minute presentation that is effective and engaging.

I enjoy this aspect of my job and I am constantly seeking to get better at it. I think I am better than average, but short of where I want to be. No matter how good one gets at this, an engaging presentation requires time to craft and practice to deliver well. I can still fall on my face if I do not have enough preparation time.

Every time I start to prepare a new presentation I do so with the intent of rivaling what Steve Jobs would do. The limitations of time and talent will keep me well short of that, but that is the mindset I start with.

Most folks in the corporate world start their presentations using a PowerPoint template created by the marketing department; and, most of those templates are awful. When Steve Jobs introduced a new product did his slides have the top 1/3 reserved for a giant title? Did every slide need to be branded with the an Apple logo and tag line. Did those slide use bullet pointed lines of text which he would read to the audience? Be brave, dump your corporate PowerPoint template.

There are a couple of books that I have found helpful and would recommend to anyone wanting to become better presenters. Garr Reynolds’ Presentation Zen has lot of suggestions about the entire process of creating and presenting a presentation. It really shines in the guidance it gives on creating engaging slides, the kind of slides Steve Jobs would use.

Another book that I have recently begun to re-read is Granville Toogood’s The New Articulate Executive. It is filled with presentation wisdom.

If anyone has presentation tips or book recommendations I would appreciate appreciate it if you left them as a comment to this post.