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 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.


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.

Read The Regulations

Periodicals, blog posts and journal articles are great for gaining an understanding of complicated laws such as HIPAA and the HITECH Act. But, if you are responsible for such an area for an organization, I highly recommend that you read the actual text of the regulation.

Reading the regulations will help you avoid the trap of subscribing to conventional wisdom that is NOT wise. Having an understanding of what the regulations really say will help you find the best solution for your organization.

And, I find that the laws are surprisingly readable. In the case of the Meaningful Use Final Rules, the first 85% of each rule is ONC’s response to all of the comments that they received. These are very insightful and, in my opinion  well-written. The actual regulations are really just a few pages and are a very quick read. The most confusing part is when the rule’s reference a specific standard using the legal number system. But that is navigable (the Find function is your friend).

Be Wary Of Healthcare IT Startups

Mike Silverstein wrote a wonderfully candid story on HISTalk. Everyone that buys heatlcare IT needs to read the entire post. This part in particular is a gem…

“Their [healthcare IT startup companies’] game plan is often the same: spend a bunch of money to hire salespeople who can go out and sell something, then hope something sticks and figure out the rest later.”

My take is this…due diligence is more important than ever and most of us aren’t doing it right.

Creative Marketing Ploys

I can’t imagine how difficult it is for people that sell IT services and goods to reach the people that would buy from them. Every organization has a different org structure and we are all inundated with requests for our time and attention. Many attempts to get our attention are complete failures, such failing to explain precisely what it is that you are selling. I have read complete press releases or magazine advertisements without understanding what is being sold. So, I have an appreciation for those that are able to craft a clear, efficient pitch. Some go the route of being very creative and I thought it would be fun to share some of those.

CommVault marketing

Today I got this in the mail. Not only does it include an innovative give-away (a bottle of BBQ sauce), but I really appreciated the attached letter. It starts…”Blah, blah, blah, blah, CommVault Simpana, blah, blah, blah, modern protection, blah, backup and recovery.”

They really understand how busy people read their marketing materials. They satirize those traditional materials and still communicate the most important message – what they are selling. If I were someone that was currently seeking that type of solution I would be inclined to look a little closer.

I think I am comfortable accepting a $2 bottle of BBQ sauce. But anything more valuable than that would strike me as crossing the line from attention-getter to an actual gift which is subject to several additional policies. Ministry has a policy that dictates gifts from suppliers which includes the following guidance:

  • Decisions made by Ministry Associates in the course of their duties must be objective and based solely on the best interest of the Organization. Decisions should never be influenced by any considerations of personal gain or gain to any personal associate of a Ministry Associate (such as a friend or relative). Purchasing and other decisions are made solely on the basis of the Supplier/Business Associate who offers the best value for the goods and services required.
  • Ministry Associates must avoid doing anything that could give the appearance or suggestion that a purchasing decision may be influenced by any irrelevant or improper consideration, whether illegal (such as a kickback or bribe) or technically legal (such as personal friendship, favors, or Gifts). Ministry Associates shall carry out their interactions with Suppliers/Business Associates in accordance with the guidelines set forth by the Corporate Integrity Program.

I am much more comfortable with things I can share in the office than something I would take home.

Lastly, I am NOT a fan of the ploy where the supplier will give me a gift if I sit through a sales pitch. Typically those enter into the realm of the gifting policy. It is important that I do not create an impression that I am deciding how to spend my time based upon personal gain.



Proactive Customer PC Monitoring

We are users of a cool product from Aternity for application monitoring. The Aternity app runs in the background on our PCs and monitors the end user experience. When a customer says “the system is running slow” we have a wealth of data that can confirm that is the case, quantify how slow, and correlate the slowness with a myriad of other factors (PC model, network segment, OS patches installed, etc.). There are other solutions in this space, including one from Compuware. But, we have been happy with our Aternity investment (a 6 figure expense).

There is a fair amount of setup required to train Aternity how to monitor each application. So, it is not completely magic.

To date we had used this tool to respond to customer complaints and to review monthly performance of our more troublesome applications. But recently our use of application monitoring was taken to the next level by our Field Services group (they support the technologies that our customers touch).

That group is using Aternity as a proactive monitoring tool. They are monitoring three parameters to that serve as an indicator of PC health:

  1. Boot time
  2. Blue Screen of Death (BSOD)
  3. Application launch

When a device encounters a Blue Screen or exceeds a threshold for boot time or application launch it appears on a list. Then, the Field Services team from the appropriate region will replace the device and take the old one back to the device for troubleshooting and re-imaging or disposal.

By being proactive and showing up to replace a device before an incident is reported our Field Services team is creating a “wow” experience for our customers.


Customer Communications During an Outage

There are a few keys that I have found when communicating with customers about outages and service interruptions:

  • Our customers can accept bad news, they cannot accept no news.
  • Getting the team out into the patient care areas, communicating face-to-face buys a lot of goodwill.
  • Don’t use generic email addresses, send genuinely worded emails from a real person, ideally someone that shows the level of attention the problem is receiving (like the CIO). It is easier to be mad at a department than a person who is trying their hardest.
  • Empathize, don’t apologize. Say something like: “We understand that this is disruptive to your work and patient care. This is important to us and we will work day and night until things return to normal. Thank you for your patience and support.”
  • When closing the outage, make sure your customers know that there will be a full Root Cause Analysis and systemic changes will be put in place to avoid a recurrence.