One-on-One with Dale Sanders, CIO, Cayman Islands Health Services Authority

DS: We have Cerner in the hospital — and what is worth noting from this experience is that we have a cloud-based solution for Cerner. So we run Cerner through a dedicated VPN back to their data center in Kansas City. The Cerner infrastructure stayed up, it stayed secure and protected, which is good news. The bad new is that all the PCs that are necessary to connect to Cerner were down.

DL: We forget that PCs are clinical tools.

DS: That’s right, and so many organizations in healthcare allowed themselves to be held hostage by the PCs.

DL: Tell me a little about HSA — is this public health for the whole country?

DS: It is. I’m still getting my arms around the model. It’s a government sponsored, government mandated healthcare system, and they’re obligated to provide care to anyone on the island whether they’re tourists or native. Everyone that’s a citizen is mandated by law to have healthcare insurance. It’s a little like a national system, it’s a little like a commercial system and it’s a little like a US system in that we process ICD-9s just like Northwestern did. So it’s a little different, it’s mandated by the government and funded by the government. It’s open to any citizen, but those citizens are still mandated by law to carry insurance just like we’re mandated to carry car insurance. And of course there are self pay options where you can buy up.

DL: The self pay options: Cayman Islands has the reputation of having some very wealthy people — are there two tiers of healthcare?

DS: Well, the second tier goes to Miami or Houston for care.

DL: What is the one thing that struck you most about your new life there — something you hadn’t considered.

DS: The influence of religion here is much more significant than I had realized. And the separation between church and state that we hold in such high regard, there’s none of that here. There are Baptists, Seventh Day Adventists, there are 124 churches on this island for 65,000 people. It kind of reminds me the way Baptist influence is so ingrained on Southern culture in the US and how important it is. It’s an integral part of society and plays a big part in the way that they deliver healthcare. They see the notion of delivering care here as much as a spiritual obligation as a healthcare obligation. It gives you a very solid foundation.

DL: Many people dream of doing what you're doing: walking away from a great job to something completely different. But they rarely have the courage to act on it — what would you tell them?

DS: I don’t want to die regretting or wishing I would have done something that I didn’t. I know had I not taken this job I would have always wished I would have done it. When I first started talking to people about the possibility, they all said you’ve got to do this. And when I saw the excitement in other people it was like, I kind of have to live up to this, I can’t let this opportunity blow by. And it’s going to be something I can share with them. And I look forward to sharing this whole experience.

I also wanted some experience with a national healthcare system, I’ve been with Intermountain, I’ve been with a commercial integrated health plan, I’ve been in an academic medical center, and I really wanted the experience of a national public health system to kind of round out my career.

And something else I would tell people is that for the last several years I’ve been very deliberately “leaning” my life down. I’ve been getting rid of furniture, reducing my expenses, getting to no debt. If I didn’t have that lean lifestyle I couldn’t have done this. So I am very happy I’ve been down that path for the last several years because it made the move easy and financials affordable — because I took a giant pay cut. It enables you to live these experiences that you couldn’t do otherwise.

DL: How did you hear about the job?

DS: There was a headhunter who always stayed in touch with me, sending me updates, and a lot of times I don’t even open the emails. I just happened to open this one purely by accident. It said that he wasn’t representing the client but wanted to pass it along because I was the first person he thought of. And I read it and thought, “Oh my gosh.” You just go, “This is meant to be.”

DL: There’s one question I’m sure everyone wants to know, Dale — are you hiring?

DS: As a matter of fact I am.