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Chuck Podesta Shares His Perspectives on CIO Leadership and Current Challenges

November 14, 2016
by Mark Hagland
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UC Irvine Health’s Podesta shared his perspectives on leadership issues and challenges facing CIOs

Chuck Podesta, CIO at UC Irvine Health, the integrated health system at the University of California-Irvine in Orange County, California, spoke on Friday, Nov. 11 at the Health IT Summit in Beverly Hills, sponsored by Healthcare Informatics. At the Sofitel Hotel Los Angeles at Beverly Hills, Podesta delivered Friday morning’s keynote address, entitled “Partnering with the CIO: Views from an Expert Healthcare IT Buyer.”

In his speech, Podesta spoke very bluntly about the challenges facing CIOs in interacting with some in the vendor and consulting community, emphasizing that CIOs have very little time, and that many of the maneuvers that certain vendor and consulting firm representatives make can actually alienate CIOs in terms of wasting their valuable time. That said, he also made it clear that he is looking for smart vendors and consultants to partner with him and his team at UC-Irvine Health, to take on the challenges facing their organization and all patient care organizations in the current operating environment in U.S. healthcare.

Afterwards, Podesta, who has spent more than two full years now at UC Irvine Health (he joined that organization in September 2014), sat down with Healthcare Informatics Editor-in-Chief Mark Hagland for a discussion of some of the top challenges facing CIOs in the current moment. Below are excerpts from that interview.

Given the dizzying pace of change right now and the many challenges facing CIOs, this is a time involving unprecedented pressure on healthcare IT leaders. What would you say to CIOs and other healthcare IT leaders about the present moment?

Yes, the times are changing faster than ever. And what I say to CIOs is, I ask them, who are you using to help you with all of this? Who are the people you’re using—other providers, as well as vendors—to help you with all this? The other part would be to start breaking down some of the things that are on our IT strategy roadmap right now. One example would be security. We know that the presidential election won’t change what’s going on with security at all—that’s a given. And nothing will change in terms of the analytics needed for population health. And even if they were to throw out the ACA [Affordable Care Act], the commercial payers are all focused on population health and moving towards risk, so the analytics need will be important anyway. And I don’t believe that the value-based aspect of career and payment—high quality and low cost—will go away; that’s a given. And the private insurers have bought off on that. So I don’t think the clock’s going to go back on any of that.


Driving Success at Regional Health: Approaches and Challenges to Optimizing and Utilizing Real-Time Support

Regional Health knew providing leading EHR technology was not the only factor to be considered when looking to achieve successful adoption, clinician and patient satisfaction, and ultimately value...

Chuck Podesta speaking at the HIT Summit

Given how much is going on, it seems clear that prioritization is going to be a huge issue for CIOs, along with IT governance and project management. Your thoughts?

The first analysis you need to participate in is this: of your top 25 things on your list, what are the 15 things you can let go of. Now, you need consensus in your organization, of course. So you’ve got to go to your governance, and then make the hard decisions. What’s happening in organizations is that they’re not letting go of anything on their plates, but instead are adding new items based on new demands. But again, your partners can help you.

And that group will include consultants, vendors, associations, and other partners?

Yes, absolutely. I’ve been telling consultants, the best that could happen would be the uncertainty of this election result, because there’s chaos, and you guys as consultants thrive on chaos. And now we have great uncertainty.

You’ve been at UC-Irvine Health for just over two years now. And you’ve made progress in numerous areas. What critical success factors have been involved in your progress so far?

Because I’ve been in the industry so long, I’ve seen what not to do as much as what to do. So when I go into a new organization, I ask, how does the help desk function? How is their PMO [project management office]? What is their IT governance? And in many cases, all three areas are lacking. And in 72 hours, I can tell them, we need to put those things in place. And I’ve done it before, so I can do it again. But if you haven’t done it before, you need partners. And partners can help you be successful. Because you’ve got to have those things in place. You’ve got to have the day-to-day things functioning at a high level, so you can have credibility when you go into the executive suite and not come in out of crisis. Then you can be a trusted adviser. After 8 or 10 months, the c-suite people can say, we trust you, because you’ve established yourself as a CIO, through excellent operations management. That’s what I did here, I knew I had to reorganize and provide strong management and leadership. And that’s what I did, bringing in a mix of internal and external people to build that team. And a lot of CIOs are afraid to rock the boat, to do that reorganization. Some of the managers are liked by the staff, maybe. But if managers don’t have the ability, if you don’t move them out of the role, then that reflects on you. Six months or a year later, if you haven’t done that, then the c-suite looks at you, and you’re not new anymore. And then you can go have lunch or play golf one afternoon, or do a speaking engagement like this one.

In terms of the policy-, payment-, and industry-driven demands on CIOs, what do you see happening in the next year or so for CIOs as a group?

I think there’s going to be more churning of CIOs. You have the retirement aspect, but also, you have the CIOs who aren’t cutting it because they’re not really strategic. And as things change in the industry, that’s where you will see more churning, because if CIOs can’t be trusted advisors, then they’ll churn. And with mergers and organizations, there will be fewer organizations and fewer top CIOs. And that will continue. So if you want to be one of those top CIOs, you’re really going to have to do your homework and be strategic. The other thing with CIOs is that if you’re a CIO with a successful track record, you’ll be highly, highly valued. And CEOs understand the importance of the top CIOs. You’ll see some CIOs being seven figures and up in some of the top healthcare organizations; it’s already happening. There will be this gap between some of the higher-level CIOs and others.

When you look at CIOs who have tried to make the transition from being technical people to being true organizational leaders, what do you see as making the difference in terms of who is able to successfully make that leap, and who is not?

When you’re a CIO, you’re 80 percent strategy and 20 percent operations; the opposite is true of directors of IT. And there are a lot of people who can do the director of IT thing beautifully. My director of IT operations is perfect in that. Now, I’ve seen so many people who are directors of IT who want to make that leap to CIO, but within a year, many of them are gone. How many CIOs like that do we know? They’re micromanagers, and they remain operational people, and now they’re in the wrong job. To be a leader, you need to think and ponder. If you’re a micromanager running day to day operations, you’re not doing that leadership position. I’m lucky in that I’ve bene able to make that transition. And you don’t just go in as a strategic CIO; you come up. You’ve got to break that thinking where you’re managing day-to-day operations. It’s no longer, what am I doing today? But rather, what am I going to be doing in a year from now?

What would your advice to your fellow CIOs be, with regard to the tumultuous waters that all healthcare CIOs will have to navigate in the next few years?

I would speak to two areas. One, on the patient safety and quality side, keep doing all that. Make sure your organization continues all its initiatives around quality and safety. On the cost side, cash will be king. This is going to be chaotic, and you need to say, I’m going to help put my organization, because we don’t know exactly what’s going to happen, but we need to be prepared to invest in things. So build up cash reserves. Look at non-labor first, look at your benchmarks across the industry. Maybe things with pharmaceuticals, med supplies, keep going back at that. And look at your labor side. One of the exercises you need to go through is around span of control. There should be any more than five levels between the CEO and the person sweeping the floor. In private industry, that’s becoming the standard. And analyze how many managers you’ve got.

So you need to look across your organization in terms of who you have as managers and how many managers you have, relative to what needs to be done. See who you have for managers, and anyone they have reporting to them. And any less than ten, can this person manage more people? And you can do some of that through attrition, or over time. But that whole span of control analysis is so important. Because otherwise, you end up with staffing creep. And you’re dealing with management, not staff. And that message is a little easier around management than staff. And to be honest, some CIOs like castle-building, which is a problem. And the reality is, at some point, as a CIO, you’re going to be benchmarked in terms of your staffing levels; and if you’re over-staffed, then there will eventually be some kind of bloodletting.

How do you lead through change, and build a confident organization, one that isn’t driven by fear?

Every organization has natural leaders. In our organization, I’ve got Adam and Curtis. And if I go to a meeting and say, what do you think about Curtis? And everyone says, ohmygosh, he’s wonderful! Take those people and elevate them> And once you elevate those folks, it shows the organization, hey, he knows and sees talent, and gets it. And those guys will perform even better, because they’ll be empowered. And then you have to move some people out. And people will get that. OK, he’s brought those people up who deserve it, now he’s having to focus on people who aren’t so strong. And We had a culture at UCI that was very insular. So the people I brought in and moved up were all customer-service focused. And the CFO called me up and said, I don’t know what you’re doing, but you’re doing something great. And that’s what you’re hoping for.

Is there anything else you’d like to add?

It’s going to be a bumpy ride for sure. But you remember when Obamacare started up, everyone said, ohmygosh, this is going to be crazy and difficult. But it was fun. And new approaches and technologies were developed because of it. Again, chaotic times sometimes can be fun times, too, as long as it’s organized chaos. So put your big boy and big girl boots on!



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Allscripts Sells its Netsmart Stake to GI Partners, TA Associates

December 10, 2018
by Rajiv Leventhal, Managing Editor
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Just a few months after Allscripts said it would be selling its majority stake in Netsmart, the health IT company announced today that private equity firm GI Partners, along with TA Associates, will be acquiring the stake held in Netsmart.

In 2016 Allscripts acquired Kansas City-based Netsmart for $950 million in a joint venture with middle-market private equity firm GI Partners, with Allscripts controlling 51 percent of the company. With that deal, Allscripts contributed its homecare business to Netsmart, in exchange for the largest ownership stake in the company which has now become the largest technology company exclusively dedicated to behavioral health, human services and post-acute care, officials have noted.

Now, this transaction represents an additional investment for GI Partners over its initial stake acquired in April 2016, and results in majority ownership of Netsmart by GI Partners.

According to reports, it is expected that this sale transaction will yield Allscripts net after-tax proceeds of approximately $525 million or approximately $3 per fully diluted share.

Founded 50 years ago, Netsmart is a provider of software and technology solutions designed especially for the health and human services and post-acute sectors, enabling mission-critical clinical and business processes including electronic health records (EHRs), population health, billing, analytics and health information exchange, its officials say.

According to the company’s executives, “Since GI Partners' investment in 2016, Netsmart has experienced considerable growth through product innovation and multiple strategic acquisitions. During this time, Netsmart launched myUnity, [a] multi-tenant SaaS platform serving the entire post-acute care continuum, and successfully completed strategic acquisitions in human services and post-acute care technology. Over the same period, Netsmart has added 150,000 users and over 5,000 organizations to its platform.”

On the 2018 Healthcare Informatics 100, a list of the top 100 health IT vendors in the U.S. by revenue, Allscripts ranked 10th with a self-reported health IT revenue of $1.8 billion. Netsmart, meanwhile, ranked 44th with a self-reported revenue of $319 million.

According to reports, Allscripts plans to use the net after-tax proceeds to repay long-term debt, invest in other growing areas of its business, and to opportunistically repurchase its outstanding common stock.

The transaction is expected to be completed this month.

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Study Links Stress from Using EHRs to Physician Burnout

December 7, 2018
by Heather Landi, Associate Editor
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More than a third of primary care physicians reported all three measures of EHR-related stress
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Physician burnout continues to be a significant issue in the healthcare and healthcare IT industries, and at the same time, electronic health records (EHRs) are consistently cited as a top burnout factor for physicians.

A commonly referenced study published in the Annals of Internal Medicine in 2016 found that for every hour physicians provide direct clinical face time to patients, nearly two additional hours are spent on EHR and desk work within the clinic day.

Findings from a new study published this week in the Journal of the American Medical Informatics Association indicates that stress from using EHRs is associated with burnout, particularly for primary care doctors, such as pediatricians, family medicine physicians and general internists.

Common causes of EHR-related stress include too little time for documentation, time spent at home managing records and EHR user interfaces that are not intuitive to the physicians who use them, according to the study, based on responses from 4,200 practicing physicians.

“You don't want your doctor to be burned out or frustrated by the technology that stands between you and them,” Rebekah Gardner, M.D., an associate professor of medicine at Brown University's Warren Alpert Medical School, and lead author of the study, said in a statement. “In this paper, we show that EHR stress is associated with burnout, even after controlling for a lot of different demographic and practice characteristics. Quantitatively, physicians who have identified these stressors are more likely to be burned out than physicians who haven't."

The Rhode Island Department of Health surveys practicing physicians in Rhode Island every two years about how they use health information technology, as part of a legislative mandate to publicly report health care quality data. In 2017, the research team included questions about health information technology-related stress and specifically EHR-related stress.

Of the almost 4,200 practicing physicians in the state, 43 percent responded, and the respondents were representative of the overall population. Almost all of the doctors used EHRs (91 percent) and of these, 70 percent reported at least one measure of EHR-related stress.

Measures included agreeing that EHRs add to the frustration of their day, spending moderate to excessive amounts of time on EHRs while they were at home and reporting insufficient time for documentation while at work.

Many prior studies have looked into the factors that contribute to burnout in health care, Gardner said. Besides health information technology, these factors include chaotic work environments, productivity pressures, lack of autonomy and a misalignment between the doctors' values and the values they perceive the leaders of their organizations hold.

Prior research has shown that patients of burned-out physicians experience more errors and unnecessary tests, said Gardner, who also is a senior medical scientist at Healthcentric Advisors.

In this latest study, researchers found that doctors with insufficient time for documentation while at work had 2.8 times the odds of burnout symptoms compared to doctors without that pressure. The other two measures had roughly twice the odds of burnout symptoms.

The researchers also found that EHR-related stress is dependent on the physician's specialty.

More than a third of primary care physicians reported all three measures of EHR-related stress -- including general internists (39.5 percent), family medicine physicians (37 percent) and pediatricians (33.6 percent). Many dermatologists (36.4 percent) also reported all three measures of EHR-related stress.

On the other hand, less than 10 percent of anesthesiologists, radiologists and hospital medicine specialists reported all three measures of EHR-related stress.

While family medicine physicians (35.7 percent) and dermatologists (34.6 percent) reported the highest levels of burnout, in keeping with their high levels of EHR-related stress, hospital medicine specialists came in third at 30.8 percent. Gardner suspects that other factors, such as a chaotic work environment, contribute to their rates of burnout.

"To me, it's a signal to health care organizations that if they're going to 'fix' burnout, one solution is not going to work for all physicians in their organization," Gardner said. "They need to look at the physicians by specialty and make sure that if they are looking for a technology-related solution, then that's really the problem in their group."

However, for those doctors who do have a lot of EHR-related stress, health care administrators could work to streamline the documentation expectations or adopt policies where work-related email and EHR access is discouraged during vacation, Gardner said.

Making the user interface for EHRs more intuitive could address some stress, Gardner noted; however, when the research team analyzed the results by the three most common EHR systems in the state, none of them were associated with increased burnout.

Earlier research found that using medical scribes was associated with lower rates of burnout, but this study did not confirm that association. In the paper, the study authors suggest that perhaps medical scribes address the burden of documentation, but not other time-consuming EHR tasks such as inbox management.


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HHS Studying Modernization of Indian Health Services’ IT Platform

November 29, 2018
by David Raths, Contributing Editor
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Options include updating the Resource and Patient Management System technology stack or acquiring commercial solutions

With so much focus on the modernization of health IT systems at the Veteran’s Administration and Department of Defense, there has been less attention paid to decisions that have to be made about IT systems in the Indian Health Service. But now the HHS Office of the Chief Technology Officer has funded a one-year project to study IHS’ options.

The study will explore options for modernizing IHS’ solutions, either by updating the Resource and Patient Management System (RPMS) technology stack, acquiring commercial off-the-shelf (COTS) solutions, or a combination of the two. One of the people involved in the analysis is Theresa Cullen, M.D., M.S., associate director of global health informatics at the Regenstrief Institute. Perhaps no one has more experience or a better perspective on RPMS than Dr. Cullen, who served as the CIO for Indian Health Service and as the Chief Medical Information Officer for the Veterans Health Administration

During a webinar put on by the Open Source Electronic Health Record Alliance (OSEHERA), Dr. Cullen described the scope of the project. “The goal is to look at the current state of RPMS EHR and other components with an eye to modernization. Can it be modernized to meet the near term and future needs of communities served by IHS? We are engaged with tribally operated and urban sites. Whatever decisions or recommendations are made will include their voice.”

The size and complexity of the IHS highlights the importance of the technology decision. It provides direct and purchased care to American Indian and Alaska Native people (2.2 million lives) from 573 federally recognized tribes in 37 states. Its budget was $5.5 billion for fiscal 2018 appropriations, plus third-party collections of $1.02 billion at IHS sites in fiscal 2017. The IHS also faces considerable cost constraints, Dr. Cullen noted, adding that by comparison that the VA’s population is four times greater but its budget is 15 times greater.

RPMS, created in 1984, is in use at all of IHS’ federally operated facilities, as well as most tribally operated and urban Indian health programs. It has more than 100 components, including clinical, practice management and administrative applications.


Driving Success at Regional Health: Approaches and Challenges to Optimizing and Utilizing Real-Time Support

Regional Health knew providing leading EHR technology was not the only factor to be considered when looking to achieve successful adoption, clinician and patient satisfaction, and ultimately value...

About 20 to 30 percent of RPMS code originates in the VA’s VistA. Many VA applications (Laboratory, Pharmacy) have been extensively modified to meet IHS requirements. But Dr. Cullen mentioned that IHS has developed numerous applications independently of VA to address IHS-specific mission and business needs (child health, public/population health, revenue cycle).

Because the VA announced in 2017 it would sundown VistA and transition to Cerner, the assessment team is working under the assumption that the IHS has only about 10 years to figure out what it will do about the parts of RPMS that still derive from VistA. And RPMS, like VistA, resides in an architecture that is growing outdated.

The committee is setting up a community of practice to allow stakeholders to share technology needs, best practices and ways forward. One question is how to define modernization and how IHS can get there. The idea is to assess the potential for the existing capabilities developed for the needs of Indian country over the past few decades to be brought into a modern technology architecture. The technology assessment limited to RPMS, Dr. Cullen noted. “We are not looking at COTS [commercial off the shelf] products or open source. We are assessing the potential for existing capabilities to be brought into “a modern technology architecture.”

Part of the webinar involved asking attendees for their ideas for what a modernized technology stack for RPMS would look like, what development and transitional challenges could be expected, and any comparable efforts that could inform the work of the technical assessment team.




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