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At the Health IT Summit in San Francisco, UC Health’s Tom Andriola Urges CIOs Forward on Leadership

April 5, 2018
by Mark Hagland
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UC Health’s Tom Andriola offered HIT Summit attendees insights on CIOs’ current leadership challenges

What are some of the main challenges facing CIOs right now, in the evolving operational landscape of U.S. healthcare? Tom Andriola, vice president and CIO for the University of California System and UC Health, shared his perspectives on the subject on Thursday morning, in his keynote presentation, “Managing the Changing Role of the Chief Information Officer: Clinical Transformation, Governance, Workforce Development,” at the Health IT Summit in San Francisco, sponsored by Healthcare Informatics, and being held Thursday and Friday at the Palace Hotel in downtown San Francisco.

Andriola directs IT strategy for the University of California System and UC Health; UC Health encompasses five University of California health systems—at San Francisco, Davis, Los Angeles, Irvine, and San Diego), accounting for $11.3 billion in annual patient revenues, and which trains 50 percent of California’s medical students and medical residents, and performs more than half of the organ transplants in the state every year. It is the fourth-largest health system in the state.

“There’s never been a better time to be in the business of technology, because IT is having more and more influence on the way we work,” Andriola told his audience. “And, as IT leaders, we have to start thinking more broadly, because there are more and more questions we have a role to play in.” An absolutely key element in CIO success, he emphasized, is that “We need to be in the right conversations at the right times, and to be ready to ask the right types of questions, to help our organizations engage in asking the questions about where we go next” in healthcare.

Tom Andriola

Andriola summarized some of the “dramatic changes taking place in U.S. healthcare,” focusing on some of the major challenges facing patient care organizations around “revenues, cost structure and payer mix”—where, he noted, “we have a huge challenge in cost structure around our academic setting”—as well as “care quality, patient mix and access,” and the increasing “consumerization” of healthcare. “It’s not just what’s going on in the Epic booth or the Cerner booth any longer,” he said, referring to disruptive entities coming into healthcare from all quarters. “The consumerization element and the broader recognition of who can actually help me with healthcare, that’s starting to change, and there are alternatives to getting care that will take revenues out of our pockets,” he said, referring to non-traditional providers of care that are emerging from outside established patient care organizations. “Now,” he said, “you’ve got disruption happening everywhere. There are disruptive outside forces around value-based care models, scientific advances, technological advances. The world has gotten more complex,” he added. “It used to be that competitors were well understood,” meaning traditional fellow providers. But incumbents are rapidly being gained on by new insurgents in the industry.


Integrating Data Sources for Successful Care Delivery

The advances in and availability of data from disparate sources create new opportunities and frontiers in care coordination for complex patients. These can range from mobile health/Internet of...

The impacts are multi-dimensional, and span the strategic to the practical, Andriola noted. Just to cite one very practical consequence of some of the disruptive changes affecting the healthcare CIO environment in California, he noted that “Very few people understand both the clinical science of healthcare and the data science around AI”—artificial intelligence—“and we have had a hard time keeping those people” within the UC Health system, he reported. “They get offered huge salaries to go work at technology companies across the Bay Area, with Silicon Valley ever-present in his hiring management calculations. The disproportionality of scale is a considerable issue, he noted, between what the public sector, including the state university system, and government, can offer skilled data scientists and other informatics experts, and what the private sector can offer them. “One of my colleagues,” he said, “recently pointed out to me that the entire budget of the National Science Foundation is $10 billion a year, whereas Amazon, Google, and Microsoft alone are investing $100 billion right now in cloud infrastructures”—and hiring data scientists, data engineers, and informaticists to help build out those architectures.

What should CIOs be doing right now?

“What should CIOs be doing today, and what should their contributions be to the organizations be?” Andriola asked his audience. “And what will advice to CIOs look like in 2025? One of the things I poke fun about is the fact that we CIOs now get way, way too much advice,” he said, “from Gartner, from CHIME”—the Ann Arbor, Mich.-based College of Healthcare Information Management executives—“and from everybody else. And some of what some of those organizations are saying is confusing.” He showed a slide from Gartner that he testified was very confusing. It was an unusual graphic showing a CIO’s “old job,” and then a cluster of bubbles showing “actions” the CIO should take, including “preempt disruption,” “define your new job,” “live your new job,” and then a final bubble labeled “new job.” “I’m not sure what this graphic even means!” he noted.

Importantly, Andriola said, “CIOs need to focus on the fundamentals.” First, “Can you be an effective leader? Understand what it means to be an effective leader.” Second,” In your environment, can you drive, coordinate, facilitate, effective collaboration, working outside boundaries?” It’s time, more than ever before, is to break down silos.

Third, “How do we innovate? Innovation is really about moving a set of people or organization forward, whatever that might be—through new solutions, or incrementally—but do you know how to create an innovation process in your organization?” And fourth, “Can you create value for your organization’s mission and goals? How do you help your organization’s leaders create something of value? And are you relevant in your organization? Having a CIO title doesn’t make you relevant. And being invited to the off-site meeting for two days doesn’t make you relevant, if you sit silently on the sidelines. Can you help people to work together?”

In that, Andriola said, “You’ve got to mold consensus. And in the executive search world, there’s a lot of talk about seeking diverse perspectives, finding people who can seek out diverse perspectives and find common ground, and bend the curve on costs and other things.” At the same time,” he said, “CIOs still face headwinds, and continue to have to fight for their place in important and relevant conversations” in health system c-suites.” Indeed, the sad reality, he said, is that many health system c-suite executives perceive CIOs in very narrow, cramped terms, as operational managers, technology consultants, and budget managers—in other words, as non-leaders. But, he added, it is up to CIOs themselves to break out of that narrow box that some of their c-suite executives put them in.

And, per breaking out of the box of limitation, he said, “It starts by changing what you think. Network latency is not a value metric,” he asserted, though he quickly added that it is also true that “We have to fix our operational issues before we start trying to align on more strategic initiatives.” Meanwhile, he said, “Why do we say that ‘IT must learn to align with the business? Does your CFO or CPO talk like that? We’ve created this perception that we’re not just a part of the business.” In fact, he said, “’The business’ is neither IT’s ‘customer,’ nor its ‘partner.’ A better metaphor is this: we’re just part of the team.” In fact, he said, even would-be thought-leader organizations like Gartner reinforce the idea of IT’s apartments with slides that say things like, “CIOs must close the gap with top executives.”

Importantly, he told his audience, “If you want to be relevant, stop talking like a technology person, talk like a businessperson. I work hard to understand how my executives talk, understand what they’re saying, and when I’m talking with them, use their language.” And, as he said that, he shared a slide that showed a graphic that said, “100-percent geek-speak-free.”

Is data an asset—or a form of currency?

One important point that Andriola made for his audience had to do with how CIOs should define the importance of data within a patient care organization. “Is data an asset or a currency?” he asked. “ An asset is a little bit more fixed, more binary as a concept—either I’m using it or not using it, as with a hospital bed. Currency is something a little bit more fluid, like dollars; I can be using it in multiple ways at the same time; it’s a form of exchange. Data for us now is much more of a form of currency,” he insisted.

What’s more, Andriola said, “We’re starting to realize that the data we collect isn’t necessarily the data we need. We’re realizing we’re leaving a lot of data out in terms of capturing data at specific data points. Where do we need to capture data in the life cycle of data? And data only gives you insights; we have to turn those insights into action,” at the point of usage.

At the University of California Health, Andriola said, “The way we think about our data environment, is that we’re trying to leverage data by building an unparalleled ‘learning health platform,’ in order to transform healthcare delivery through data-informed services and better enable the ecosystem.”

One example he cited was that “We have about 140,000 cancer patients throughout our system—one of the biggest populations of cancer patients anywhere.” And, per that, he said, “We can use our data to improve patient outcomes, better manage populations, and create better real-world evidence- and real-time-based feedback. For example, a pharmaceutical company approached us around how we’re prescribing medications for certain types of patients in cancer registries. And we said, why don’t we bring in images? They were very interested. So we’re thinking about new transformative care models: how can we disrupt our own care models, and use data differently.”

Such situations speak to some of the new ways in which the CIOs of patient care organizations can reframe what they and their colleagues in IT do, and how they use the building blocks of their work. “I think many times, we think we’re in the technology business, that our job is bringing technology to the organization, when really, we’re in the business of influencing change. So what is the change we’re looking for, what is the desired outcome, and how can technology be the lever in a way that makes sense and adds value?” he asked. “Unfortunately,” he added, while we may have had a strong business or technology foundation in our careers, most of us don’t get formal training in managing change; we learn that on the job. And in any domain, there is a body of research here on what works, and how to do this.” For example, he noted, there is the classic schematic of the “Eight Steps for Leading Change,” created by John P. Kotter, Ph.D., which he presented in a slide. Those eight steps are:  create a sense of urgency, build a guiding coalition, form a strategic vision and initiatives, enlist a volunteer army, enable action by removing barriers, generate short-term wins, sustain acceleration, and institute change.

Change cannot be forced from the top, Andriola emphasized. It must be nurtured, guided, and led. What’s more, he said, “We have roughly 7,500 IT people across the entire UC enterprise”—academic, healthcare, etc.. “How do we get 7,500 people energized to go transform the mission of the University of California? And how do we think about growing the organization’s capability to drive change?  Organizations are so complex now, it’s not possible to think about how the CIO can create all the change.” In the end, he said, “It’s about leadership, collaboration, and innovation.” And in all that, he said, CIOs will have to develop leadership within the IT ranks of their organizations.



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Vanderbilt Announces Health IT Leadership Transition

November 6, 2018
by David Raths, Contributing Editor
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Patel to succeed Johnson as leader of VUMC HealthIT

Vanderbilt University Medical Center HealthIT has announced a change of leadership. In January 2019 Neal Patel, M.D., M.P.H., who has been VUMC’s chief health information officer, will succeed Kevin Johnson, M.D., M.S., as HealthIT leader.

HealthIT’s responsibilities include informatics support for a broad scope of VUMC’s health system demands. Tools supplied and supported through HealthIT help enable VUMC to achieve its strategic objectives within the clinical, educational and research enterprises.

Johnson, Cornelius Vanderbilt Professor, will continue to serve as chair of the Department of Biomedical Informatics (DBMI). A professor of pediatrics, he joined the Vanderbilt faculty in 2002 and has been chair of the DBMI since 2012. He was named Senior Vice President for Health Information Technology in 2014.

During his tenure, Johnson served as leader for the multi-year, system-wide effort to replace its homegrown EHR with Epic, which went live in November 2017. Patel joined Johnson as co-lead during the Epic launch.

Through this leadership change, Patel will now report to John F. Manning Jr., PhD, MBA, Chief Operating Officer and Corporate Chief of Staff. “With Dr. Patel succeeding Dr. Johnson in this role, there is an assurance of continuity as we move forward. With our Medical Center and health system at an important inflection point, and in a period of significant growth, I want to express my appreciation to Neal for assuming these new responsibilities,” Manning said in a prepared statement.

Patel joined the faculty of the Department of Pediatrics in the Division of Pediatric Critical Care in 1997. He was named Chief Medical Informatics Officer in 2006. His responsibilities in this role included leading efforts for translating the Medical Center’s healthcare delivery, quality and patient safety goals into informatics strategies to optimize the delivery of patient care.



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CHIME’s Russ Branzell: A Tech Revolution is Coming to Healthcare

November 2, 2018
by Rajiv Leventhal, Managing Editor
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The president and CEO of CHIME said at the association’s Fall CIO Forum this week that collaboration and being a community will be key steps to succeeding in the new healthcare

Healthcare CIOs, CMIOs and other top IT leaders are under increased pressure these days for a variety of reasons, and staying out in front of emerging health IT innovations, while maintaining a big-picture view of how digital transformation will affect business operations, are right at the top of the list.

Russell Branzell, president and CEO of CHIME (the Ann Arbor, Mich.-based College of Healthcare Information Management Executives) for the last six years, leads an executive organization which has a membership of a few thousand CIOs, CMIOs and other senior healthcare IT leaders. And with so much happening these days around technology innovation, new entrants into the market—some of which could be seen as potential disruptors—in addition to policy considerations and cybersecurity challenges, associations like CHIME are relied on to drive clinical IT executives in the right direction.

At the CHIME 2018 Fall CIO Forum in San Diego this week, Branzell sat down with Healthcare Informatics Managing Editor Rajiv Leventhal to discuss the challenges and opportunities that lie ahead for CIOs, and what skills will be critical to success going forward. Below are excerpts from that interview.

I am sure you would agree that it’s both an exciting and anxious time in healthcare. What is top of mind right now for your members?

Yes, I think there is a duality to this that is exciting and scary at the same time. There are practical and technical challenges we are being faced with now, with one of the biggest being cybersecurity and the threats and pains in those areas. Organizations are changing to new models [of care], and there is also consumer engagement that is unique to this time period; it’s not the same old game we have always played.


Integrating Data Sources for Successful Care Delivery

The advances in and availability of data from disparate sources create new opportunities and frontiers in care coordination for complex patients. These can range from mobile health/Internet of...

The most interesting thing coming at them, though, is this next wave of what we refer to as “fourth revolution technology” that’s on the way. So that means 5G [technology], robotics, biosensors, genetic manipulation, and neural networking. These are buzzwords, but the reality is that they are real. Things are coming at us, and we have not been able to deal with at this level of advanced technology before.

What we have done in the past is incrementally gain the existing technology that has been in play in healthcare for the last 30 years. So we are trying to keep the trains on time, advance the organization, help them get benefits realization, and move to a new care model of consumerism and value. But we also see this other thing coming down the track that will dramatically disrupt all this. While it’s a unique time, and a little bit scary, scary is another way to say “great opportunity.”

Is the traditional/current CIO ready for this revolution? 

We have always been able to keep up with the small, incremental learnings. We have had the CIO 2.0 model out for 15 years, and that brought people from the traditional technology environment to driving change in organizations. The difference now is, the new things coming at us will require us to learn at a pace we have never learned at before. There will be disrupters in the industry for us to adapt to and understand at a pace we have never understood before. Undoubtedly, the CIO 3.0, the health IT leader 3.0, and the digital leaders of the future will monumentally change their internal skillsets and how they work.

On the policy front, lots of relevant regulations are set to drop in the next few months. The administration has been aggressive thus far in its proposals for promoting interoperability, but some would argue that fundamental data sharing challenges need to be ironed out first. What is CHIME’s stance on this?

There is still a strong degree of gap between the reality of today and the things that need to be put in place to enable [interoperability]. Some of those things are relative to standards and the universal transport across the country from an information sharing perspective. The government is trying to say there shouldn’t be barriers to inhibiting things that we are being successful in.

San Diego offers a good example in that things are well put in place, health systems are willing to share, I would say that there is no ubiquitous information blocking here, and the organizations generally all want to do the right thing for the patient. So in this micro-environment, though a big city, they do a good job of sharing information and being interoperable with each other.

But now magnify that across California, and it’s a scale issue in which we don’t have in place the universal standards, identification, transport layer, agreements, and multi-state consent. So many things still need to be addressed, whether that’s through administrative rule, law, or presidential order, some things need to be addressed at a macro level to accelerate that last 10 percent. About 90 percent is being done in local environments. Most people don’t often leave their local environment to seek care. But for the 10 percent or so that do, these things are not quite in place yet.

I’ve been interested in reading CHIME’s comments on aligning 42 CFR Part 2 with HIPAA, though this provision was not passed in the recent opioids package. Could this be reconsidered down the road?   

We were disappointed that it wasn’t [included], but we also considered different areas of statute ownership, within the government, relative to this and we [knew] they had to get [the bill] out. We will still advocate for the alignment in these areas so that we could accelerate solutions and service the people who need the help. This was ubiquitous across all our membership, and this was something that could have been addressed, but what we heard was, and I understand this, that they needed to get this out [now], and then possibly the [alignment] piece could be bolted on later.

In this pressured current moment, what advice could you offer to CIOs?

Like never before there is a need for people to hone and advance their skills, and become educated in what’s coming down the tracks as far as advanced technologies, while also getting the solutions they already have in place to higher degrees of success. The answer to all of this will be about us being a community.

We have been successful here at CHIME for almost [three decades] in building this network, building the relationships, and building the trust environment that we need. We need to lean on each other. People do this in small pockets and big pockets, and to survive in the future, we will need to ubiquitously share with each other. You don’t want to have everyone invent and innovate locally; not that we shouldn’t in a micro sense, but in the macro sense, we have to share in ways that we never have before. 

I’ll use opioids as an example. If Anne Arundel [County in Maryland] and Geisinger Health System are the two best in the country [at fighting the opioid epidemic], why would the other 5,000 or so places go and start from square one. That makes no sense whatsoever, but that’s the way our industry has worked for a long time. They key to us solving problems is communication and collaboration.

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CHIME Hands Out Innovator, Transformational Leader Awards

October 31, 2018
by Rajiv Leventhal, Managing Editor
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At the College of Healthcare Information Management Executives (CHIME) 2018 Fall CIO Forum in San Diego, health IT executives were recognized today for their transformational and innovative leadership.


Omer Awan, senior vice president and CIO, Navicent Health in Macon, Ga., joined the patient care organization two years ago, but in just that short amount of time, he has changed the culture in his department and has elevated the profile of IT within the ranks of Navicent’s executive leadership, giving him a seat at the table as they carry out Navicent’s vision, according to CHIME officials who presented Awan with this year’s Transformational Leadership Award.

Awan said he institutionalized a framework that called for simultaneously strengthening their IT foundation, advancing the culture and innovating, always keeping in mind Navicent Health’s business needs. IT staff embedded themselves within other groups to better understand their programs and get more involved in problem solving and decision making. This process changed mindsets within the IT department and throughout the organization.

“IT has broken out of the shell of technology,” Awan said. “It is all over the place. It is in business; it is in the clinical areas. All of my IT managers and directors rewrote their job descriptions. They are not just managers and directors, they are solution partners. It was incumbent on them to know as much about their respective clinical and business areas.”

One of the organization’s specific IT-related successes has been the rollout of a real-time care coordination platform that serves as a one-stop shop for surgical staff and patients. The program, utilized for OrCarestra, Navicent Health’s surgical patients, has eliminated the use of faxes, phone calls and hand-written requests and added standardized processes. OrCarestra has shortened scheduling times, decreased scheduling errors, sped up financial clearances and allowed them to complete more cases faster, according to CHIME officials.

Also this morning at the Fall CIO Forum, CHIME presented Simon Lin, chief research information officer at Nationwide Children’s Hospital in Columbus, Ohio, with its Innovator of the Year Award, citing Lin’s innovative approach to help pediatric burn victims through their recovery.

The Ohio patient care organization collaborated with the Center for Pediatric Trauma Research and the Pediatric Burn Unit at Nationwide Children’s to develop and pilot test a virtual reality app that immerses young patients in a game while clinicians remove and replace dressings. Preliminary results showed a dramatic reduction in reported pain scores compared to controls—a reduction achieved without altering pain medication.

Burn patients already are in distress from the pain that can occur during dressing changes, Lin said. Watching the process may intensify children’s trauma. The game, which requires patients to wear a headset, distracts them while the headset shields their view of the clinical activities going on around them. Patients can passively watch the game or they can actively engage in it using breathing controls that substitute for hand consoles.

The app itself has been well received, based on study results: 96 percent of patients reported satisfaction with the game; 100 percent of parents were satisfied; and 83 percent of physicians reported that virtual reality is helpful. Lin and his group are now conducting a larger study that stratifies children into three groups: active participants, passive watchers and a control group that will receive standard care. The long-term goal is to be able to reduce or eliminate the use of pain medications such as opioids in this patient population by using innovation.

“Simon’s virtual reality app is a perfect example of patient-centered care,” said CHIME Board Chair Cletis Earle, senior vice president and CIO at Kaleida Health. “They developed a tool that children will respond to–a game– and worked with clinicians to make sure it fits within their work flow. The result is a better experience for the patient with no added burden for clinicians. This is a win for everybody.”



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