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University of California Health System CIOs Collaborate for Change

June 19, 2017
by Mark Hagland
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Six CIOs connected to the University of California have been producing strong results through broad strategic collaboration

Exciting things are happening these days in California healthcare, particularly in the integrated health systems connected to major University of California organizations—the University of California, San Francisco (UCSF), the University of California, Davis (UCD), the University of California, Los Angeles (UCLA), the University of California, Irvine (UCI), and the University of California, San Diego (UCSD).

As part of a broader initiative around strategic planning and strategic coordination among the CEOs and other senior executives at the University of California campuses, the CIOs of the five health systems connected to University of California organizations, have quietly been working together for nearly three years now, to harmonize health IT strategies, drive forward strategic organizational initiatives, and find operational savings where possible, across all five health systems, as they collaborate for the common good.

Recently, six CIOs involved in the initiative sat down for a videoconference interview with Healthcare Informatics Editor-in-Chief Mark Hagland. The six are: Tom Andriola, CIO of the University of California Office of the President, the group’s facilitator; Joe Bengfort, CIO at UCSF Health; Christopher Longhurst, M.D., CIO at UC San Diego Health; Mike Pfeffer, M.D., CIO at UCLA Health; Chuck Podesta, CIO at UC Irvine Health; and Will Showalter, CIO at UC Davis Health. The six healthcare IT leaders have been collaborating on a broad range of areas of effort, including sharing data centers, extending their instances of their common electronic health record solution (from the Verona, Wis.-based Epic Systems Corporation), and working to pool clinical data in a single warehouse, among others. Below are excerpts from the recent group interview.

Who would like to summarize some of the key elements of this important initiative?

Tom Andriola: in response to the challenges in the healthcare industry, we’ve created a coalition allowing five of us and myself to come together, to look at things both at a local level and an enterprise-wide level. We just had a very engaged discussion around data-driven use of analytics for strategy to help us compete at the local level and also at the enterprise level.

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Was there a formal mechanism to begin to bring this together?

Andriola: It was our executive leadership that saw there was a lot of benefit to come together to deal with changes in the marketplace, and they launched the program in which we as CIOs could come together.

And what has the timeline been? When might you be able to say this began?

Andriola: We kicked this off in 2014.

Chuck Podesta: My second day here, I attended the first meeting around leveraging value.

Joe Bengfort: So we’re in our third year. Chuck was a new member when he started at UC-Irvine in 2014, Chris was new when he started at UCSD in the fall of 2015, and Will just came in, in the last four months. So we’ve had about 50-60 percent turnover of CIOs since then.

What can you do together, broadly speaking?

Bengfort: Very early on, we mapped opportunities on a two-by-two grid. What are the things that CIOs can do, versus major operational challenges? We mapped our opportunities against that, and said, let’s start on things in the easier, more-in-our-control category. So we started with major spend, and contract development, and consolidation of data centers. We can do that without changing things like formularies or clinical workflow. That’s where we started; now we’re doing things around clinical decision support and the VNA [vendor-neutral archive].

Chris Longhurst, can you share a few thoughts based on your experiences as a clinician leader and former CMIO?

Christopher Longhurst, M.D.: I just joined 18 months ago, and this is my first CIO role. Another tremendous value-add of this group is just sharing best practices. There are five health systems here, and most of these folks bring years of experience, so for me as a first-time CIO, that’s tremendously beneficial. We’re meeting face-to-face on a monthly basis. We’re meeting in Los Angeles right now. And that proximity and closeness generates opportunities. And that floats down; our CTOs are meeting today. Dr. Pfeffer sponsors our CMIO group,. I’m sponsoring our analytics team. So the best practices benefits are great. CISOs as well.

Bengfort: Also being able to trust each other. That’s probably the number-one thing here.

Dr. Pfeffer, could you also speak to your  perspective on this with regard to your background as a former CMIO?

Mike Pfeffer, M.D.: Joe and Chris really said it well. And this kind of comes from teaching medical students and residents the importance of role-modeling. We all trust each other and hold each other in high regard. That role-modeling has really trickled down to all the people who work with us on our teams. As Chris has said, the CTOs are successfully meeting. You can’t force people to work together.

Bringing down the collective spend by working together, in other words?

Podesta: Initially, as Joe mentioned, some of the low-hanging fruit. We were able, from a hardware perspective to stratify things from highest to lowest, and we knew storage was a huge cost for us, so we got our CTOs together and our procurement people together, because we all had different contracts, for example with Cisco and IBM and HP, and we were able to move from five contracts to a single contract, and shifting the timing.

And that means working together to develop single contracts whenever possible, correct?

Podesta: Yes. We started right away in 2014, picking off some of our bigger-spend items, and continually go down the list, to see where we can make a difference.

Could you give some kind of metric on the savings?

Bengfort: We do have system-wide contracts. Because of the nature of state-sponsored organizations, those contracts sometimes aren’t the best. But we were able to take another 13 percent off from some of our vendor contracts. So it’s millions of dollars of contracts. And the savings were material to every heath system, not just the high level.

You’re also moving forward on VNA [vendor-neutral archive] development, correct?

Pfeffer: the VNA project is a great example of a pilot where we could try things out at one or two organizations first. The VNA has been a really amazing project; it’s been very collaborative across the sites, and has significant potential.

What has it involved, and can you give me a sense of the timeframe around that project?

Bengfort: We’re nearly a year and a half into that. And when you’re making a decision across five health systems, it takes a little bit of time. You’ve got to get people together and agree to certain parameters, and the implementation takes a little bit longer. But we’ve initiated an RFP, have awarded a contract, and will go live sometime in early 2018.

Did everyone already have a VNA within their individual organizations?

Podesta: At Irvine and San Diego, we had some semblance of it. But the other thing that’s important here is that we had to bring five radiology chairs and their teams together to collaborate on this.

Bengfort: We’ve had to think about areas where collaboration was more or less possible. Radiology was a good one.

Longhurst: And in terms of spend, there are shared data centers now. The two northern systems in one data center together, and the three southern systems in another. We’re also enabling strategic initiatives. And you’ve spoken with Chuck about leveraging their Epic instance. And beyond the cost avoidance, there’s the benefit of collaborating around pop health, and we’re all working towards a single data warehouse for the entire system.

Could you all speak to the challenges and opportunities for CIOs to show leadership, in settings like this one?

Podesta: For me, it’s balancing the local and system priorities, sometimes they’re not aligned.

Andriola: Having been here since the beginning, this group embodies what some have called the genius of the “and.” And having leadership capabilities to balance those things. Collins (Jim?) said that. And also understanding that, maybe this is not where my organization is going. So maybe we’ll let two of our systems come together on a particular initiative or not. That balance of the genius of the “and” is key.

Bengfort: And in Lean methodology, there’s also a saying that’s used: respect the past. We’re not going to force everybody to cut over to a new thingamabob. We have timelines we’re working on, but respect differences.

Pfeffer: Having a common purpose is also important. We’re all at academic medical centers, and we know that every dollar spent on IT potentially takes dollars away from patient care, education, and research—that’s a driving force for us.

How does that iteration of bringing things back to your respective organizations, for affirmation and consensus, work?

Longhurst: The fact that we’re creating a single data warehouse that will aggregate multiple visualizations, including claims data, employee location, etc., should help us to innovate in ways we couldn’t otherwise, and reduce duplicative initiatives.

Pfeffer: Yes, and cultural change is a big part of this. It’s now part of how we do business. The teams wouldn’t think about going out and buying a vendor solution without talking about it together first. And that takes time, but that’s been part of the success.

Joe: And we’ve seen great examples where our teams have been bringing things to us. So we’re having to prioritize all those opportunities.

Will Showalter: And it’s very collaborative among all the teams, and that’s very important.

Podesta: And our CIOs, for example, are collaborating on the NIST cybersecurity standards. So we’re actually lessening the risk across the UCs, in a coordinated fashion, that’s huge; you couldn’t put a dollar figure on that.

Chris: For the readers, takeaway, this is an example of five separate systems with five CIOs and five separate balance sheets, who have found a way to work together collaboratively for the benefit of all.

In the next year or two, could you name two or three things that you expect will be accomplished?

Longhurst: We have a single data warehouse now that’s aggregated some of the data from each site, and we’re using that to begin strategically evaluating our position in the marketplace. So certainly analytics is a huge opportunity in the next 12 months. And Chuck’s site goes live on a shared EMR instance, so we will all be using a single vendor platform.

Bengfort: And also, converging on the computing and storage side of things, there’s a lot of opportunity to converge platforms and that might be within our two-data-center strategy. Both on a purchasing and technology platform point of view. And some of that we may do in the cloud, and in terms of the VNA, we’re piloting some of that now. Also, affiliations and hosting of affiliates on our medical records, that’s very complex from a contractual standpoint, with lots of compliance work.

Could organizations not under a combined governance umbrella work together in this way?

Longhurst: We’re not a true system with a single P&L [profit-and-loss ledger], so this is like a “Star Alliance” kind of arrangement; each organization is still competing in its own local market. So I would say that this is a replicable strategy. But part of what’s been driving this is that our CEOs have been collaborating together, and you really need that to move forward.

Andriola: Yes, I agree. When you’re down at the deeper levels of infrastructure, looking a storage, we’re all looking to go to the cloud. And in those areas, even if you don’t have a legal entity partnership, you could still do things at scale. Things like VNA and EHR are going to be hard, because you have to align clinical processes; but at this technology infrastructure, I think are easy opportunities.

Is there anything anyone would like to add?

Longhurst: I just want to go on record as being humbled to work with this group, and by sharing best practices, and work together. The opportunity is unique. To me, it’s a special time at the University of California, and a pivotal moment.

Bengfort: We’re all overwhelmed with increasing demands and needs, but together, it’s like we coming together bringing special strengths.

Longhurst: It’s true, it’s like everyone at the table brings a special super-hero power.

Podesta: We also actually genuinely like each other, that helps a lot.

Bengfort: And you’ve got to be willing to talk the tough stuff, and we’ve been doing that.

Podesta: Chris calls it “being willing to throw fish on the table.”

Bengfort: If people aren’t willing to talk frankly with each other, you start to lose trust. So we just call each other out, in a respectful way. You’ve got to have that truth-telling, and that respect—and then it all works.

 


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The Modern Healthcare CIO, CMO, and CTO

December 10, 2018
by Lori Williams, Industry Voice, vice president of fulfillment, Gigster
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Disruption in the healthcare space comes primarily from the expansion of data’s role in the industry, and the healthcare C-suite’s familiarity with that expansion will help drive company and industry success

For the healthcare C-suite executive, the industry has never been more complex—nor has it ever contained so much potential. Emerging technologies mixed with political uncertainty has created an environment where incredible amounts of healthcare data are revolutionizing how patient care is handled, but patients remain uncertain about the future of their own health. With better data and the means to draw insights from it, healthcare CIOs, CMOs and CTOs are in a position to help address patients’ uncertainties and make hospitals and clinics more accessible and effective than ever before.

Here’s a look at how the role of the modern healthcare CIO, CMO and CTO is changing:

The Modern Healthcare CIO
The modern healthcare CIO’s role has evolved to become more innovative. No longer a title reserved strictly for engineers and IT professionals, today’s healthcare CIOs are focused on information science instead of simply setting up network infrastructure or providing back-end support. The trend towards a more data-centric role began as hospitals rolled out electronic health records, equipping individuals with better access to healthcare provider data. Through enterprise data warehousing, CIOs are becoming masters of data management, governance and predictive analytics, and passing along the many benefits of those knowledge bases to patients.

The Modern Healthcare CMO
The confusing healthcare landscape makes the role of a healthcare CMO more necessary than ever before. Thanks to ongoing regulatory changes, uncertainty surrounding the Affordable Care Act, and shifting consumer expectations for on-demand services, healthcare CMOs are responsible for helping patients navigate their way through a complex and opaque industry. As patients continue to assume the role of consumers, carrying out comparison shopping as they would for any other industry, CMOs must be adept in crafting a healthcare provider’s brand and messaging.

At the same time, CMOs must also ensure that healthcare providers offer a modern online experience, ensuring websites are mobile-optimized and social media accounts are generating engagement. This also means CMOs need to help move marketing efforts into the 21st century, transitioning away from direct mail or billboards towards digital marketing and CRM tools. Because if they don’t, there are plenty of med tech startups that will promptly eat into their market share.

The Modern Healthcare CTO
Unlike healthcare CTOs of the past who remained siloed off from the rest of the organization, today’s modern healthcare CTO is fully engaged with healthcare providers and their technology stacks, utilizing new software and hardware to improve daily workflows. The CTO is enabling the transition to patient-oriented self-service operations, enabling patients to carry out administrative tasks like scheduling appointments or refilling prescriptions over the internet. Because medical data is often stored in a variety of different sources, it’s critical for the CTO to be able to keep these systems interoperable with one another. For hospitals riddled with legacy software, CTOs should expect to continue employing middleware solutions to bridge the gap between old and new.

Members of the healthcare industry C-suite have the power to transform lives, and the CIO, CMO and CTO have roles that directly affect a provider’s ability to carry out positive change. With better data from the CTO’s tech stack, the CIO can use better analytics to help providers determine the best solutions for their patients, marketed to consumers by the CMO through modern platforms in clear, easy-to-understand language.

Lori Williams currently serves as Gigster’s vice president of fulfillment. Prior to joining Gigster, Lori was the general manager for Appririo.


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What Does Your Magnum Opus Look Like? A Few Operatic Thoughts

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I was given the privilege and pleasure recently of presenting, for the second year in a row, a lecture on Richard Wagner’s “Ring” cycle, as the leading opera company in my city, a world-class opera house, has been putting on, in yearly succession, the four operas of the “Ring of the Nibelung” cycle by German composer Richard Wagner (1813-1883). Last year, the second opera in the tetratology, “Die Walküre,” was performed; this year, the third opera, “Siegfried.” After the concluding opera, “Götterdämmerung,” is performed, the entire cycle will be presented in festival format, always a major cultural event. I spoke on “Siegfried.”

I’ve been fortunate to have seen six complete “Ring” cycles in live opera houses in different cities, and I can tell you, it’s a life-changing experience, as this four-opera work (16 hours of music altogether), sits at the absolute summit of western art. Richard Wagner was a hideous human being himself, but spent numerous years working on something that changed the course of classical music and redefined opera.

What’s more, from the summer of 1848, when Wagner wrote a first sketch of the libretti, or texts, of the operas, until their true compositional completion in 1871, more than 23 years were to pass; and it would be another five years before the tetralogy was fully presented, in a purpose-built new opera house in the Bavarian town of Bayreuth. It was a herculean feat to create the entire text of these four long operas, and compose 16 hours of music that would completely redefine the concept of opera. Indeed, when the crowned heads of Europe, the great living composers, and the 19th-century European intelligentsia and glitterati, gathered at the new Festspielhaus in Bayreuth in 1876, many were so overwhelmed by what they saw and heard, that they were rendered speechless. Even now, 142 years later, first time Ring-goers are overwhelmed by the breadth and sweep, the musical and dramatic audacity, and uniqueness of the “Ring” operas, with their story of gods, giants, dwarves, flying Valkyries, Rhinemaidens, one huge dragon, humans, gold mined from a river, magic swords and spears, and of course, a gold ring whose possessor can control the world and its fate.

Even just looking at the third opera, “Siegfried,” Wagner struggled mightily. For one thing, being essentially a grifter and a cad, Wagner borrowed/took money from everyone who would lend/give it, and often had affairs with the wives of the patrons bankrolling his compositional work, leaving his life in constant chaos, as he fled from one city to the next. One such wife, Mathilde Wesendonck, inspired the opera “Tristan und Isolde,” groundbreaking operas that Wagner wrote during a 12-year hiatus in his composition of “Siegfried.” And “Tristan” itself changed the entirety of classical music, its tonality-challenging chromaticism.

Well, no one is expecting anyone to match the unique creativity of Wagner’s “Ring” cycle. But the leaders of U.S. patient care organizations are doing a lot of important things these days, including using formal continuous improvement methodologies to rework core patient care delivery processes in order to transition into value-based healthcare. What’s more, as our Special Report on Leadership outlines, the entire role of the CIO is being rethought now, as the demands for leadership and strategic capabilities are catapulting that role forward; and patient care organizations are beginning to make real headway in advancing equality for women and people of color among the ranks of healthcare IT leaders and managers.

So while no one is expecting anyone to create an operatic tetralogy that will change the face of music, there are plenty of heroic endeavors open to anyone willing to envision the healthcare system of the future. The opportunities are as limitless as the imagination.

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Using Performance Management to Scale

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Performance management is so much more than just a year-end performance review
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Performance management and goal setting have always been part of my DNA. It’s like a compass that tells us we are steering the ship in the right direction or gives us a chance to course correct if we wander off track. It’s hard for any organization to determine how they are doing unless there are clear measurable objectives. CIOs and their leaders need monthly, quarterly and annual goals to measure how you and your team are doing against the plan. I also firmly believe they should be S.M.A.R.T. goals: Specific, Measurable, Achievable, Relevant and Time-based.

Once the goals have been established, you need a written plan. I like three-year rolling plans so you can look into the future and describe your vision of what your organization will look like 36 months out. Then you can work back to the second year, and eventually the first year, to give you the framework for what you need to accomplish in the next 12 months. I suggest you do it with your managers. It makes them accountable to the organization since they are involved in the formation of the plan.

Your plan must be a living document to be used frequently during team meetings throughout the year to see how you are performing as a team and individually. This is not a process you invest in to review at year-end to see how you performed. By then it’s too late. It must be reviewed on a consistent basis to make sure everyone is on track. Performance management is so much more than just a year-end performance review. If there are individuals who are not performing against the plan, you can use the plan as a tool to performance manage them to re-engage as an important member of the team. 

I just returned from the Scale-up Conference in Denver and learned so much about taking goal setting and performance management to a whole new level by adopting the "Rockefeller Habits," as written by Verne Harnish. After reading the book, everything changed for me in the way we will be doing our planning, goal setting and performance management forever. It’s so brilliant and easy to understand. Here they are:

Rockefeller Habit #1: The executive team is healthy and aligned

Rockefeller Habit #2: Everyone is aligned with the #1 thing that needs to be accomplished this quarter to move the organization forward

Rockefeller Habit #3: Communication rhythm is established and information moves through the organization accurately and quickly

Rockefeller Habit #4: Every facet of the organization has a person assigned with accountability for ensuring goals are met

Rockefeller Habit #5: Ongoing employee input is collected to identify obstacles and opportunities

Rockefeller Habit #6: Reporting and analysis of customer feedback data is as frequent and accurate as financial data

Rockefeller Habit #7: Core values and purpose are “alive” in the organization

Rockefeller Habit #8: Employees can articulate the key components of the company’s strategy accurately

Rockefeller Habit #9: All employees can answer quantitatively whether they had a good day or week

Rockefeller Habit #10: The company’s plans and performance are visible to everyone

Accountability is no longer hard to measure since the entire plan is visible to everyone throughout the organization. Each part of your team should have key people accountable for every functional part of your organization. No more guessing is required. I’ve read countless books about leadership, performance management and goal setting, as I’ve been an avid student on the subject for decades.

These ten habits, once adopted and measured regularly, can change any organization that wants to grow and scale, and keep everyone accountable along the way.

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