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Unpacking the Gains in HCA Healthcare’s HIT Governance Evolution

July 2, 2018
by Mark Hagland
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HCA Healthcare executives shared with HIT Summit attendees learnings from the evolution of their HIT governance process

On Friday, June 29, during the Health IT Summit in Nashville, sponsored by Healthcare Informatics, two executives from the Nashville-based HCA Healthcare shared their learnings and perspectives around their organization’s streamlined project governance model.

Speaking at the Sheraton Hotel Nashville Downtown, Karen Thompson, associate vice president, strategy and innovation, and Dr. Edmund Jackson, vice president and chief data scientist, both based in the organization’s Nashville headquarters, told Summit attendees about the complex but successful path forward through healthcare IT project prioritization that they and their colleagues at HCA are pursuing these days, as the demands on everyone’s time and resources accelerate in the current healthcare operating environment, in a dual presentation entitled “Govern Not Squash: The Road to Building a Flexible Clinical IT Governance Model.”

To begin with, Thompson and Jackson referenced the fact that HCA Healthcare is a huge organization, one that encompasses 179 hospitals, 1,800 total sites of care, 240,000 employees, 37,000 active physicians, 80,000 nurses, and 27.1 million patient encounters every year, across 20 states.

That alone has made for a complex, challenging journey. “Many people, when they think of governance, think, ‘hall monitor,’” Thompson said. “But that’s not what this is about. In this space, we’re always talking about innovation; we want to go faster. Governance is not something that helps you do that.” But what it does do, she said, is to help everyone in the organization get on the same page. What’s more, she said, “No, we don’t have it all worked out; it’s an ongoing journey.”

Meanwhile, Jackson said, “The data science” that supports innovation in patient care organizations “moves quickly, fails frequently, and is expected to fail. So the challenge Karen and I took on was, how do we get an agile space built into the business structure?”


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As a result, Thompson, Jackson, and their colleagues came up with a three-phase conceptual solution. From 2008-2011, the focus was on standardizing and scaling the project prioritization and authorization process. From 2011-2012, the focus was on “exploring and innovating.” And, since early 2017, the focus has been on accelerating and on measuring innovation and progress.

“I’ve been at HCA a little over 12 years, the formal governance process has been in place about 15 years, and it has ebbed and failed,” Thompson said. “At first, it was like a franchise model, everyone was doing their own thing. We had to create a standardized foundation,” he reported.

Karen Thompson (r.) and Dr. Edmund Jackson (l.), during their presentation on Friday in Nashville

And, Thompson added, “Edmund and his colleagues came up with great idea, and they said, hey, we’re going to save babies’ lives. How can you say no to a baby?? But what challenged everyone was, OK, what was the priority? What if you have 15 ideas and they’re all about safety and quality? And beyond the clinical, there are other aspects of our business that we also have to pay attention to—things like registration. And things like providing physicians and nurses with the technology they need to do their jobs.” Looking at what faced them, she said, “Since we’ve been able to prioritize more, it’s been, what about quality, speed, and efficiency? How can we get faster and better, but also do it cheaper? Can we do something in 18-24 months? So you’ve got this great idea to integrate a sepsis tool. Well, we’ve got 179 hospitals. But we’ve got this great idea. OK, so pilot it. You want me to go slower? No, pilot it.”

And in that regard, Thompson noted, “We have a gate review committee. It’s like ‘Shark Tank’ with 20 of your closest colleagues! We need to be sure that we’re acting as good stewards with your money. Because sure, you’ve got a great idea. But there are 20 other colleagues who’ve got great ideas, too. So our gate review committee makes sure we prioritize our projects appropriately, and pace them correctly. And people will say as a result of going through this, they end up with a better project. And you can’t keep going to the same markets to test things,” so pilots are launched in a variety of different facilities and local healthcare markets. And, she notes, “Testing is great for us.”

Of course, Jackson said, “That was kind of a hard lesson for the innovative side to take on. Because we operate in silos, though I hate that word. And I might want to take on some kind of innovation project, and I can’t understand why Karen says she’s not ready for my project; but then I find out that there are 20 other projects like mine, and she knows that, and I don’t. and that took me a while for me to onboard and fully understand.”

Indeed, Thompson said, “We are shifting from an annual prioritization process, involving clinical, hospital operations, IT, etc.; and we have x millions of dollars to fund projects this year, and so we look at such elements as breadth, impact, and time and intensity of projects, and then we draw a line after a certain amount. But are we leaving anything on the table that it’s a priority for our company? And so now we’re doing what we call our ‘Evergreen’ prioritization process. You prioritize and integrate across strategies as opposed to just business areas. So we’re trying to look across strategies and not just business areas.”

Thompson said, as a humorous note, “So, someone will show the ‘baby’ slide” in a presentation proposing a project, “and we’ll say, hey, we’ve got three projects saving babies already. And we need to have a bit of a sense of humor around this, too. But it’s about balance and composition. So this is why we have this evergreen portfolio process. But sometimes, someone happens to pass Sam, our COO, in the hallway. And the hallway hit-up is real.”

“Karen’s being humorous, but the issues are real,” Jackson said. “And you have to stick to process. The move to the Evergreen Process was real. And yes, most projects are 18-24 months in terms of their timeframe. They had been of various lengths, with some only three months long.” But innumerable short-term projects had become impossible to govern, he said. “So Karen and I and the CEOs and COOs got together and asked ourselves, how do we work this out? And the Evergreen Process emerged. For many years, we had lived on a yearly funding process, and it wasn’t working.”

What’s more, Thompson said, “The time and amount of energy it would have taken,” would have been overwhelming, had the Evergreen Process not been developed. “We couldn’t give units their own pools of money. So we would test ideas within individual areas. That’s how Edmund and I worked this out. We said, yes, you do need to go faster. And it’s more about an iterative build.” As a result, she said, it’s worked out well to work with the innovation team on specific pilots and tests, while maintaining an overall governance structure.

In that regard, Jackson noted, he and Thompson and others created a Lean Oversight Committee, which meets quarterly for 60 minutes, and includes group presidents, CFOs, and senior vice-presidents across the nationwide organization. “It’s a group of people who understand the full scope of the company’s strategies and work,” he explained. “We review potential projects. And we do a forced ranking. We don’t promise we’ll fund the projects, but we do force-rank them. And designing that process took a little bit of time. We actually had to get some friends to support us.” That approach is working well, he reported. “HCA is big and doesn’t move particularly quickly. So one of the keys to success in this was gathering people and aligning support.”

“What I love about what Edmund’s done is the fact that it’s about educating people and letting them know what’s going on; and not everybody needs to know what’s going on all the time,” Thompson said. “So the composition of that committee was important. We wanted some people from the strategic planning committee. But we also wanted the naysayers, because otherwise they’ll throw rocks from the side. And so the more closely you collaborate with people and build trust over the years. Those are the conversations you want to have. What’s going well and what’s not, and why not? And the lessons we’ve learned here, we’re going to apply to the rest of the portfolio. And we’re going to manage ourselves. And the honesty of those conversations really begets trust among people. When you’re honest about what doesn’t work, you beget trust.” “And Karen’s point about getting the naysayers on the committee is exactly right,” Jackson added, “because those people will buy into the process.”




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Why A.I. Will Never Replace Recruiters

September 12, 2018
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AI can be a great tool, but recruiters aren’t going away

I remember fear settling in like a big dark cloud when I opened my search practice in 2005 with all the dire predictions of how the Internet and all the online hiring websites were going to put recruiters out of business. Many articles were written on the demise of the recruiter as Monster.com would literally scare us out of business.

Then came other job opening aggregators like Indeed.com, ZipRecruiter and a whole host of other websites chasing HR gold as if there was a switch they could simply flip to eliminate the human touch that recruiters bring to the table with engaging candidates, only to be replaced by a text message alert or an email notification of all the new jobs that were now open. The only thing they were missing were qualified applicants.

These predictions never came true and all the prognosticators simply forgot what recruiters actually do every day that their technologies will never replace. CIOs need to remember the critical nature of hiring leaders and team members for key roles in their organization. Candidates need to be vetted and coached to listen to an opportunity to join your team when we call the candidates. You have to remember:

  • We talk with people. Yes, we use a cell phone, or now a VOIP phone, and actually engage in a dialogue with candidates about opportunities. It’s a novel approach—I get it.
  • We engage with people that will never look on those job posting sites because they are not looking for a new job. Period.
  • We contact passive candidates that up until our call were never going to leave their job because they are so focused on the now that they don’t even think about looking on a website for a job they are not even interested in.
  • We help clients and candidates come together on the right offer and provide two-way communication during the hiring process, so each party has a deep understanding of the other party’s point of view. Online sites—well you get the picture…
  • We hammer out the details of relocation packages with our clients and the candidates and their families to make sure the move is done smoothly to allow the family to begin their transition to a new city. It’s the personal touch that matters here because we are dealing with people’s lives.

Fast forward: The next wave of artificial intelligence (AI) products for hiring are cropping up everywhere and we are hearing similar calls for recruiters to give up and retreat as the latest algorithm and data analytics tools are able to speed up the hiring process supplanting recruiters. Within seconds, these tools are touting they can determine who the perfect candidates are based on the analytics and machine learning tools designed for hiring. Guess what? It won’t happen.

AI can be a great tool, but it falls dreadfully short of meeting hiring managers' expectations. It won’t wave a magic wand suddenly making hiring enjoyable and much quicker with the same quality as the work performed by most search firms. I’ve been in technology in some form or fashion for a very long time. I love technology and what technology can do to speed up productivity and actionable data I can use every day in the work we do. It’s awesome!

But to be clear, I’m not going away. I have seen this movie before and I am fairly certain I can tell you how it ends. The work recruiters do to find and recruit great talent is something humans must do.

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Cerner President Zane Burke to Step Down This Fall

September 10, 2018
by Heather Landi, Associate Editor
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Cerner president Zane Burke, who first joined the company in 1996, will step down November2, the Kansas City, Mo-based electronic health record (EHR) company announced today.

“Cerner has been a disruptive force of positive change across health care throughout its history, and I’m pleased with the accomplishments we’ve achieved together with our clients and the broader industry community,” Burke said in a statement. “Complex and evolving challenges remain, and Cerner is uniquely positioned to continue innovating for the good of consumers and health care providers.”

 “We thank Zane for his contributions to Cerner across more than two decades,” Cerner Chairman and CEO Brent Shafer said in a statement. “Zane leaves the company with a strong client focus and commitment to continued innovation, partnership and sustainable growth deeply engrained in our culture and leadership philosophy. I am very confident in the capabilities of Cerner’s strong and experienced leadership team.”

John Peterzalek, executive vice president of worldwide client relationships, will assume Burke’s responsibilities and the title of Chief Client Officer.

Since joining Cerner in 1996, Burke had a range of executive positions across sales, implementation, support and finance. He was named President in 2013 after leading Cerner’s client organization. Burke came to Cerner in 1996 from the consultant KPMG, and has held a number of positions in the company, including president of Cerner west from 2003 to 2011, and, more recently, executive vice president of Cerner's client organization.

During his five years as president, Burke has been involved in a number of significant deals, including playing an instrumental role in Cerner winning two massive EHR modernization contracts, first with the U.S. Department of Defense (DoD) in 2015, a $4.3 billion contract, and then just this past May, with the U.S. Department of Veterans Affairs (VA) in a $10 billion contract.

During Burke’s tenure, Cerner also completed one of the biggest deals in healthcare IT history with the acquisition of Siemens healthcare IT business for $1.3 billion in 2014.

The Kansas City Business Journal reported on September 4 that Burke had exercised option to sell nearly $10 million in stock.


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Leadership Changes at HHS as CIO Transferred to New Role

August 21, 2018
by Heather Landi, Associate Editor
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Beth Killoran is stepping out of the role of CIO at the U.S. Department of Health and Human Services (HHS) and is moving over to a new role at the Office of the Surgeon General, within HHS.

The news was first reported by Federal News Radio. In an email, a HHS official confirmed that Killoran, who stepped up to the HHS CIO role in July 2016, has joined the Office of the Surgeon General at HHS to develop a "comprehensive information systems strategic plan for the U.S. Public Health Service Commissioned Corps.”

The HHS official also confirmed that Ed Simcox, the HHS Chief Technology Officer, will take on the added role of serving as the HHS Acting CIO, until a permanent selection is made. “Simcox has led multiple, large IT transformation efforts, both as an industry executive and consultant. As HHS’s CTO, he leads HHS’s efforts on enterprise data management, data sharing, technology-related healthcare innovation, and public-private partnerships,” the official said via email.

Simcox started as the HHS CTO in July after serving as acting CTO starting in May and deputy CTO since July 2017, according to Federal News Radio.

Killoran began working at HHS in October 2014, moving over from the Department of Homeland Security. At HHS, she has served as the acting Deputy Chief Information Officer and as the Executive Director for the Office of IT Strategy, Policy and Governance. The HHS official stated that Killoran has served in a number of high-level information technology positions at HHS, “providing leadership on a number of high priority projects.” Killoran also worked for the Department of the Treasury, where she provided IT infrastructure support and operations for over 20,000 employees across 1,500 locations.  During her tenure, she provided IT operational support in response to the 9/11 and Oklahoma City bombing events, the HHS official said.

Federal News Radio reporter Jason Miller reported that, during her time as HHS CIO, Killoran tried to move the agency forward in a number of areas through an updated strategic plan and a more aggressive approach to cloud adoption. “Recently, Killoran led a reorganization of the CIO’s office, naming Todd Simpson as the first chief product officer and promoting innovation,” Miller wrote.

Killoran becomes the fourth major agency CIO to be reassigned during the Trump administration, joining former Treasury Department CIO Sonny Bhagowalia, former Agriculture Department CIO Jonathan Alboum and FEMA CIO Adrian Gardner, according to Federal News Radio’s reporting.

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