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Have You Written Your Health System’s Constitution?

April 13, 2017
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Sound IT governance requires the federalist approach to centralized vs. local authority, says Advisory Board’s Ernie Hood
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Are there parallels between the development of your health system’s IT governance structure and how the Founding Fathers compromised to create the U.S. Constitution? According to Ernie Hood, senior research director for the Advisory Board Co., there should be.

Hood, former vice president and CIO at Group Health Cooperative in Seattle, gave a recent online presentation about creating true “systemness” in this era of health system consolidation.

First, he noted that despite all the consolidation that is taking place, it has rarely led to greater efficiencies or lower costs for patients.

Part of the reason, he argued, is that many merged organizations haven’t done the hard work to really become one entity with everyone pulling in the same direction. But changes in the marketplace, including the shift to accountable care organizations, are making it more necessary to have higher levels of competency in integration. That often involves making hard choices, Hood said. “People have to commit to disruptive change, but that change may be hard on them as individuals.”

What can go wrong during healthcare mergers? Local executives tend to remain focused on maximizing the performance of often-competing “fiefdoms.” Physicians can remain locked in cultures of individualism and tribalism despite stronger contractual alignment. And front-line staff members can be unaware of or disengaged from system priorities.

Information technology can hamper or aid efforts to create a single system. Merged organizations can have a hodge-podge of siloed applications that don’t talk to each other. Data used for quality metrics aren’t “apples to apples,” so you fail to get clinician buy-in. Hood noted that access to consistent applications across all modalities of care is important, and IT governance rules are key.

Hood spoke about some rules for “writing the constitution” for your health system, in terms of centralized vs. local control. “You can’t centralize all decision making,” he said, so like the Founding Fathers you have to find the health IT equivalent of a “federalist” balance between the states and the federal government. “Getting the balance right can be tricky.”

From his research, Hood says, organizations tend to cede too much authority to the local level. Potential drawbacks include unjustified variation and conflicting efforts. In those cases, organizations can end up with the “tail wagging the dog.”

But in the opposite case, centralizing every power merely exchanges strategic failures for operational ones, Hood said. If you fail to distribute authority over resources, you risk disempowering people. People may feel run over as local needs are underemphasized, he said. You reduce staff engagement and lose local perspective.

In defining roles, IT governance at the system level should emphasize planning but should delegate implementation to the local level, he said. This may involve limiting governance to guidelines that can be localized and limiting rules to a minimum set of guardrails. “A rule of thumb is that planning should be elevated to the system level and implementation should be delegated to the local level,” Hood said.

And just as the Founding Fathers sought a more engaged citizenry, you want to get employees to think like system citizens, Hood said. You need to make special efforts to engage front line staff and be as transparent as possible about why decisions are being made. “The more you share, the more engaged they are going to be at the local level,” Hood said. “Governance should provide a means for the local level to review and coordinate changes that impact them.”

Because Hood had served as CIO for Group Health Cooperative (GHC) in Seattle, I immediately thought of its recent merger with Kaiser Permanente. I asked Hood if a merger like that between two large organizations with sophisticated IT infrastructures was easier or more difficult than one in which a large fish swallows a much smaller one.

Mergers are much easier when one organization simply swallows the other because there is a working system that’s being adopted rather than something new being created, he told me in an e-mail exchange.

“In the case of GHC and Kaiser, the situation is a bit unusual in that their path is eased by familiarity. The two organizations have been close for decades, have no overlapping territory, have often shared intellectual property and they use many of the same IT systems (both are on Epic for example),” Hood said.

The two organizations know each other pretty well, he added, and there are even a lot of cultural similarities that should help compensate for the complexity. “Their changes may go a lot smoother than one would typically expect for two similar organizations trying to merge.”

IT governance is not a project with a start and end date, but an ongoing challenge. And in an era of mergers and acquisitions, it is one of the health system CIOs greatest areas of focus. How many are getting it right? How many are in need of constitutional amendments?

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Rasu Shrestha Leaving UPMC to Join Atrium Health as Chief Strategy Officer

December 18, 2018
by Heather Landi, Associate Editor
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Industry thought leader Rasu Shrestha, M.D., formerly Chief Innovation Officer at the vast 40-hospital University of Pittsburgh Medical Center (UPMC), is leaving Pittsburgh to join Charlotte, North Carolina-based Atrium Health has the new executive vice president and chief strategy officer.

For the past 11 years, Shrestha has held various roles at UPMC, including, most recently, executive vice president and chief innovation officer, responsible for driving UPMC’s innovation strategy. In addition to leading innovation at UPMC, Shrestha also served as executive vice president of UPMC Enterprises, the venture capital arm of UPMC.

According to a press release from Atrium Health, a 40-hospital health system previously named Carolinas HealthCare System, in his new role Shrestha will lead enterprise strategy, including planning and tactical direction for Atrium Health’s strategic roadmap. In addition, he will spearhead a renewed focus on innovation, launching new healthcare inventions, discoveries and ideas to benefit Atrium Health patients and the communities it serves.

Shrestha will officially join Atrium Health in February 2019, reporting directly to President and CEO Eugene Woods. He will take on the position formerly held by Carol Lovin, who was promoted to executive vice president and system chief of staff.

“It is our honor to welcome Dr. Rasu Shrestha into the Atrium Health family,” Atrium Health president and CEO Eugene Woods, said in a statement. “As Atrium Health looks ahead to how we can reimagine a brighter and bolder future for care, Dr. Shrestha will help us develop the strategy and innovation to bring health, hope and healing to more people.” 

A respected thought leader and visionary in the field of healthcare information technology, Shrestha was recognized as one of the “Top 20 Health IT Leaders Driving Change” and as a “Top Healthcare Innovator” by InformationWeek, according to the Atrium Health press release. In addition, he is chairman of the Healthcare Information and Management Systems Society (HIMSS) Innovation Committee, and co-chair of Health Datapalooza.

“I am awestruck by the ambitions of Atrium Health to fulfill their mission to improve health, elevate hope and advance healing – for all,” Shrestha said in a statement. “I look forward to working with this incredibly talented team to forge ahead with meaningful strategies, partnerships and opportunities – and to support this organization’s commitment and dedication to its patients and communities.”

Shrestha announced the move to Atrium Health via Twitter Tuesday afternoon and also posted several comments on LinkedIn. “I find myself in a reflective mood, as I contemplate leaving the many teams I’ve had the honor of making an impact in, the culture that I’ve had the privilege of being able to help craft, and an organization I love, in a city my family and I have called home for the last 11 years since moving here from Southern California. I am humbled with the honor of having worked with some of the most brilliant leaders and doers I have met, and proud of the many accomplishments we have made as a team here at UPMC and across the industry,” Shrestha wrote. “It is this purpose-driven passion that will be a recurring theme, as we continue to cross paths and push ahead through the many challenges and opportunities.”

He remarked that he was drawn to the “human ambitions” of Atrium Health to “improve health, elevate hope and advance healing - for all.”

“What a remarkable place to start my next chapter forward. I know that when we put our hearts and minds together, anything is possible,” he wrote.

Shrestha received his medical degree from CCS University in India, completed his fellowship in informatics from the University of London and earned his MBA from the University of Southern California.

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Early Career Physicians, Pharmacists, Keen on Working in Tech, Survey Finds

December 18, 2018
by Rajiv Leventhal, Managing Editor
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A survey of 502 early career U.S. physicians and pharmacists revealed that 47 percent of these healthcare professionals are interested in working in the technology sector.

A LinkedIn survey, conducted in October, queried 502 physicians and pharmacists in the U.S. who completed their degrees within the last five years. The participants, all of whom have LinkedIn profiles, were chosen at random and reflect different specialties and years of experience.

Thirty percent of respondents said they were “somewhat interested” in working in tech, while 17 percent said they were “very interested.” Another 21 percent said they were “somewhat uninterested,” and 20 percent said they were neutral. Just 11 percent of respondents said they were “very uninterested.”

Participants were also asked to share their views on why they would or wouldn't consider working in the technology sector. Fifty-eight percent of respondents cited substance of the work, 57 percent said total compensation, 50 percent said working hours, and 49 percent said the impact of the work.

Notably, 85 percent of survey respondents said that having peers with their background represented at tech companies could lead to innovation for “traditional” industries.

Another 48 percent of respondents said the technology sector has an allure that makes it difficult for other industries to compete for top talent. Meanwhile, 47 percent said that those who move into tech from a different industry are more interested in “big impact.”

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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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