August 22, 2017
Frank Myeroff, President of DCA recently had the pleasure of interviewing Mary Alice Annecharico, SVP and CIO of Henry Ford Health System. She shared her background, the keys to system implementation, and more about the HIT industry.
Please tell us about yourself and The Henry Ford Health System (HFHS).
My role with Henry Ford Health System is the highlight of my career. I have more enjoyed my position as Sr Vice President and CIO from its inception to the point where I am today than any other role for a number of reasons. It has enabled me to have the autonomy that I need, decision-making authority, and the real opportunity to take some risks and to invest in sustainable conversations and relationships. As a registered nurse, I lived and breathed in the critical care environment for several years before I was introduced to the world of computers and the role of change management that has enabled technology to reform a great deal of the work we do in healthcare. My nursing identity even in healthcare consulting was retained. I believe that much of the consulting work that I did and culture in which I was involved as a nurse enabled me to influence behaviors and be a partner in the elements of change to move organizations more and more toward technology enablement.
HFHS is uniquely positioned as a very diversified academic healthcare environment and has, for its 102-year history, been a seat in Detroit’s quality healthcare throughout the northeast and western regions as well as Jackson, Michigan. Because it is as diversified as it is, there are so many services that are richly embedded into the fabric of HFHS. This includes a profitable health plan and expansive community care landscape, which in today’s market have been serendipitous advantages for the System in this cost constrained market.
What led you to choose a career in the Healthcare IT industry?
The Healthcare IT industry actually LED me. I am a registered nurse by profession and was the Director of ICU in a large academic medical center when I was offered the opportunity to help transform the way that doctors and nurses communicated requests for patient care needs and provide a more efficient pathway for charges to be sent to finance for billing. I was successful and happy with managing people in my nursing role and that was what was attractive about me that made me the sought-after choice to move the organization into the digital world. My stipulation was that I would still be identified as a nurse and that my passion for quality patient care had to drive my decisions and our collective efforts.
For several years, as the Director of IT, I was in learning mode with the creation of a CON for the data center, the selection of clinical and financial vendors, and leading the development and implementation of the organization’s first EMR. I later left the health system to join the management consulting ranks for a dozen years to assist other healthcare systems through similar planning and implementation journeys.
What trends are you currently seeing in the HIT industry, and what do you expect to see in the next 5 years?
Create Value: I think the name of the game today is creating value. It is certainly part of our motto of ‘true north’ that work we do needs to add value. We create resiliency and capacity for the system to utilize operating funds as well as capital investments in different ways so that we are driving the agenda forward. We evaluate the effort and eliminate unnecessary work so that what we are doing is focused on our ‘true north’ for today and the future for the organization. It also means that we take a look at new technologies like telemedicine, tele-presence and the adaptive tools in our analytics space to help us move in the direction of precision medicine and population health. We do this by having more concrete information about individuals based on their genomic patterns that can target care in precise directions. That’s an exciting part of the work that I do in adapting our use of the electronic medical record and analytics to help clinicians determine more efficient, effective care pathways.
Digital transformation: At last. The core reason for implementing EHRs and business systems is to “get to the data”. Analytics is becoming the basis of clinical and business decisions and is driving organizational leaders to become more standardized and accountable for the quality outcomes of care and the fiduciary responsibilities to better manage resources. Machine learning will harden over time and will enable organizations to improve clinical and business decision making as they consider populations and markets with new lenses. Value-based care success is dependent on having analytics capabilities to know what to do, how to achieve the best outcomes, and how to minimize waste and cost at the same time.
Consumerism is driving much of healthcare technology: Consumers have a voice — a very powerful voice about what is planned for them and how they need to share in the responsibilities and partnerships with clinicians to manage their health and wellness. Their opinions count and healthcare is measured by those opinions. Organizations are facing enormous pressures to attract and retain their markets and are being forced to consider innovative means of leveraging data that they know about consumers to personalize the manner in which they offer services.
As we have seen, much of the innovation and demand in mobile and wireless technology across our workforce (AKA consumers in their personal lives) has been driven by the diverse uses of smart technologies to make life more convenient. We are now compelled to add feature-rich secure functionality to our applications and services that support a mobile workforce.
With your extensive experience implementing new systems, such as Epic, called Helios at HFHS, what do you find to be the biggest challenge in implementing new technology and systems in a healthcare setting?
Challenges exist, not as barriers; they create opportunities. The largest single level of effort that we need to do as we introduce change through applications and systems is to help mold the culture. It is really changing behavior in a way that enables people to understand why the change is coming, what they get as a benefit of a change, and then helping them through that process. We used change management, change behavior, and illustration extensively in the implementation of our Epic engagement here.
Because we implemented both on the electronic medical record and revenue cycle in 18 months across the entire environment- ambulatory, inpatient and all of our clinic and medical centers, we really did a deep dive in getting people’s feelings about gaps the existing systems had and what would change in a transformed environment. We found there was a lack of good handoff, data never was where they expected it to be. We did not have a fully engaged patient environment because patients were always in the state of confusion rather than in a state of engagement, and regulatory changes were coming so rapidly. This was the important turning point for our workforce to begin realizing clinical transformation for the organization really did include them and they owned it just as much as anybody else in making sure that it was successful. We painted that picture and it was a great illustration efficient care handoffs with the patient in the center of all of that communication for the first time.
The project was led by 3 diverse Leaders, like the legs of a 3-legged stool. Breaking away from the tradition, IT did not lead the project. Again, in this illustration, the Epic implementation became a system-wide effort to increase ownership and adoption and to clinically transform how the organization operated. A physician lead physician adoption and a business leader ran the integrated project plan and budget. IT was responsible for the infrastructure, the disaster recovery site development, quiescing old applications and platforms, and those services that touched our communities of users. This included the desktops and those services that were closest to our community of users. The trust and respectful relationship that we developed across all business lines helped each user to be successful, and this has been a hallmark of the pathway forward.
The third one is really engaging your key stakeholders right from the very beginning and make decisions that have stickiness so you can scale, manage scope, and move forward with implementation.
So the three challenges are changing behavior, working as a team, and working with your key stakeholders.
Cybersecurity in Healthcare is a huge topic right now. What are some of the steps you are taking at HFHS to prevent future cyber-attacks?
One of the things I have focused on in the last 15 years has been privacy and security largely because of my clinical background. I realized that the privacy of the patient record is sacrosanct and while at the University of Pennsylvania when the HIPPA privacy and security laws were being enacted and the regulation associated with what we must do and what we should do were just coming into the spotlight, I was part of a national academic think tank to talk about how we should advise our organizations to address the laws of privacy and security. I have had a passion and desire to be part of reducing risk for well over half of my career. When I came to Henry Ford from Cleveland, I was given a great opportunity to work with a leader who became the Chief Privacy and Security Officer to formulate an approach to help the organization simplify the way we look at these risk areas. We should transparently be able to help the organization know what they must do and what they should do and combine privacy and security in a program that helps them more easily understand and be responsible for that culture of confidentiality. Working with Meredith Harper for the last 6 years, we have created a pathway that helps us understand the risks in our environment and then how to best manage them. Cyber risk is ever present – we are never going to be able to completely control it. It’s an evolving threat environment and we have to manage and educate our communities of users about the guidelines and then put controls around our physical environment; our networks, so that we know what’s happening on the network and we understand that our responsibility is to maintain that constant surveillance around that environment. This will keep the patient data, as well as the institutional assets free from breach and we will prevent brand, institutional harm, or reputational harm by identifying it early enough to manage and contain risk that we’re accountable and responsible for.
You have a background as a registered nurse, and experience in nursing leadership. How has your nursing experience most benefited you for your roles in Healthcare IT?
From the time that I was 3 years old I wanted to be a nurse. I had a baby doll that was my patient and I carried it around and never wavered from what I wanted to do in life. I wanted to be a nurse and a mommy so that I could take care of people and take care of my family. I worked through high school instead of being out on the ski slopes and doing other things my peers did, to save money for nursing school and had the fortune of being admitted to the number 1 diploma nursing school in the nation at the time. It continues to be who I am and the experience that I had in nursing that enabled me to continue to grow professionally and quickly. Every time I became comfortable with where I was, every 2 years or so, I was being promoted into a new role. It was given increasingly greater levels of supervision and leadership and it became a stepping stone from nursing into IT leadership. It was that constant vigilance on being empathetic about where people were and helping them move to a different space, whether that was my staff or it was the patient population or it was my peers across the organization. It was being thoughtful and transparently vulnerable to appreciate where they were and to help them solve problems or create solutions that were going on within the environment. I think those traits just carried forward in the consulting I did as well as in the roles I had as CIO at Penn and in Cleveland.
Have you had mentor(s) throughout your career?
Yes. I have had a number of incredible mentors who believed in me and helped me mature as a woman leader and as a leader who has been able to pay-it-forward in my efforts to support and encourage the growth of both men and woman leaders who show leadership potential. Mentorship responsibilities are a cornerstone of what I believe CIOs must be able to do organically. Succession planning begins on the first day of a new experience within an organization. It never ends until one leaves.
My Master of Science degree from the University of Pennsylvania is in Organizational Dynamics, purposefully. I feel that the primary role of a CIO is to prepare an organization for change by building trust and confidence in IT and then supporting the changes with them.
What advice would you give to individuals pursuing careers in the HIT industry?
Consider why you want to pursue a career in IT, look for a champion or organization to sponsor you, and be thirsty for growth. More importantly, do not box oneself into a single mindset. My favorite type of candidate is one who is enthusiastic and humble and willing to learn and contribute quickly. I love millennials as much as I love seasoned IT professionals. The creative tension that they produce together keeps the environment innovatively live and challenging for both groups. Millennials will move on quickly from one role or job, seeking upward mobility quickly; whereas others have organizational loyalty and use their innovative spirits to progress incrementally and add value across a number of different service lines.
What skills or traits do you look for when hiring new talent at HFHS?
As above, I look for thirst and fit. For entry and non-managerial positions, I look for those talents first. For managerial and leadership roles, I look for personality and leadership style and experiential successes as well as important failures that led to new insights. I also love bringing in people who are not necessarily skilled in the role that they will play, but they are open, eager, interested, very bright, and add a tremendous dimension of creative tension in decision making. You can tell by engagement scores across IT and it really does make a difference when we have a blend of ethnic, age-related, gender diversity across the team that it’s much better rather than a homogenous group of individuals.
Your HFHS bio states that you are actively engaged in national efforts to create sustainable and secure statewide HIE, offering interoperability between regional and national health information networks. What is your biggest motivation to drive this effort?
My biggest motivation is to help the industry achieve functional integration of data seamlessly across diverse systems. We are compelled to help achieve these data standardization objectives. Today, too many vendors have veto power in how our industry shares data. Provider/vendor interoperability work led by KLAS for the past 2 years has done more to bring visibility and transparency among the major vendors toward achieving true interoperability than we have seen thus far. We are getting closer. At this time, our organization is exchanging clinical data securely across the continental US and across multiple platforms. As the discrete needs grow, we must be prepared.
I also believe that the traditional HIE environment of the past 10 years should be considered a ‘bridge strategy’ toward lasting open data exchange across our environments. Traditional HIEs have helped connect the dots for our more rural and independent provider environments but add layers of cost to provider organizations whose EHR vendors should be doing the same things.
The ubiquitous needs for sharing data compel us to think more broadly about data sharing. We are seeing a shift within our state governments who are looking for personal data to help manage business and civic needs as well as provide vital services based on location and population health needs based on leveraging social determinants of care once known.
June 23, 2016
Jaime Parent, Associate CIO, VP IT Operations, Rush University Medical Center & Assistant Professor, Rush University Interviews with DCA
Why did you choose a career in Healthcare IT?
I get bored very easily and there is absolutely no boredom in Healthcare IT, nor Healthcare in general. Often times, I do not own my own agenda and on any given day servers crash, phones go out, etc. But I’ve been around long enough now that very little surprises me. Technology changes so fast and now academic medicine is arguably changing at the same rate and speed. Healthcare IT is not for the faint of heart but these rollers coaster rides are a blast.
To what or whom do you attribute your success? Did you have a Mentor(s)?
My terrific wife Tracy has been my hero for many decades now. Without her, I would simply be a misanthropic outcast. Another source of success for me is having a son with autism (Bryan). He is now 29 and works at the Rush University Warehouse; his/our continuing challenges are outweighed by the joy of his/our successes. If a group of dads can have their softball team lose to state rivals, then take them to a restaurant mall on a Saturday night, well, you can manage a surfeit of personalities all throughout Healthcare. God had some good reasons to put Bryan in our path.
As a CIO, is cybersecurity one of your largest concerns right now? What measures are you taking to deter cybercrime and data breaches?
Healthcare is wide-open for security breaches and is a reflection of the on-demand services that are demanded by clinicians, students, faculty and visitors. While we have some excellent technologies to protect our environment, nothing is absolute. Social engineering continues to be our biggest vulnerability which is why cybersecurity training for all personnel is your best defense weapon. No technologies will work if Johnny or Mabel put their username and password on a sticky note on the front of their monitor; not even the best technology can plug that hole.
You combined your current experience as an IT executive with your past experience as an Air Force Colonel to create the EN-Abled Vet program. How does your internship help veterans reintegrate into civilian life and IT careers?
We created a 13-week fast track on the job training internship that makes veterans competitive in the Healthcare and general Healthcare IT marketplace. Fortune 500 vendors have stepped up to provide free on-line training, with special kudos to EPIC who offers free Epic certification opportunities for up to 5 vets per Epic customer, and 60 opportunities nationwide per year. As confirmed by both CHIME and HIMSS, EN-Abled Vet is a unique approach to Healthcare IT career building. For example, we will hire veteran’s spouses and other family members while a veteran is recovering from service-connected injuries. SOMEONE has to put food on the table and a lot of well intending organizations overlook this. We pay a stipend of $12.50 per hour, 4 days a week for 13 weeks, which comes out to a total cost of $5,200 per veteran. I would offer that cities, states and the feds pay more to veterans in benefits sitting at home watching TV, rather than being in a productive and successful internship.
You’ve had great success in bringing veterans into the HIT workforce. Has EN-Abled Vet inspired similar internships across the country?
Veterans possess a combination of skills that may be difficult to find in the today’s workforce. Honesty, integrity, maturity, teamwork, stay until the job is done etc. are skills that anyone, anywhere would want to have as their employees. Capitalizing on this, and after proving that this program works and is transportable, we have built a consortium of 7 health systems from Delaware to California who are in the early stages of developing their own programs. The program is pure and is essentially freeware. Everything you need to start your own program can be found at http://en-abledvet.org. Isn’t that something that hospitals should be doing already – giving back to the communities they serve?
What is your advice to up and coming Healthcare IT talent?
You have to be somewhat obsessed and possessed to do this stuff. I’m hard pressed to find anyone in this field that hasn’t been yelled at at 4 AM by parents or spouses to get off that $#!# computer and come upstairs and go to bed. Reminds me of the love of music. If you put your mind to it, the more you will practice the better you will be. In my case, my wife says I turned being a regular geek into a successful career geek and it’s hard to refute that.
What is your philosophy on how organizations can attract top Healthcare IT talent?
Always keep in mind that as a not-for-profit, you will always be competing with the for-profit sector. Most of my staff can easily find a job downtown that pays $20k+ more than their current position, so you have to be creative and engaged. Such things as flex hours, PTO when needed, occasional parties, respect, work from home, etc. can all be effective recruiting and retaining tools. You also have to tap into that altruistic gene. As one developer told me, “I get a special feeling knowing the patient healthcare pages I build can help make patients get better and healthier quicker which is more inspiring than creating an insurance page or auto buying website.” Organizations need to tap into this type of engagement for once your employee starts to return staffing firm cold calls, the slippery slope out the door begins.
May 2, 2016
DCA recently had the opportunity to interview Ms. Sue Schade, Interim CIO, University Hospitals, Cleveland, Ohio. Ms. Schade is also a nationally recognized health IT leader and a founding advisor at Next Wave Health Advisors providing consulting, coaching and interim management. In 2014, Ms. Schade was recognized as the CIO of the Year by HIMSS and CHIME.
Please tell us a little about yourself:
In terms of my work experience, I have over 30 years in Health IT Management. I started out as a programmer (way back when) and I’ve worked for several large integrated health systems in Chicago, Boston, and Michigan. I’m currently doing an interim CIO engagement at University Hospitals in Cleveland.
My non-provider organization experience was running the software division for a vendor that was a few years old at the time I joined them. I spent some time doing consulting for Ernst and Young. I’ve also been very involved in a lot of industry activities, serving on boards and committees to give back.
On a more personal note, I’ve been married forever (40 years) and have two grown daughters, three granddaughters and a grandson on the way!
As of January, I started my next chapter to focus on consulting, leadership coaching and interim management. All with the idea that I can live where I want, which is back in New England close to my daughters and grandkids, and hopefully work less than full time over the course of a year and have more flexibility.
You have over 30 years of experience in HIT, what/whom do you attribute your success to?
When you say whom, certainly I’ve had mentors along the way; people I have either worked side by side with or as my boss. These have been some really solid people who have been able to give me good advice and who have been supportive and helped me stretch. Knowing how I have been supported in my career is why I have been so willing to do the same for others, to give back now that I have something to offer.
I would also comment about tenacity and drive. As my husband says, I am a “workaholic”. He has accepted that and he knows that wherever I work I’m going to work hard and put in long hours. So he wants me to make sure I am happy and that I respect the organization and the people I work with. This is great perspective because it’s hard to maintain that kind of work ethic when some of those other things are missing.
So, tenacity, drive, and passion for what it is we do in healthcare, loving the change that technology brings, and being able to make a difference in people’s lives are all what I attribute my success to.
You have spoken and written blogs on ways to encourage women in pursuing careers in the STEM field with examples such as providing technology based gift ideas for young girls. What other ways do you think could be used to enlighten more women about this field?
One thing I want to emphasize here, is the need to get girls interested in technology and STEM fields early. I think the middle school age is a very critical time, especially from a gender perspective. How you are steered, how you’re encouraged. You are getting a better sense of yourself as a girl, and what you want to do. You are very influenced by others and what they think of you. I just think that getting girls interested young, having programs for them, and continually encouraging them is very important. Whether it’s by their parents, teachers, or an organization.
What is your philosophy and/or methods with regard to retaining top IT talent?
A couple of things come to mind. I truly believe that hiring decisions are some of the most important decisions that anyone in management makes. At the same time, it can be a crapshoot. How much time do you have to really get to know that person, how many people need to talk to that person before you make the hiring decision. You have to take into account as best you can everything you have available to you — the interview, references, their background, etc. Making the call to bring in the right person is a big decision and if it doesn’t work out, it’s best to figure that out sooner rather than later.
In terms of retaining top talent, you have to constantly provide challenges, support and help them be successful. One of the directors in the organization here who started the same day I did, is very strong. He’s dealing with a lot of challenging projects as he gets up to speed. I had a conversation with him recently to check in because I was seeing emails and presentation decks that he was working on coming through after mid-night during the week. We talked a little bit about that and I asked him what support he needed. The key point here is that you need to stay close to your people and make sure that the work load is sustainable. That is part of preaching the work/life balance, and I say preach because sometimes it’s “do what I say” not “watch what I do”. That is coming from a workaholic!
Making sure your people feel supported, have what they need to be successful and that they are constantly being challenged is very important. If someone has the next, right, great opportunity in their career outside the organization and you don’t have that next step to offer them, that’s okay! That may be the best thing for them. I continue to be supportive of people who make the decision to move on. I understand that it is what is right for them. At the same time, I am also happy when people decide to make moves within the organization. I always say great, you have a step up, or a lateral move, but you are staying in the family. Regardless I’m always happy for them and their next opportunity.
What are some challenges you are facing being an Interim CIO?
When you’re an interim from the outside, it’s an opportunity to get into the operational issues you need to deal with, as well as providing a consulting component. The executives here are looking for my perspective and view on things given the experience I have had in other leading organizations. I really like that part of being in an interim.
A really generic challenge is trying to figure out what makes sense to take on and change or start new. As opposed to thinking, I’m interim and I’m here for “x” amount of months so I’ll let the new CIO make those changes. I jump in and focus on the key problem areas. I can be a change agent and I am doing some of that here. It’s recognizing what makes sense to address now vs. wait on.
I have had meet and greet sessions with the senior executives and hospital presidents. The four questions I ask them are:
- What is working well?
- What is not working so well?
- How can I have the greatest impact during my interim period?
- What are the key criteria to look for when searching for the new CIO?
Those are four questions that have been able to elicit a lot of good perspective and input. It’s helping shape what I am focusing on and what I’m trying to change. Around week five, I’d already had many of these meet and greets and I figured out what my focus should be during my interim period. As an interim, you need to quickly be able to get to know the organization, get to know the people and get to know the culture. You don’t have a lot of time to ramp up. You’re in the thick of it quickly, but it’s important to understand the people, issues and culture!
Congratulations for being selected as one of the Top Healthcare IT Experts by Health Data Management in December 2015. How has life changed as a nationally recognized health IT leader?
That is an interesting question! I think my network is even bigger than it was before. I’ve met a lot of people that have somehow found me and want to connect. I feel like I’ve reached this point in my career and within the industry, where I garner a lot of respect from people. I get a lot more calls and requests to do a variety of interviews. I’m really enjoying all of it.
What advice would you give up and coming healthcare IT talent…Those who have recently graduated or will graduate?
You have to be open to possibilities. You need to make sure you own your career because no one else does. In regards to new grads and up and coming talent, the message is network, network, network. Build your network and work it. Find role models you want to learn from and be like. Probably one of the greatest compliments I get is when someone says “I want to be Sue Schade when I grow up”.
The last point is patience. I have had progressive responsibility over my career and have done well. Don’t expect that you can be somewhere for just 6 months, a year, or even 18 months and that your boss will think you’re ready for the next step. I guess I don’t want to quantify reasonable intervals, but I would emphasize patience as you grow in your career.
What are the most important characteristics an IT leader needs to be successful?
You need to be a business leader in your field or industry and not just the expert in the IT domain. Know the business you are in. Being viewed as and respected by your peers and the executive team, as someone who contributes not just in delivering on the IT agenda, but making a greater contribution to the business.
The ability to build effective relationships with your peers (in the c-suite so to speak), and making sure you have a really solid alignment between the IT work and the strategic goals of the organization is very important.
How has healthcare IT changed since you entered the industry, and where do you see it going?
Back in the day, it was all about the mainframe. Over time we know how the environment has changed from a technology prospective and we’re still dealing with a lot of the same core applications and systems. We’re dealing with a lot of integration, but we’re moving to that next generation of IT within the healthcare arena. There is a greater emphasis on virtual health and mobility. We’re certainly being shaped by consumerism and the increasing expectations that everybody has of what technology can do for them.
Obviously with payment reform and value based care, the demand for more technology solutions, taking costs out, analytics, the ease of access for our patients — all of that is going to increase. It’s an exciting time! Healthcare IT has always been exciting and it’s getting more exciting as time goes on.
Thus far in your career, what do you feel is your greatest accomplishment?
This is always a hard question to answer. When I was recognized in 2014 as the CIO of the Year by HIMSS and CHIME, that was definitely a peak in my career! I have gotten a lot of different recognitions and been named on a lot of different lists, but that was definitely a highlight. I am committed to developing the next generation of HIT leaders and doing what others have done for me. My biggest and proudest accomplishment; being a role model! Hopefully I will leave a legacy as a leader, specifically a female leader within the HIT field!
Follow Sue’s blog, Health IT Connect at www.sueschade.com
March 8, 2016
Direct Consulting Associates recently had the pleasure of interviewing Mony Weschler, Chief Technology & Innovation Strategist at Montefiore Medical Center.
Please tell us a little bit about yourself.
I am a creative and driven leader with extensive experience (25+ years) spanning the full range of clinical IT and MIS operations in various leading academic healthcare systems and institutions. While specializing in imaging informatics, my subject matter expertise extends to all healthcare and IT including strategy and operations, with clinical expertise in Radiology, Cardiology, Pathology, Perioperative, Perinatal, Surgery, Pediatrics, Nuclear Medicine, Orthopedics, Ophthalmology, Pharmacy, ACO’s, Population Health, Bio-Medical and Innovation.
In the course of my career, I have had the opportunity to establish and solidify Montefiore’s reputation as industry leader for testing and integrating groundbreaking technologies, result in multimillion dollar cost savings by pioneering an innovative cross-training support model, maximize operating room availability and spearheading the clinical use of innovation and mobile solutions.
What fascinating projects are you currently working on?
Mentor to startups at Junto, PilotHealth and BluePrint Health, bringing new innovation and technology to improve healthcare.
3D printing – How to incorporate and expand the usage of 3D printing to improve personalized medicine and outcomes. Imagine printing an airway for an infant or a printed custom hip replacement. How about a printing the before and after for conjoined twins that need to be separated?
Population engagement – communicating with your clinical providers using secure texting and smart Apps. Getting appointment reminders, nutrition guidance from your health system.
Wearables – Advanced activity monitors being handed out in the school systems to help change behavior and tackle pediatric obesity and diabetes with wellness and no drugs.
What is the most challenging aspect of your job?
Changing culture in a system that is resistant to change.
You have over 25 years of experience in HIT. What or who do you attribute your success to?
A love and passion for what I do. No one can escape the healthcare system sooner or later a loved one or ourselves will need care. I am privileged to have made a difference and improved the care and experience of millions of patients.
Did you have a mentor(s)?
Yes, my career began at NYP in 1989 and back then it was called Columbia Presbyterian Medical Center. I was fortunate to have had mentors like the world renowned Dr. Paul Clayton, Dr. Bob Sideli, George Hripcsak, Clair Hill, and other great mentors and friends. What I really enjoy is mentoring others and infecting them with a passion for Healthcare IT.
How has healthcare IT changed since you entered the industry, and where do you see it going?
EPIC was but a thought in Judy’s mind. IBM, 3M and DuPont were in the clinical space mostly with the beginnings of Lab systems. Most large academic medical centers had large programing staffs on hand and were building their own systems on mainframes and AS400’s. There was very little technology and informatics being used in healthcare. In fact, when the first digital imaging modalities like CT’s arrived we printed films to read the studies. Everything was paper and sharing vital information to treat a patient was very difficult.
Today, one can say that technology is completely integrated and integral in how we treat patients. Without technology a system could not properly treat its patients.
With the current pace of innovation and technology we can see the vast improvements in care and outcomes. I see healthcare becoming better and more accessible to everyone. I see great changes similar to the changes in the banking industry experienced. I grew up going with my mother to the gothic bank my children have never been inside a bank. Patients in the near future will have access to virtual visits with their physicians and with the next generation of wearables and implantables your physician will be able to take care of you even before you get sick.
I recently published a piece on the clinical tricorder and how the Star Trek Vision is becoming a reality.
How will the emphasis on patient engagement change healthcare in the future?
We’re already communicating with our patients using SMS text and mobile smartphone technologies. The government has pressured healthcare providers to shift from a fee for service to a fee for performance that makes the system accountable for the health and well-being for the patients it serves. This is a big step in the right direction but it can’t be successful without the patient being engaged and taking care of themselves. Mobile and other technologies allow the provider to help the patient and care giver become engaged in their care. Key communications such as appointment and medication reminders, nutritional guidance, activity coaching and encouragement are essential in improving care and reducing costs. New technologies can monitor patients at home while providing early warnings of decompensation and risks.
How do you incorporate leading-edge healthcare technology systems at Montefiore?
Our innovation process enables me to be a mentor at local accelerators and incubators like Blueprinthealth, PilotHealth and Junto Health. As a member of HIMSS, RSNA, mHealth, MEMS, CES and others I have the opportunity to engage startups early and select the solutions that solve our biggest and most important challenges. Having 25 years of operational and strategic informatics experience I can best champion the new technologies across the Montefiore systems which includes the medical school, acute and ambulatory care, home health, care management, school health and everything in between.
A few years ago you said your challenge was to reliably deliver data to physicians regardless of their physical location in ways that fit and enhance their workflow. Is that still a challenge?
Yes, but it is much better in the last 5 years we really took advantage of mobile devices so today our clinicians have access to Fetal monitoring strips from labor and delivery, cardiac EKG’s, PACS images, EMR data, analytics, communications, collaborative platforms and secure image capture from anywhere. Tele-psychiatry is rolling out, Tele-stroke is next.
What has been the hardest part of pioneering the integrated healthcare delivery network at Montefiore?
It’s always the culture and the ability to take risk. You can’t change and service model if you don’t have the vision and the authority to go in and shake it all up. What makes is most challenging in healthcare is that lives and real people are involved.
What’s the most cutting edge application you’re seeing now? What other innovations might we see in the near future?
TYTOcare this is a device that enables a person to do self-evaluation that captures key vitals and images that enable a clinician to properly diagnose during a virtual visit.
Siri, Amazon Echo, Google Talk, these are just the beginnings of machine learning and what was once known as artificial intelligence. The next big change in how we interact with computers will make the keyboard obsolete and move us into the era of natural language processing where we can communicate with the computer simply by speaking to it. In the clinical world it will allow the clinician to focus once again on the patient and not struggle with the keyboard.
How do you find and develop talented employees at Montefiore?
NY is a great place for talent as the city is home to many universities, prestigious healthcare organizations, financial Mecca. Investing in and growing staff is important but key is partnering with the clinical teams and the knowledge that the systems you support directly impacts on the care that is being delivered to our patients. The best talent like to create and implement new and revolutionary technologies and at Montefiore that’s what we do. Being the parent company to Einstein School of Medicine and the top performing ACO in the country helps as well.
How do you retain top industry talent?
Mentor each staff member, know your people and put them in positions that helps them succeed.
What soft skills do you look for when hiring new talent?
Very soft… Bright, wants to learn, team player, motivated like to ask questions.
What are the most important characteristics an HIT leader needs to be successful?
A leader needs to lead and think out of the box and be willing to take risk. Healthcare is changing at an extraordinary pace the likes of we have never experienced before. IT is critical in the survival of our healthcare systems if a CIO makes the wrong call or no call at all the implications will resonate at the system level.
I have seen IT leadership undergo many phases during my career.
In the 90’s, IT was the dictator; we did things and the business had to do what was mandated. In 2000, after the Y2K nonevent, IT was beaten up and the clinical folks took over; we were servers and did whatever the business asked for even if it was not the right thing to do. Outsource years.
By 2010 CIOs were back at the table but reporting to CFO’s with limited influence there were also many transplants from the financial world and that is not a good fit.
My approach and advice is to always be a true partner with the clinical leadership and to do that you must understand the business you are in. Be a change agent, understand the big challenges and provide the solutions, engage clinical champions and break the mold by introducing new innovation and technology. Only the best and most confident HIT leaders will step into this role. Unfortunately, most fall short and that is a major reason that HIT lags so far behind other industries when it comes to accessibility, ease of use and the inability to share data between systems. There is hope though the population is demanding change and technology is a major change agent. HIT has come a long way in the past 25 years but I’m optimistic that the next 25 will be legendary.
January 20, 2016
Direct Consulting Associates recently had the pleasure of interviewing Yiscah Bracha, PhD, Research Health IT Scientist at RTI International.
Please tell us a little bit about yourself.
I started in “analytics” before that word was widely used, as a mathematics major in college, also in a private tutorial relationship where I learned Philosophy of Science. In my last year of college, I taught myself statistics, where the only way to compute parameters was by using the calculator bolted to the desk in the lobby of the Psychology Department. A few years later, I learned how to use MINITAB which was available through large mainframe computers with dumb terminals, and that made it possible to apply statistics in ordinary life, or at least a life where mainframe computers were ordinary. They existed at the manufacturing giant 3M, and for several years I taught their MS and PhD chemical engineers how to design experiments and analyze data using traditional statistical techniques, to improve their outcomes and processes. This is exactly what I would be doing decades later, in health care, but there were many circuitous twists along the way.
The first circuitous twist, and the one that moved me from manufacturing to healthcare, where I would remain, was serving as a master’s level statistician supporting a large, world-renowned, NIH-funded clinical trial for primary prevention of coronary heart disease in middle-aged men. While I was teaching at 3M, I had decided to go to graduate school and get a master’s degree in statistics. I figured that the degree would give me legitimacy, and a theoretical grounding in what I already was doing empirically, and also expose me to methods that I otherwise wouldn’t have stumbled across on my own. All that happened according to plan, and it wouldn’t have happened if I had gone to grad school directly after college, because both the world and I had to ripen a bit.
So I got the MS, and consulted a bit across multiple industries, and then accepted this job at the Coordinating Centers for Biometric Research, in the Division of Biostatistics at the University of Minnesota. It was blind luck, but I happened to stumble into a position that gave me opportunities to collaborate with some of the world’s leading MD/PhD clinical epidemiologists in chronic disease. I interacted with them routinely, learned how they thought, learned how to translate their clinical vocabulary into questions that could be answered with the data we had. It gave me publication opportunities, because I also could write; I not only was analyzing data, I also was preparing the manuscripts that shared what we found. The job also exposed me to these new technologies called “email” and “internet”; for years, I was the only person in my social circle who routinely used a computer for work, who was even aware of these new communication and information tools. But the really unique exposure, that informed many things that followed, was how the technology, data management and analytic functions were organized in this very high quality analytics shop. We were two hemispheres of the same brain: Tech and data management on one side, and analytics on the other. Each hemisphere had its own unique ways of processing and contributing to the world, they knew enough about each other to communicate, and together we did much more than each could do alone. I took this for granted at the time, not realizing how important it was until I got out of academic clinical trials research and into healthcare delivery.
I made the switch because I had lost interest in clinical trials, or more accurately, I had lost faith that randomized controlled clinical trials could produce information that was relevant in the real world. In the real world, the patients are the ones who walk through the door; they are not carefully selected like they are in trials. In the real world, nobody is giving patients their treatments and medications for free, nobody is following up with them assiduously to make sure that they are adhering to treatment protocols, nobody is making sure they return to the clinic for follow-up visits every few weeks or months. I was interested in the real world, and I imagined what the analytic possibilities could be if I was working with data that emerged from processes that took place in real life. It was the early 2000s, a few years after I made the switch (but many years before the passage of the Affordable Care Act), and in Minnesota, the large vertically integrated healthcare delivery organizations were one by one starting to implement electronic health record systems. The prospect of harvesting EHR data and using them for research was very exciting, and I got involved in that effort in the organization where I worked. We failed to attain our goal, which was to use these EHR data to identify and redress disparities in health outcomes and care, particularly in chronic disease. The goal was simply too aspirational for current state at the time, and ten years later, it still is aspirational in the place that first proposed it. But we did use the EHR to support a real-time, guideline based decision support tool that helped clinicians select the optimal treatment choices for asthma while they were with the patient in the clinic. That decision support tool could have been used to obtain real-life data about treatment choices and outcomes, which could have been analyzed to generate new kinds of evidence, grounded in the real world, but doing that required a sponsor, along with an acceptance of the “evidence” that emerged that way, and neither were possible while research and delivery were so distant from each other organizationally.
The project became the basis of my PhD dissertation, because along the way, I had returned to graduate school again, this time to get a PhD in Health Services Research and Policy. It seemed like a fitting discipline for how to work with real world data, learn from them, and apply the lessons back in the delivery environment. Once again I was interested in legitimacy, and theoretical grounding, and new methods for my analytic tool box, and once again it worked, except this time it took seven years! I finished the degree after I had moved to Cincinnati, to lead the Data Analytics team in the very robust and advanced quality improvement department at Cincinnati Children’s Hospital. Here I had the most direct opportunity to apply those early lessons from clinical trials about how to organize a team that produced high quality analytic results consistently, and during my tenure, I transformed our group from an undifferentiated collection of generalists to a well-organized multi-functional team comprised of specialists. We were good, and they still are.
I spent my last 18 months at Cincinnati Children’s working closely with the IT department, to design a set of technologies, staffing structures and governance models that would produce high quality analytics across the enterprise. This was the logical next step, because excellence required an organization-wide strategy for managing and governing its data assets, and IT had that responsibility. But I had been homesick for Minnesota almost from the first day that I arrived in Cincinnati, and eventually I left to come home. A few months ago, I joined a non-profit research firm, telecommuting from home. I’m back in the research world, and this time paradoxically applying some of what I learned in delivery to the research environment.
The world around analytics is accelerating very rapidly. What other “trends” are you seeing right now?
I’m seeing expectations that data from consumer wearables and medical-grand sensors will become routine elements of the health data ecosystem, and that analyses of these data will help patients, providers and researchers improve health. The data management and analytics worlds are not really ready to meet these expectations, but they are coming anyway.
What fascinating projects are you currently working on?
I’m currently part of a team that is preparing a proposal that responds to the President’s Precision Medicine Initiative (PMI). The initiative is hugely aspirational: One million Americans will be followed for many years, contributing self-reported data about their health states and disease, and also giving permission to harvest data from the EHR systems that their providers use, from the activity trackers and environmental scanners and biorhythm sensors that they wear, and from biospecimens they contribute. All these data are to be integrated and curated and made available for analysis not just to academic researchers, but also to participants and citizen scientists. The goal is to understand how lifestyle, environment, genetics, medical treatment, all affect individual states of health and disease. NIH Director Francis Collins recently gave an interview to Politico, which ran the story under the headline about the high hopes and mad schedule for PMI. Yep. The PMI is really pushing the envelope on what is currently possible, and it is great fun to learn about all the resources out there that can be leveraged to pull it together.
You have over 20 years of experience in HIT. What or who do you attribute your success to? Did you have a mentor(s)?
I’m not sure if I’ve “succeeded” in the conventional sense of the term. It is true that I’m now being invited by people like you to offer insights and opinions about data and analytics in healthcare, but that has a great deal to do with forces outside my control, such as changes in technology and public policy. I just happened to be available when the world started to ask for what I’d been seeking for a long time. For many years, I was on a lonely path, pursuing a vision that wasn’t widely shared. In that vision, we leverage data produced through ordinary life, grab hold of them, manage them, and analyze them using appropriate methods, to understand what is actually going on in ordinary life. The academic health research world did not consider this to be a legitimate vision, as it privileged data from randomized controlled trials (RCTs) above everything else, with an enormous infrastructure and huge funding streams dedicated to supporting RCTs. And the healthcare operations world did not understand what we were talking about. Less than ten years ago, the leading EHR vendors were mystified by this vision as well.
Much has changed and is changing rapidly, partly due to changes in technology that make the previously unthinkable almost routinely possible, a phenomenon that has punctuated my career several times, from college till now. Technology can indeed drive change, but often in very unexpected and unpredictable ways. Also, the Affordable Care Act has now, finally, created a set of policy levers that provide incentives to improve quality and reduce costs. It is as if the country and legislature finally realized that if we don’t get a collective handle healthcare cost and quality, we will be spending every last dollar on medical care that doesn’t make people any healthier. The ACA provided incentives to get the house in order, and the data and the analytics based on them are essential to making the change, and there now are technologies available that make both the data and analytics more accessible than ever before. Those EHR vendors that were bewildered by this talk of using their data for analysis are now offering products of their own in data warehousing and self-service analytic tools. The vendor space has exploded with data management and analytics products and services targeted to healthcare providers and health information exchanges.
But still, I must say that even with all the changes underway, widespread institutionalized vocabulary is still rooted in the past. For example, I recently found a 2011 web site put up by the National Heart Lung and Blood Institute, called Data Coordinating Centers’ Best Practices. I was hoping to find something about best practices for managing the dirty crude data emanating from EHRs, medical sensor technologies, etc. Nope. After all these years, this was about best practices for managing data from multi-site clinical trials.
So if personal/professional “success” means that I’m now perceived as a thought leader and expert (which, by the way, is not how I perceive myself, because daily I am aware of what I still don’t know), then the attribution goes to a determination to seek truth, and follow that path wherever it leads. It also goes to friendships and professional relationships with kindred spirits I found along the way. I didn’t do it completely alone; I always found partners who shared the vision, as odd as it may have been at the time. We supported each other and had fun together, and we did some things that were wildly creative at the time, and we kept each other going. So the determination to stick to the vision, and the friendships and professional relationships, got me personally to the point where I am now, but it wouldn’t be perceived as valuable if the world hadn’t caught up as well. Now the world is kind of overtaking us, which is a giddy sensation indeed.
What personnel are required to succeed as a data-driven organization?
Organizations that wish to become data driven need both producers and consumers of actionable information.
The producers are not single individuals, but rather individuals with complementary skills working together on multi-functional teams. The data produced by EHR and other systems are like crude oil coming straight out of the ground: The crude won’t run your car or heat your house until a lot of refining, transformation, and delivery takes place. The same is true for “data”. What you get from the system is crude; what you want is refined, actionable information. It’s a multi-step process to transform that crude data into the actionable information, and different personnel with different training and skills are required along the way. You need database engineers, people who know how to store data, keep them safe, manage inflows and outflows. You need people with skills at cleaning raw data, and mapping the contents to standardized terms so that they make sense for analysis. You need people with data architecture skills, who can package data together in forms that analytic users can navigate easily. You need people who know how to work with state-of-art self-service and visualization software, to create applications that give consumers the ability to answer questions on their own. And you need people with high-end analytic skills, who know how to deploy advanced analytic methods or who can develop them, to answer questions that don’t have readily apparent answers. Especially at the end of the process, where you’re getting closest to the consumer, the people fulfilling these roles must serve as communicative bridges as well, translating customer questions and concerns into something that can be addressed with available data, and helping the customer understand and interpret the meaning of what they are seeing.
That’s on the producer side of a data-driven organization. The consumer side is equally important. Culturally, there has to be a hunger for this kind of information, a determination to really know the truth, and to do what it takes to get that truth. There have to be people who demand self-service analytic tools, because they refuse to wait for the next available “analyst” to service them. They want to poke and probe into the data themselves, going to an “analyst” only when they realize that their quest for information has exceeded their ability to acquire it independently. Ideally this mentality is prevalent at the highest levels of leadership, because leadership sponsorship is required to invest in the resources required to satisfy that demand. If the demand exists without the leadership necessary to satisfy it, frustration and chaos will ensue, as everybody scrambles independently to meet their own informational needs.
What soft skills do you look for when hiring new talent?
I look for curiosity, a deep desire to learn. I look for determination to get to the truth, and an insistence on producing the highest quality work while realizing that you can’t allow the perfect to be the enemy of the good. I look for a service mentality, a desire to help others, and make others’ lives and jobs easier. I look for both confidence and humbleness: Confidence that there is a way to solve the problem at hand, humbleness in the ever-present awareness of what we still don’t know. I look for an ability and desire to work as a member of team, but also independently, as both are required to meet analytic needs.