Interview with Joe Vincent, Senior Vice President of IT, FirstMerit Bank

September 29, 2015

Direct Consulting Associates recently had the pleasure of interviewing Joe Vincent, Senior Vice President of IT for FirstMerit Bank. Mr. Vincent was kind enough to answer questions about his career, trends in technology, daily challenges he faces, and how he finds and develops top talent. 

Please tell us a little bit about yourself.

I am a Senior Vice President in IT for FirstMerit Bank. I’ve been at the Bank for 23 years in a variety of Technology and Management positions over that time, with considerable experience in IT Governance, and major technology initiatives. Over the past 5 years alone, my responsibilities have included 3 very successful mergers and acquisitions, as well as a major upgrade to our Branch infrastructure and Teller system software. I am a person who loves new technology, but also loves to work with people to determine technologies that can help them be successful, and ensure they can meet their goals.

I also have a passion for supporting Education. I taught Adult Education for quite a few years, and currently volunteer my time in support of Kent State’s Center for Information Services Program. As part of that work, I’ve participated in Business Leader meetings to review trends in the workplace, as well as actually participating in classes acting as a mentor to project teams. Amazing how real world the classroom can be – right down to one of the teams losing all of their work due to no backups!

What is the most challenging aspect of your job?

I typically see two challenges: effectively managing and motivating people, and managing customer expectations.

Most employees desire to do a good job, yet everyone is motivated differently. Identifying that motivation, and finding ways to cultivate it, takes time and dedication on the managers’ part. The flip side of the coin is that this is also the one of the most rewarding aspects of the job. Identifying someone’s true motivation, and finding a way to utilize it for the betterment of the employee, as well as the company produces a very highly motivated and high performing workforce. It is truly a sight to behold.

Managing expectations can also be a very difficult part of running an IT organization. There are always more desires, with competing priorities than time and resources available. Having a great working relationship with the business lines, and transparency on work being done are keys here.

How can IT identify what their businesses actually need and make sure the technology they choose is the right fit?

This is a great question, and one that I find absolutely critical. The answer is “Listen.” Empowering IT to develop a close relationship with the business ensures they have a greater understanding of the operation of the business, and its many needs. Many IT organizations have seen their business units hiring IT staff (commonly referred to as “shadow IT”) to ensure they get the appropriate technology in place to attain their goals. This is a direct reflection of IT not servicing their business requirements sufficiently. Many centralized IT staffs are very in-tune with their responsibilities for running the IT side of the shop, but fail to spend the appropriate amount of time understanding the needs of their business customers, to allow them to serve in a true consultative role. This, in my opinion is a critical mistake.

The other half of the equation is keeping up with the latest technologies. IT must be able to provide leadership to the business line once they have a full understanding of their needs. Only the combination of the two – listening, and understanding the latest technologies, can lead to a truly successful partnership.

How do you find and develop talented employees? How can organizations find, train, cultivate and retain championship-caliber IT players?

We find that talented employees tend to know one another, so employee referrals are vital to helping an organization find top talent. Once on board, identifying the employee’s goals, and ensuring appropriate training and mentoring to meet those goals is very important.

The other key to retention is creating a work environment where employees understand and embrace the IT strategy, feel empowered to ask questions, and come up with ideas to support it, execute on those ideas, and receive the credit for achieving the desired results.

Is the rise of “hyperconverged” data center platforms driving IT leaders to take another look at Virtual Desktop Infrastructure?

I believe it is. Even 5 years ago, Virtual Desktop Infrastructure technology was in its infancy stage. From a management standpoint, implementation was a very large investment in both time and people, which in many cases still resulted in suboptimal implementations. It is very different to put all of the desktops into a single environment, similar to terminals attached to a mainframe, but without the maturity in processes and systems within the environment that the mainframe has developed through many years of service. To think that a server, or storage could go down, and no one would have a desktop to work with was very unsettling to many managers at that time.

Today’s “hyperconverged” data center platforms are much more robust, and mature, providing a viable solution for virtual desktop implementation. Virtual Desktops still require a significant investment in hardware, software, and engineering resources, but the underlying technologies have begun to prove themselves much more redundant and reliable, thereby alleviating some of the earlier concerns.

How do you foresee fraud and cyber security evolving in 2015? How should leadership teams at financial services organizations approach this threat?

Cyber security will continue to be a major threat in 2015 and beyond. Organizations continue to ramp up spending to attempt to proactively address key security concerns such as patching, email phishing attempts, etc., but proactive efforts will never be enough.

With so many incidents of compromised customer credit card data, compromised personal data, and espionage being reported in the news, there is a real risk of damaging a company’s reputation, and alarming the consumer, either of which can be fatal to a companies survival.

The current belief is that it is not if a company will get hacked, but when. This has caused significant increases in expenditures throughout the industry for new and better detection and containment technologies, in addition to the normal focus on enhancing prevention of a cyber crime.

I believe integrating Security teams throughout the organization is key. Whether it is project architecture, coding architecture, or every day processes and procedures, the IT security team needs to be involved.

Are you seeing any trends right now in the industry?

Within the banking industry the major trend continues to be customers banking remotely. Foot traffic for monetary transactions in the physical branch continues to decrease as the Baby Boomer generation dies off, with more and more customers doing their banking online, and via their mobile devices. We consistently see reports in the news of banks consolidating their physical locations. This will likely continue in the years to come.

You have over 25 years of experience in IT. What or who do you attribute your success to? Did you have a mentor(s)?

I like to listen – listen to the needs of my customers, listen to the needs and ideas of my staff, and provide them the freedom to get the job done.

My success has been directly attributed to the teams I work with. With three major acquisitions / conversions in the past 5 years, our teams have just done an outstanding job working together. Teamwork is always the key!

How do you retain top industry talent?

Understanding the motivations of your top performers is key in their retention. With the labor market being as tight as it is, just offering a competitive salary is not going to get it done. Your top employees need to understand and believe in your mission, and need to feel empowered to make a noticeable contribution toward its success.

I also believe it is a mistake to micromanage. Top performers like to figure out the best way to accomplish the task at hand, then get it done. Micro-managing drains the creative energy right out of a top performer.

What soft skills do you look for when hiring new talent?

I look for interpersonal communication skills and teamwork. In this ever increasing digital age, interpersonal skills are becoming more difficult to find, and thus a key differentiator in candidates coming out of school. These skills are critical to their success in managing peer relationships, as well as relationships with supervisors and successful participation on project teams.

In my experience, a well functioning team will always significantly outperform the individual contributions of its members. It is truly fun to watch as a team tries, then comes together to exceed it’s goals!

What are the most important characteristics an IT leader needs to be successful?

For their customers, an IT leader needs to be a visionary. They need to understand the requirements of their business partners, and work tirelessly to ensure the latest, most effective, and most efficient technologies are made available to them to ensure they have every potential advantage in the marketplace.

For their teams, they need outstanding leadership and people skills. Their success, and the success of their teams and business partners, often require heroic efforts to meet timelines and achieve results required to give their business partners the “edge” they are seeking with technology implementations.

One final characteristic that I believe truly sets successful IT leaders apart is transparency. Individuals, regardless of standing in the organization need to know what you are thinking. I make it a point to ensure that in all of my interactions, I am as honest as possible with an individual. In discussions with others, this has consistently been one of the traits highlighted as truly important to them, and factoring in to their overall satisfaction with their manager, and subsequently their jobs.

Interview with Shirley Nickels, Founder and President of Sentact

August 20, 2015

Direct Consulting Associates recently had the pleasure of interviewing Shirley Nickels, Founder and President of Sentact. Shirley was kind enough to answer questions about herself, her career, how she acquires new talent, and advice she would give other women starting their careers in the IT industry.

Please tell us a little bit about yourself.

I am the founder and President of Sentact LLC. Since our founding, my role has evolved as our Company has progressed through its exciting lifecycle; from a start up with only a business concept, to an organization that supports healthcare organizations throughout the country. With our growth and the addition of great Sentact team members, I primarily focus my attention on our technology platform and how our existing (and future) healthcare users can more efficiently and effectively meet their objectives with its use in their delivery of care. That includes bringing use-case concepts to life with our expert development group and spending significant time with customers and potential customers understanding their needs today and in the future. Pairing those valuable insights from healthcare experts with Sentact’s core competencies produces exciting possibilities. Identifying future needs that we believe we can most effectively address, become the fabric of our technology road map.

My prior career experiences were focused on solving business process challenges in the IT services industry. I enjoyed breaking down a process into definable elements, assessing each step’s value and efficiency, then putting them back together in a manner that met a specific business need. In essence, that same concept is the foundation behind Sentact’s business model.

Ultimately, I am passionate about leveraging technology to simplify processes and maximizing resources to drive tangible outcomes.

You have over 15 years of experience in IT. What or who do you attribute your success to? Did you have a mentor(s)?

I attribute much of my success to my parents and upbringing. As a first generation American-born child of a large Filipino family, strong work ethic and values were instilled in me at a very early age. My parents immigrated here because of the great opportunities our country provided. They made sure that every one of us understood what was available to us if we applied the right effort. It has been the foundation of who I am. I was taught that you need to earn your keep and value every opportunity no matter how large or small.

Having that upbringing and the good fortune to be part of organizations and great leadership that fostered personal growth gave me the exposure needed to evolve my career path. I have also surrounded myself with like-minded individuals that have challenged both my personal and business goals.

Are you seeing any trends right now in the healthcare IT industry?

As the market expands and IT evolves and becomes more abundant, I find that integration with other systems to provide a broader solution is essential. By allowing for integrations between systems, healthcare organizations have a true solution that allows them to become more efficient as well as productive.

Another key trend in the healthcare industry is mobility. We are seeing more and more mobile devices being deployed throughout healthcare networks. Technology companies are challenged to offer mobile applications allowing support staff, physicians, nurses, and other healthcare employees in the field not returning back to a central office.

What is the most challenging aspect of your job?

We are extremely fortunate to have a customer base that includes many of the leading hospitals and brightest minds in the healthcare industry. It’s always exciting when they come to Sentact with new development ideas or use cases. The challenge however is ensuring that we stay focused on our platform’s core functionality and purpose and not steer away from the long term plan for our services. Maintaining a cohesive service platform that scales and can be appropriately supported by your organization today and in the future is critical.

How has Sentact been able to be so lean and continue to grow rapidly and stay ahead of the competition?

We’ve applied the same rigors to the composition of our organization that we do when we approach an implementation of Sentact for our customers. We simplify our internal processes, leverage technology and constantly re-evaluate our group’s effectiveness relative to our business objectives. It ensures maximum efficiency in everything we do. Our team reflects what we think is a thoughtful approach to making sure our customers receive the best service and support. You can’t grow without satisfied customers. In fact our customer referrals have been the number one source of new business opportunities for us. We have also designed Sentact’s technology to in part, minimize the typically required resources for onboarding a customer, administration of the application, and developing or enhancing the platform. Our resources are freed up to focus on new ideas and value enhancements that keep us a leader in our industry.

It’s exciting that you just went mobile! What else can you tell us about as far as what is on the horizon for Sentact?

Mobile is a big step for us. We recently launched our new platform that features enterprise capabilities, mobile solutions, interactive reporting, and analytics to enhance the user-friendly experience. This was a big undertaking for us and we are currently working on transitioning all of our customers to the new platform.

We are also very excited about the redesign of our BI reporting capabilities. By increasing the reports available to our users and enabling more analytics, our customers gain more insight into their operations to make an impact with the information. Additionally, we continuously explore strategic API’s to leverage our technology and expand its value within our customer base.

How do you find and develop talented employees? How can organizations find, train, cultivate and retain championship-caliber IT players?

Our best source for finding new associates has come from our existing team and in some cases, recruiting partners. Our ability to attract talented individuals lies in the excitement around our technology platform and its impact on the healthcare industry. I’d like to believe that prospective associates sense our passion and become more interested in being a part of it. Our ability to retain talented individuals lies squarely with our culture. Things like compensation and benefits are important. You have to be competitive. But we’ve found that Sentact’s culture is what keeps people here. We empower our team to innovate and lead. We foster and embrace a strong team environment that allows individuals to refine their skill set and enhance their professional experience and personal goals. There are always new and exciting challenges at Sentact that give our associates an opportunity to grow.

What soft skills do you look for when hiring new talent?

Communication and creativity are valued assets. Our development cycle moves fast and we need good communicators to voice their opinion and have thoughtful feedback. Being able to challenge existing process and workflows for alternative solutions keep our services ahead of the curve.

What are the most important characteristics an IT leader needs to be successful?

IT leaders today need to be able to listen and adapt. IT and healthcare are changing so rapidly that it can be difficult to keep up. A good strategy driven by the market is important, but adjusting your tactics to the current climate is critical to success and even survival.

We recently started a “Women in Business” group here at Direct Consulting Associates. As the founder of Sentact and with all of the success you have had, what is the best piece of advice you can give other women in the tech industry who might be starting out or facing challenges in their career?

That’s an interesting question. I’m mindful that we don’t live in a perfect world. Early in my career I didn’t view things through a gender identity prism. However, after my first experience being the only female as a quality assurance consultant of a large financial institution’s help desk of 10 males, I quickly realized how gender can indeed play a role in impacting the success you attain in your job. That experience taught me how important it was to persevere and maintain my confidence to make an impact.

And after many meetings where I’d find myself in a male dominated room, whether it is IT, facilities management, or C-suite executives, I know it’s imperative to make that first impression count as it can eliminate any underlying gender, age or race bias to allow you to really control the outcome.

Interview with Matthew Clark, Senior Director of Global Infrastructure, Qualcomm Inc.

June 24, 2015

Direct Consulting Associates recently had the pleasure of interviewing Matthew Clark, Senior Director of Global Infrastructure at Qualcomm Incorporated. Mr. Clark was kind enough to answer questions about his career, Qualcomm, the challenges he faces in his job and overseeing a global company, how he finds and develops talented employees, current trends and the direction of IT.

Please tell us a little bit about yourself.

I’m currently the Sr. Director of Global Infrastructure at Qualcomm Incorporated. I am responsible for leading the architecture and operations of multiple teams including security operations, externally hosted application support, middleware services, database administration, Windows, Linux and Unix servers, storage administration, virtualization, email and collaboration, and engineering support. I have over twenty years’ experience in management of distributed systems and infrastructure technologies. I hold a B.S. degree in Engineering from Trinity College in Hartford, Connecticut and a Masters in Architecture-Based Enterprise Systems Engineering from the University of California San Diego.

I am very proud of the global teams I have worked on and have established over my career at Qualcomm. My current team is approximately 475 full time employees with $200M+ Operational Expense budget. I reside on a number of executive advisory councils including HP, VMWare, and Oracle.

I volunteer my time to 2-1-1 San Diego. 2-1-1 San Diego connects people with the community health, disaster services through a free, 24/7 stigma-free phone service and searchable online database. Using the power of technology and innovation 2-1-1 connects people to the help they need instantly.

What does it take to be successful in IT?

To be successful in IT, you can’t do it behind your desk. It’s important to manage both vertical and horizontally. Vertical meaning your employees and your management. Horizontal meaning your customers.

As an IT leader, it is essential to have your priorities aligned with the business. I have seen many CIOs purchase IT products and services to solve a non-existent problem. The closer you are to your customer and understand their challenges, the more effective an IT professional you will be.

Over the years, I have had many different mentors. Having a mentor that you meet with on a routine basis is an important tool in the IT professional’s toolbox. Reaching out to someone for coaching/mentoring who is one or two positions above you AND does not report into the same manager as you, is priceless when working through challenging situations throughout your career. I also realized very earlier on in my career that I could gain more knowledge by listening and learning from other’s accomplishments as well as their mistakes.

Are you seeing any trends right now in the industry?

Cloud, Big data… OEMs are stating that these are the silver bullets for all IT professionals. I see them as revisions of technologies which IT professionals have utilized throughout their careers. These 3 technologies need to be on your roadmap and part of your strategic direction.

Cloud doesn’t necessarily need to be public. Many of us IT professionals may not be able to obtain approval from their company executives or legal teams to move data out of your data centers. However, you can still have an internal private cloud strategy. You can still increase the utilization of your workloads/applications of your existing virtualized environments and allow these workloads to shift across physical servers depending upon various characteristics. Cloud is about utilizing the appropriate, most efficient, and cost effective workload/resources for the application at hand. Many times these are the resources you own in your data center already.

Big Data. Not every company needs to have a Big Data initiative. However, Metrics and Analytics are important at any level and in any organization big or small. As an IT professional, you need to know how well you and your team are providing service compared to industry standards or your own goals.

What is the most challenging aspect of your job?

The most challenging aspect is managing and maintaining a cohesive global team across multiple time zones. With 40% of my staff in India supporting our local and global engineering needs, 5% of my staff in Ireland supporting our global needs, and 55% of my staff located in San Diego, it is very challenging keeping this IT infrastructure team running at full speed.

The key is communication. We have implemented Telepresence in the majority of our offices. Email and phone calls are not as personal and doesn’t promote a strong team bond. Video calls give you the personal face to face touch and let’s your global team know they are important and essential to the success of the IT organization.

What are some of the challenges you face overseeing a global company?

Because of the time zone differences, it is important to be flexible and adaptable to having meetings at 9/10 PM or 5/6 AM in the morning. I am also connected 24/7 and routinely on calls or responding to texts all throughout the night. This is just something we will all adapt to over time in this globally connected world.

What has been your key to success in transforming existing IT teams into robust, flexible, and cost effective IT organizations?

If I had to nail this down to one aspect it would be clear understanding of the IT strategy and ensuring each IT employee knows how their role is important to the success of this strategy. It is very common to have IT employees not understand how their job relates to the success of the overall IT organization much less the Business strategy and direction.

I have found it is very important to talk informally to your team members in the hallway or any other opportunity to ask them what they are working on. You can easily determine how excited they are about their job. Spending a few minutes and listening to your employees will give your insight into the breadth and versatility of your organization.

How do you find and develop talented employees? How can organizations find, train, cultivate and retain championship-caliber IT players?

Talented employees follow and know other talented employees. I can’t stress enough how many employees have been hired through recommendations of current employees. It is also imperative to utilize the OEMs and VARs that you work with to help navigate and find employees around the industry that may be interested in positions that you have open.

Training is important, but it is imperative that employees who are trained in a particular technology share this knowledge with their peers. As an IT leader, performance management of your employees must include a “team work” or “cross training” skill that should be rated and discussed with each employee. A team is not a team unless your employees are sharing their knowledge with everyone.

What soft skills do you look for when hiring new talent?

Communication is the most important soft skill that I look for. IT is long past the days of employees who sit behind a desk and have pizza slid under their door while they resolve issues. IT systems are very complex systems requiring the knowledge and expertise of multiple employees. If an employee can’t communicate appropriately with others, then architecture, development, and resolving issues requires long lead times and reduces the efficiency of the IT organization.

What are the most important characteristics an IT leader needs to be successful?

An IT leader needs to have a number of characteristics including flexibility, fiscal understanding, and charisma. But I want to focus on one aspect here and that is vision. IT leaders need to have strategic 1, 3, and 5 year plans. Your one year plan needs to be fairly static and perfectly aligned with business objectives. Your 3 year strategic plan should focus on technologies that you are currently investigating and may potentially begin to implement within the next year. Your 5 year strategic plan should be completely visionary and will change each year. Don’t be afraid if your 5 year strategic plan changes dramatically within a year. That is good and ensures you are looking at forward thinking technologies and how they may fit, change, or enhance the business.

Another aspect which I feel is very important is fostering transparency and open dialog across your organization. I have recently begun having interactive town hall meetings allowing employees across the globe to ask questions “on the fly” directly to me and answered in real time. This has built a stronger, trusting and more supportive organization. Open communication builds trust. Employees trusting management and one another is key to the success of your organization. This doesn’t mean everyone needs to agree all of the time. As long as the team agrees on the problem to be solved, each person can agree to disagree on the solution of that problem. It is up to the IT leader to foster this open communication so all employees feel their thoughts and solutions have been heard.

Awhile back you said in a presentation that everyone is gambling with their data centers today. How are self-healing data centers the answer?

Data centers are loosely coupled complex systems that require a lot of care and feeding. Most IT professionals don’t notice (or don’t care) about the facilities infrastructure that is required to maintain a data center. Make friends with your facilities team and take a tour of all the infrastructure required to maintain power, cooling, and security of your data center. You will be amazed of what it takes and then soon realize just how fragile the mechanics of these systems. Thus why dual redundancy of these facilities is not enough to maintain the service levels your application consumers have come to expect.

Self-healing data centers is another concept to allow IT Infrastructure organizations the ability to determine when a facility issue could potentially occur BEFORE it happens. Giving the IT teams the time to migrate workloads to a safer portion of the data center or to another data center depending upon the characteristics of the potential issue.

How has your previous life as a semi-professional hockey player translated to your success in the IT industry?

Besides being able to handle irate customers? It really comes down to a team. I relate most of the aspects around an IT team to sports teams. Doesn’t matter if it’s hockey, football, baseball, cricket, etc… In all of these sports, a superstar doesn’t win the game. A superstar helps by playing within a system and working with their team to win the game. Superstars who can’t work with a team usually cause their team to lose.

IT is not about having the best CIO, architect, or sysadmin. It’s about having a strong and diverse team. As an example, you wouldn’t put a Quarterback as a Linebacker in football. Each team member has a role and this is the same in IT. A strong IT leader should hire employees across diverse backgrounds to give you different perspectives and ideas on how to tackle the challenges you face.

What are the biggest issues you are seeing with IT security?

Security is the fastest growing area within IT. I feel it has been the past 5 years and it will continue for the unforeseeable future. The only secure system is one that is locked up behind 4 walls, doesn’t have any connections into it, and only one person has biometric access to it. Since this is never the case except for in movies, the challenge is the balance between ease of use and security complexity. There is not one answer to this balance. IT leaders need to understand the level of risk, security and governance that the business is willing to handle.

What role has IT played in improving the agility of Qualcomm?

Qualcomm is a very agile business. We have many different business models and product offerings that are added or divested each year. Engineering, manufacturing, health care, consumer based products, mobile software, etc… IT has played an important role in the success of Qualcomm through our flexibility. In our IT organization, we have multiple support models including tiered classifications across all of our infrastructure. This allows our business units to choose the level of support and gives them a relative cost model for their P&L.

Interview with Jeffrey Pelot, CIO, Denver Health

January 19, 2015

Frank Myeroff, President of Direct Consulting Associates, recently had the opportunity to interview Jeff Pelot, CIO at Denver Health. Mr. Pelot was kind enough to answer questions about himself and the direction of Healthcare IT.

Please tell us a little bit about yourself and Denver Health.

I have what might be a unique history that leads me to the CIO position at Denver Health. Without being overly long winded I trace my path back to the time I served in the Army where at one point I was selected to participate in an advanced weaponry research and development effort. That position saw me trained in the Army’s program for project management. Later during my final duty assignment teaching AROTC at CU Boulder I received a Master of Science in Computer Systems, and then began marketing myself as an IT PM as I was retiring from service. This got me into an entry level PM position at Denver Health, which was just the stepping stone I needed to demonstrate the value of Army leadership training which quickly helped to propel me through the ranks and eventually into the CIO position.

Denver Health is an amazing organization whose mission is to take care of those who are uninsured, disenfranchised or homeless. This is a mission that is community focused and the employees of this great company feel tightly tied to the community creating a caring and giving culture. This is truly a wonderful place to work.

There’s a lot of discussion about the need for patient empowerment, getting patients involved in their care and having some control over their episodes of care. Are there any projects that you’re working on to address that?

Denver Health has taken on patient engagement and patient experience as our number one strategic initiative. So all aspects of how we better incorporate the patient into their episodes of care and more importantly in their long term care for chronic conditions is top of mind. An example of that is our Ambulatory clinic Board of Directors, 50% of the membership is comprised of patients.

We have invested heavily in two way patient communication to our patients using automatic SMS messaging for appointment reminders, step counts, diet support, A1C levels, etc. with the intent to make a patient’s engagement simple and effective, this has been met with very good success by the way. To do this we took the concept of CRM and have applied its principles to the patient experience.

What is Denver Health doing or what are you looking for in terms of analytics and population health management?

Business intelligence and data analytics is a huge growth area for Denver Health. We have employed two data scientists, a relatively large team of warehouse/analytics experts and we are continually improving our approach to population health management through smart uses of data. It helps that Denver’s Public Health department is a business unit of Denver Health. They have been aggressively building out data sources to focus on population health for all of Denver using warehousing, CDC information, GIS and many other data sources; plus there is a major focus on quality indicators that are predictors of “patient health”.

How would you characterize the current state of IT security in healthcare?

There are numerous challenges that we face in Healthcare IT security. Regulation requires the sharing of information and conversely regulation requires the extreme protection of that same data. This is a difficult and costly proposition which is further compounded by legacy systems which are virtually wide open. Further compounding this is a very active threat environment for anything or anyone that touches the Internet.

The real dollar value of patient records is quite high, much higher than just credit card information which makes all of us a desirable target. Coupled with active attacks, malware and more the environment of the World Wide Web is a toxic and dangerous environment.

The tool sets available to provide adequate protection are costly and complicated and frankly they provide no guarantee of safety or security. There are so many examples of how the bad guys are able to get at that which we are so interested in protecting. They get at it through Advance Persistent Threats, malware, drive by attacks on web sites, phishing and sometimes through efforts sponsored by nation states like we recently saw with Sony, and not to mention the very real threat of social engineering. Hospital systems cannot assume that they are protected and should realize that the data is already at risk. The best course of action is to make use of the data difficult through encryption and segregation and to prepare for the inevitable breach.

Finally the wave of the need to be more mobile on a variety of devices brings a whole other world of security challenges. One that I think we are up for currently, but in the future I am betting that the world of cloud computing will be the only affordable way that we can ensure that our data is protected.

In terms of innovation, what system-wide initiatives are you currently working on to improve and expand Denver Health’s use of technology?

There are many IT initiatives at Denver Health that directly support the organization’s strategic imperatives. Most of these are centered on financial growth and stability, patient engagement and quality, system stability and reliability, etc. Of course this list would not be complete without mention of the fact that we are replacing our current EHR for a more robust and innovative system.

Nevertheless, telemedicine opportunities, the incorporation of smaller healthcare systems and practices onto our platforms all offer an explosive opportunity to take advantage of IT innovation.

Over the last 10 years, how has IT changed the way that patients receive care and in your eyes how has it affected care-givers ability to provide quality care?

Healthcare IT is still awkward at the face of patient care causing gaps in the way nurses and physicians practice their trade. At every intersection we have placed some form of computer system between the patient and the care giver. Our thirst for useful data/information has caused the “story” of the patient to be diluted into drop down lists and constrained fields where copy and paste is the norm. Gone are the days of the rich narrative that was represented in the paper charts of old. Until this gap can be addressed I do not believe that we will have truly effective IT at the point of patient care.

Remember the halcyon days when a physician could very rapidly scan a paper chart and actually know the salient points of the patient’s history, current complaints, medication lists and more; all before they laid eyes on the patient. Today the electronic record has to be opened and a series of web pages has to be navigated before the care giver has the same level of comfort with the right information for the patient in front of them (they very likely will not know the patient’s name until they have interacted with the computer).

Until this very simple problem is addressed I do not believe that IT will truly be successfully replacing the paper record. We are moving that direction with these newer, single database highly feature rich systems, but it won’t be until we can give the provider back the narrative that we will truly be effective.

In spite of this the quality of care does get better and better using EHRs. There is so much information, so many advances every day in how we handle disease states, in how to administer medication, in what tests are available such that no one can retain all of that information and keep up with new data. IT systems make this easy, so yes care is getting better but the systems still have to improve.

Big Data and its expected benefits should address some of this and coupled natural language processing the future looks very bright.

What do you see as your biggest challenges and opportunities in the next few years?

Every year brings new challenges to healthcare. The regulatory aspect for healthcare reform has been costly and difficult to keep up with. The government has to bring some sanity to what they are mandating healthcare systems do to stay compliant.

It is very likely that the current reform laws will be costly for the lower income consumer, which will lead to do-it-yourself healthcare which will further lead to patients presenting to hospitals with advanced disease states that most likely will be difficult and costly to control. This can be ameliorated with population health programs in many cases but for mental health concerns, which are on the rise, only the opportunity to get care will help.

Security concerns will intensify month over month with the Internet becoming more and more dangerous. To counter this we will see cloud offerings become more robust and certainly more affordable. We need to be ready to take advantage of cloud offerings in as they develop a “sweet spot” for healthcare offerings.

Technology costs will soar in the face of decreasing reimbursements. Keeping systems up-to-date and fully functioning will be a costly adventure further eroding operating margins, but conversely they will make the cloud more palatable.

Thus far in your career, what do you feel is your greatest accomplishment?

I tend not to dwell on past accomplishments, there is much to do on this journey and getting side tracked with past work is not all that productive. However, I do look at past accomplishments as incremental steps to achieving larger strategic objectives.

Do you have a mentor or mentors that helped contribute to your success?

There are several people that I look to as role models; several fellow CIOs locally and nationally, extraordinary physician leaders and past military leaders that I have worked with or under. I have sought out CIOs in various industries that have been willing to provide mentorship or act as sounding boards when I have been faced with difficult situations. I also look to my immediate cadre of direct reports whom I have great faith in for their insight and leadership. This job is much too important for me to think that I have the answers all of the time.

What do you feel are the most important characteristics an HIT leader needs to be successful?

HIT leaders need thick skin, they must be extremely versatile, they must believe and practice broad organization collegiality, they must be able to listen and to empathize, they must be able to develop trust in subordinates, they must trust their peers in the organization and they must trust the hospital leadership, they must have a sense of humor, they must possess or foster a cooperative nature, they must not let their ego lead them and most importantly they must be willing to put themselves in the shoes of the care giver and the patient.

What are your philosophy and/or methods with regards to retaining top talent?

Our people are our business, in the Army we oft stated “mission first and people always”. This is a philosophy I think about every day. Take care of people and they will take care of you.

Nevertheless we cannot guarantee anyone the levels of success that they are searching for in their careers, but I will flatly state that I have enjoyed very little turn-over of staff while an HIT leader and that is because I try to recognize what people have to offer, what they desire and then try very hard capitalize on those characteristics. I expect results from everyone, I expect people to be able to think on their own, to make sound decisions and to operate in the face of no specific guidance. What I have learned is that people thrive in situations like this because they know they are making a difference and they know that they are valued.

Interview with Vincent Johnson, COO, UC Davis Medical Center

DCA had the opportunity to interview Vincent Johnson, Chief Operating Officer at UC Davis Medical Center. Mr. Johnson was kind enough to answer questions about himself and the direction of Healthcare IT.

Please tell me a little bit about yourself.

Before becoming the Chief Operating Officer at University of California Davis, I was the VP of Administration at Shands Healthcare. Then six years ago, I started working with UC Davis, which is a tremendous organization. We really work hard to make investments in technology. We are 160% invested in Epic and continue to improve patient care—that is very important to us.

With regards to being able to improve the quality of care, part of the quality is patient experience so we’ve focused a lot on access (i.e. patients being able to schedule their own appointments) and a lot on patient satisfaction. With measurements and the future—patient satisfaction is the key to reimbursement. It is going to be important to both ensure a transfer of information both in the inpatient and outpatient setting, and to the primary care doctors after specialty care is rendered. That is what we at UC Davis are continuing to work towards and focus on.

UC Davis Medical Center has been named a national leader in health information technology. You’ve received numerous awards including the 2013 Enterprise HIMSS Davies Award, 15 consecutive Consumer Choice Awards, and have been ranked among the ‘most wired’ hospitals nationwide. In terms of innovation, are you doing anything that would be considered risky or offbeat or using smaller companies that few people would have heard of?

Absolutely not. It’s not so much that we are name-brand-biased, however, given the size and complexity of the University of California almost everything that we do is subject to regental oversight. We ensure that there is a pretty rigorous process before you can do business with the university—there are a number of different steps you have to run through.

You established and chair the Operational Improvement Committee at UC Davis. What quality improvement initiatives are you currently working on? 

The Operational Improvement Committee (OIC) started out as a way of ensuring that we have the right manpower resources—that the hiring committee and staffing decisions were made not in a vacuum but with the input of a number of the different senior managers. The OIC includes myself, the chair, and also includes the Chief Financial Officer, Chief Nursing Officer, Chief Medical Officer, Directors of various departments, and Human Resources. A lot of the discussion and dialogue is about workforce, re-engineering, using lean concepts, and trying to determine rightsizing the institution. That is what it was initially meant to do. Then over time it has developed a quality focus. This is more of just an overview because quality is not just one thing—it is so, so many things. For example, we were just awarded status for our primary care sites as being patient centered medical homes. That is an initiative that is quality focused but also operationally driven.

What is UC Davis doing or what are you looking for in terms of analytics and population health management?

We have a population health division and are looking at the potential of a global health school (it’s in its early stages). What we are really doing now, and the reason I mentioned the primary care patient centered medical homes, is that we are doing a lot of things in terms of looking at what is called REAL data, which is race, ethnicity, and language data. So we are trying to catalog and get some pretty significant information about the types of patients who we are seeing. That is very much a part of what we are doing around population health and the patient centered medical homes. We are also in the throes of incorporating some LGBT questions—to the extent of not getting involved in people’s personal decisions but it is very true that knowing an individual’s sexual orientation can help in terms of treatment plans and sensitivity and so forth.

Over the last 10 years, how has IT changed the way that patients receive care and in your eyes how has it affected care-givers ability to provide quality care?

The biggest thing over the past 10 years is the electronic medical record. What we used to hear more than anything else was the frustration on the part of the physicians—when a primary care doctor has a patient that is seen by a spine doctor and then they go back to their primary care doctor and there is no knowledge of what the spine doctor found or a way to communicate that. EMRs definitely helped with that and made it so that information can get out in a much timelier manner.

Have we reached a point or are we close to a point where the improvements and benefits in patient care through the use of technology justify the cost of IT spend and if not, where do you think that breakeven point is?

Quite frankly, no. I think that there are a number of different questions to ask about that. I think on average, academic medical centers spend about 7% – 10% of their margin on IT investments. To the extent that there is a real cost based justification to the pretty significant investment—we’re asking those questions fundamentally as a medical center and also as a health system and as part of UC health. The Gartners of the world and other partners are trying to evaluate and validate the value associated with IT. One of the things that has been a pleasant offset is what is being incentivized—the meaningful use language associated with/engagement with CMS and others and has fueled and offset some of the cost of IT. But it is a pretty significant investment, needless to say. And then it is not just the initial investment but the ongoing maintenance and ongoing investment that has to be made as well.

You have had a lot of success in various roles nationwide — How have you successfully transitioned into these new roles? 

In general the most important talent that an individual can have, particularly going from one institution to another and one city to another, is the ability to listen. It is important to try to figure out how you can help. How can you help the organization meet its mission, vision and values and be a servant leader for that, any way possible? That is probably the biggest thing—to be able to communicate and listen. Listen twice as much as you hear. As I am fond of saying: God gave us one mouth and two ears so we have to listen twice as much as we talk. That has really helped me.

What is the biggest challenge you have in recruiting talent?

Recruit talented people. The technical pieces of the job are the easy pieces. The hard part is the fit. The fit can be culture, it can be work style, work ethics, and those kind of things I’ve found can trump someone who can be very successful doing the job. It is not always about the talent of someone, but work style. My philosophy is that talented people like to work with other talented people. But again, culture trumps the technical ability to be successful. That is everything.

What do you see as your biggest challenges and opportunities in the next few years?

Trying to balance the resources that we have. Trying to see as many patients as we possibly can for the right reasons and do the right things. We’ll have to see the impact of the Affordable Care Act. There has also been a lot of discussion about ICD-10-and it being delayed more and more. Now it’s delayed for more than a year, maybe longer. And now the real challenge with that is that we’ve made the investment in trying to prepare—we have a computer aided system to help us with coding and living in the coding world of ICD 10—but the rest of the world has already gone to ICD-14. So we’ll be behind as soon as we make the jump to 10. Just by the very name itself—it is 2014 so it is already 4 years late. I think those kinds of decisions and those kinds of challenges will be what healthcare executives will really be faced with next year—trying to balance the investments that we’ve made to make it all work right.

What do you accredit the significant delay to ICD-10?

I think that when you talk about going from 14,000 codes to 70,000 codes it has got a great deal of complexity in it. Living in California there was a State Bill 1953 that said all hospitals in California would be seismically compliant by 2017. Well again, that sounded like a really laudable goal—to make sure that health systems can withstand an earthquake of anything greater than 5 or 6 on the Richter scale. Then folks started to think about the investment and saw that for a hospital to do that—they couldn’t afford it. I think the same thing is true with a number of initiatives going forward. Some of them have the best intentions but just aren’t affordable. And rather than penalizing institutions and causing hospitals to close down because of lack of compliance, we have to think of things in a different way. Once we do that we will be able to solve some of those problems but until then it’s going to be lots of starts and stops and reconfigurations and those kind of things.