Interview with Mony Weschler, Chief Technology & Innovation Strategist at Montefiore Medical Center

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.

Interview with Yiscah Bracha, PhD, Research Health IT Scientist, RTI International

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.

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 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.

Always Be Job Hunting by John Yurkschatt

Just as companies are always recruiting even if they’re not currently hiring, you should be on the look-out for your next opportunity even if you’re currently employed.

I know what you’re thinking right now… You finally found a great opportunity so why should you keep your job search going? Well, it’s easy to think that you’re all set and there’s no more worrying about a job. However, in today’s job market, that’s the wrong way to think.  You should always be thinking about your next career move and how you plan to get there.  Remember, no one is guaranteeing that your current job will last forever or even one year.

So what should “always be job hunting” mean for you? I recommend taking the following steps:

1) Build and develop as many skills as you can at your current job. A wide assortment of skills enhances your resume and makes you more attractive to the next employer.

2) Build your own personal brand.  Make sure you present yourself in a good light and professional manner on social media outlets. Be sure your LinkedIn profile is up-to-date and post your latest skills, responsibilities, etc.  Also, don’t be shy about asking colleagues for recommendations.

3) In conjunction with #2, if you are in a management role and want to be recognized as a “thought leader”,  get involved with your company’s marketing, PR or social media team and volunteer to be a guest blogger, public speaker and/or write white papers.  Always strive to enhance your personal portfolio.

4) Join associations that are relevant to your career and industry and get you known.  Networking is too important to put on a shelf until you are out of work.

5) Volunteer in your community. Volunteering is great way to give back but to also meet new people who can introduce you to other people in the know.

6) Keep an eye on companies that are of interest to you.  Ask about their reputation, when they’re hiring and their company culture.  This way, you’ll feel more in control of your job search. It’s better to be proactive than passive.

If you can add to this list, please leave your story or comment below.