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CIO Unplugged – 3/15/10

March 15, 2010 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Connected Health
By Ed Marx

One of my favorite preteen games was Connect Four, the vertical checkers game. The objective is to be the first to connect four of your checkers in a row. I often played it with my children when they were young, and inevitably one of them would bump the catcher base prematurely and send all the checkers rolling onto the table and floor. But, oh, the fun we had playing.

I’m now playing a new kind of Connect Four. I am not sure who first coined the term connected health, but I like it. Where my organization has labeled our mobility strategy “mHealth,” we call our connected health strategy “cHealth.”

“But,” you ask. “Is this really a strategy worth my promoting efforts?” What about the whiners and traditionalist? What about the departments that insist on doing things their way?

This is a do or die reality. In Going Mobile, I argued that we must drive mobile computing into our strategies or risk getting lost in backwoods roads and putting our organizations at a serious competitive disadvantage. A twin sister to mobility is connected health.

In his sentinel book “The Innovators Prescription,” Christensen advocates dropping the private-public debate. He says we need to disrupt the way in which healthcare is delivered today. He points out that the way to cut costs is to put care and insurance in the same bed. Emerging models include Accountable Care Organizations (ACO) and the medical home. Each of these requires the four traditional silos—hospitals, physicians, payors, and patients—to break down barriers and act as one entity for the sake of patient centered care.

Essentially, to Connect Four.

Today, healthcare suffers under a fragmented care network. Embedding connected health into our hospital’s strategic thinking and summarily executing that strategy will set future success in motion. And yes, we’ll have to brave those who try to tip the catcher base and disconnect all our checkers. But may we never be the cause of IT atrophy!

Health Information Exchange (HIE), while critical, is not the same thing as “cHealth.” Think of HIE as 1.0, and then bump “cHealth” to 2.0 status. HIE shares some common traits and can create the infrastructure, but “cHealth” disruptively advances the transformation of our healthcare ecosystem. The leader who settles for a business-as-usual attitude is probably stuck in HIE.

Let me give some “cHealth” examples. These are purposefully high level so not to divulge strategies specific to my employer.

Patient Portals
Personal Health Records
Mobile Connectedness
TeleHealth

Between Physicians
Between Hospitals
Between Hospitals/Physicians
Between Hospitals/Patients
Between Physicians/Patients

Wellness Programs
Secure Messaging
Home Care
Remote Monitoring
Wireless Monitoring
Education
HIE
Payors

We all understand the fragmentation of healthcare processes and costs in existence today. “cHealth” provides alignment. By executing “cHealth,” we’ll have the connectedness necessary to actualize ACOs and Medical Homes—providing the highest quality of care at the lowest price point—Ultimate value.

Connect Four. Who would’ve guessed that we could learn so much from a kid’s game? Except now the stakes are much higher.

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. (Use the “add a comment” function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists.”

CIO Unplugged – 3/1/10

March 1, 2010 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Manage Your Aura
By Ed Marx

1997. The reverberating rave music generated a hip vibe. Cameras flashed as bright lights drew the crowd’s attention to the student models. Attending my first fashion show, I sat at the end of the runway—as one of the judges. I felt like a punk rocker at a symphony. The dean of my alma mater had appointed me to the board of the fashion school (long story). My fellow judges—all of whom were in the business of fashion—and I were responsible for appraising the undergrad and graduate champions of design. Initially excited about the opportunity, I quickly realized my business skills didn’t match my responsibility as fashion critic. (I hear your laughter. My daughter agrees.)

But I gained one valuable lesson through that experience. The beauty of a model or her/his clothing design didn’t captivate me; the confidence with which the model walked did.

Lacking the typical, requisite seasoning for a CIO, I fell into the position at a young age. My CEO asked me what I needed to be successful. “Two things,” I replied. “A year of formal mentoring from you and a ticket to the CHIME CIO Boot Camp.” I received both.

Although the Boot Camp curriculum and instructors proved incredible, time spent with my group leader influenced me most. Here’s one of the many pearls I received from John Glaser: “Learn to manage your aura or someone will manage it for you.” I took his wisdom to heart.

Aura defined: a distinctive and pervasive quality or character; air; atmosphere. In the 7 years since my Boot Camp graduation, I’ve aggressively assimilated this golden nugget. Borrowing from my friends in marketing, you have to brand or be branded. Here are a few ideas.

Network. Continually expand the breadth and depth of your professional and personal network. Proactively reaching out to others saves you from isolation and becoming irrelevant.

· LinkedIn

· Twitter

· Facebook

Publish. Editors are interested in genuine stories from real leaders. Send queries and don’t give up when initially rejected.

· Magazines

· Online services

· Blogging

Present. Get over your fears. Presenting forces you to nail your subject matter and confront fears.

· Professional societies

· Neighborhood associations

· Your organization

· Church, Synagogue, etc

Involvement. Jump into the community. Let leaders know you are interested in adding value.

· Professional societies

· Special interest groups

Volunteer. Find regular opportunities and your network will expand.

· Internally

· Externally

Routinely self-Review. Build in times to review progress and make adjustments. Ask for feedback.

· Update your Brand

· Develop a career strategic plan

· Ask your mentor

Education. Take the initiative to self-educate. Learn from inside and outside of IT and healthcare.

· Blogosphere

· Marketing resources

Add to Existing Body of Knowledge. Comment on what others have to say. (You don’t always have to be the author.)

· Post to blogs

· Contribute whenever the opportunity presents

No action will spoil your aura more than damaged credibility. So while I’m all about a personal hallmark, it must be built upon a solid foundation of execution. These are not sequential tasks. Proactively improve performance and brand simultaneously.

Keep your aura in perspective, and let this humble you. The value of a stellar aura should reach far beyond its owner, and its primary benefits should accrue to the people and the organization served. If not, then it’s all about you. Possessing a personal brand, which should never come from arrogance or false humility, is key to success. For without it, you are allowing others to determine your brand.

You’re on the runway, lights flashing, cameras clicking. Make no mistake; the crowd is analyzing your every step. So brand yourself and accentuate it with confidence.

CIO Unplugged – 2/15/10

February 15, 2010 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Meaningful Use Requires Meaningful Leadership
By Ed Marx

A few weeks ago, under authority of the Health and Human Services Secretary, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator of Healthcare Information Technology (ONC) issued proposed regulations on the definition of meaningful use and the initial set of standards, implementation specifications, and certification criteria for EHR technology. Certification criteria specify the capabilities and related standards that EHR’s must include to support the proposed meaningful use Stage 1 requirements for eligible professionals and eligible hospitals. The comment period will end shortly with the final rules released this year. The industry’s wailing and gnashing of teeth is in full force.

As a taxpayer, I’m pleased with the IFR. My concerns that the industry would water down Stage 1 requirements have been largely dispelled. Meaningful use was designed as an incentive-based initiative. As such, it strikes a healthy balance between attainment and stretch. It’s not a welfare program, and not everyone reaches Stage 1 in year one. If that were the case, IFR would not be an incentive program. I praise the government for raising the bar high, and I urge them to stand their ground.

When does tolerance of low standards begin destroying value? Is not an underlying lack of fortitude detrimental to the overall fitness of our nation’s healthcare? I get invited to dozens of meetings and surveys all aimed at lowering the bar. Well-intentioned organizations exercise political freedom and amass collective resources (including financial and personnel). Online and traditional healthcare media are whipping activity into a frenzy. We’re inundated with position papers, press releases, mobilized lobbyists, and pundit opinions.

But I’m convinced that if we channeled the above energy and focus into meaningful use, more organizations would lift themselves over the bar.

Leaders. Avoid the temptation to jump on bandwagons that lower the bar. Make your opinion known and then get about the business of attaining meaningful use. While the lazy lament the IFR, you be the catalyst that makes meaningful use a reality for your hospital and physicians. Demonstrate meaningful leadership.

CIO Unplugged – 2/1/10

February 1, 2010 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Leadership Equations
By Ed Marx

It was the department chairman, emergency medicine, University Hospitals Case Medical Center. “Ed, this is Dr.Michelson, do you know what is going on in our emergency department right now? He was so upset that I thought I was on speaker phone. I could tell he was calling from our pediatric level1trauma center. I politely ended the call. As a new CIO, I did not want to have impersonal relationships. I wanted to talk face to face.

There he was directing traffic and evaluating patients. One of the IT applications had failed which was wreaking havoc on their process flows. While there I noticed that we could alleviate some of the cramped conditions by updating their technology. While it took a couple of hours to restore the application, the next day we gave back additional space to the ED. Simple things like replacing monitors, PCs and printers.

I received a call the next day from the Chief Medical Officer. “Ed, I heard what happened yesterday. Nice work. That is the first time a CIO ever did something like this. Left the comfort of the ivory tower and walked the walk”. Soon the story went viral and the benefits to an eye to eye approach become clear. I would coin the term i2i and encouraged its adoption by all in my IT division. I started to live it. I stopped handling serious matters by email or phone. I did presentations of i2i for other departments. I was maturing as a leader.

I also began to use i2i for crucial conversations. I began to confront others i2i. We had a physician executive who routinely abused anyone who he believed stood in his way. Because he produced results, his behavior was tolerated. After exhausting escalations with chain of command and human resources, I took matters into my own hands. Over coffee, I mustered my courage and laid it out in no uncertain terms to this senior officer. He tried to look away but we connected i2i. He hid behind his coffee cup but my message landed. That was the last time he abused my staff.

I received a call from the medical director of one of our newborn intensive care units (NICU). This NICU is consistently ranked in the top 5 across the nation. After several attempts to get resolution on some technical matters, she and her administrative staff had become rightly exacerbated with IT. They had 20 mobile carts for their NICU and only 2 were operational. She stated that their nurses and physicians would literally stand in line to update charts and enter orders taking care of the sickest of the sick. I myself was growing angry listening. I had seen this escalate over the last couple of days and was certain IT had provided resolution. I told the medical director I would be right over. I called the Service Desk as I walked over to have the manager and 3 technicians meet me at the unit. I could not believe what I saw. All these beautiful tiny babies and sure enough, nurses and physicians waiting around to use the limited carts. The sides of the halls were littered with unusable carts as if a tornado had passed through. I became indigent. I approached the medical director and you could see the tears in her eyes because she was so upset. The only thing I knew what to do was to embrace her and we both cried. Frustration, anger, compassion. There was release. Someone cared. Now time to execute. I learned it was key to meet emotion for emotion, or e4e.

My staff arrived and I had them go to the other floors and see if we could borrow carts from other units. In 30 minutes we had 10 working carts. Others were replaced or repaired within 48 hours. I returned to our IT offices and my director and VP of operations were still talking about what to do. I replaced them.

i2i and e4e are part of my nature today. While there is no formula to leadership, these equations provide a reminder that at the end of the day, nothing demonstrates care and commitment like looking someone in the eye, and weeping with those that weep and laughing with those that laugh.

Technology is the easy stuff. You are not a leader because you know technology.

CIO Unplugged – 1/15/10

January 15, 2010 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Why I Fired and then Rehired Myself
By Ed Marx

I received a message New Years Eve from a former colleague in human resources at University Hospitals (UH). In response to something I’d shared a few years back about firing myself, she said, “I loved it so much I’m firing myself today, too. Monday will start a fresh look at my job (that is, if I hire myself back).”

I think we all should give ourselves the pink slip.

A few years ago, Intel was losing market share and profitability. Consequently, the company floundered. Knowing it was a matter of time before the Board would take mending actions, the leadership (Grove, Moore) discussed a particular phenomenon they’d observed. Nearly every time a company or division installed new leadership or brought in consultants, outcomes improved. They concluded that the new leader came in energized and with a fresh pair of eyes. Knowing he was being evaluated, he took his responsibility more seriously than a tired leader.

Needless to say, Intel’s old leadership had a brainstorm. Why not fire themselves and come back to the job as the “new” leaders? "If existing management want to keep their jobs when the basics of the business are undergoing profound change, they must adopt an outsider’s intellectual objectivity." They fired themselves over a weekend, and, after shifting markets (memory chips to microprocessors), Intel became the clear leader in a very competitive market.

Although UH and IT weren’t in dire circumstances as was Intel, we needed to guard against complacency. I challenged my leaders to follow my example and take time over the holidays to reflect. Pondering how you would approach your position as a new employee is a healthy and worthy assignment. Look at yourself as a potential candidate for your position then ask: How will I evaluate the talent, change processes, and service mix? Should I alter my interactions with customers, my personal engagement, or my attitude? Will I embrace innovative ideas I formerly rejected/feared? What strategies and tactics will I deploy to ensure business and clinical convergence with the health system? Do I have the courage and fortitude to remove employees that no longer add value? Am I stretching the boundaries of innovation? How will I be a better servant…?

The variations are endless! To survive, you probably won’t need to change anything you’re doing. But to thrive means constantly reinventing self and operating differently. We embraced change, adopted an innovation oriented culture and began to walk in the fullness of our authority. What Got You Here Won’t Get You There.

Several other University Hospital leaders fired and rehired themselves that New Years Day of 2007. The result? We experienced a dramatic shift moving from transactional to transformational services that had a net impact on our business and clinical operations. Our business, quality, and service metrics shot up to new heights. I experienced exponential growth, personally and professionally.

I’m due for another firing. What about you?

CIO Unplugged 1/1/10

January 1, 2010 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Think with your Heart
By Ed Marx

Will it bust your view of me to know I cry at work? It’s true. Whenever I give a tour or visit staff on a floor, at some point I excuse myself and cry. I can’t help it, especially after talking with skilled clinicians who demonstrate sympathy. Seeing the patients overwhelms me, and starts me thinking about the sanctity of life. My heart swings between brokenness and compassion, between impressed and thankful. And this all drives me to keep doing what I do.

I never want to forget that I’m here to serve those in their most vulnerable, and often dire circumstances. One benefit of no longer having an office is my increased time spent in our hospitals and on our patient floors. My weekly leadership meetings—when we do meet in person—are often held at one of our medical centers.

Why do I make my team do this, you ask?

A few years back, I realized that what separated the top performers from the average worker was neither skill nor experience but talent. Further analysis revealed compassion as the key talent. Top performers connected skills with compassion. They linked their hearts to their brains.

I had to help others understand that what they did daily affected a patient’s life. But how? A motivational speech might nick their emotions for a day or two, so that wasn’t good enough. I needed an approach that transcended their mental understanding, a connection so strong that synapses would rewire and link the brain to the heart and infect their souls forever.

Since realizing this need, I’ve employed several strategies. The single most effective method is the annual Connections program. This spring will mark my 7th year of Connections. The remarkable happens when you remove the physical barriers between clinicians and those that support them. When a programmer sees the impact of his code on a patient, his heart is changed. When a service desk agent sees the face of the physician she’d helped navigate through the electronic health record, her heart grows a size. Sympathy wakens in the data center engineer when he learns from a nurse that patient outcomes improve because of the technology delivered without interruption. And an administrative assistant understands the urgency of communication when she personally sees the life and death stress.

Their brains tap into their hearts.

Here’s how it works, and then I’ll show you the outcomes.

· Everyone must participate, especially you the leader. (Given how easy it is to revert to insular ways and become ingrown, I keep my connections fresh)

· Speak with your hospital leadership and identify points of contact

· Develop a schedule and begin registration into clinical areas

· Allow employees a choice according to their interest such as ED, OR, Lab, Nursing, Pharm, etc.

· Spend a minimum of a half day with a clinician, full day optimal

· Set up an interactive site to have employees post feedback on their experience

· Follow up immediately on any items clinicians need help with

· Send thank you notes to all clinicians involved

· Repeat yearly

Outcomes:

· Transformations-

“I must admit I hated this idea but did it because I had to. I have worked for the health system for 20 years and for the first time I realized we have patients. Of course I knew what we did as a hospital but really, this was incredibly impacting and I will never be the same.”

“I am not the same today as yesterday.”

“I volunteered to observe in the OB unit. With clinician and patient permission, I witnessed the birth of twin babies. I never realized all the behind the scenes coordination required and it opened my eyes to a whole new world.”

“I never saw myself as part of the patient care process until now.”

“My life is changed; I always wanted to be care giver but didn’t like blood so chose a different path in technology. Now I tell people I am both.”

“I run marathons. I was more exhausted shadowing a nurse today. I never knew.”

“In one day I witnessed the joy of healing and the pain of death. I now see how critical IT is and why we need to be the best that we can be to support the front lines.”

“I am a nurse and did not see why I had to take part in this program. After today, it was like I was hit by a ton of bricks! Wake up call! Thank you, thank you, thank you.”

· The clinicians shadowed learn more about technology. They learn that we care and that they have this incredible support structure surrounding them. This aspect is almost as beneficial as the Connections themselves.

· Respect from operational leaders increases because they see that you care.

· While not scientifically validated, there appears to be an overall correlation between organizational outcomes and Connections.

· As Connections form, employee engagement rises and new talents are created and nurtured.

I love a great speech, giving out raises and bonuses. But evidence suggests these have fleeting influence on performance. In fact, some studies indicate the enthusiasm over a raise lasts two weeks. I speculate this is because money only engages the brain. Conversely, transforming a person’s way of thinking and view of themselves results in long-term effects and a new person. Even the hardest of hearts and the most gifted intellectual will begin to view things differently. Once they’ve connected.

CIO Unplugged 12/15/09

December 15, 2009 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Business Continuity is not Disaster Recovery
By Ed Marx

Colorado 1997. After six tennis matches in two days, I had played my way to the semi-finals of a USTA clay court tournament. The morning of finals, I parked in the lot then went to retrieve my gear from the trunk. I always carried three near-identical racquets to a tournament. If a string busted or the environment necessitated an adjustment, I’d simply grab another and keep playing. A great disaster recovery plan.

This time, however, the trunk wouldn’t unlock. I even tried unsuccessfully to take apart the backseat, which was not a disaster I’d planned for. The match started in 20 minutes, and I had no racket, nor had I warmed up. At least I had my wallet. I found the pro shop and borrowed a couple of demo racquets similar in weight and feel to my own, and then rushed to the court.

Texas 2009. I received a call from work delivering an automated message stating that a disaster had occurred. I immediately joined the virtual command center. Our corporate offices had been shut down and evacuated. This emergency impacted corporate and all our health system facilities within a five-mile radius, which included a hospital and our central business office. Oblivious to the fact our sixth hospital in seven months was Going Live on EHR and a revenue cycle management system, the crisis persisted.

Since corporate was located within five miles of the Dallas Cowboys Stadium, Six Flags over Texas and Rangers Ballpark in Arlington, planning for the worst-case scenario was a must. This drill evaluated how well the ITS division could respond. After significant annual trialing, we had the disaster recovery piece down pat, but we’d never tested our business continuity.

Confidence in our enterprise business continuity, however, could only come after we were prepared. We could never benefit our organization in a disaster if we were personally unable to operate in challenging circumstances.

Here are the lessons we learned:

Leadership

· Pressure reveals character. One whom I thought was a great leader had a complete meltdown. Conversely, one of our quiet leaders surprised the heck out of me. As the one most affected by the drill, she executed brilliantly

· Leaders should never leave their laptops at the workplace

· The borderless office was brilliant in hindsight

Technology

· Ensure you have enough licenses to handle increase in remote workers

· Ensure that all workers have access to systems from home (PC or laptop)

· All departments should incorporate use of remote technology and collaborative tools in daily practice

Communications

· Standardize calling trees and routinely review accuracy

· Call notification system should be branded with a familiar screen ID name so people answer the phone

· Call notifications should incorporate a minimum of 3 touch points per employee (cell; text & call, home phone, work email, home email, etc)

· Call notifications should have the ability to reach successive layers of leadership in the event primary responsible parties are non responsive

· Call plans should be backed up to flash drives and be kept with you always

· Established processes with corporate business continuity leadership to ensure coordination

· Include contractors in call notification processes

· Have multiple options for communications (traditional and 2.0) in the event your primary tools are unavailable

· Given the dependence upon technology in healthcare, set the expectation that knowledge workers are essentially on-call 24x7x365

Logistics

· Develop and routinely review coordination plan with hospitals space availability to house displaced workers

· Code worker badges to allow entrance into all hospitals

· Ensure all workers are comfortable with the remote technology both for traditional and nontraditional applications

· Purchase laptops for all IT workers. This is not the 90s!

Operations

· Ensure the Service Desk in particular is comfortable with business continuity

· Groups less prone to borderless offices tend to be the most unprepared for remote work (Service Desk, Field Services)

· Leaders should conduct more frequent leader-only drills to ensure they can run the organization remotely

· Drills should be conducted quarterly at a minimum so that everyone is mentally/physically prepared for the real thing

· Develop Business Continuity portal with step-by-step instructions on execution

· Seeing as disaster does not discriminate, do not allow exceptions for participation

Other

· Future drills should extend from 3 days to 30 days

· Make sure executives and hospital leaders are aware of the need for IT to conduct business continuity exercises, which may affect operations

· Include executives and hospital leaders in planning and coordination efforts

I was pleased with our first-ever business continuity drill performance, a significant learning experience. As healthcare IT workers, we had a massive responsibility and an obligation to our customers and patients; the show had to go on. I believe the drill better prepared us for the real thing.

Finally, no employee evaluation, leadership assessment, or 360-degree feedback analysis exists that can give as keen of insight as observing people under pressure. Some will search out the spare racquet and win the tournament while others will crumble under the pressure and double fault.

Determine who’s got talent before the next tournament.

CIO Unplugged 12/1/09

December 1, 2009 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Going Mobile
By Ed Marx

“I’m going home, and when I want to go home, I’m going mobile. … Keep me moving…Out in the woods, or in the city, it’s all the same to me. When I am driving free, the world’s my home. When I’m mobile.” Going Mobile, by The Who, 1971 Who’s Next, triple platinum album.

Remember the day you bought your first automobile? Mine was a ’73 green Chevy Vega with a six-cylinder aluminum block—not exactly a dream car, but she kept me moving. The above lyrics speak to the freedom and liberty attached to owning your personal set of wheels. Like a bird released from his cage, I remember cruisin’ town while cranking that song on my cassette deck. Ahh, those were the days….

Today, a similar concept of autonomy manifests in mobile computing. I recall, not too long ago, networking at social gatherings and realizing I needed access to my email, but my computer was all the way back home, plugged into a wall outlet. Thanks to ongoing advancements in technology, a Blackberry Storm now rides on my belt, putting email, internet and other info right at my fingertips, literally.

According to emarketer, 59.5M Americans used their smartphones to access the internet in 2008, and the researchers expect this number to climb to 134.3M in 2013. That’s one in every three people using mobile tools!

Has healthcare fully capitalized on this technological revolution? While the nearsighted would say yes, or worse—who cares?—the visionary battles against the restraints of tradition and skepticism. For the sake of our customers who are demanding access, we’ve got to drive mobile computing in or lose pace with society.

No institution wants to fall behind, especially once we start navigating the new highways and byways constructed by healthcare reform (Medical Home, Accountable Care Organizations, etc). An organization must intentionally merge their mobile computing strategy with the hospital strategic plan. Failure to act will run the risk of getting lost on the backwoods roads and putting their organization at a serious disadvantage.

Mobile computing provides a platform through which we can influence quality care, patient safety, and financial results. We call our mobile computing strategy mHealth. Although I cannot divulge this strategy or share specifics, one well-publicized example has to do with our OB/GYN physicians and the iPhone application AirstripOB. This mobile solution had a notable impact on clinical care and physician satisfaction. You can find other examples from forward-thinking healthcare organizations—sales force automation, intelligent devices, personal health records, patient registration, electronic health records etc. Today, iPhone alone carries thousands of healthcare-oriented apps. Some are trial balloons while others hold promise.

Other related strategies include connected health (cHealth), which I will define in a future post. Health Information Exchange, mHealth, and cHealth are all linked—a trifecta with potent force for the successful healthcare organization of the future. Accessing information anytime, anyplace, anywhere, anyapp, anymedia, anydevice, anyperson. And these are just the beginning.

The sage CIO is already engaged.

CIO Unplugged – 11/15/09

November 15, 2009 Ed Marx 1 Comment

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Why Healthcare IT Lags
By Ed Marx

Last week, one of our hospitals went live on CPOE. My boss and I were there as part of the ribbon cutting ceremony and to commend IT and the hospital for their hard work. When we met in the entryway, he eyed my attire with surprise. I was wearing scrubs, a violation of the dress code.

“Ed,” he said. “I bet you caused a lot of trouble growing up.”

“Yes, I did.” I liked coloring outside lines then; and I still do today.

But, why do I? Shouldn’t a leader be a good model to his followers?

I attended a national meeting with my healthcare IT (HIT) peers. Had you been a casual observer, however, you would not have pegged us as technology leaders. For all anyone could tell, we were glockenspiel salespersons. Our celebrated keynote, the government czar encouraging the adoption of HIT, was relying upon paper notes—yes, the physician who rightly wants our nation to lose the paper chart in favor of the electronic health record used hardcopy notes. And the audience was copiously taking notes…on paper. Need I say more?

Besides coloring outside the lines, I’m a fierce competitor. I aim to win every race I start. I’ll only accept defeat gracefully if I know I’ve poured my all into the competition. When I cross that finish, my tank had better be empty. In the same way, the lack of HIT progress aggravates the heck out of me.

Why are we so far behind other industries? Look in the mirror. That’s right. Time to come clean. It’s because of you and me. Granted, there are numerous other valid excuses, and I will touch on a few. But at the end of the day, the buck stops with us. When I lose a race, I don’t blame my blister, my clothes, the event management, the weather, the course, the timing chip, my equipment. I lost because of me.

Stop reading and let this sink in. You and I are the reason HIT lags.

But there’s hope. If HIT lags because of us, we can reverse the situation and make IT strategic in our industry and career.

When I asked my Tweeters and Yammers for ideas, here’s what they sent. Thanks to all of you.

Some reasons why we lag:

· Leadership

CIO’s not leading

CIO’s not culturally relevant

CIO’s reporting to CFOs

C-Suite not understanding or acknowledging HIT strategic value

CIO’s fear of failure

Leaders tend to be older and less receptive to technology

Decision makers often have clinical backgrounds, an area that has a bias for rigor, analysis, and is slow to change

· Healthcare Complexity

Burdensome government regulations stifle attention and consume financial resources

Payment systems and processes

Lack of standardization

Piecemeal approach to application deployment

Clinical and legal liability

Fragmentation – hospitals are silos of individual services, often used by independent practioners, all with differing cost and profit structures

Complexity is so great that leaders don’t want to deal with it

Incentives to innovate and minimize inefficiencies, if they exist, are contained to a specific workstream – not the entire ecosystem

Adoption of any new treatment or procedure in medicine has traditionally been slow because of the need for long-term testing and proving of safety and efficacy. This approach has transferred to the adoption of anything “non-medical”, new or different like HIT

· Financial Resources

Lack of margin to focus on innovation

HIT investments are not appropriately correlated to outcomes

Historical under investment

· Healthcare Culture

Healthcare by nature is precise, protocol-driven, and we teach the need to be "in control" at all times. While this is true for clinical care, the same mentality in other areas (IT) hinder change

A corollary to the above- By nature, people with these characteristics self-select into healthcare, making the climb that much more steep

A schism exists between IT and those who provide hands-on caring service to patients

Much like the traditions connected with our clinical training counterparts, HIT leaders are still promoted and recognized for experience and longevity

Social-cultural issues; change resistant

"High touch" aspect of healthcare views HIT as intrusive

HIT must be proven safe before it can be used, where as in other industries, if you test and fail there’s little harm

Waiting for next big thing

Lack of market-driven demand

Knowing and holding information is power and HIT threatens that power by enabling easy sharing of information

CIOs are in a unique and coveted position that allows us to observe and tie together the healthcare ecosystem, first within our own gates, and then beyond. The single biggest change agent to move HIT from laggard to leader is not healthcare reform. It’s you.

Ways to reverse our situation:

· Stop throwing up your hands and blaming the environment

· Take responsibility

· Take calculated risks and color outside the lines

· Take proactive actions internally and externally at the local, state, and national levels

· Challenge the status quo

· Tackle the tough issues and demonstrate HIT investment value realization

· Model innovation and technology use

· Get deeply involved with your clinicians and live their processes

· Be disruptive

· Stop traditional hiring and promotion practices. Instead, favor talent

· Look outside of healthcare for new ideas

By the way, I wore scrubs at the GoLive so no one would mistake me for a chaplain, a lawyer, or a glockenspiel dealer. The color matched the rest of the IT team on the ground and fosters a close working relationship with clinical staff. I was proud to wear it, to show I cared. And because I love to surprise my people.

So…I commission you to help your organization and physicians understand the strategic value of HIT. You hold the salve to heal what ails healthcare today.

CIO Unplugged – 11/1/09

November 1, 2009 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Best and Worst of Leading
By Ed Marx

“It was the best of times, it was the worst of times; it was the age of wisdom, it was the age of foolishness; it was the epoch of belief, it was the epoch of incredulity; it was the season of Light, it was the season of Darkness; it was the spring of hope, it was the winter of despair; we had everything before us, we had nothing before us; we were all going directly to Heaven, we were all going the other way.”

So begins Dickens’s classic “A Tale of Two Cities.” With leadership comes the good and bad, day and night, the best and the worst.

We recently underwent layoffs, something I wish didn’t exist. The impact affects all levels from analyst to deputy. As I agonized over these decisions, I reflected on the complex aspects of leadership. I’ve come to understand that the absolute worst is also the absolute best. One in the same. Let me explain.

Worst

Betrayal. Although I advocate “go to grow”, I also preserve a spot for any employee with an interest to groom for a future role. I pour myself into that person. I invest time and resource. Then, despite the path I create for them, they leave prematurely. I once had a rising, star manager dump their promising position, and healthcare, for a few extra bucks.

Moral Failure. A breakdown of social conscience happens too often. A shining star burns himself, shearing the people around him and the company brand. Infidelity. Embezzlement. Integrity meltdowns. When this happens within my circle of influence, my heart breaks for all involved.

Discipline. Poor performance demands correction. Nevertheless, most leaders can’t discipline much less give a decent annual review. I struggle with it, and I’m guilty on all counts. But long term, I know that effective discipline is a sign of true compassion and care. I call it tough love, and it’s hard to administer consistently.

Best

Fruit. Seeing someone grow. You sow, then watch for the seedling; you fertilize, and watch them blossom. Double best when they germinate others and replicate themselves. We recently promoted this analyst to Director, and—Shazam!—a star was born. We looked like geniuses.

Team. Start with a mashup of individual players who can achieve good outcomes and shape them into a team that accomplishes great things. I’ve been on more than one turn around, and it all happened because of the pooling of incredible individuals who were better together. 1+1 = 3.

Promotion. It brings me joy to promote someone, or to recognize them publically, perhaps nationally, through a professional society. Double best if there is a significant salary bump/bonus associated.

Absolute Worst and Best

Sacrifice.

The worst: I give up personal things to fulfill my leadership calling. I’ve given up the freedom of full expression as my actions are witnessed by many and monitored by others. I gave up my childhood dream career…

The best: …Yet I’ve found myself in incredible places and roles. And, oh, what rewards! To lead is to serve, and sacrifice is the sacred prerequisite to serving.

Dying to Self.

The worst: Pride and confidence. My reality- I’m right and I’m not comfortable accepting other’s opinions. The truth- I don’t know as much as I think I do, and I need others. Despite my experience, education, and knowledge, I force myself to move from micro manager to macro manager. I resist the urge to jump in (most of the time).

The best: failing forward. I set the vision then allow my people to strive, thrive, and make mistakes. For all involved, humility is the key to growth.

Layoff.

The worst: Telling someone they no longer have a job when it’s not related to their performance. I agonize for days and don’t sleep the night before. I understand the impact to career, self-esteem, and family—I’ve been there.

The best: But if it must be done, I want to be the one to deliver the news personally. I want to support my people in the most challenging career circumstances they face. I need them to know they matter, they’ll make it, and I care. Love can be practical, yet it’s too often forsaken.

Death.

The worst: The death of an employee or a family member of an employee. I see your faces.

The best: I’ve tried to attend every funeral. I weep with those who weep and rejoice when they rejoice. If a person/family suffers, I want to offer support, lead them through it.

Leadership is never easy, never to be abused, and never for self-promotion. It’s both pleasure and pain, joy and sorrow. Leadership is a calling.

CIO Unplugged – 10/15/09

October 15, 2009 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Embrace the Cloud
By Ed Marx

Friends of mine recently returned from a trip abroad. The advanced wireless infrastructures found in these third world countries both astounded and pleased them. By unintentionally leapfrogging the technological revolution, these cities had bypassed the incremental advancements of the last 30 years and gone straight from laggard to leader. Societies that have not had a telephony infrastructure, for example, are suddenly delivering the highest per capita cellular subscribers.

Leapfrog advancement. Can we do it in healthcare IT? I believe we need to.

Does the fact that we trail our non-healthcare peers by 5-10 years embarrass you as much as it does me? Do you realize that we think of EHR as advanced when in fact it’s an application that’s been around since the 90’s! We have various excuses for our delay of advancement, and some are valid. But they don’t change the reality. We are behind.

We do nevertheless have an opportunity.

Cloud—it’s clearly the future of both software and hardware. And consistent with the past, it draws both resistance and hesitance, which perplexes me. We act as guardians, but have no basis for such. We pontificate more than we lead while the people we serve need us to advance.

I’m tired of employing self-depreciating humor to cover the glaring technology gap whenever I speak to non-healthcare audiences. I’m ready to leapfrog and bridge the gap using technology as a key lever. So let’s embrace the cloud.

Lead!

CIO Unplugged – 10/1/09

October 1, 2009 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Work-Life Balance…Debunked!
By Ed Marx

The first thing we boys did after disembarking the school bus was head north for the neighborhood 7-Eleven. Liberated from a day of junior high classes and a numbing thirty-minute bus ride, we hungered for entertainment. Pinball was the current rage, and we all sought the coveted crown of The Who’s, “pinball wizard.” Grasping the corners of the machine, I’d let my fingers become one with the flipper-buttons, slapping the ball into the pins and rails and racking up points. In the heat of the moment, I’d jiggle and rattle the sloped table, eager to outscore my buddies. And then…it happened. My overzealous manhandling would cause the dreaded tilt—the machine disengaged—and my silver ball drained straight down the middle. Even as I write this, I can hear and feel the ominous skull-pounding, buzz. I lacked the perfect touch between allowable manipulation and sheer force. Tilt!

We all go through life encountering a fair amount of tilt. The abundance of balls we’re juggling come crashing to the floor because we can’t manage them all. The contemporary word for the phenomena today is “balance.” Stores carry dozens of books on the subject, and magazines print oodles of articles trying to help us live balanced lives and avoid a tilt scenario.

As CIO’s, our careers are demanding and change is a common constant. Yet families are our support and our hobbies provide fulfillment and, thus, both deserve our time. We desire to perform well in all aspects of life. It’s how we’re wired.

I never experienced as much imbalance, or tilt, until I tried to seek after the elusive balanced life. I’d read all the articles and believed the myth. Like the man chasing the end of the rainbow, I found a pot of disappointment instead of gold. In my stressed effort, I tried to run faster.

At last, it occurred to me. In this information age, the balanced life is not achievable. Nor should it be. We fool ourselves into thinking that life is made up of set components with solid boundaries that stack neatly together like Tetris, with micro interfaces where convenient.

I advocate a different approach—Life-Work Integration. We all look for ways in which to maximize areas of our lives without having a negative impact on our values and ideals. We all desire to live a life of significance. I had the privilege of speaking on this theory at a recent healthcare professional society meeting. The President had heard me touch on the subject a year back while giving a talk on mentoring; he thought the concepts would be of value to his society. Based on the session feedback, the ideas resonated with the majority of attendees.

Balance implies that you give up something on one side of a scale until both sides are even—an exchange. Integration, on the other hand, is fluid and dynamic, bending and blending endeavors—time sharing. I don’t want to allocate 50 hours for work, 10 hours for fitness, 25 hours for family, 50 hours for sleep, etc. I want to bend and blend—to work 60 hours one week but 30 the next. I want to symphonize the flow of all my roles and responsibilities. I may have a desire to get up early and complete an outstanding task, or catch all my daughter’s daytime dance recitals. I may need an extra 10 hours per week to perfect the Argentine Tango with my wife, made doable by combining practice with our weekly date night. I don’t turn off my connectedness to any aspect of life. It is fluid and dynamic, bend and blend.

Here are some everyday examples of integration. One that serves me well is my virtual office. This setup untethers me, further enabling bend and blend opportunities. I carry a single device, and my digital schedule reflects all of my life roles, including my “honey do” list. No more home phone, multiple email addresses, or home PC to slow me down. I network socially through a single portal. Ninety-five percent of my athletic events have, in some aspect, included one or more family members. And I try to bring at least one family member on every business trip. I leverage systems, as well. I belong to an athletic club offering multiple locations. Depending where I start my day, I find the nearest club, all of which are preprogrammed in my GPS. Then there are repetitive tasks. You can hard wire these so you have more time and energy to focus on things that will have greater impact. Andy Stanley states that “systems can have a greater impact on behavior than mission statements.” For some tips on how to maximize the time you do have, see Green Standard Time.

A strong foundation will enable life-work integration and help avoid tilt. Some key aspects:

Develop and maintain a strategic plan for your life
Make sure principles/values are well defined and unmoving
Ensure your life passion is identified and calibrated
Surround yourself with accountable relationships and mentors
Embrace technology to master time and leverage efficiencies (don’t let them master you)
Create margin and set boundaries
Develop systems to support your principles and plans
Expand your creative capacity
Adopt a consistent worldview and belief system (for me this is based on my faith)
Man up and make tough choices

The last one is the hardest. Many people go through the process of prioritizing and discovery but then fail in the execution because they won’t pull the trigger on the difficult choices that would propel them to the next level. No one can do everything; and creating healthy boundaries often means eliminating the “good” in order to keep the “great.” Yet, out of a fear of change, of hurting others, or other perceived pains, some continue down the same path, trying to find an unachievable balance.

Take some time to reflect on this post and the possibilities of life-work integration. Review the elements of a strong foundation and how they might keep you from Tilt.

You can do it!

CIO Unplugged – 9/15/09

September 15, 2009 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

The Politicalization of Health Information Technology
By Ed Marx

Admit it. Health information technology (HIT) deployment is headed nowhere fast. Despite the evidence and supply side rhetoric, demand wanes. Depending on whose study you believe and their definition of HIT, industry adoption of CPOE is languishing in the low teens at best. We can do better for our patients.

Before we dive in, I want to acknowledge the Office of National Coordinator for Healthcare Information Technology (ONC). The National Coordinator plays a central role in how information technology transforms our care delivery system. The leadership is strong, and the Office is blessed by a greater level of funding and authority than in the past. ONC is the principal Federal entity charged with coordinating nationwide efforts to implement the use of the most advanced health information technology, including the electronic exchange of health information. The position of National Coordinator was created in 2004 through an Executive Order and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act [HITECH Act] of 2009.

Next to the ONC, the Centers for Medicaid and Medicare Services (CMS) is another powerful division of the Department of Health and Human Services (HHS). The CMS mission is “To achieve a transformed and modernized health care system.” A key tool for success in their workbench is leveraging information technology. CMS, a professional bureaucracy, was clearly the driver for federal HIT direction and investment until recent legislative changes codified ONC. The ONC and CMS will need to work in concert, finding unity of command and vision, in order to achieve their unsynchronized goals.

Complicating the situation is the legislative branch attempt to control healthcare reform and policy via HIT. On one hand, you have ONC laying out a firm HIT direction; they have the necessary framework, but it’s juxtaposed to the quagmire of healthcare reform. Congress and the white house are materially on different sides of what to do, when to do it, and how. The only certainty is that HIT will be a key component. Unfortunately, due to the lack unity of vision and clarity of goals, HIT is quickly becoming a political lever. And that scares me. HIT is the means, not the end.

Morphing into a government program, HIT could rank with cash for clunkers. We’re incentivized to turn in the old and adopt the new. Although I’m a serious advocate of care transformation via IT, I fear that the motivation is becoming more political than substantive. Where the cash for clunker strategy is a onetime event, we should be investing long term (10 plus years) in HIT and looking for sustainable advocacy with demonstrable support. Incentives are misaligned.

We need to push for challenging meaningful use criteria. What started out provocative and game changing has since been watered down to a welfare-like program. The bar is set too low. Everyone qualifies!—which means we’re not demonstratively leveraging HIT. Instead of reaching high, expectations are lowered, thus removing the incentive to progress materially.

Advocacy groups. Although active dialogue is essential and everyone deserves a seat at the table, too much politicking will derail HIT. Potential is lost in the quagmire of uber engagement, and special interest groups tend to lower expectations and standards. Each group claims to represent a large number of constituents, but at the end of the day, hospital leaders are the ones who will need to make the tough decisions, and execute.

While I appreciate the private/public approach to forming advisory committees, we must intentionally set aside our personal biases to favor the common good. If you look closely at the outcomes derived thus far, you can trace the DNA back to some of the participating organizations. I face the same challenge at the State and City level. It takes a degree of maturity to set aside personal thoughts, prejudices, and organizational goals to pursue the common good. Keeping the patient benefit foremost in our minds will yield the best outcome.

What can we do to help ensure ideal outcomes and prevent the politicalization of healthcare information technology?

Actively support the ONC leadership.
Contact senior staff of the House Committee on Ways and Means.
Contact senior CMS leadership.
Advocate for more meaningful meaningful use.
Provide feedback to advisory committee members and pushback on tailor made recommendations that may be of a minority interest.
Lead by example by ensuring your organization is ahead of the curve.
Actively participate in your region and state HIT efforts.
Keep pressure on for healthcare reform

Do it while we still have the freedom to make these choices and influence government decisions.

CIO Unplugged – 9/1/09

September 1, 2009 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Healthcare Passion Refueled
By Ed Marx

My passion for healthcare sprouted in high school while working in environmental services at an outpatient facility; they called us janitors back in the 80’s. From that point forward, different encounters have renewed that passion. The most dramatic experience was personal.

A Journey Home. Three years ago this month, my mom traded her earthly rags for a robe of righteousness. After a courageous four-year fight against the ravages of ovarian cancer, Ida Wilhelmine Marx bid us farewell. The entire experience had a profound impact on me not only as a son but also in my profession.

My mom and I were tight. As I blindly plodded my way through adolescence, she represented mercy and grace. When I shoplifted, got arrested for joy riding (14 yrs old), set the house on fire, partied excessively, and flunked junior high, she was there. I’m convinced that if it weren’t for my father’s discipline balanced by my mother’s care, I would not enjoy the successes of today in my education, career, and family.

Radiance. Mom suffered much from illness her entire life. She took the cancer in stride: eight rounds of chemo; two rounds of radiation; and a couple of surgeries. Her sole desire before transitioning from this life to the next was to celebrate her 50th wedding anniversary. When we transferred her to hospice, it became apparent that she would be a few weeks shy of reaching her goal. With my parents’ permission, my brothers and sisters planned an early 50th anniversary party and vow renewal—the final celebration of Mom’s life. Knowing our world would change the following day, that night we put on a heck of a celebration.

Hollywood could not have written a better script. Hospice physicians agreed to give my mom life-sustaining nutrients and fluids through the big day (normally not allowed). They arranged for a “Sentimental Journey” pass: a limousine (ambulance) service for my mom and dad to the picturesque Cheyenne Mountain Resort in Colorado. Two paramedics waited in the background just in case their services were needed (they weren’t). They quipped how special my mom was because the only other person who ever received two paramedics as an escort was Dick Cheney when he came to town.

All 7 of us children attended plus all 15 grandchildren. My parents invited their closest friends. With the backdrop of the Rockies and all the majesty of a traditional wedding ceremony, I had the privilege of walking my father to the front. My oldest brother, Mike, had the honor of escorting my mom in her wheelchair to join my dad at the altar. She looked ravishing; my sisters had dressed her to the “nines.” Her dream was unfolding in real time.

Each of her children had a part in the ceremony as did each grandchild. Assigned to deliver the sermon, I decided not to use notes but instead prayed that God would intervene and deliver a message that would bless my parents and set vision for successive generations. The primary message: my parents had created a legacy of marriage that would impact not only the first generation (me and my siblings), but the grandchildren, and their grandchildren, and so forth. The fact that my parents stuck it out and endured a lifetime full of sickness and health is a testimony to the world: “Yes, it can be done.”

The ceremony ended with the exchanging of vows. A co-worker of mine had arranged for a Papal blessing of the 50th milestone as well, which touched my parents deeply. We printed the blessing in the renewal program. Unity candles, songs, prayers, and standing ovations lent to the evening’s incredibleness. But this was only the beginning.

One Heck of a Show. We then entered the adjoining room for a superb five-course meal. Taking advantage of the live music and dance floor, Dad rolled Mom out in her wheelchair to dance. My parents are fantastic dancers, and seeing my dad wheel my mom around was moving. Throughout dinner and beyond, we danced to our hearts’ desires. All four sons danced with my mom, who was clearly delighted. Even my son, Brandon, danced with her, to which she commented: “You’re not dancing. You’re just shaking your ass!” Next came toasts and the garter ceremony, and all the similar accruements of a fine celebration. At that point, Mom addressed the room with loving words. Dad tried but fell apart. As a finale, guests and family formed a tunnel by joining hands. Dad wheeled Mom through as we hugged, kissed, cried, and spoke blessings. Returning to her limousine, she was still beaming. My dad shared that as he laid Mom in her bed that evening, she said, “We sure gave them one hell of a show tonight, didn’t we?”

Timing. During her illness, I flew out often to visit her. I wanted to be at her side when she transitioned, just as she had been at my side so many times. I missed by 8 hours. But that was okay. Over the years, I’d left no doubt in my mother’s heart of my care, admiration, appreciation, and love for her. Arriving shortly after her passing, I supported my brokenhearted father and assisted with the funeral arrangements.

Kiss. My mom had taken her last breath shortly after midnight. Two of my siblings and my father were at her bedside and described that, while painless, her body struggled for every last breath. As a result, her mouth was stuck wide open. The hospice nurse explained that, given the timing, the mortician would be the only one able to close Mom’s mouth. My sister in-law, an ICU nurse manager, validated this.

Meanwhile, my dad knelt at Mom’s bedside and held her frail body, the first time in months where he could hold her without causing her pain. He kissed her lips. Wept over her. Sometime in the next two hours, while they awaited the mortician’s arrival, Mom’s mouth closed…and she smiled. Comfort permeated the room and reinforced our belief that she had indeed transitioned to a happier place.

Passion Fueled. My mom’s battle allowed me to spend considerable time in various care settings. I observed the processes, evaluated technology, and pondered how things could be improved to benefit caregiver, family, and patient. The clinicians treating my mom lacked the communications and clinical decision support needed to deliver the highest quality of care. I was shocked by the lack of access to critical and timely clinical data. The wasteful amount of paper utilized and manual processing disappointed me. I swore it would never be this way in my work environment. As I took mental notes from the perspective of patient and family, my passion to leverage technology and transform the clinician and patient experience was renewed.

It’s this passion that drives me in my daily work. This is why I’m tenacious in advocating technology, why I continually innovate and collaborate with clinicians, and why I blog. This is why I advocate for more meaningful, meaningful use. It’s the heartbeat behind why I spend more time with my people on leadership, customer service, process, and passion than I do on bits and bytes. Until my people have a heart for patients and are in a position to empathize with their plight, the bits and bytes will be limited. The full potential of technology in the delivery of high quality healthcare comes with a transformed heart.

Thanks, Mom, for refueling my passion as a leader of healthcare technology.

CIO Unplugged – 8/31/09

August 31, 2009 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

The Secret to Successful CPOE Adoption—Revealed
By Ed Marx

Before revealing the secret, let me establish credibility. I first implemented electronic health records in 1995. A few years later, while CIO at University Hospitals, we achieved a 95% CPOE rate at our academic medical center. Presently, with 12 of our 14 hospitals implemented at Texas Health, we are averaging over 80% CPOE. Remarkably, half of these are entered via standardized order sets. What makes the Texas situation particularly unusual is the lack of executive mandate. The all-voluntary medical staff made it happen. Although I had little to do with the above successes, I did learn the secret.

Organizations will spend millions on consultants, hoping to tap into some sort of magic sauce that they can liberally apply to ensure significant adoption. The majority of these consultants will have had no direct professional experience implementing or supporting the technology. The secret to successful CPOE adoption rides not on one silver bullet, but many. You can do better than a consultant can, and here is how.

These 21 factors, when in synch, will bring your institution success with CPOE. You must be excellent at 18 or more of these to forge the secret.

· Senior Leadership Engagement- CEO must actively promote and reinforce, and receive regular reports. Base enterprise incentives on CPOE adoption levels.

· Hospital Leadership Engagement- Presidents need to be very visible and articulate. Same with directs.

· CMIO- This rare individual can bridge the gap between IT and medical staff. If IDN, recommend multiple CMIO approach. (Not an expensive tactic in the big scheme of things)

· Project Leadership- They must walk on water and be clinicians. They are the face and brains of the operation. Surround them with grace and all the resources they ask for.

· Project Team- Majority should be clinicians. 90% of your team must be actively engaged. The road is long with many winding curves. Build up staying power.

· Clinical Staff- Can’t be successful without engaged physicians and nurses. Sometimes you must facilitate their engagement if initially resistant.

· Culture- Culture eats strategy everyday. Set up literal shared incentives for success. If IDN, culture must acknowledge but transcend individual hospitals.

· Relationships- Relationships cover a multitude of sins. Develop relationships with everyone from clinicians to support staff to leadership.

· Visibility- Key leaders must be visible during Go Live and after. Most of our leaders participate in Go Live support, even if just to answer phones.

· Agility & Velocity- Have a pool of highly trained staff who can respond to crisis at a moment’s notice. Team should report to CMIO.

· Build- Lay a solid foundation from the onset to withstand the continual storms. Design must include clinical staff for usability and acceptance.

· Standardized Order Sets- Present CPOE as the ultimate tool to drive transformation, clinical quality, and drive out costs.

· Governance- Set up an effective decision-making body on two levels: a senior executive team for strategy; a larger team for tactics and operations. Assign clinicians to key roles.

· Change Control Process- Control application evolution at a rate that introduces new features while maintaining an acceptable learning adaptation curve.

· Implementation- Keenly organized, with additional staffing at the physician’s elbow.

· Marketing & Communication- Need a multi-dimensional, targeted strategy including actual customers. Don’t limit yourself to traditional media; be innovative and leverage social networks.

· Training- Use multiple venues: traditional methods blended with modern, such as our video vignettes. Make access to applications dependent upon completion of training.

· Support- Post implementation support must be impeccable and ubiquitous.

· Vendor Connections- Best relationships start at the top, with C-Level execs exchanging strategy and vision. Establish escalation paths to solve issues quickly.

· Infrastructure- Monitor and tune to ensure optimal uptime and response speed.

· Software- Select a seasoned application. Test and retest enhancements and patches prior to releasing to clinicians.

If you can’t deliver on the majority of the above factors, stop your project. Take the hit early where impact is limited rather than when you are too far down the tracks where a collision will occur. I.e. we took a three-month hiatus because our standardized order sets were suboptimal. We retooled. Today, we have 80% CPOE adoption with 50% of all orders coming from the standardized order sets.

A final point to remember. None of these factors is a onetime event. Each requires continual care and feeding. Indefinitely.

Want more? Follow our CMIO and Medical Director on Twitter; ftvelasco; Isaldanamd

CIO Unplugged – 8/1/09

August 1, 2009 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

The Lost Art of Mentoring
By Ed Marx

Who taught you life skills? Did anyone coach you in the ways of culture and values? An uncle? Your grandma? The television?

I just watched the movie Gran Torino with Clint Eastwood. In a nutshell, Eastwood attempts to teach the immigrant neighbor boy how to be a man. He starts by teaching Thao the skill of carpentry: how to hold a hammer, and which tools to always have on hand. Then he comically endeavors to educate the kid on manly talk and on how to act like a man. Eastwood verbalizes it, then demonstrates it, and finally observes Thao doing what he’d learned. The mission took time, money, energy, and the forging of a relationship, but it was worth it.

Some of us wish we had that mentoring experience. Speaking from experience, we all need mentors. When I became CIO of a large prestigious organization in my mid-30’s, I was both elated and scared. What accelerated my comfort and success were my mentors. Even with my experience today, I simply can’t grow without a mentor.

Dictionary.com defines mentoring as…an ongoing, planned partnership that focuses on helping a person reach specific goals over a period of time. Unfortunately, the art of mentoring has rarely caught on in the business world, healthcare included. We see this reflected specifically in the graying of existing leadership and the lack of succession planning.

This type of one-on-one interaction between individuals—lost somewhere after the apprenticeships of the pre-industrial age—has been replaced with short-term, focused leadership programs. These programs attempt to turbo-charge management education by cramming years of collective wisdom into a one-week synopsis. For example, the College of Healthcare Information Management Executives (CHIME) has an excellent leadership development program entitled “The CIO Boot Camp” that cannot keep up with the demand for enrollment. One reason for its popularity: it fills the mentoring void in today’s organizations.

Is mentoring beneficial in healthcare? Done right, both formal and informal mentoring programs can promote patient safety and implement clinical process change. Mentoring is key to building alliances within an organization and to ensuring a new generation of trained leaders. Committing to mentor another person is an investment in the long-term success of an organization, a selfless act of service for the sake of the profession and the future of healthcare.

This type of partnering also offers something a person might not get directly from their supervisor: broader experience, organizational perspective, and new skills.

For instance, an information technology professional will benefit greatly from having a CFO or CNO as mentor. Consider the differences between learning the technical aspects of one’s position and career versus learning leadership from someone else in authority, regardless of his background. In other words, an IT person should not enter a mentoring relationship with another IT person, lest their focus becomes overly familiar to their specialization.

Determining the appropriate mentor. Examine your strengths and weaknesses. A professional who lacks a strong clinical background should seek out their CMO/CNO or another well-respected clinician. Conversely, someone who already has a strong clinical background may want to seek out a CFO in order to gain key insights into the healthcare financial world. Seeking such mentors within your own organization offers the advantage of proximity and familiarity. Furthermore, the development of such relationships assists in the overall development of teamwork and connectedness. (Mentors from outside of the organization or healthcare might offer a level of anonymity and broad perspective, but they would lack the context for key elements of discussions.)

Mentoring Programs and Recruiting. Job candidates respond favorably when they understand that the organization cares for their professional development and will enable them to achieve career success. Over time, as the mentoring program becomes a major differentiator in recruitment efforts, your organization will become an employer of choice. Gallop has statistically demonstrated that an organization with a high level of engaged employees significantly outperforms non-engaged workforces in areas including customer satisfaction and financial results—both employee and employer win. Clearly, such programs lead to improved health in the corporate setting.

Mentoring Enables Clinical, Business, and IT Success. Most IT leaders have a clear understanding of their task: to leverage technology to enable clinical and financial success.

Much of this understanding however resides in head knowledge, not in transformative experience. Clinical mentoring, for example, would facilitate the adoption and understanding of what really takes place in the clinical setting. The IT leader gets first-hand experience and sees with their eyes what they had merely heard and read about.

Partnering an IT leader with a CMO or CNO will expose them to new insights and understanding. One academic medical center I know sends its IT leaders on annual short-term mentoring assignments to all of its clinical departments including ED, Radiology, Lab, etc. The CIO began routine rounds with physicians and residents. In each case, the mentor allowed the IT leader to experience the specific clinical care setting, answered questions, and discussed the critical intersection of IT and quality patient care. Each IT leader came back with a new sense of purpose and motivation. They in turn made immediate changes to IT systems and support to help ensure a higher quality of care.

Mentoring serves to develop future IT leaders. Given the limited pool of emerging leaders, mentoring becomes more critical than ever. Identifying and growing talent within our organizations is imperative. Our leadership effectiveness is not so much based on formal education and rigorous reading, but in real life, on-the-job experiences. Partnering up-and-coming IT leaders with members of executive leadership allows for this real life experience, accelerates growth, and ensures critical succession planning.

Restoring the Lost Art. We are the sum of our collective inputs. I credit my success to my mentors. I have been deliberate in this process. On even years, I mentor someone; on odd years, I am mentored. I require each of my direct reports to do the same. I’ve been formally mentored by health system CEO’s, COO’s, CFO’s, CMO’s and hospital Presidents. I have mentored many who have since moved into positions of authority. Check out the many resources available on establishing quality mentoring programs.

Resources. Anyone who posts a comment below or via FaceBook, Twitter, or LinkedIn, I will send to you a simple one page mentoring contract you can use to facilitate your own relationships. I will also send to you a list of “golden nuggets,” the bits of wisdom I have learned from being both a mentee and mentor.

CIO Unplugged – 7/15/09

July 15, 2009 Ed Marx No Comments

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Legacy Leaders
By Ed Marx

How can so many of us hold the title of leader, yet never be remembered? Why do some leaders make a difference while others do not? Fear.

Fear keeps us from making a difference. Too often leaders fade without notice or with merely a modicum of fanfare because of their longevity in a company, because they stuck with tradition, and perhaps they achieved small wins. Conversely, legacy leaders stick their necks out and occasionally go against the flow. They spin the roulette wheel while their peers play it safe. Anyone can play safe – status quo. But legacy leaders fight fear, calculate options, then jump in with both feet. Leaders who leave legacies take risks.

No risk, no legacy. Our founding fathers pursued a risky mission, and look at the legacy they left us. Martin Luther King Jr. took risks that prematurely ended his life, but his legacy endures. Pause for a moment and think of a legacy leader who advanced with nothing at stake? Thought so.

I overhear leaders say they want to make a difference, want to transform healthcare locally and nationally. Yet healthcare is stuck in neutral, if not reverse. Decision makers are overly conservative in their approach to innovation and opportunity. Paradoxically, some I know in management were risk takers early in their careers and enjoyed success. For whatever reason, they shifted gears into a risk-averse posture and ran out of gas short of their destination. We as healthcare leaders must intrepidly drive forward, or surrender the wheel to someone who will.

I want to encourage and reward the courageous, and the best way to do it is to lead by example. Push the envelope. Try new programs, systems, and services before they are mainstream. I don’t settle for giving lip service, I fund and staff risk ventures. Then I reward my risk takers publically, even in failure, because they gave it their all. Perseverance will eventually pay off.

Risk provides a competitive advantage. Do you want to create separation and differentiation in your marketplace? Risk. Tap into the creativity of those employees with a passion to innovate and transform. Yes, there will be failure. Use failure as a catalyst to increase your risk tolerance, not shy away from it. Learn and embrace failure. Edison did.

Stop analysis paralysis. Adopt Colin Powell’s leadership lesson #15, “P@40 to 70.” P stands for the probability of success; the numbers indicate the percentage of information acquired. Once the information is in the 40 to 70 range, go with your gut. Procrastination in the name of reducing risk actually increases the potential of failure or falling behind.

To those who favor remaining conservative. Do you fear losing your job? When you play safe, you’re rewarded with keeping your position, right? But if you don’t rock the boat or challenge the status quo, do you lose part of your soul?

A board vice chair told me, “Ed, if you do your job right, you won’t be here a year from now.” I took his comment as encouragement to take risks on behalf of our patients and providers. If I lose my job in the process, so be it. I do not operate under the fear of man but under the fear of not influencing my part of the world.

Risk is a lifestyle not just a work mode. When hiring like-minded staff, determine the risk quotient of potential candidates by finding out what they do outside of work. If they stick to the standard fare, move on. If they play it safe, move on. They won’t act any different in the workplace.

What about you? Are you a legacy leader making a difference? Will anyone remember your years of effort? Will healthcare be transformed because of your actions?

What are you doing today that is risky? What are you doing today to encourage risk?

Demand it. Live it.

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