Newsday – Swapping Vaccine Stories, Interim CIO, and Managers Adapting to Hybrid Work

Newsday – Swapping Vaccine Stories, Interim CIO, and Managers Adapting to Hybrid Work

Episode 386: Transcript – April 5, 2021

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Bill Russell: [00:00:00] [00:00:00] Welcome to This Week in Health IT. It’s Newsday. My name is Bill Russell, former healthcare CIO for 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged.

[00:00:17] Today we catch up with Sue Schade, new interim CEO for Boston children’s. We talk hybrid work trends, our vaccination stories and whatever else happens to come up.  Special thanks to Health Lyrics, [00:00:30] WWT, Intel and Sirous Healthcare our Newsday show sponsors for investing in our mission to develop the next generation of health leaders. If you want to be a part of our mission and become a show sponsor send an email to [email protected] One last note, before we get to Sue and her big news, we launched our website redesign and we’d love your feedback.

[00:00:51] www dot this week. health.com. We tried to unlock the insights that we’ve gained from three and a half years of interviews with industry [00:01:00] influencers. And we want to know. Let us know your thoughts. Design, usability, ease of finding things. Our guests today sent over a few comments already and we appreciate it and it helps us to make the resource better for the industry.

[00:01:12] In fact if I go to the website right now, as we speak, it has a nice little search bar at the top. I’m going to put our guests name in there and see what comes up. There we go. Put her name in there, Sue Shcade. And it pops up up with her contributor page. It pops up with all the videos [00:01:30] of her and and with David Muntz. The, wow, you’ve been on a lot of podcasts, about 10 or 12 podcasts and article we highlighted.

[00:01:40] So it’s, we hope we’ve made it easier and hope you guys you know, find it better, but we would love for your insights into what we can do to make it better. Sue welcome to the show. Good morning. 

[00:01:51] Sue Schade: [00:01:51] Good morning. Hey Bill how are you? 

[00:01:54] Bill Russell: [00:01:54] Pretty good. Pretty good. So, what’s new? 

[00:01:57] Sue Schade: [00:01:57] What’s new. So as I shared [00:02:00] with you and I shared more publicly yesterday in my blog post and on social media, two weeks ago, I started as the interim. CIO at Boston Children’s Hospital. And we are off to the races. This is week three and definitely ramping up. Excited to be part of this organization, even though it’s temporary. They’re a great organization. We can, get into that more. 

[00:02:26] Bill Russell: [00:02:26] Yeah, no, absolutely. We had John Brownstein on [00:02:30] the show and that was a phenomenal conversation. He was on Good Morning America. He was on. All the shows, talking about the pandemic cause he has a epidemiologist background. So he was a fantastic interview and to get to work with him. I think it would be a lot of fun. 

[00:02:45] Sue Schade: [00:02:45] Oh yeah. We’ve already connected and very easy to talk with and connect with.

[00:02:49] I’m looking forward to partnering and we joked about his being a contributor on ABC. I watch a different channel mostly, so I see different contributors, but yeah, he’s great. 

[00:03:00] [00:02:59] Bill Russell: [00:02:59] Did I even get that right? What is ABC’s show? Is it Good Morning America? 

[00:03:03] Sue Schade: [00:03:03] Yeah, I think so. Yeah. I think so. I think that’s what he said. 

[00:03:09] Bill Russell: [00:03:09] TV and TV at this point, I don’t know about you but we as a family are binge-watching stuff.

[00:03:15] So it’s been Ted Lasso..The the Chosen has been one of the things we’ve watched and now we’re watching Escape to the Chateau where this British couple has bought a 45 room chateau and they’re rehabbing it. It’s like the ultimate rehab [00:03:30] show. I’ve it’s unbelievable. Yeah.

[00:03:32] Sue Schade: [00:03:32] Yeah, we do binge-watching too. Absolutely. And we just finished a series the other night so we got to find a new one. 

[00:03:38] Bill Russell: [00:03:38] Yeah. So what, are you guys binge watching during the pandemic? 

[00:03:43] Sue Schade: [00:03:43] We, we do a lot of Brit box. A lot of English shows and I’ve got a list somewherebecause I’ve got girlfriends I talk to every Thursday night from my Michigan days and one of the things we do, they’re all retired. They were all VPs at Trinity [00:04:00] IT at one point. And that’s how I got to know them all when I was at Michigan medicine. And so we exchange shows. But don’t ask me for the list right now. Yeah, I have it on my phone somewhere. 

[00:04:12] Bill Russell: [00:04:12] I find everybody’s doing that now. That’s how we found Escape To the Chateau.

[00:04:16] So Frank came over and saw all the work we’ve done in our house and was like Hey, have you seen the show? And I’m like, Oh, I’ve seen so many of these shows. He goes, Oh, you haven’t seen this one. And he wasn’t kidding. If you’re into, if you’re into rehab shows for four [00:04:30] homes. This is the next level of that.

[00:04:33]Before we get into it I got my first shot at a mass vaccination event. How about you? You’ve been vaccinated? 

[00:04:40] Sue Schade: [00:04:40] Yep. We got the second dose last Saturday and it was through the town and it was at the junior high school in the gym. And first dose, February 27th of Madorna and second dose on March 27th. Good experience. I made some suggestions after first [00:05:00] dose on process improvements. And they definitely took one of the suggestions. So that was good.

[00:05:09] Bill Russell: [00:05:09] I wanted to, oursa was fairly big. It was by the health department out of our County. And they took over a park and tried to do the throughput like you, like we talked about on the, podcast. So we talked to UC Health, we talked to Atrium. They partnered with [00:05:30] significant sports teams.

[00:05:31] So they had large parking lots that they could be very creative with. This park well, it’s a park, right? So a lot of windy streets and those kinds of things. It did not work quite as well. We ended up spending about an hour, but you know, I, to be honest with you an hour to get the vaccine I was really fine with it.

[00:05:50] It probably took a half hour longer than it really needed to if they thought through some things. So hopefully before I get my second shot they’ll listen to the, [00:06:00] podcast and some of the, great things that UC Health and Atrium had to share. 

[00:06:06] Sue Schade: [00:06:06] Yeah. We’ve talked about this before and it was a rough start to the rollout it appeared. To be hitting approximately 3 million. Doses a day, you know, that things have improved and smoothed out. And that the organizations that are doing the administration have gotten it down. The two, you mentioned UC Health and Atrium [00:06:30] great lessons learned there and a great workflow and efficiencies that they’ve been able to accomplish.

[00:06:35] Bill Russell: [00:06:35] Well early on I was on the phone with some of my clients were talking through it and I asked them how it was going. And they said, look, if they were to give us another 10,000 doses they’d be in arms already. They just couldn’t get the doses and the numbers I’m looking at now. There’s almost 150 million doses in the supply chain. I mean, that are actually out and about.

[00:06:58] And maybe not unaccounted [00:07:00] for, not at least not in arms yet. So the the supply is there. And I think the health systems have really learned from each other new England journal of medicine article you shared with me. And sharing best practices. I think we know what we’re doing. 

[00:07:15] I was actually kind of surprised it was the Department of Health and some EMT people doing the vaccine in our community and not the hospitals themselves. I don’t know. I guess that just goes to show we [00:07:30] have a lot of health resources in communities that we can do this through.

[00:07:33] Sue Schade: [00:07:33] Right. It was the MTs for us. 

[00:07:36] Bill Russell: [00:07:36] It was. Okay. Yeah. That’s interesting. To be honest the vaccine part of it was all of a couple of minutes, not even a minute, to be honest with you came over the stuff. I was a little disappointed we had to, they handed us a paper to fill out once I got there and I thought man they, this could have been done a little better but 

[00:07:59] Sue Schade: [00:07:59] Do you mean [00:08:00] the little vaccination card you have or something else?

[00:08:03] Bill Russell: [00:08:03] Well no I got the vaccination card, which cracked me up a little bit. It looked like the vaccination card I got back when I was in, back in 1975, but the no, but they handed me a thing to put all my information in you know name, address and whatnot, which is information I had already given. Yeah. And so it just didn’t, it didn’t transfer digitally like I thought it should have. 

[00:08:25] Sue Schade: [00:08:25] Well we didn’t do that at all. We just, you know, I registered online. [00:08:30] We checked in, they crossed our name off. We went through the process. I didn’t have to fill out anything else. 

[00:08:36] Bill Russell: [00:08:36] Wehat I’m wondering, will my information get into an EHR anywhere. Or will it be in the county registry for vaccine what, you know, where’s that, nobody really wanted to answer my question. As you can imagine, I wanted to ask everybody questions. They were just having to be like keep moving, sir, keep moving. 

[00:08:56] Sue Schade: [00:08:56] That’s like me. I call myself a secret shopper when [00:09:00] I’m CIO in a hospital and I go for care and I’m like having the ambulatory visit. And I’m like, Oh, what do you think of this, that and the other thing. But I’m not secret. I tell them who I am and then I ask how it’s going. You know, I don’t think it’s going to get into the EHR without you doing something. So I got my second dose and then I got something sent to me that says keep this for your records.

[00:09:22] And what I need to do now is get that over to my PCP or upload it, do as an attachment to a communication in the [00:09:30] patient portal. So my PCP gets it. 

[00:09:33] Bill Russell: [00:09:33] Yeah. So the little card cracks me up and now we’re hearing like international travel. You’re going to have to show your information. And I don’t think this little card is really going to suffice.

[00:09:42] I think they’re gonna look at me like. What’d you make that Photoshop? What did, you know? It just, so it will probably have to be a digital record of some kind that we’re going to show. And so there’s a lot of movement at this point on the you know the vaccine credential [00:10:00] initiative, obviously pulling all the information together. But some sort of wallet type thing that you can show record that you have gotten your vaccine and that’s an interesting thing and why we need to do it.

[00:10:12] I’m just afraid how far people will take it. I’m okay with essentially governments looking at it and saying, Hey, we may or may not let you in the country based on your vaccine. I’m really okay with it on certain travel and those kind of things. I’d like everyone who gets on a cruise [00:10:30] ship. If we go on a cruise to have had the vaccine, I think when you have those kinds of close quarters, it’s important to have the vaccine.

[00:10:37] I’m just afraid it might get, like who can use it is my, concern. You know, how far do we go? Sports teams? If you go to a major sporting event will you have to show it. And if you show it, will they create a section that is non-vaccinated and vaccinated. You know that feels weird to me. I also am not jumping up and down about having to show it to [00:11:00] go to see a high school event where my kid are participating in things. So I, I’m more, I’m not worried about it from a perspective of making it available and having it done and done well. I’m more concerned of who’s going to use it and how they’re going to use it because we don’t really legislate that. What are your thoughts on it? 

[00:11:22] Sue Schade: [00:11:22] You know, we have different political views in general and you’re probably more concerned about that than I am. I’m more [00:11:30] flexible and open on how it gets used. I saw someone tweet the other day something about what we’re talking about and they said that have you ever tried to get your kid into a public school? Right? I mean, you have to have the vaccinations, the immunizations. So we are used to this in some places at some level and yeah, it, you just separated out where you’d be okay and where you might not be. [00:12:00] I hope that we take a more progressive position on this and don’t let anti-vaxxers or anti-whatever get in the way of how we use this information. That’s my, opinion. And we can watch other countries as well to see how it works and the results. 

[00:12:19] Bill Russell: [00:12:19] Yeah. I mean, I’m, I live in a community. It’s not a retirement community but it’s as close, I live in Florida so it’s all a retirement community. The, [00:12:30] so a third of the people who own homes in our area are Canadian and they’ve been telling me what’s going on in Canada.

[00:12:37] And I thought, I wonder if that would ever fly in the United States. It’s, to say it’s restrictive would be an understatement on one side, on the, other side to be honest with you, it doesn’t impact the people with money, the people with wealth. So one of the things is if you fly into Canada as a Canadian citizen you have to, you essentially have to quarantine at the airport and [00:13:00] one of the hotels on your own nickel. So you leave the country and come back, it could cost you for a family of four an additional five grand just to quarantine for the period of time that you have to coordinate. And I thought wow that’s really  interesting.

[00:13:12] So  I said something to my, one of my neighbors and I said blah, blah, blah. And he goes, Oh, I’m not doing that. I’m flying to Buffalo, I’m renting a limo, we’re going across the border and I’m going to my house. And I thought, yeah it doesn’t impact people of means, it impacts people who [00:13:30] don’t have the means to fly into Buffalo, rent a limo to go back to Toronto.

[00:13:35] And so it just gets, and I I reserve the right to watch how people are implementing it and go that’s good. I like that. That’s over the top. Cause I think it can be used inappropriately. All right. Let’s get to some IT stories. 

[00:13:49] Sue Schade: [00:13:49] We reserve the right to always the right to disagree on things. 

[00:13:53] Bill Russell: [00:13:53] Oh, absolutely. So a lot of directions we can go. I’ve been spending a lot of time on return to work. [00:14:00] Actually let’s, talk a little bit about your Boston children’s a little bit here because there has been some turnover in the CIO ranks. Why an interim? How long does it take to find a new CIO at this point? Aren’t there CIOs is available? 

[00:14:18] Sue Schade: [00:14:18] Of course. There’s lots of people looking for new positions, whether they are in between or interested in leaving where they are. CIO, Dan Migrin a physician had been there [00:14:30] in the 20 year range and he left. Went to MaineHealth. They did start to search when he left and they did not land a candidate, a final list and an offer.

[00:14:44] And they decided that they had some internal alignment around the EHR strategy to work on and that they were going to bring in a external interim CIO during this period to help in that space in particular, that’s kind of my highest priority, [00:15:00] while the search continues. I’m looking at the EHR strategy with them and keeping other things moving forward and supporting the search firm to find the best candidates for the future at this point.

[00:15:14] Bill Russell: [00:15:14] Well how long, do you think a healthcare organization can go? Without somebody sitting in the chair. Now obviously, you know Dan and others we all work with our direct reports and they’re really running a lot of the day-to-day operation. [00:15:30] Is it three months, if you think you’re going to replace it in three months you could probably not do an interim but if it’s six, nine a year, you almost needed an interim to fill that gap I would think.

[00:15:41] Sue Schade: [00:15:41] Yeah. Yeah. You know, let me talk broadly about interims, cause I’ve definitely been tracking this over the past year because as you know, our firm Starbridge advisors, one of our core businesses and services is interim management. And it’s slowed down during the pandemic, even though there was a whole lot of movement of [00:16:00] CIOs around the country.

[00:16:02] What I saw was there was a lot more take the second, the most senior person, second in command, have them do the internal interim role and not bring someone in from the outside for the period of time. I think it was both, it’s a cost saver to have internal person do it. And if that person knows the organization let’s have minimal change and let’s just have, you know that person run things during the [00:16:30] pandemic.

[00:16:30] I think it might start changing going forward. In the case of Boston children’s our VP of IT Operations and CTO Scott Ogawa, who I’m talking here next to Did serve as the interim CIO when Dan left. And because the search is taking a little longer than they thought they wanted Scott to be able to focus on what he was focusing on before and have me as an external person come in and do some of these other things. So [00:17:00] I think it’s very situational organization to organization. And searches can take four, six months. They can take a year or more, depending on the organization, I’ve seen an academics where it takes a very long time and some of that is the search committee process, the consensus, how many people, need to weigh in.

[00:17:23] I did. I went for a position at one point several years ago that I think I [00:17:30] interviewed with 50 people over the course of the process. And it was confidential. So I was hoping none of those 50 say anything to the organization I was at. So it varies. 

[00:17:43] Bill Russell: [00:17:43] Wow. That’s a lot. 

[00:17:46] Sue Schade: [00:17:46] That’s a lot of people. Yeah. Yeah. It wasn’t academic.

[00:17:51] Bill Russell: [00:17:51] Yes. Yeah. Yeah. But I’ll tell you that alignment is really interesting. We hired a head of HR for our health [00:18:00] system way back in the day. And they had an interview with they had the candidates interview with a bunch of different people. And to be honest there just wasn’t alignment.

[00:18:10] And so it got to be very challenging to hire, to narrow it down to the right person because you had different camps, looking for different things out of the role which is normal, but a good search firm is going to drive that alignment, I would think. 

[00:18:26] Sue Schade: [00:18:26] Yeah. And they’re working on it, I’m working on it. The person I [00:18:30] report to is working on it. And it’s early yet. This is week three. I’m in the process of meeting one-on-one with key executives. All of the department chiefs and trying to get a sense of their thinking and where they’re at this point as part of the process.

[00:18:48] Bill Russell: [00:18:48] Yeah. And I, wasn’t talking specifically about their situation. I’m just talking in general. That alignment is so key. Okay. Hey, managers, roles are changing as a result of this [00:19:00] hybrid work and it’s, there’s been a lot of work done by Microsoft specifically. They’ve done studies of their own staff. They’ve done studies of 30,000 people around the world in terms of their expectations. And it looks like a handful of things are really changing as a result of this. One of the stories, and I talked about this in the today’s show last week was Microsoft looked at let’s see a hundred and [00:19:30] 150,000 plus of their own employees and found that the connectedness, which is a metric that they get from their pulse surveys had gone from 93% to 71% over, over the last six months or so. And they were like we appear to be doing the right thing. So why are people feeling less connected?

[00:19:52] And one of the things they said is our data tells us that employees need us as managers to focus on the [00:20:00] basics first, like work-life balance and prioritization before we start to do the really fun things, like a virtual happy hour and those kinds of things. Those things accentuate it but we have to take care of that you know each individual’s work-life balance, how do we help them to do that and prioritizing their work. Because those are two of the hardest things as we’ve come home. You know, what do you find finding as you work with? You have a fair number of people you work with at Starbridge plus [00:20:30] how, is that going?

[00:20:32] Are we doing a good job? Or are we learning a new set of skills in order to keep people connected? 

[00:20:39] Sue Schade: [00:20:39] You know, that’s a great question. And it is something that I asked my folks at Boston Children’s when I started, because it’s all virtual. I’m virtual. Virtual into June. There is a group that’s trying to figure out the return to work [00:21:00] plan.

[00:21:01] Apparently this group of IT folks, they call the department ISD. I often forget to say ISD. I just say it. You know what I’m talking about. They were doing a lot of remote work before the pandemic. So they were pretty used to it but this is going on a very long time. So I think the work-life balance issues are that much more critical and they’re, this is a great survey.

[00:21:26] I went over it last night in preparation for talking today. [00:21:30] As they break down the respondents between men and women ages, married, single. You know I think we can get into that. It’s not. It’s not one story for everybody, in terms of how this has impacted them. The work from home situation and I mean, specifically the work-life balance. You work from your home office and it’s always there. It’s, you have to be able to step [00:22:00] away from it at a certain point. 

[00:22:01] Bill Russell: [00:22:01] Yeah. And that speaks to why managers are so important. Because you can do things on a broad level, but when you have. 10,000, 5,000, 10,000, 20,000 employees across the entire organization. It’s not one size fits all because not everybody has the same background.

[00:22:18] And as you said business leaders married, working moms, gen Z, frontline workers. New employees is an interesting category. So we now have a group of people that have been hired [00:22:30] post pandemi,  post the start of the pandemic. And those people didn’t have the foundation really of the lunches and the relationships with the staff and whatnot.

[00:22:42] And as you know Microsoft broke that down in the survey. They found a majority are surviving or struggling in that category rather than thriving. And so the manager, we always knew that the manager was important. But in this environment, [00:23:00] the one-on-ones the, personal interactions between the manager to help set priorities and understand your specific situation and what they can do to help your situation. I think is so critical. 

[00:23:15] Sue Schade: [00:23:15] Yeah, absolutely critical. In the, in the survey, I think one of the last things was about people being more humane and the number of people now who have seen their colleagues dogs or [00:23:30] kids, you know, it’s just  Again back to my current  experienc on Tuesday we had a all IT staff virtual meeting basically to introduce me. They do quarterlies and they’d done a quarterly in February. And I said, well we’ve got to do one. I got to see all the, I got to see everybody, they got to see me. And let me tell them a bit about me and, what I’m going to be focused on.

[00:23:57] And we had plenty of time for Q and A. [00:24:00] And in the Q and a half of the questions or about the return to work. Partly it’s getting close to people, starting to think about it. What’s it going to mean to me. But I encouraged people as we were hearing a few different stories, talk to your manager, make sure your manager understands your particular situation and where you’re at.

[00:24:20] And there are a lot of people that want to keep. Working from home, but there are, I’m sure many who it’s not working so well for. 

[00:24:29]Bill Russell: [00:24:29] One of the other [00:24:30] stories I sent over to you, and I’m just going to cover the headline, which is Citi Group CEO calls for Zoom free Fridays to promote better work-life balance. And this really has to come down from the top. There’s a certain aspect of this that the CEOs have to do and have to have their finger on the pulse, but as a CIO and as a, you know, potentially a VP or director within it there are things they’re looking up for, they’re looking for. [00:25:00] Are we prioritizing? One of the things that came out in one of the studies was not to connect with connectedness within the teams but we’re losing the connectedness across teams where they used to work closely together and come up with solutions. Let’s just spit ball a little bit here.

[00:25:17] You know what, kind of things should could managers be doing to continue to, I we talked about the individual one-on-ones really understanding having the empathy. And [00:25:30] designing an environment that works for each employee. But let’s talk about actually getting work done, which I think we’ve done a good job of. All the indicators have been good but maybe there’s things falling through the cracks that we’re not, we’re just not seeing yet until we get to a little further into this.

[00:25:47] Sue Schade: [00:25:47] Yeah. Spitballing huh. That’s just okay. 

[00:25:52] Bill Russell: [00:25:52] We’re just throwing things out. I know. What could managers be doing? 

[00:25:56] Sue Schade: [00:25:56] Yeah. What could manabngers be doing. Well one thing I’ll say, I think it’s a [00:26:00] good, and it gets to the Zoom free Fridays and maybe it’s partly the fatigue as well. And people talk about Zoom fatigue.

[00:26:08] At Boston Children’s the culture is you’re on camera. And I think that’s good. I did work with a but that also adds to the fatigue, but I hope, I think it helps with the connectedness and being able to read people and body language and all that kind of stuff. I did do all virtual consulting project with a health system [00:26:30] last year.

[00:26:32] They did not have that. Everybody have to be on camera and it was hard to read the room and get to know people when I couldn’t see that. So that’s, I mean, that’s one thing in terms of the connectedness. You know I, don’t have a good read on, but you said we’re spitballing the, team connections and the team working together cross teams, I think probably individual teams are working well together and maybe more of a challenge for some of that collaboration.

[00:27:00] [00:27:00] I’m thinking ahead too. I’m thinking ahead to not everybody remote work, but more hybrid situations. Because I know there’s organizations that are saying we’re going to be all remote. I talked to a CIO who said, we’re staying remote. We’re going to do national recruiting. We’re in a hard to recruit area.

[00:27:17] Right. You can see, but again, I’ll go Boston centric. Boston is a hard commute. You know, I think organizations are going to say, wow, if we can get [00:27:30] happier people more productivity, they don’t have to commute every day. They come in some days. So I think if you’ve got hybrid situations, you’re going to have to figure out when should which teams be in the office together for collaboration?

[00:27:46] Are you staggering teams based on social distancing and how you’re going to use space or less space, but how do you bring people back in and make sure that you enhance the collaboration? [00:28:00] That’s so important? I don’t know. I don’t have the answers. I’m going to be talking to Scott, who is our, point on the return to work committee.

[00:28:10] In fact, I shared the articles that you’ve shared with me with him. And you had Today in Health IT podcast where you talked about this I think on Wednesday of this week, I listened to it. I shared that with him. A lot of good, a lot of good insights from the surveys. 

[00:28:28] Bill Russell: [00:28:28] Yeah. I’ll tell you, one of the things is [00:28:30] if, you didn’t have that connectedness before you went virtual, you definitely don’t have it today.

[00:28:34] And one of the things I found when I came in as a CIO for a we had just insourced from from a national player and the, mechanisms, the processes and the communication wasn’t really established or solidified by the time I got there. And one of the things I found was we, but between the department heads, the VP level, they didn’t know what the other VPs were doing.

[00:28:59] And so we [00:29:00] set up a, what I call a cadence meeting and the first one was four hours. And what we did is we had every project from all of IT come in and present. And they had essentially 15, 10 to 15 minutes to present their project. But it was interesting. We got done that first meeting and all the VPs looked at each other like, Oh my gosh, I didn’t realize we were doing that.

[00:29:20] There were so many times when they were like, wait a minute, you should be talking to I didn’t, realize you had those data needs. I didn’t realize you had those development needs. And after that [00:29:30] first meeting, they looked at each other like, all right, we need, this needs to be a meeting that we’re doing.

[00:29:34] At some level, at least monthly so that we know what projects are going on across the board and we can help our teams to connect. And so I still believe that even if we were all in, in person, we would still have this, The silo breakdown in a lot of organizations. And so it needs to be intentional and now we need to do it virtually, but quite [00:30:00] frankly, what I just described can be done virtually and still create that connectedness across those silos.

[00:30:05] Sue Schade: [00:30:05] I I totally agree. I totally agree. And in big organizations, big IT organizations, you may have teams spread out in different office locations, or you may have them in a huge office location and people think that’s that team over there, I maybe go see them once a week. So you have those silos, even when you’re in the same physical space.

[00:30:25] Bill Russell: [00:30:25] Yeah. Well Sue happy information blocking day, by the way. 

[00:30:30] [00:30:30] Sue Schade: [00:30:30] Okay. Yeah. 

[00:30:31] Bill Russell: [00:30:31] This, goes live, let me tell you so I’ll, tee this up with an article. that I just pulled up Med City News, HHS information blocking rule goes into effect on Monday, today. And for nearly a year providers and IT vendors have been racing to prepare but they have faced several hurdles along the way, including figuring out how to handle scenarios that could make them noncompliant. The rule goes into effect but the expansive nature of the regulation and the lack of clarity around [00:31:00] what could be considered information blocking is making it hard. And so they said a couple of things here. Let’s see according to John Mass, Cerner’s lead regulatory strategist, this is a lawyer and Dr. Joseph Schneider chair of the Texas medical association committee on health information technology. And I didn’t share this story with you. So you’re hearing it as everybody else’s area. Mass and Schneider spoke about some of the challenges their organizations are facing navigating the rule.

[00:31:28] At the virtual [00:31:30] 2021 ONC annual meeting and there were some really good breakouts in that. The definition of electronic health information is any information contained in a designated record set he said and that is a whole lot of information. North Kansas city, Missouri based Cerner is looking at all the products and services that they have to determine where are those pieces of information live so that when they get a request they can pull that data in as needed. For health IT [00:32:00] developers requests for information can come from anywhere. Clients, patients, even third-party entities. So Cerner is also working to identify where requests are coming from.

[00:32:10] Mass said they are trying to tag each request they receive as well as how to respond to each one of those requests. The gentleman from Texas medical association shared a story. For example, Schneider recalled how a physician recently went to the Texas medical association to sort out a data conundrum, a [00:32:30] data conundrum. That’s interesting. 

[00:32:31] The doctor’s office had asked a local hospital for information on the clinics patients that were also admitted at their facility. The office requests, the office requested that the hospital send the information directly or via the local health information exchange as it had a non-Epic EHR but the hospital’s Epic system could neither coordinate with the offices EMR nor was it set up to integrate with the local HIE resulting in a potential [00:33:00] information blocking violation.

[00:33:02] All right. So that’s, a lot of background. And by the way that last scenario, that absolutely should be considered information blocking. They’re not there. They’re not communicating with the local HIE. That’s the HIE it’s designed to receive information. They put the regional HIE in place and said, okay, how can we get everyone to share with us?

[00:33:22] And Epic has ways to share the information. That is a clear indication that somebody is not, [00:33:30] intentionally not sharing information because all entities were designed to share information. So that’s my personal opinion on this. I’ll preface this by saying I have not been hearing a lot of stories on this.

[00:33:43] I have not been following this nearly as closely as I should with with CIO. So I’ll probably start throwing this into the interview question on information blocking. You know, I other than what we’re reading here, I don’t really have a lot of color to add. [00:34:00] Or do you have are you hearing anything at this point it’s struggles or or positives on this?

[00:34:09] Sue Schade: [00:34:09] I will admit I haven’t kept up on that topic in terms of information blocking and what’s expected, but in the greater scheme of things it’s about interoperability and sharing of information. And you’re absolutely right. What are the HIE designed for? The greater good. Right. And to share information and [00:34:30] every organization’s got to do it.

[00:34:32] It’s some of the challenges that we’ve got where I am now at Boston Children’s as looking at the interoperability. When you are a children’s hospital and you get a lot of referrals and you’re working with all the community hospitals and the community pediatricians you absolutely have to have that easy open data exchange.

[00:34:53] Bill Russell: [00:34:53] Yeah and I make this point every time we talked about this, they may have been sitting back and saying, Oh the Biden administration’s [00:35:00] coming in, maybe this will change. But the reality is this started under the Obama Biden administration. And it was continued through the Trump administration. I think if you think of two administrations that are more different and it continued through those administrations, I think that would lead everyone to believe this is as bipartisan an issue as we can possibly get. And this is moving forward. 

[00:35:23] Sue Schade: [00:35:23] You know to the extent that you can conflate this with the interoperability rules and [00:35:30] Cures Act. It’s, I think people in 2020, IT and IT leaders in 2020, might’ve thought it, you know, some of this might get delayed. Not that it won’t happen, but if it gets delayed because we are so focused on dealing with the pandemic that’s okay.

[00:35:50] So I think there are organizations that on some of this are just, you know, purely playing catch up as these things don’t end up getting delayed. 

[00:36:01] [00:36:00] Bill Russell: [00:36:01] You know, as I talk to people there’s, two sides that I sort of fall in and I could be caught in either direction. One is, it’s not like you didn’t have a decade of knowing the interoperability was important. So there’s part of that. But I do empathize with the fact that there’s a lot of scenarios. There’s a ton of scenarios we have to deal with here. There’s and they’re right. In saying any number of people can make a request for this information. It’s not only the patient. It could be a third-party app that [00:36:30] gets developed on behalf of the patient that makes a request for the information.

[00:36:33] Then we have to worry about the security mechanisms and identifying the the, authenticity of that request on behalf of the patient and those kinds of things. And so there’s just a whole lot of complexity to get through this rule. But again we had, it’s not like we didn’t have a decade, but now we actually have let’s just say, we’re not auditing the course anymore.

[00:36:57] We now get a grade for our course and [00:37:00] the grade is are we blocking information or not? And it’s yeah this is, a, this is, going to be hard to implement. Let’s see. One more story. So I actually would probably just hit the headline here. I’m just more curious what your, thought is.

[00:37:19] And this is the Kaufman Hall study. It’s that negative operating margins would likely for 39% of the hospitals this year. What does that mean for health IT? 

[00:37:28] Sue Schade: [00:37:28] Yeah, I think it means [00:37:30] tighter budgets. Hopefully it doesn’t mean layoffs. And people are greatest asset and organizations, but I think IT leaders are gonna have to find more ways to reduce costs. The, you had a interview recently with is it William? 

[00:37:51] Bill Russell: [00:37:51] Yeah. Yeah. William Walders with Health First out of space coast of Florida. 

[00:37:56] Sue Schade: [00:37:56] Yeah. When you talk about [00:38:00] he made a commitment in terms of taking costs out. And did he talk about application rationalization and area? Primary for many organizations but what he took out, he wanted to be able to keep and reinvest. Right. 

[00:38:15] Bill Russell: [00:38:15] He didn’t keep it all. He kept but he kept a portion of it so that he could reinvest and continue to modernize the it side of things. And that was not only the app rat side of it. He was renegotiating contracts and yeah almost immediately [00:38:30] coming in as a CIO almost immediately, he was able to save millions of dollars just by renegotiating contracts.

[00:38:35] Sue Schade: [00:38:35] Yeah. Yeah. Yeah. You know, app rat and renegotiation of contracts, I think are some of the do we want to call them the low-hanging fruit? They take a lot of work. But when you hear about them, you hear about X number of instances of the same product or multiple vendors for the same product function. Mmmm  really that needs to change.

[00:38:57] And I think yeah, there’s [00:39:00] opportunities there. Yeah. That’s what it means for IT. 

[00:39:02] Bill Russell: [00:39:02] All this stuff is leading towards more efficiency for the acute care in academic medical centers that are out there. It’s interesting. I think this gets back to one of your fate, one of David Muntz’s, your partner’s favorite topics and you knowa Partners at Starbridge Advisors, and he talks about governance all the time.

[00:39:22] We talked to Theresa Meadows and had an interview with her and she, and one of the things she said [00:39:30] is I said so projects are the old projects kicking off? She goes yeah the old projects are all kicking off again. I said, all right, are they asking for new projects? She says, yep new projects are being asked for.

[00:39:42] I said, what about the COVID project? She goes, all the Covid projects have to continue. I’m like it’s, like everything is in addition to. We didn’t go back to saying, all right, we’re going to put everything through governance. Do we live in the same world we lived in just a year ago and are these things [00:40:00] still priorities? We just kicked them all back off again. And now we’ve got not only the projects that we were doing, new projects that are coming down the plank, plus the COVID projects. I’m not sure how you could do that operating in negative margin territory without. Not doing things well. So I am, I’m concerned about that and the greatest asset we had, the biggest silver lining we had during COVID was focus. We had a very few things that we were doing, and we did them very well and, [00:40:30] everyone raved about it. Isn’t it amazing how much we got accomplish over that timeframe. And I think this is one of the things as leaders we struggle with. We say, when we, when you say yes to something, you’re saying no to something else. And when we say yes to everything, we’re saying no to either effectiveness, the ability to get things done in a timely fashion or whatnot. So this really is a leadership issue. I think. 

[00:40:58] Sue Schade: [00:40:58] I think you’re right. It was focus [00:41:00] and it was decision-making. Quick decision making. Clear the obstacles. Do it. One thing that I would project or a few things I would project is going to come out of all this is greater standardization. Reduce the variation. More more integration within organizations.

[00:41:21] The pandemic has had an effect on the entire organization and [00:41:30] organization. Healthcare provider organizations have had to come together to deal with that. And if that has exposed, Oh gee, they do it this way. We do it this way, going forward. We’re going to do it this way. Greater standardization, reduce the variation. I think that we’ll be coming and that’s also a way to reduce the costs. 

[00:41:51] Bill Russell: [00:41:51] One of the most important hires I made within IT was essentially  a CFO forITt. They didn’t have that title, but they were [00:42:00] essentially that person, they interacted with the finance arm. But the thing that person did for me was to constantly be looking at, i, would give them scenarios, like if we need to do a 10% cut next year. So we’re just starting this budget year. And I would say 12 months from now, they asked me for a 10% cut. I need to know where that’s going to come from. And so we could be working 12 months ahead at reducing the cost within it so that we wouldn’t have to do those.

[00:42:27] Those staff cuts if we [00:42:30] didn’t didn’t need to do them when, that time came around. And there’s, so many things here last. I said that was the last story but let me ask you this Amazon Care, is this a big deal or not a big deal? Are people in hospitals and healthcare delivery talking about this?

[00:42:51] Sue Schade: [00:42:51] You know, it’s probably a big deal. I’m really am not sure. But again I think another positive coming out of the [00:43:00] pandemic is the level of innovation that’s happening within the industry. And I think these disruptors are going to continue and I think that’s fine. And I think that provider organizations need to figure out how to work with them.

[00:43:13] And one of the stories I shared with you was kind of what was it? Amazon here joins coalition. Man home care, 14 and other healthcare it notes. It was in Becker’s and those notes all had a link behind him. And most of those notes were about partnerships that provide organizations now [00:43:30] have with big players within the healthcare ecosystem. So I think we’re going to continue to see this evolve and that’s good. 

[00:43:38] Bill Russell: [00:43:38] I’d love. I love getting your thoughts on that and you get the last word today on that. So I appreciate it. Sue good luck in your new role. You still have the old role. You’re, like you have no governance in your jobs. You just keep adding to them. 

[00:43:54] Sue Schade: [00:43:54] Yes. I still have the Starbridge Advisor’s role as a principal and the business. But my focus is [00:44:00] full-time interim CIO at Boston Children’s right now. I will somehow make it all work. 

[00:44:08] Bill Russell: [00:44:08] I look forward to seeing how it goes. That’s all for this week. Don’t forget to set up for Clipnotes, hit the website, big subscribe button in the top right-hand corner.

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