Sue Schade and David Muntz with Starbridge Advisors discuss everything from EHR implementations to IT governance in a fun back and forth on topics that will shape your 2020. Hope you enjoy.
[0:00:05.5] BR: Welcome to This Week in Health IT Influence where we discuss the influence of technology on health with the people who are making it happen. Today we talk to two of my favorite people in the industry, Sue Schade and David Muntz from StarBridge Advisors. They are industry veterans, they are highly decorated, CIO’s of the year, innovation, fellows, you name it, they’ve done it all.
My name is Bill Russel, healthcare CIO coach and creator of This Week in Health IT, a set of podcasts, videos, and collaboration events dedicated to developing the next generation of health leaders. This episode is sponsored by Health Lyrics. I coach health leaders on all things health IT, coaching was instrumental in my success and it is the focus of my work at Health Lyrics. I’ve coached CEO’s of health systems, CTO’s, CIO’s you name it. If you want to elevate your game in 2020, visit healthlyrics.com to schedule your free consultation.
I recorded this episode in late 2019 prior to our studio move, a couple of things about that, from a timing standpoint. Sue was in the middle or just getting ready to do an epic go live for a health system and which she is now completed and several months past. My sound is actually not that good because we’re in the middle of a studio move but Sue and David’s sound great. We play a little health IT jeopardy. I give them about 10 topics, they select the topic and we talk about the state of the industry and where things are going.
It’s a lot of fun, I love their wisdom, they just do a fantastic job, great guests. I hope you enjoy.
[0:01:26.2] BR: Today I’m excited to be joined by two leaders of StarBridge Advisors, previous guest of the show, Sue Schade and David Muntz. Good morning you two.
[0:01:33.8] SS: Good morning.
[0:01:34.9] DM: Morning.
[0:01:36.1] BR: You guys are kind enough to be testing out this new format for me while we’re trying to do three guests, we’ll try not to talk over each other because the video sort of bounces between us. But we’ll see how it goes. You know, as previous guests, we’re not going to go into your credentials but would it be fair to sum it up by saying, highly decorated industry veterans or is that offensive?
[0:01:57.6] SS: We’re okay with it. Thank you, Bill. We’ll try to live up to that.
[0:02:06.5] BR: Officer of the Year, Innovation Officer, Legacy Award Winner, you get the picture, you guys have seen a lot of action in health care and I have been successful at doing it.
Today we’re going to do something a little different, we’re going to do state of the industry. I have eight categories and here’s what we’ll do, we’ll do it a little bit like a game, I’m going to put out the eight categories. Sue, you can go first by picking whatever category and then, what we’re going to do is we’re going to talk about what’s the state of the industry Health IT today and what’s the next step, where we’re going, not maybe, what’s 10 years from now or five years from now but what’s the next step?
And so, the eight categories are: IT operations and security, IT budgeting, governance, EHR implementation optimization, mentoring and training, staffing, innovation, and experience, either internal experience or consumer experience. Sue, we’ll give you the first choice of the category for this episode.
[0:03:01.9] SS: This is like Jeopardy. Okay, I’m going to take EHR implementation optimization.
[0:03:05.5] BR: Yes, because that’s right where you’re living right now. What’s the state and we’ll start with you Sue. I mean, what’s the state of the industry from your seat and potentially what’s the next step for us?
[0:03:15.2] SS: Sure. You know, state of the industry versus a place I’m working right now where we have a big Epic go-live in 42 days, something like that. Overall, I think a lot of organizations have the EHR implementation behind them. You get that sense looking at the industry at this point. However, there are still pockets where that’s not the case. And due to merger and acquisition is still a lot of implementation activity going on.
I think those organizations that are in the throes of that are heads down on that. They’re not focusing on telehealth which has become table stakes or you know, digital health and consumer engagement. You know, obviously, they’re dealing with basic operations and security and other challenges that they have. But when they’re in the midst of you know, the EHR implementation and then that close period of optimization, it is just heads down.
[0:04:09.0] BR: It is hands down. It’s interesting, because you just gave us three other topics which we’re going to digital health and telehealth.
[0:04:14.5] SS: Nice segue.
[0:04:16.3] BR: We’re going to ignore that but I’ll kick it over to you David on this topic which is there is still a lot of consolidation going on in the industry. I see these different jobs that are coming across and different consulting opportunities and that are coming across. It has a lot to do with the integration of disparate systems, if not, three or four disparate systems.
Do we ever see a – well, let me start with this question. Is it good in right goal to get your entire health system on the same EMR? Let’s start there and in the next one, which is if it is, how do we continue to do, maybe walk and chew gum? Do that as well as do some of the other things that are going to move the health system forward?
[0:04:55.2] DM: Sure, well, I’m going to go ahead and take the less popular approach if you don’t mind. That would be a little more provocative on this. I’ve always believed, even though I want to see the pendulum swinging, that you really have to live in a multi-vendor environment. You can’t escape it and it’s certainly desirable to have your primary hub come from one vendor and the reasons are pretty obvious. People, you know, used up probably not necessarily nice approach, went [inaudible 0:05:24], they talk about the integration they expect to see and they expect that the products will develop more quickly and I’m not sure I agree with all of those benefits.
The fact is that the world that we live in is being bombarded by new apps and new applications, new vendors, new ways to do things and if you really want to go through a transformation, you can’t wait on that central vendor to do the work. Innovation depends on you being able to have API’s that attach to the vendor that sits the center and that’s not necessarily the best interest of the vendor.
I would challenge that even though a central vendor is important, it certainly is not the thing the only place you should focus. And you need to figure out how to do real integration and that’s not just interface. That’s also looking at API’s and figuring out a way to incorporate new ways of thinking, new ways of working.
And you know, the government and having served in the government during the time where meaningful use is there, people talked about API, but the API’s were limited essentially pulling data out of the electronic output. And what I think we missed the boat on completely was the ability for us to say we want to pull out API’s but ingest data, from other sources.
As we start to do analytics, you’ll see that they’re just getting pulled from all kinds of sources, many of which are not EHR’s. It’s pulling information from census data, pulling information from community services et cetera.
I’d like to see us embrace the multivendor environment and I see a lot of companies, you know, I’ve seen these companies where you have one of the two big vendors come together and then all of a sudden, they take one portion of the organization and they move it to the other vendor.
Because they think the consolidation of the vendors make sense and it’s really the consolidation of the data that makes sense and you’re going to have to do that regardless of how many vendors you have in the space of – not a big fan of single vendor approaches.
[0:07:29.0] BR: Yeah, you know what that is? Pretty provocative. Although if you’ve been in the consulting world as we have been for the last three or four years, I mean, I’ve seen those request come in, “Hey we just we merged these two organizations and think about how silly this is. We’re a shorter shop and we just implemented Epic at this hospital and we’re getting rid of Epic over here.” Or vice versa, “We just finished our Cerner implementation a year ago at this health system but it got acquired. Now we’re taking it to Epic.”
I mean, just the whiplash on that organization from a culture standpoint has to be pretty significant. But Sue, I’ll let you have the last word on this. What’s next for us? What are we looking at? Are we going to get better at optimization? Are we going to get better to the point where this whole idea of clinician burnout and clinician fatigue around the EHR starts to dissipate?
[0:08:19.0] SS: Well, I would hope so, there’s been a lot about position burnout that KLAS Arch Collaborative, right? That whole effort, really focus in on that. I listen to some of the reports out of that and then as the usability factor of the EHR and there’s the training factor and you know, we’re in the midst again right now going back to where I’m working, we’re in the midst of the training piece and you know, that’s absolutely critical to how to address that.
Are we going to get better? I mean, we have to get better. there’s always lessons learned that vendors in a consultants are bringing forward from client to client. We absolutely have to and I think what you’re seeing, you know, we’ve all been around a while with more foundational products and not doing all the customization. That changes the whole optimization piece. It may open up more needs in terms of optimization because an organization says, “qell, the vanilla just doesn’t work for us.”
At the same time, it may be do say a whole optimization piece as the organization tries to get to anymore common vanilla is probably a bad word but a more common approach. I don’t know, that’s a tough one in terms of what’s the silver bullet around optimization and getting these EHRs or the point they need to be so we’ve got happy efficient physicians and clinicians.
[0:09:33.0] BR: Yeah. It’s interesting, a lot of the CIO’s I’m talking to are ramping up and trying to figure out that quarterly update thing. That’s from Epic, a pretty significant change and lifts for a lot of IT organizations. That sort of gives us the – this is what it feels like, it’s not a deep dive into any one of these. But it’s sort of a high level – David, if I could guess what topics.
Remember, IT operation security budgeting, governance, mentoring training, staffing, innovation and experience. Which one would you like to talk about?
[0:10:00.8] DM: Probably governance and –
[0:10:03.4] BR: I didn’t even know you were going to talk about governance.
[0:10:05.3] SS: That’s okay.
[0:10:08.3] DM: Not government. Governance. There’s a thing that I’ve noticed is the lack thereof in the organizations and sometimes governance is such a broad category but people define it generally speaking, in terms of demand management. But the place where I see the greatest need right now is for data.
We have a data tsunami on us. And you know, I’ve said the interesting thing about a tsunami is, a tsunami will be fabulous if you could harness the energy that’s associated with one. But the difficulty is that the water just comes ashore and destroys everything. I see a similar situation for data, we get a tsunami of data but if you can’t harness it and figure out how to use it, what’s relevant and how to incorporate it all, well, then we’re going to fail.
And you know, as we had social determinacy of health. All that does is going to freeze the amount of information that’s flowing our way. I would suggest that where we need to focus is on three different things that are all related.
And the first one is the data governance which deals essentially with a small element. Then with information governance which is radically different than data governance but also is important to figure out how we’re going to take the raw materials that’s been processed and use it in ways that makes sense. And then finally, one that I don’t so anybody paying a lot of attention to and that’s knowledge governance and it’s like one chance of information and made a discovery that’s going to potentially have great impact or discover something that’s having a harmful impact. How do you take the knowledge and distribute it?
And you know, you hear in medicine all the time about it take 17 years from the time something happens or is discovered until the time we actually use it in our everyday lives and so with data and all the information that could be generated in the knowledge that it could be spread, how do we take advantage of that?
And then finally, I know it’s not necessarily related to the other three but I think it’s probably at a higher level, that’s innovation governance. And you know, innovation should not be a hobby or a game. Innovation should be I think founded in pragmatism and practicality. And – but you can’t figure out how to use all the three things I just talked about in the innovative way to transform what it is that we’re doing now, then innovation is great but it’s not as effective as we wouldn’t want it to be. I put that governance wrapper around all of those things and think it’s important we pay attention to those.
[0:12:44.5] BR: You know what’s interesting is, we’ve heard death by pilot is now a term we’re hearing pretty often in that it seems like it’s no big deal to spin up a pilot. But if you spin up too many of them, you lose focus, you lose energy and potentially, people get sort of lost in the whole thing. And data governance is another one that I find interesting because I talked to Dale at the Health Catalyst Summit and one of the things that he pointed out was that we have an opportunity with analytics to show the value that all of this work has meant over the last decade or so around the HER. I mean because we are going to get some real valuable data and some real game changers essentially out of this data if we work it right.
But if we do it incorrectly we stand on a cliff where we could jam this in at the wrong places in the wrong ways and really drive the clinicians even further away because we aren’t doing it in a way that he keeps using words like empathy, but is – I keep coming back to the word design that is designed to help. It is listening and understanding and then putting that data back to work in a way that they are asking for it to help.
[0:13:54.5] DM: Well I think – oh I’m sorry but to your point I think analytics spits some innovation I mean on the information and knowledge governance levels and it is just part of the activities. But what I have seen and just talked to a very prestigious organization everybody would know and one of the things they were celebrating was the fact that everybody is able to pull data and use it and it’s like, “Well who’s directing the formulation of the right questions to do the investigation that are going to mean something?”
And so, it’s kind of fun to harness creativity and you know people can be very innovative. But again, without having some way to tie together the activities and marshal the resources which are precious in every organization, it really adds more chaos than direction and I think that is part of the issue.
And by the way death by pilot, I have now advise the people who used to report to me when I was a CIO and all the clients to stop using that word and use the word demonstration.
Nowadays pilot kind of infers that at some – I mean I infer from piling that are failure. But potential use the word demonstration and it is like you get confidence in your idea and you are going to show its value as oppose to take a chance on the fact that something might fail.
[0:15:12.8] BR: So, David I want to back you on what’s next. Sue, any thoughts around governance.
[0:15:16.7] SS: Sure, One broad comment around governance is one size doesn’t fit all yet every organization needs help here from what I can tell. And my experience in the last couple of years doing inter rounds, every organization I’ve gone into has had some gap area around governance. And some of it pretty basic that would surprise you.
So, it absolutely has to be addressed and I think David did a good job of kind of outlining some of the different components of it. I like the point about innovation governance because I think this is something maybe that’s one of your categories that we can pit but I don’t think people talk about innovation governance so much. It is more about who is in charge of innovation? What are the different roles, where is IT fit? So, we can get into that maybe when we pick innovation.
[0:15:59.5] BR: So, David what’s next, where do we go from here?
[0:16:02.2] DM: In terms of industry or you are talking about activities?
[0:16:05.0] BR: Yeah so you know we try to be pragmatic on the show and some CIO’s are listening and they are going, “How are you going to find the gaps in my governance? And how do I assure that up?”
[0:16:14.5] DM: Well I am just going to pick two and I will let you pick out which direction we go but one is of course the ERP’s. We didn’t even talk about them. But the fact is that they have been ignored for so long. I see an awful lot of activity with people investigating ERP’s and now coming back to pay attention to all of the things that are necessary.
And you know when you look at the cost of health care, the biggest portion of our spend is on staff. Okay so that relates to our staffing issue and the second biggest portion of the budget is supply chain. That counts for about 90% of all the spend that goes on in health care institutions.
So, if you are trying to look for efficiencies over empathy, those who are trying to reduce cost and be smarter. ERP’s are a natural place where we should be spending some of our time moving forward but it just moves it may be as much as decade old. So I think there is a lot of opportunity there.
The other thing I was going to mention and this is related to mergers and acquisitions and what happens afterwards and it is somewhat related to governments and systems and that is the ability of an organization to act consistently across all the different components. And so, I’d offer those two as places where there is opportunity for discussion and opportunity for improvements in every organization space.
[0:17:33.8] BR: So, I want to pick the next topic as I could go off of that for a little while but I’m pick the next topic and keep us moving. That’s IT budgeting. So, a couple of things I will sort of set it up and then Sue we’ll go to you next. Here is what I’m seeing, there is pressure on the IT budget, there is still an education that needs to happen at the executive level if not the board level on the need for ongoing maintenance of the equipment and the maintenance of the tools that you’ve purchased.
It is interesting that we are still seeing people go, “Hey we want 4% cut from IT.” And when you think about a 4% cut from IT, it is almost silly to ask for a 4% cut from IT because you are sitting there going, “Well I can’t cut my EHR implementation because after it’s done, after the capital because they are not going to renegotiate the license.” We are still using all of the parts we are using, you are not going to renegotiate your access.
So, there is a whole bunch of fixed costs that once you buy it they are just fixed cost. And then there is cost of operating those things and so when they say 4% to IT essentially you cut out 70% of the budget which you can’t cut anyway and then what they are really saying is now the 4% of the total you now have to get out of 30% of your budget. Which you can do the math is pretty significant cut from IT and so we keep having these conversations that I think it’s why a lot of health systems have spent the time to put things like Apptio in and what not, so that they can justify the spend and educate the executives.
I am curious and you know Sue we will start with you. I am curious are we seeing that across the board or is that just a handful of class that I’ve run into?
[0:19:13.3] SS: What I am running into clients and I think it’s probably fairly common at this point, you know the pressures healthcare, healthcare organizations are going to continue and everybody has got to hold the line and find ways to reduce costs.
So, I don’t think that’s going to change. I think a couple of things that need to happen you know says CIO’s are listening, what do you need to do? Fundamentally if you are not aligned with your executives in the board about the value of IT, you are going to have an uphill battle when it comes to any of these budget conversations.
And I think there is organizations unfortunately in 2019 that are still in that position though I think many are not. I think the value of IT has become a lot clearer.
The other thing that I would say is you know everybody, IT, every functional area has a fiscal responsibility within the organization to be as cost effective as possible. And you know I know in all of years of working as a CIO and you are at the table annually and that annual budget process can take months in some organizations. And you’re listening to what all other executives are asking for and making your case for what you need an IT. And you know the days of being able to pad the budget and just really rapid increases in growth and IT budgets at the expense of some other things are way gone. So, you are negotiating what you need with your peers.
When it comes to your comment Bill about maintenance and that core, I mean there is a core that you can’t take away, right? And if you can tee up for your executives this is the base line, you cannot take this away. But if this is all I have. I am not doing anything new. We are just keeping the trains running. The door is open whenever you want to say. So, what you need to do is always be getting that easy and efficient as possible right? At the baseline I think we all agree and you need to create the capacity for the new, the add on and show the value of it.
[0:21:14.9] BR: So, David, we’ll give you the last word on budgeting because I know you’re back to talk about this topic but take the question a little different for you and that is should we expect health IT budgets to continue to grow? And what areas within the health IT budget should we be looking to minimize or reduce?
[0:21:32.7] DM: A great question by the way. I agree entirely with what Sue is saying. My experience as well and by the way, I always love budgeting. So, you know I am one of the peculiar CIO’s. But part of the reason was the governance process that we had in place where IT did not make decisions about priorities or how the money could get spend and instead what we did is we went to the users said, “How would you like us to spend the money?” You are generating revenues that we are using.
So, I think that is a big deal what we came up with was instead of using ROI because in the net present value every infrastructure purchase we made was always negative and so we could never compete if you looked at it from pure ROI or [inaudible 0:22:13] standpoint. So, we created what’s called a value investment, which is a much broader different view of things and it looks at the traditional ROI and it looks at the flexibility that you get with the investment you’re making, it ;ooks at the intangibles that is going on and looks at the risk of not performing or upgrading party for infrastructure. And then finally there is a social value from a patient’s perspective about what IT should do and so I think it is important to look at this ROI or budgeting radically in a different way.
So again, making the business case for that was huge.
And the other thing that’s happening in the industry and I have said this again I think it is a little provocative but I see the infrastructure has really reached commodity steps. And so, rather than making IT the burden of the CIO or the person who is responsible for the digital health strategy, to me that is just the cost of doing business into the degree that you could outsource your infrastructure. Then people are going to pay for it then the difference is it’s like buying pizza by the slice. The more you consume it you know it is going to be a variable cost as oppose to a fixed cost.
And if you can make the leap to lose all of your IT or the bulk of your IT cost from fixed to variable, now the budgeting becomes a whole different matter and because if it has reached commodity status or utility status it is just like saying we are not going to be air conditioning the facilities. We are not going to put water out into the facilities. If IT becomes just one more utility and then we get to focus on the analytics and the other things were we are truly Chief Information or Chief Innovation Officers who are helping drive the business as oppose to being driven by the business.
[0:24:00.4] BR: Again, I can go off of that.
[0:24:03.0] DM: We are teasing you.
[0:24:04.8] BR: Very, very easily because the infrastructure has become commoditized. We are hearing that from a lot of the forward leaning CIO’s but it is provocative still amongst a significant portion of the group who still believes that you know the cloud is not secure. It is not to be trusted and so forth and you know we’ll see how that all plays out.
[END OF INTERVIEW]
[0:24:24.3] BR: I really want to take David and Sue for taking the time to join us this week. You’re going to have to come back next week, next Friday for the second part of this episode. They were kind enough to give me about an hour of their time. And we just ran through these topics and just had a good time talking about them. They are so knowledgeable and articulate it is always great to have them on the show.
Special thanks to our channel sponsors, StarBridge Advisors , VMWare, Galen Healthcare, Pro-Talent Advisers and Health Lyrics for choosing to invest in developing the next generation of health leaders.
Please come back every Friday for more great interviews with influencers and don’t forget every Tuesday we take a look at the news, which is going to impact health IT.
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Thanks for listening. That is all for now.
Sue Schade and David Muntz with Starbridge Advisors discuss everything from EHR implementations to IT governance in a fun back and forth on topics that will shape your 2020. Hope you enjoy.