Note: In case you missed the other 12 Days of #HITChristmas, you can start with the first day here along with the story behind #HITChristmas or read all 12 days here as they are published.
On the 3rd Day of #HITChristmas we’re excited to feature, Lee David Milligan, MD, CHCIO, CIO at Asante Health System.
Tell us a little bit about yourself:
OK, I grew up in Erie, PA. From there, it’s a whirlwind. Undergrad at University of Utah, Med School at George Washington in D.C., Internship/Residency at UCLA-Harbor, then landed in Oregon to practice Emergency Medicine. My wife Jennifer and I are raising 4 teenagers in southern Oregon—Sean, Jake, Molly & Danny. Following a lifelong dream, I went back to school in 2008 to pursue computer science. Soon after, our system started the selection process to convert from paper to EHR. The timing was perfect and so the journey began.
What’s the biggest traffic problem you’re directing at the intersection of healthcare and IT?
In a word: Prioritization. Infinite desires in a world of finite resources. Getting to nirvana on this is critical for the sanity of my staff and for the health of our organization. All the ideas that come down the pike are good—no doubt—but identifying which are worthy of precious fixed human resources is the actual question we need to answer.
What are you doing to address it?
Re-tooling how we engage with stakeholders and the PMO. Instead of responding to requests thrown over the wall, my team is now calculating the available monthly resources (in hours) for each team. Then we meet with the PMO monthly to deliver our finite availability. Based on our strategic direction, they can now choose which projects are worthy of each team’s pre-identified time.
Over the next 6 months, what is going to be the majority of a CIO’s focus?
21st Century Cures (#21CC) has to be top of mind for most CIOs. First, let me say that I’m a big fan of #21CC. IMO, it’s a patient’s rights issue and our historical patriarchal approach is antiquated and needs this and other changes. In addition, artificial barriers to access the record must be removed. However, the requirements are very broad and it’s easy to miss things. Each health system will need to devote hundreds or thousands of hours of effort just to discover hidden Information Blocking workflows. We are now in the midst of that discovery and we definitely have significant work to do.
What’s the best solution you’ve ever seen implemented in your career?
Secure Messaging. We chose Halo (@HaloHealthInc).
What did it accomplish and what made it special?
Secure Messaging provides the digital layer of asynchronous communication within a health system. Getting this right is at the base of Healthcare’s Hierarchy of Needs. Not only did it allow us to retire outdated technology (pagers) to provide a traceable and effective mechanism to rapidly exchange medical communication (doctors to nurses and vice-versa as well as other clinical communiques), but we were able to completely re-organize how we communicate. Our stroke activations, trauma activations and STEMIs are all now messaged through a single click on Halo.
In addition, it solved problems we didn’t expect. For example, we have an ITS call system whereby a manager is scheduled to be “Manager of the Day” (MOD) and is designated to be first line should the Service Desk need to escalate an issue. When an escalation occurs, if the MOD needs additional input, we simply communicate through our Halo distribution list. We are able to resolve nearly 80% of all issues without standing up an Incident Command or even calling a meeting to discuss. Its an effective means to get the right people in the conversation and make informed decisions fast. Now, other non-medical departments in our health systems use this in a similar manner.
As an MD, what perspectives does that provide that other CIOs that aren’t MD’s might not understand as well?
Pain. The pain of using poor technology to deliver 1:1 patient care when it matters most. Knowing what its like to experience a poor user interface when you have someone’s life in your hands. This one is hard to put into words other than to say that there is a feeling of helplessness combined with accountability that’s hard to replicate. Every time I find myself in a discussion around technical choices that impact end-users, by internally referencing these personal experiences I’m confident we’ve made better decisions.
Where do you think we’ll land with remote work in healthcare post-COVID?
Hybrid. In a perfect world we would all just work from home with a lovely and large home-office. The devil is in the details. Questions we’re grappling with right now include: How do we print? What are our Compliance issues? What about Home office ergonomics? Do we buy everyone a sit-stand desk for home? What about Home Office Information Security concerns? And the list goes on. I anticipate this will continue to evolve. For now, my staff can work from home and they can adjust their hours as they see fit so long as they meet two requirements: (1) they keep up with their work as negotiated with their supervisor and (2) they attend the Daily Standup (30 minutes long). So far, the staff love the flexibility while productivity remains high.
Which part of health IT is not getting enough focus and attention right now?
Data Governance (DG).
Why not and what will be the impact of the lack of attention?
DG is not sexy. And, there is a false, inherent assumption that the data is good or, at least, good enough. Wrong. Bad data ingested->bad information gets teed up for operational decisions->bad decisions.
When we started our DG journey in 2015, in order to anecdotally test and also to prove a point, we built a SQL query tool that allowed us to ask basic questions where the answer should be zero. For example, ‘how many patients do we have that are older than age 125?’ Or ‘how many patients have a HBA1C level of >300 (an impossible number)’. Well, we had around 5,000 patients older than 125. Are we a blue zone or do we have incorrect data in our database? We also had hundreds of patients with this impossible HBA1C level.
It forced the conversation with operational and clinical leadership. This allowed us to establish an enterprise-wide Data Governance program with accountability throughout the entire organization. Now we know, within certain established confidence intervals, how valid our data is. Without this in place, false assumptions around data quality will lead to poor decisions.
What can the health IT community do to help you?
Keep doing what you’re doing. Raising awareness and problem solving through informed community discussions is something that we depend on– whether to get a specific answer to a challenge or to simply commiserate together about a shared problem. The inclusive dialogue is a healthy digital space. Thanks for everything the team does. Now, go do something ridiculously fun this holiday break and tell us about it in an upcoming piece!
Be sure to follow all of the 12 Day of #HITChristmas.
