Datica Podcast

June 11, 2015

Sue Schade, CIO at University of Michigan Hospitals and Health Centers

Datica: Thank you, Sue, so much for joining us today. Looking forward to our conversation. First and foremost, besides thanking you for joining us, I wanted to congratulate you on getting CIO of the Year.

Ms. Schade: Thank you.

Datica: Hopefully you have been getting a lot of congratulations. It's a pretty big honor. There are people, there are a lot of good CIOs, and so it's a pretty big honor, so congratulations on that.

Ms. Schade: Thank you very much.

Datica: I don't think it's an easy honor to get either.

Ms. Schade: Right. [Laughter]

Datica: I kind of wanted to dig in a little bit, you know, the CIO of the Year, and your experience as a CIO. What does it mean to you to be an effective CIO, to be somebody who can be in a place to get an honor like that?

Ms. Schade: Great question, and I have been asked that question in some of the other interviews I've done. Let me comment that there's both a personal component and a professional component.

From a personal perspective, I have a husband of many, many, many years and two grown daughters, and I think they're both very proud of my accomplishments and also know how hard I have worked over the many years that I have been in this field, which is in the range of 30. And it's great, especially in raising young women, to be a role model for them and watching them grow in their careers is part of what I do as their role model, as a mother, and as a professional woman.

From a professional perspective, being honored by my peers is a true honor. And I know that I join an impressive group of leaders over the years. I think I am the 26th CIO of the Year. That's how long they've been doing it. And I will say that I am the 4th woman in those 26 years, so hope to see many more women receiving this kind of an honor in the coming years as there are more and more women in the ranks of healthcare CIOs.

Datica: From our own perspective, we hire a lot of developers and engineers and there are challenges with rounding out our team to be more representative, and so that's actually a challenge for us still. But I think having role models, people that they can see, so it's not 26 men that have gotten the award, that there's a little bit of blending, I think, is a great thing. Those types of examples are more of what we need. So, additional kudos.

Ms. Schade: Thank you. Well, and that actually is something I've been talking more about lately, in terms blogging, is the need to encourage more women to go into technology, because the numbers just aren't there, and to find ways to encourage them and support them as they grow in their careers. I know people helped me along the way, and I'm committed to helping the next generation of HIT leaders to grow and develop.

Datica: Shifting gears just slightly, and looking back at some of your previous experience, you were at Brigham and Women's right before going to Michigan. Is that right?

Ms. Schade: Correct. I was there for almost 13 years as their CIO.

Datica: Wow. That's a good amount of time. When you were there you implemented or used the Balanced Scorecard Initiative. We've read about Balanced Scorecard. I'd like to get a better sense from you, hands-on experience, why you felt like that was an effective tool to Brigham and Women's, and why you feel like it's an effective thing to use within healthcare organizations.

Ms. Schade: Sure. First off, just the Balanced Scorecard, to frame it, is a framework, conceptual framework, not a specific tool, and that framework says that there are four key components. One is finance. But too often, we think only finance, and what's the bottom line, and what's the revenue and the cost look like. One is your customers, or your patients, in our case. One is your operational effectiveness and quality. And the fourth one is employees, so what you are doing to grow your own employees and develop them.

When you look at something from that balanced perspective, you're really looking at metrics in all those areas and how they interact. It was a framework that had been adopted by many of the Fortune 500 companies as of the early 2000's, and it was relatively new for healthcare. We had a champion leader within Brigham and Women's who said it's time for us to do this. He and I partnered, made it happen, and ended up being a showcase site within healthcare for our initiative over the years. We used a particular vendor's analytics, dashboard kind of product to implement it, but it's a concept framework that you can do with various tools.

Datica: Interesting. As you became the case study in Boston and now as you transition to Michigan, do you see that, or are you maybe not whole hog using that framework but potentially integrating aspects of that as you start to think more broadly than maybe just finance driving decisions?

Ms. Schade: Yes. In fact, at University of Michigan Health System right now we are talking about a framework that includes—make sure I get it right—safety, quality, delivery, finance, and people. So there's five components, and we're looking at what are the major initiatives, you know, the definition of each of those, the major initiatives in each of those, and then what the metrics are. So there's a similarity there. It's something that we're working through at this point.

Datica: That framework didn't really exist before you were at Michigan? It's something that's in development now?

Ms. Schade: It's in development now, but I can't take credit for bringing it. I've been here two and a half years, and I think whenever you move leadership levels from one organization to the next, you want to bring some of the best ideas and best practices from the organization that you are at into your new organization, and, certainly, I tried to do that in this case as well as in other examples. But it's a combination of that input along with where this organization is at and some other leaders here, recognizing the need that we need to do that.

Datica: With this framework that you're developing at Michigan, I wanted to ask some questions around in new solutions, new innovative products or service lines, or whatever form they might take. It may be technology-enabled, it may just be new services out in the community.

When you look at new innovation initiatives proposed at Michigan, do you funnel all those through that framework to look at how you would assess something like that? Is that how you would assess it?

Ms. Schade: No. I can't say that those two match up at this point. What I just described is very much a framework we were starting to roll out within the clinical care delivery component of the health system, and, in all honesty, much of the innovation that's going on is more coming out of the medical school and the research side. I think we need to probably do a much better job of marrying those two up, to be quite honest with you, but we have lots of examples in terms of our research area and our faculty where we're looking at various innovations that we can talk more about.

Datica: When you talk about marrying up, you're talking about innovations or new research-based things coming out of the medical school or the research area and having those then translate into actual clinical delivery?

Ms. Schade: Yes. As well as looking at those innovations through that lens in terms of how could they improve safety care. Could they improve quality of care? How could they improve the timeliness of delivery of care? I will give you an example that one of the things that has been going on for the past several months is a group that has been looking at disruptive innovation in care at home.

I won't be able to quote it exactly right, but there were three key metrics that they were charged with trying to improve. One of them being the admission rates, for example. Just very recently, in fact, I have the 100-plus page report and set of recommendations from them was sent to me on the weekend, I've been able to read the executive summary but not really wade into it yet.

Its extensive set of recommendations and ideas that they have, it was a faculty-based group on how we can do things differently in terms of care outside our four walls, within the home, to affect some key metrics right now, which is something that all healthcare organizations really are going to be going through as you look at less inpatient care, more ambulatory, more care in different care settings.

Datica: That makes a lot of sense. I had a follow up on that, but I was curious, too: You talked about different care settings, and you talked about providing home care. Are there other broad bucket areas of innovation that you see coming out of the medical school or that were being research driven at Michigan?

Ms. Schade: Certainly mobile. And that's a really broad statement, but mobile apps for clinicians, mobile apps for patients. I mean, you think about it in your own life... In fact, this was one of the blogs I wrote in a December timeframe. I think it was maybe the timing relative to the announcement of the CIO award and the combination of the fact that I had a really catchy title on this book blog called "Great Textpectations". It got a whole lot of views.

What I talked about was when we were back in Boston over the holidays to see family. We spent time in a hospital with his brother, who had surgery, and in and out of the hospital every day. I talked about how technology is everywhere—you're getting an Uber to get somewhere, you've got an iPad put in front of you when you're in a restaurant to order off the menu. It's just, as consumers, technology is everywhere. We've come to expect it.

But when you walk into a hospital, some of that grinds to a halt. There's so many examples that you could apply in terms of how to make that access and process easy or more friendly for the patient as well as the clinicians if you think about various apps and particularly mobile apps.

Datica: I would agree. Beyond mobile, which, as you framed it, is a very broad bucket, and in home care, which we touched on, are there some other areas that you see emerging?

Ms. Schade: Yeah. We have a big initiative right now in one of our centers called, the acronym is MCIRCC, M-C-I-R-C-C. It's Michigan—always think of M as Michigan—Michigan Center for Integrative Research in Critical Care. This is an effort to capture clinical data off monitoring equipment on the patient and be able to predict potential complications or patient crashing, etc.

I'm not going to do justice to it not being a clinician, but it's a very leading-edge area for us, and we're looking to partner with different vendors, third party vendors, some of whom have visual integration tools in terms of bringing all that information together for the clinician, in another case, companies that do work with sensor devices. Just another broad area in terms of innovation here.

Datica: Technology seems to be a component of every discussion we have in some way, shape, or form. Looking internally at innovation or new initiatives, how do you see your role in IT supporting that?

Ms. Schade: Let me give you an anecdote from my time at Brigham and then comment more generally here. At Brigham several years ago, we recognized that there was a huge backlog, if you will, of ideas for innovations that were never going to get to the top of the priority list when you look at standard IT budgets. We were able to get some funding separate from the CEOs funds, separate from the IT operating budget and capital budget to establish a program.

We called it Health Innovation Program, I think, Brigham Health Innovation Program, or HIP. We had a twice a year cycle, we had a very formal process for submitting applications, evaluating them, and scoring them in deciding which ones we would fund. It was up to $100,000 per project that we were willing to fund, and then what we expected for those projects to come back in and present the results and a decision then to be made as to whether or not it's something that we should invest through the normal budget to scale, to full house, or is it something that was a good idea but not something that we were going to pursue.

We did that program at Brigham while I was there. It was relatively successful. We don't have a program, that was through IT, we don't have a program like that here through IT. As I said, I think much of the innovation is being driven through the medical school and the faculty and the researchers. My role as the CIO, I have responsibility for the clinical care delivery, the hospitals and health centers. I don't have responsibility for the medical school and the research and education component. There's a separate IT department that manages that or supports that.

I work very closely with those faculty as they are coming up with new projects, because they know that, ultimately, if they're going to scale, if they're going to run on the infrastructure, if they're going to integrate with our core systems, they've got to be talking to my staff and to me.

The sooner that we can be in those discussions and help guide them and raise some of the issues that they're going to need to be concerned about, the better. As opposed to hearing that it's done, it's ready to go, can you just plug us in, or can you just roll it out whole house. I don't want to be the obstacle at that point, so I want to partner and know about it up front and help them as much as I can.

I think one other thing I would comment on about sometimes a barrier around innovation, I already said in the anecdote about Brigham is, those aren't going to get to the top of the list and compete with the other core stuff you have to do. You have to have separate mechanisms, separate funding.

What we found at Brigham was a challenge, is once those projects were approved, those innovation proposals were approved, then we'd have to get people to work on them, and we had to pull people from our staff who were working on the core project. Then we ended up with a resource issue. If we said you can use some of those funds to hire contract health to get it done, if, in fact, that innovation needed to integrate with our core systems, it still came back to needing our core IT staff.

Those are just some of the challenges I think you face in trying to implement innovation programs. Ideally, what you want is it to be part of what you do and not a separate thing over here, like who's got good ideas, go to work on them. It needs to be part of the fiber of what you do. But I don't know too many organizations that have really accomplished that.

Datica: I think you're right. It's really hard in healthcare with significant IT budgets, but there's also significant IT needs. We hear commonly that there's just not room in the IT budget for X number of years or months or whatever. It's interesting and it's novel.

Datica: Shifting gears slightly, stepping outside of internal innovation and your experience at Brigham and Michigan, we work with a lot of smaller companies building new platforms for bundled payments, or telemedicine, whatever it might be.

As a small IT company—not an Epic, right, not the big ones that we all know and love—but being a smaller organization, how do they go about selling to a clinical champion? Then, two, going through the IT integration process, security, compliance, all those pieces?

Ms. Schade: How to do that and how to be successful?

Datica: Yes.

Ms. Schade: I think one thing that's critical is that they have a unique solution and that it's solving a real problem. To me, it's never technology for technology's sake. At the point that we understand that solution is solving X problem, and, yes, we, in fact, here at University of Michigan, do have X problem, we maybe didn't think we needed to address it yet, but here's an opportunity to do so—then I can be all ears.

I think what's important is that they have a way to either sit on top of what, in a very kind of noninvasive way, are core systems and infrastructure, or they have clear integration path. That it does need to be, for example, any new product that needs to be integrated into our EHR, which happens to be Epic, that they've done it before, they have a way to do it, you know, so on and so forth, or that it really sits on top and maybe can have integration in a future phase.

Back to what I said about the need to partner with those who are looking at innovation now within the organization. Startup companies probably come in all sorts of places within the organization. They're not calling the CIO going, You know, we've got a product and we need to talk to you. They're probably making inroads and getting people excited. Then I might hear about it, or my staff might hear about it down the road.

My advice to those companies is the sooner you have engaged either directly the CIO, or had the folks that you are talking to in that organization, make sure that the CIO is aware and engaged, the better. Or IT will be in react mode and can, you know, put up some obstacles and slow it down.

Datica: In a lot of ways, they're the same thing you're describing internally, like being involved as early as possible?

Ms. Schade: Right.

Datica: And to not be the road block. That's not necessarily what you want to be, but you need to understand that there's also a lot of considerations for you.

Ms. Schade: Right. I talk about keeping the trains running, doing the core, day-to-day production, getting the systems in and keeping them running. I can't think of a CIO in the country that I know that only wants to be doing that. I think all of us want to be helping our organization fully leverage technology to solve real business problems and moving things forward. Don't view IT as that big, bad, oh, they're going to stop us, but as partners.

Datica: We're just about out of time. Was there anything else you wanted to add, Sue?

Ms. Schade: Just to talk a little bit more about advice to startups, because I know that was one of the questions that you asked. When I start talking to any of those organizations, I want to know who their leaders are, who their founders are. I want to have a sense of how viable they are. Before I talk too seriously, I want to know they have capital backing.

They need to find ways to understand healthcare, because I think you'd probably see a lot of good technologies from other industries coming in that could be applied to healthcare, so they need help sometimes understanding healthcare, which is important. I think they also need to understand that, especially an academic organization may be extremely complex. It might move slower than they want, but to have the patience to work with the organization if they're going to be successful.

Datica: You're in a resource-constrained area, right?

Ms. Schade: Right. Solve real problems that need to be solved. And we have plenty of problems to solve, don't get me wrong.

Datica: I was going to say there's a good number to work on, so. All right. Fantastic. Greatly appreciate your time. This has been wonderful.

Ms. Schade: Good. Fun to do. Thank you.

Datica: Okay. Thank you so much, Sue. __

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