CIO-of-the-Year Sue Schade: Eight ways to nail an EHR implementation

In naming Sue Schade the 2014 John E. Gall, Jr. CIO of the Year, her peers in CHIME bestowed upon her the profession’s highest honor, one that Schade earned the old-fashioned way. She is the veteran of several large EHR implementations since 2000, including Brigham and Women’s Hospital, where she gained national attention for their use of the balanced scorecard, and most recently guiding an EHR implementation at the University of Michigan Hospitals and Health Center, where she has served as CIO since 2012.

Schade recently returned to Michigan after delivering a talk on “Lessons Learned from Large EHR Implementations,” part of a course on Leadership Strategies in Health Informatics at the Harvard School of Public Health in Boston. In an interview with Clinical Innovation & Technology, she shared advice on achieving a successful EHR implementation, ways that CIOs can help their organizations become more competitive in the new healthcare environment and how to be the change agent that the job demands.

Your CMIO, Andrew Rosenberg, MD, provided this example of your innovative leadership through the effective use of technology: Your contribution in reshaping two large HIEs in Michigan into one entity. Why did you believe this was important and possible?

Schade: Being new to Michigan and the environment, I was attending meetings at the state level (for the Michigan Hospital Association HIT Strategy Committee), as well as participating on the board of the HIE that the University of Michigan Health System was a member of, Great Lakes Health Information Exchange (GLHIE). I was getting to know a lot of my colleagues within the state, getting the lay of the land and meeting people who had been here a long time and had all of the history.

When I started here at the University of Michigan, my leadership was saying, “Why do we have multiple sub-state HIEs and why do we have these two big ones that are competing? Why don’t we just have one?” University of Michigan Health System is the only provider organization in the state that serves patients from every county in the state. You can see why we would prefer one HIE to asking, where is this patient being seen in upper Michigan, what HIE are they coming through and do we communicate with that one?

I was the devil’s advocate, the change agent who kept asking the question at the state meetings, why? People would describe the history and tell me the sub-state strategy. They would tell me they had tried to change it and why it didn’t work. I kept asking why and kept pushing it until there was enough support and interest in doing something about it.

The lead person for the other large sub-state, which was Michigan Health Connect, said, “OK, if we are going to talk about it again, then we should take action. Let’s not just talk about it, we need to do something.”  I said, “Great. You and I need to talk.”

Out of that came an MOU between the two organizations that we took to our respective boards, and it was approved. There was almost a year’s effort of due diligence by a 6-person committee (three from each board) that worked through the merger. We had a successful merger as of July last year, and the new HIE is called Great Lakes Health Connect (GLHC). Together it represents provider organizations that have 80% of the beds in the state.

You joined University of Michigan Health System in 2012 to oversee an EHR implementation and in July of this year achieved Level 6 on the EMRAM model. Any lessons learned during that implementation that you would like share with others on this path?

Schade: [#1] Number one, it is really important for the CIO to determine where it is that you have to be more deeply involved at different phases of the project versus just on top of what’s going on and ready for escalation. Change management and a robust change management program—especially when you have multidisciplinary areas that you are working in—is critical.

[#2] The whole training program is an area to which you have to pay a lot of attention. I won’t go into some of the specifics that we had to go through at our organization, but just think about what it takes to train 14,000 people in a seven-week period. It was a large-scale effort that included having to negotiate the use of a building with the university. We then had to retrofit for training to have enough concurrent classrooms and get everyone through it in that time frame.

[#3] One of the key lessons for CIOs is the importance of being very hands-on and present throughout the actual activation and go-live. I spent my time in the command center or nearby being available to people. I was not running things, my project director was running things, but I was available. I was aware of the issues and helping to resolve the issues that got escalated.

[#4] In terms of post-activation, I’d emphasize the importance of managing expectations and communications and the overall messaging to users and leaders, not minimizing what is involved in ongoing—and it truly is ongoing—optimization. Making sure that you have all the right processes in place so that you can prioritize the optimization work that needs to get done is very important.

[#5] Having engaged executive sponsors, is critical. If you feel that as the CIO, you are the only one at the leadership level truly worried about this project, that’s a problem. On the other hand, you don’t want to say it’s not an IT project, it’s up to the business. It really is a partnership, and I would emphasize the importance of that partnership.

[#6] In terms of your governance structure, you need very clear decision rights so that you know what your committee structure is and who is making what decisions throughout the lifecycle of the project.

[#7] I think that the go-live readiness assessment methodology is critical—120 days out from go-live, then 90, 60, 30 days. You have got to have all teams reporting in on status issues, with your scorecard coming out of that, so that you know, 120 days out, here are the issues we need to stay on top of if we are going to stay on track to go live. Really structured methodical transparent process is important.

[#8] Lastly, you need contingency planning. If something goes wrong an hour out, and you have to back out before you go in, you have to have that plan ready. You also have to be aware of the operational impacts. You can’t slow the flow—or stop the flow—into ED. In your first days after a go-live, you can make adjustments to your clinic and OR schedules to make sure things are running well and that you are properly staffed.

Then, there could be unrelated factors that you don’t have any control over in terms of contingency: A major facility issue, a power outage, a weather-related emergency. There also could be a true emergency with mass casualties, a pileup on the freeway, and if you are bringing new systems up—taking old ones down and bringing new ones up—you need a contingency plan in case that was to happen. Those are some of the broad strokes I would share at this point.

What are the key things that CIOs should be doing to be make their organizations more competitive in the new healthcare landscape?

Schade: There are a couple of key things: One is that we are always asked to reduce cost. The business grows and the demands on IT grow, but we are always being asked to look at how we can do it in a more efficient way. You have to be able to embrace that and not fight that.

Obviously, another is being ready to leverage new technologies as new technologies continue to come into the marketplace.

I think it is important to make sure there is solid alignment with the organizational strategies, that you work as nimble as you can, and in large organizations and large IT departments, that you are also ready to deal with the reality of mergers and acquisitions and affiliations. When you get contacted that a community hospital is under consideration for affiliation, you need to be in a position to participate in any kind of due diligence from an IT perspective. If the deal happens, you have to be ready to work with it.

If you could share one piece of advice with CIOs interested in having a greater impact on their organizations, what would your recommendation be?

Schade: I don’t think there’s just one. It really is critical that you build relationships as part of the executive team and that you are part of the discussions. Sometimes that’s a natural, and you’re there and you’re included. Sometimes you have to kind of fight your way in, so to speak. I think the days of CIOs wringing their hands about who they report to and are they at the table are behind us. There is such a huge dependency on and appreciation of technology that we are at the right table.

In terms of the role and how you see yourself, yes, you are the CIO and you are the technology leader in the organization. But you have to consider yourself a part of the executive team on a range of issues. You have your domain expertise as the CIO, but you are a part of the executive leadership team.

I think looking at yourself as a change agent is important too because, in some respects, CIOs see everything: You touch so many parts of the operation that you are in a great position to question and drive change.