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How BMC gets its employees active in the tech implementation process.
This is part one of a two-part Q&A featuring Arthur Harvey, M.S., chief information officer at Boston Medical Center.
One of the primary duties of a chief information officer (CIO) is to make decisions regarding implementation of technology. If a CIO does not get clinicians and staff members at their hospital or health system involved in the process, the technology won’t be beneficial.
Arthur Harvey, M.S., CIO at Boston Medical Center
Arthur Harvey, M.S., is the CIO at Boston Medical Center (BMC). In his position, he helps come up with a road map to implement technologies and makes sure the health IT group is aligned with the rest of the academic medical center.
A graduate of Boston College and Brandeis University, Harvey is considered a “lifer” in healthcare. Prior to joining BMC, he served as program chair of health and medical informatics at Brandeis University.
I spoke with Harvey about how he makes sure the goals of the health IT team stay aligned with the mission and other committees, how he recruits talent and how he gets employees involved in the technology implementation process.
Editor’s note: This interview has been lightly edited for length, style and clarity.
Arthur Harvey, M.S.: My team operates under the philosophy that if IT is deciding what IT is doing, then you have lost the game. We’re not an IT shop. We need to focus on making sure our efforts are aligned with the overall needs of the organization. Now, I will put in the caveat that there are some purely technology items where we are the experts and will need to do things like network upgrades, operating systems and security. So fundamentally, those are things we're going to be the leaders on and drive, but most of the work we do is driven by the business.
One of the things I did when I came to BMC was look at where there were opportunities for improvement. One of them was around IT governance because there wasn't necessarily a wide-ranging process. So that's one of the things I worked on putting in. What we have is a hierarchical governance structure, where for different parts of the organization, for example, for clinical parts of the organization — the providers for the revenue cycle, for the administrative and so forth — they have what we call interdisciplinary committees, which are largely composed of leaders from within that area. As an example, we have an ambulatory clinical group largely run by a collection of providers of various levels — physicians, nurses, mid-level providers, pharmacists. They're the ones who bring forward potential product projects and discuss and debate them. IT participates as the facilitator of the committee and we collect what their recommendations are. That goes up the food chain into an area where you then get some more senior people who try and balance the needs of the organization across different committees. IT then scores the projects and says how big they are does what I call the jigsaw puzzle work of trying to figure out what we can do in the next quarter. This is a quarterly process to say, “We can do this” or “We can't do that because we have constrained resources.”
IT leadership then presents the proposed slate of work we're going to do in the next quarter to the IT governance committee, which is senior executives at the institution. I want to stress that IT gets a total of one vote in that committee and it's me because I'm a vice president, like the other people in the in the group. That group decides what we're going to work on. They take our recommendations, typically about prerequisites and what needs to be done, what's hard, what's easy and what's coming down the pike because that's where we're experts. But they make sure that we are doing work that is aligned with the direction of the organization. It certainly doesn't work perfectly. But what we're working on is what the clinicians want. I will say they always want more than we can do, which I think is something every CIO faces. Generally, however, we're not working on stuff that isn’t aligned with our mission.
Arthur Harvey, M.S.: The biggest challenge is the fact that the demand is roughly two and a half times as high as the supply. Everybody always wants things, as is typical. Let's say I'm the chief of a particular area like oncology. The chief of oncology could say, “We need to do this project, it's the most important project to me.” That's fine but the chief of radiology and the chief of medicine also have a project that's most important to them — and they are rarely the same project. How do you balance the needs of the organization strategically to make sure that we're applying resources in the right place and to make sure that there's some amount of equity and that it's not always the same voices?
It's really hard now that we have an accountable care organization (ACO), because some of the IT needs really aren't driven by our core constituency, which is the hospital and the health plan. It's really more the ACO and that's very important strategically for us to exist as an enterprise, but it doesn't necessarily make the doctors I see in the hallways every day feel very good about it.
That’s some of the challenges, mostly around balancing the resources and keeping things aligned between different groups.
Another part is balancing my team so that I have the right amount of expertise in the right areas. IT people are not interchangeable. Sometimes they are but largely, one expert knows a certain technology and is working on particular things. I might have room for that person to do projects. But there's a huge demand for projects over here. But that needs a network engineer and I can't just take an Epic analyst and say that you're a network engineer, right? So, making sure that my team is balanced is tricky. When I talked about the jigsaw puzzle part, that's what I was referring to, and that's hard to explain to people. They’ll say, “You have ‘X’ number of FTEs and they don't get that they’re not all the same.
Arthur Harvey, M.S.: Well, we have this quarterly process and we look at this stuff every quarter. One of the things my leadership team does with me is sit down to look at what our shortfalls are. What is the resource that’s constrained and holding up the most projects?
I use a philosophy that I call the next FTE. It's where I say if I magically found an FTE, one fell from the sky — and we're a safety net hospital so that doesn't happen very often — what would I hire? Where is my biggest choke point that I would apply that FTE to?
We just did have that happen — we found a way to generate some savings in some of the work we were doing and that freed up enough money that we could hire another person. So, I sat down with my senior directors, and we talked about it. The decision at the end of the day was that we were going to hire a server engineer because the server engineers were constraining most of the projects. So, that's where we put that next resource.
Now, it's painful to say, “I have too many Epic analysts,” — although I don't think anybody's ever said that. You know, “I have too many Xs and I need a Y.” Then you're in a position of retraining or exiting somebody and hiring somebody. We look at that once a year and we tracked back against where the constraint has been. Oftentimes we're easing the constraint if there's a choke point by using contract labor or temporary help in some form, and that can get us through a quarter or two, but that can't be the permanent solution.
Arthur Harvey, M.S.: It varies. I think it's good. I think when we stop and look back at the gains we've made over the last three to five years, I think people are much happier than they were. That doesn't mean they're happy. In my experience, generally speaking, no matter how much you have to spend or how many resources you have to deploy, everybody always wants more. I think it's important that you have a strategy that shows your roadmap, your direction, and where you’re going. Then you can go to people to say, “I understand you want this or that. I can't do it now, but we understand and we're putting it on our roadmap.” I think that is useful, along with the engagement with people.
The hard part there is individuals. Dr. X or nurse Y may or may not actually be actively involved in this — it may be somebody else in their group, it may be somebody who works for them, it may be somebody they work for. So, sometimes the communication is a challenge and then people get grumpy that IT is not dealing with this or that, when maybe we are it's just that they don't know it. I think that is one of the challenges.
Overall, I think morale around IT is better. We’re being viewed as a partner. There are some things we've done to increase visibility, which really helps. As an example, we implemented an ambulatory rounding program that's been very good. We've always rounded on the inpatient floors, but just making sure that IT is out there, and you can spot them — that’s helped. But the reality is that all of the additional work we're taking on now for the ACO and for some of these partnership things have drawn resources off that the individual folks at the hospital don't necessarily see benefit of directly.
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