Frank Myeroff, Direct Consulting Associates, interviews Mary Alice Annecharico, SVP and CIO, Henry Ford Health System

Frank Myeroff, President of DCA recently had the pleasure of interviewing Mary Alice Annecharico, SVP and CIO of Henry Ford Health System. She shared her background, the keys to system implementation, and more about the HIT industry.

Please tell us about yourself and The Henry Ford Health System (HFHS).

My role with Henry Ford Health System is the highlight of my career. I have more enjoyed my position as Sr Vice President and CIO from its inception to the point where I am today than any other role for a number of reasons. It has enabled me to have the autonomy that I need, decision making authority, and the real opportunity to take some risks and to invest in sustainable conversations and relationships. As a registered nurse, I lived and breathed in the critical care environment for several years before I was introduced into the world of computers and the role of change management that has enabled technology to reform a great deal of the work we do in healthcare. My nursing identity even in healthcare consulting was retained. I believe that much of the consulting work that I did and culture in which I was involved as a nurse enabled me to influence behaviors and be a partner in the elements of change to move organizations more and more toward technology enablement.

HFHS is uniquely positioned as a very diversified academic healthcare environment and has, for its 102-year history, been a seat in Detroit’s quality healthcare throughout the northeast and western regions as well as Jackson, Michigan. Because it is as diversified as it is, there are so many services that are richly embedded into the fabric of HFHS. This includes a profitable health plan and expansive community care landscape, which in today’s market have been serendipitous advantages for the System in this cost constrained market.

What led you to choose a career in the Healthcare IT industry?

The Healthcare IT industry actually LED me. I am a registered nurse by profession and was the Director of ICU in a large academic medical center when I was offered the opportunity to help transform the way that doctors and nurses communicated requests for patient care needs and provide a more efficient pathway for charges to be sent to finance for billing. I was successful and happy with managing people in my nursing role and that was what was attractive about me that made me the sought-after choice to move the organization into the digital world. My stipulation was that I would still be identified as a nurse and that my passion for quality patient care had to drive my decisions and our collective efforts.

For several years, as the Director of IT, I was in learning mode with the creation of a CON for the data center, the selection of clinical and financial vendors, and leading the development and implementation of the organization’s first EMR. I later left the health system to join the management consulting ranks for a dozen years to assist other healthcare systems through similar planning and implementation journeys.

What trends are you currently seeing in the HIT industry, and what do you expect to see in the next 5 years?

Create Value: I think the name of the game today is creating value. It is certainly part of our motto of ‘true north’ that work we do needs to add value. We create resiliency and capacity for the system to utilize operating funds as well as capital investments in different ways so that we are driving the agenda forward. We evaluate the effort and eliminate unnecessary work so that what we are doing is focused on our ‘true north’ for today and the future for the organization. It also means that we take a look at new technologies like telemedicine, tele-presence and the adaptive tools in our analytics space to help us move in the direction of precision medicine and population health. We do this by having more concrete information about individuals based on their genomic patterns that can target care in precise directions. That’s an exciting part of the work that I do in adapting our use of the electronic medical record and analytics to help clinicians determine more efficient, effective care pathways.

Digital transformation: At last. The core reason for implementing EHRs and business systems is to “get to the data”. Analytics is becoming the basis of clinical and business decisions and is driving organizational leaders to become more standardized and accountable for the quality outcomes of care and the fiduciary responsibilities to better manage resources. Machine learning will harden over time and will enable organizations to improve clinical and business decision making as they consider populations and markets with new lenses. Value-based care success is dependent on having analytics capabilities to know what to do, how to achieve the best outcomes, and how to minimize waste and cost at the same time.

Consumerism is driving much of healthcare technology: Consumers have a voice -- a very powerful voice about what is planned for them and how they need to share in the responsibilities and partnerships with clinicians to manage their health and wellness. Their opinions count and healthcare is measured by those opinions. Organizations are facing enormous pressures to attract and retain their markets and are being forced to consider innovative means of leveraging data that they know about consumers to personalize the manner in which they offer services.

As we have seen, much of the innovation and demand in mobile and wireless technology across our workforce (AKA consumers in their personal lives) has been driven by the diverse uses of smart technologies to make life more convenient. We are now compelled to add feature-rich secure functionality to our applications and services that support a mobile workforce.

With your extensive experience implementing new systems, such as Epic, called Helios at HFHS, what do you find to be the biggest challenge in implementing new technology and systems in a healthcare setting?

Challenges exist, not as barriers; they create opportunities. The largest single level of effort that we need to do as we introduce change through applications and systems is to help mold the culture. It is really changing behavior in a way that enables people to understand why the change is coming, what they get as a benefit of a change, and then helping them through that process. We used change management, change behavior, and illustration extensively in the implementation of our Epic engagement here.
Because we implemented both on the electronic medical record and revenue cycle in 18 months across the entire environment- ambulatory, inpatient and all of our clinic and medical centers, we really did a deep dive in getting people’s feelings about gaps the existing systems had and what would change in a transformed environment. We found there was a lack of good handoff, data never was where they expected it to be. We did not have a fully engaged patient environment because patients were always in the state of confusion rather than in a state of engagement, and regulatory changes were coming so rapidly. This was the important turning point for our workforce to begin realizing clinical transformation for the organization really did include them and they owned it just as much as anybody else in making sure that it was successful. We painted that picture and it was a great illustration efficient care handoffs with the patient in the center of all of that communication for the first time.

The project was led by 3 diverse Leaders, like the legs of a 3-legged stool. Breaking away from the tradition, IT did not lead the project. Again, in this illustration, the Epic implementation became a system-wide effort to increase ownership and adoption and to clinically transform how the organization operated. A physician lead physician adoption, and a business leader ran the integrated project plan and budget. IT was responsible for the infrastructure, the disaster recovery site development, quiescing old applications and platforms, and those services that touched our communities of users. This included the desktops and those services that were closest to our community of users. The trust and respectful relationship that we developed across all business lines helped each user to be successful, and this has been a hallmark of the pathway forward.

The third one is really engaging your key stakeholders right from the very beginning and make decisions that have stickiness so you can scale, manage scope, and move forward with implementation.

So the three challenges are changing behavior, working as a team, and working with your key stakeholders.

Cybersecurity in Healthcare is a huge topic right now. What are some of the steps you are taking at HFHS to prevent future cyber-attacks?

One of the things I have focused on in the last 15 years has been privacy and security largely because of my clinical background. I realized that the privacy of the patient record is sacrosanct and while at the University of Pennsylvania when the HIPPA privacy and security laws were being enacted and the regulation associated with what we must do and what we should do were just coming into the spotlight, I was part of a national academic think tank to talk about how we should advise our organizations to address the laws of privacy and security. I have had a passion and desire to be part of reducing risk for well over half of my career. When I came to Henry Ford from Cleveland, I was given a great opportunity to work with a leader who became the Chief Privacy and Security Officer to formulate an approach to help the organization simplify the way we look at these risk areas. We should transparently be able to help the organization know what they must do and what they should do and combine privacy and security in a program that helps them more easily understand and be responsible for that culture of confidentiality. Working with Meredith Harper for the last 6 years, we have created a pathway that helps us understand the risks in our environment and then how to best manage them. Cyber risk is ever present – we are never going to be able to completely control it. It’s an evolving threat environment and we have to manage and educate our communities of users about the guidelines and then put controls around our physical environment; our networks, so that we know what’s happening on the network and we understand that our responsibility is to maintain that constant surveillance around that environment. This will keep the patient data, as well as the institutional assets free from breach and we will prevent brand, institutional harm, or reputational harm by identifying it early enough to manage and contain risk that we’re accountable and responsible for.

You have a background as a registered nurse, and experience in nursing leadership. How has your nursing experience most benefited you for your roles in Healthcare IT?

From the time that I was 3 years old I wanted to be a nurse. I had a baby doll that was my patient and I carried it around and never wavered from what I wanted to do in life. I wanted to be a nurse and a mommy so that I could take care of people and take care of my family. I worked through high school instead of being out on the ski slopes and doing other things my peers did, to save money for nursing school and had the fortune of being admitted to the number 1 diploma nursing school in the nation at the time. It continues to be who I am and the experience that I had in nursing that enabled me to continue to grow professionally and quickly. Every time I became comfortable with where I was, every 2 years or so, I was being promoted into a new role. It was given increasingly greater levels of supervision and leadership and it became a stepping stone from nursing into IT leadership. It was that constant vigilance on being empathetic about where people were and helping them move to a different space, whether that was my staff or it was the patient population or it was my peers across the organization. It was being thoughtful and transparently vulnerable to appreciate where they were and to help them solve problems or create solutions that were going on within the environment. I think those traits just carried forward in the consulting I did as well as in the roles I had as CIO at Penn and in Cleveland.

Have you had mentor(s) throughout your career?

Yes. I have had a number of incredible mentors who believed in me and helped me mature as a woman leader and as a leader who has been able to pay-it-forward in my efforts to support and encourage the growth of both men and woman leaders who show leadership potential. Mentorship responsibilities are a cornerstone of what I believe CIOs must be able to do organically. Succession planning begins on the first day of a new experience within an organization. It never ends until one leaves.

My Master of Science degree from the University of Pennsylvania is in Organizational Dynamics, purposefully. I feel that the primary role of a CIO is to prepare an organization for change by building trust and confidence in IT and then supporting the changes with them.

What advice would you give to individuals pursuing careers in the HIT industry?

Consider why you want to pursue a career in IT, look for a champion or organization to sponsor you, and be thirsty for growth. More importantly, do not box oneself into a single mindset. My favorite type of candidate is one who is enthusiastic and humble and willing to learn and contribute quickly. I love millennials as much as I love seasoned IT professionals. The creative tension that they produce together keeps the environment innovatively live and challenging for both groups. Millennials will move on quickly from one role or job, seeking upward mobility quickly; whereas others have organizational loyalty and use their innovative spirits to progress incrementally and add value across a number of different service lines.

What skills or traits do you look for when hiring new talent at HFHS?

As above, I look for thirst and fit. For entry and non-managerial positions, I look for those talents first. For managerial and leadership roles, I look for personality and leadership style and experiential successes as well as important failures that led to new insights. I also love bringing in people who are not necessarily skilled in the role that they will play, but they are open, eager, interested, very bright, and add a tremendous dimension of creative tension in decision making. You can tell by engagement scores across IT and it really does make a difference when we have a blend of ethnic, age-related, gender diversity across the team that it’s much better rather than a homogenous group of individuals.

Your HFHS bio states that you are actively engaged in national efforts to create sustainable and secure statewide HIE, offering interoperability between regional and national health information networks. What is your biggest motivation to drive this effort?

My biggest motivation is to help the industry achieve functional integration of data seamlessly across diverse systems. We are compelled to help achieve these data standardization objectives. Today, too many vendors have veto power in how our industry shares data. Provider/vendor interoperability work led by KLAS for the past 2 years has done more to bring visibility and transparency among the major vendors toward achieving true interoperability than we have seen thus far. We are getting closer. At this time, our organization is exchanging clinical data securely across the continental US and across multiple platforms. As the discrete needs grow, we must be prepared.

I also believe that the traditional HIE environment of the past 10 years should be considered a ‘bridge strategy’ toward lasting open data exchange across our environments. Traditional HIEs have helped connect the dots for our more rural and independent provider environments but add layers of cost to provider organizations whose EHR vendors should be doing the same things.

The ubiquitous needs for sharing data compel us to think more broadly about data sharing. We are seeing a shift within our state governments who are looking for person data to help manage business and civic needs as well as provide vital services based on location and population health needs based on leveraging social determinants of care once known.

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