HealthsystemCIO Interviews Mark Gilliam
As the industry grows at a rapid pace, the demand for IT talent is increasing, creating a competitive market in which CIOs are scrambling to recruit top staff members – and prevent them from being poached. But in Nashville, Tenn., one of the many markets affected by the shortage, a group of leaders came up with a different solution: a multifaceted program focused on identifying untapped resources and working with universities to develop HIT curricula and create internships. In this interview, Mark Gilliam talks about the framework being developed by Tennessee HIMSS Workforce Initiative to help enhance the IT talent pool. He also discusses Ardent’s unique operating model, the massive effort to standardize IT, and how he leverages his past experience as both a consultant and small business owner.
- Attesting in multiple states – The way we attack MU is consistent
- Complexities of owning a health plan
- Caring for underserved patients
- HIEs and insurance exchanges
- Juggling priorities – It’s a new skill you have to hone every day.
- Growing the health IT talent pool
Both states we deal with have some very rural populations, so how do we extend out and meet the needs of that population, whether through the health plan or through our physician network or even through our inpatient settings? So it’s coming up with ways we can reach those populations and provide them with the care that they need.
It’s a new skill you have to hone every day. You just try to focus on making sure that we’re aligned on what our priorities are; that we understand what’s the most important thing today and really spend a lot of time on that.
It’s a balance between prioritizing, keeping your vision up so you’re not just staring at your toes all the time, and trying to take time to plan beyond the next seven days.
There are a tremendous number of college graduates that have a degree and are smart, motivated, and ambitious – they just might not have that traditional IT degree. There’s a big part of working in the HIT field that doesn’t necessarily require you to be into the bits and bytes and to be a programmer.
There are well over 1,000 open IT positions in Nashville and the surrounding areas. We’re all out there looking for them, and to think that we’re just going to fill them by the traditional recruiting methods just isn’t going to work anymore.
Gamble: Being in the position where you have to consider the requirements of different states, does that make things a little bit more complicated when it comes to Meaningful Use?
Gilliam: You know, it does a little bit, strategically. I think the way we attack Meaningful Use is consistent because we’re looking at it not only from a state Medicaid point of view, but from Medicare point of view. So we are consistent where there might be some variances in some of the menu set measures that we are able to select based upon what we feel like we’re able to achieve through sending information out to various registries and interacting with them. It just depends on which market we select, but we’re pretty consistent there.
Where it gets complicated is with our health plan in New Mexico with the public insurance exchange. New Mexico has actually selected and identified and they’re moving forward with the statewide exchange. Recently, if you’ve seen the news, the governor of Oklahoma has identified that Oklahoma is not going to move forward with that. So it’s not as big a deal for us in IT in Oklahoma because we don’t have a payer per se there. But in New Mexico, having a large health plan, we have to be pretty tightly integrated. And actually our CIO for the health plan out there is very tightly involved in that process working with the state on how to stand that up.
Gamble: So in some ways it does make things easier having the health plan, but I’m sure that has challenges too.
Gilliam: It does. From a technology point of view, there are two different needs, but they’re really starting to converge when you look at where the industry is going and where the model is going. I think we’re really in a good position to have a point of view that allows us to see every aspect of this and how it goes and the data there. That’s the way we’re really attacking this when you look at New Mexico – how do we create capabilities to connect all the different players and the provisions of care, including the patients and the members, to manage the population health out there? So we feel like we’re in a really unique but good situation that you’re seeing, I think, across the United States with some of the other large payers going out and acquiring different components of the industry that we feel like we already own.
Gamble: Just looking at the patient population in New Mexico, there are some pretty rural areas, and I’m sure you’re also dealing with a lot of underserved patients, so there’s that whole component as well.
Gilliam: That is something. Both the states we deal with have some very rural populations, so how do we extend out and meet the needs of that population, whether through the health plan or through our physician network or even through our inpatient settings? So it’s coming up with ways we can reach those populations and provide them with the care that they need. And technology sometimes has a way of helping them.
Gamble: Are you doing anything in terms of telemedicine?
Gilliam: Yeah, there’s some small activity we’re working on, and some things we’re doing in Oklahoma. But really it’s right in the middle of our swing path now. We’re really starting to look and plan how we can leverage some of our service lines of excellence across the state through the adoption of telehealth, depending on how you classify it – whether its traditional telehealth or through patient monitoring and care management capabilities. We’re actually strategizing on that right now.
Gamble: It’s an interesting area. You had said that in Oklahoma, HIE initiatives just aren’t really happening right now.
Gilliam: Well that acronym of HIE, if you think about it from the traditional HIE of information exchange, there are a number of initiatives underway. They’re actually in the Tulsa location. There’s an organization called Greater Tulsa Health Access Network (G-THAN) that’s been in existence for a couple of years now. They’ve stood up a public HIE and we’re populating that and participating in that and working through it with the other providers in the city and actually trying to work on how we leverage that with our provider network. In New Mexico, of course you have NMHIC (New Mexico Health Information Collaborative), which is one of the older HIEs across the nation. We’ve been populating that HIE with lab data and other information for a number of years and looking at how we leverage that.
So if you mean HIE from that perspective, there’s a lot of activity there, and we’re trying to figure out where the market is going. The ongoing question is what is the financial model for sustainability and how it’s going to work. It’s up for debate there. We call it the HIX now – the insurance exchange the marketability for the public to go out and buy insurance directly from a public exchange and not have to go through the health plan, as part of ObamaCare. That’s something where New Mexico is actively engaged but Oklahoma has said they’re not going to participate in it. So we’ll see how that plays out.
Gamble: Obviously, you’ve got a lot going on. You got a lot on your plate.
Gilliam: Yes, I do.
Gamble: That’s a big theme we’re seeing today with CIOs. One of the things I like to ask is, how are you kind of juggling all these different priorities? It seems like that’s a pretty big challenge right now.
Gilliam: It’s a new skill you have to hone every day. You just try to focus on making sure that we’re aligned on what our priorities are; that we understand what’s the most important thing today and really spend a lot of time on that. The reason we fly out there and spend a lot of time in our markets is so we can constantly keep the pulse of where they’re looking to go and what their strategic business directions are. We spend a lot of time prioritizing. And I know the organization kind of gets tired of me at times saying that we really need to plan these and prioritize these because we do have a limited number of resources and limited financial capacity to deliver.
So we have to make sure we’re focusing on the things that are the most important to our business units, and sometimes that means we have to pull some things off the plate. But it’s a balance between prioritizing, keeping your vision up so you’re not just staring at your toes all the time and not firefighting, and trying to take time to plan beyond the next seven days. And it’s a challenge at times. It’s creating a new wave of agility in how we have to execute. It’s interesting times right now.
Gamble: Yeah, sure. One of the things that go hand-in-hand with that is being able to hold on to good people. When things are so busy, that’s when it can get tough because there’s so much competition. I wanted to talk to you a little bit about the workforce initiative that the Tennessee HIMSS Chapter is working on.
Gilliam: Right, absolutely. Well, it’s a big issue here. I know it’s a big issue across the United States. It’s something that was forecasted a few years back with the passing of ObamaCare and specifically the HITECH Act, and the pressure it was going to put on HIT professionals and ability to deliver not only Meaningful Use but then you throw on top of that ICD-10 and all the other activities that are going on. The interesting thing is we feel like it’s very concentrated in the Tennessee area, and specifically in Nashville, because you do have such a high concentration of health care organizations here in this community. And then on top of that, Nashville has really been blooming as a general IT community.
The challenge – we joke when my peers and I have dinner together is that at times, it seems like we’re just stealing each other’s resources. And so we took time a year or so ago to really step back, along with a technology council here, and look at a lot of efforts and realize this is not something we’re going to accomplish just on one thread. It’s not a matter of just recruiting and offering more money; we’ve really got to figure out a way to grow talent here organically. How do you increase that population of skilled and qualified resources? How do you look at that? There are different ways to do it, and it can’t happen overnight, but it comes through a lot of activity around educating the primary school system on how we are preparing students and middle school and high school to think about technology as a career, and specifically, healthcare technology. When you get to the Tennessee HIMSS world, how do we educate people on what that looks like and what that means and the opportunities available?
It was interesting. On one of the boards I’m on with the university that I attended, when I sat with them and talked to them, they were starting to see a decline in students that were selecting that degree program.A lot of it came from a misconception about offshoring and outsourcing that you don’t want to get into IT because all these jobs are being outsourced and it’s limited. So we really had to spend time educating people that these jobs are not going overseas and leaving; that there’s tremendous opportunity here. That part of the initiative is just what I would call education of the opportunity.
The second part is, how do you identify what I would call nontraditional resources that might be available and are qualified. There are a tremendous number of college graduates across the United States that have a degree and are smart, motivated, and ambitious – they just might not have that traditional IT degree. There’s a big part of working in the HIT field that doesn’t necessarily require you to be into the bits and bytes and to be a programmer. It’s a matter of how you take specs, how you interact with people, how you train people, and how you learn how systems work. A lot that they do naturally today when you think about the advent of the iPad and technology has become so pervasive in our lifestyle that most of the kids graduating today are more technologically advanced than I was after five years of working in the industry. How do you tap into that knowledge of liking to play with technology but not feel like you’re going to be set in a back office? And so we’re talking about creating internships. There are a number of companies in town where we work with the universities on how we can get people exposed through internships 20 hours a week working in our environment so they get a feel for it and kind of grow our own.
And then the third leg of is we’re working very strongly with the academic institutions in the community – the four-year colleges and the two-year programs – about what their curriculum looks like, and quite a few of them have already started to develop HIT competency programs or HIT degrees. We’re bringing them up through there, so if you think about it, we’re doing education, we’re capturing the resources, and we’re figuring out how to take someone and retool them. If you take an individual that’s been laid off or is looking to get into this career or if you take a clinician that wants to get into the HIT space, how do you do that?
We’ve developed a framework for what we would call an accelerator program. One of our goals over the next year is to really try to bring that to fruition – something along the lines of a two-month or three-month initiative, one day a week or one night a week – so you could do it while you work or you can be employed. But it immerses people on a very high level either in the healthcare industry or in the aspects of IT, and then it just brings the onboarding up to speed. We’re trying to attack this across a number of ways. There are well over 1,000 open IT positions in Nashville and the surrounding areas. We’re all out there looking for them, and to think that we’re just going to fill them by the traditional recruiting methods just isn’t going to work anymore.