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How to Craft a Digital Roadmap With Clarity and Collaboration
Episode 758th November 2022 • This Week Health: Community • This Week Health
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November 8: Today on TownHall Reid Stephan, VP and CIO at St. Lukes interviews Donna Roach, Chief Information Officer at University of Utah Health about the work she is doing to create a digital framework for her organization. First Donna dives into her career journey that brought her to her role as a CIO, a role she initially had doubts about jumping into. How is she tackling creating a digital roadmap for her organization using a newly established organization-wide process? How does she negotiate priorities among different leaders when her capacities become constrained?

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Today on This Week Health.

I think first it's a real good handle on what's the problem they're trying to solve. And if they, can articulate that, I can start to make the argument of then it's really dangerous to try to solution first before you understand the problem.

Welcome to This Week Health Community. This is TownHall a show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels designed to amplify great thinking to propel healthcare forward. We want to thank our show sponsors Olive, Rubrik, Trellix, Medigate and F5 in partnership with Sirius Healthcare for investing in our mission to develop the next generation of health leaders. Now onto our show.

Welcome to the This Week Health Community Town Hall conversation. I'm Reid Stephan, VP and CIO at St. Luke's Health System in Boise, Idaho, and I'm joined today by Donna Roach, Chief Information Officer at the University of Utah Health. Donna, welcome and thanks for making the time.

Thanks, Reid. Appreciate it.

You got it. So just take a minute and share a bit about the University of Utah Health for our listeners who may not be familiar with who you.

So University of Utah Health is in Salt Lake City. We're kind of nestled right up against that WASA Mountain front. And uh, if I could show you a picture, you would see all the little red dots right up against the mountains which are presently getting a lot of snow right now.

regional partners and about:

What's interesting about the organizational structure, the CEO of that abar structure reports up to the dean of the medical school, who's also the senior Vice President of Health Sciences. So health sciences includes like the College of Nursing, College of Health, College of Pharmacy Health Sciences Library, and then also the School of Medicine.

So we're very much intertwined. I sometimes say I report up to the CEO of the hospitals in clinics, but I actually have probably 20 different department chairs that I also report to because part of. My job is meeting their needs in the clinical areas and what we do. So, it's a great, we're growing.

We actually haven't had the same impact. We, you know, We're like everybody else, we're. After Covid, we ran into staffing shortages and issues that came about, but we haven't fared as poorly as some where I see some people having some really negative hits to the bottom line. We're not necessarily meeting our budget, but we're not in the red, which is a real positive, but we're pretty fiscally sound.

We're also a state entity, so we report up to the legislature of Utah.

Okay, so you have, you, like, normally you think of red, but in this case it's actually good that you're not in the red, so That's right. Glad to hear that. Well, that's, quite a scope and we'll maybe talk in a few minutes here more about that.

I also love to have guests. I think this is great for just the community kind of awareness aspect. Just take a minute and share a bit about your education background, the career path that led you to the role you have.

Yeah, thanks. So I actually came out of the health administration background. I have a bachelor's and a Master's in Health Administration.

My master's was at Rush and the Rush program was very heavily quantitative systems oriented. So it paid off. I went to the University of Illinois as an undergrad very heavy quantitative program there. And that having that background kind of that quant it background really helped me out.

I'm also somebody and my father was an electrical engineer and so, was quickly kind of, Thrown into what do computers look like and programming languages and stuff. So had that exposure early on and I enjoy the computer side, kind of the quantitative side, but I also enjoy the people side, so I know both sides of the world.

Right. And, I love kind of marrying the two. Cause to me that's fun. It's like having that strategy view, but also knowing enough to be dangerous, of how to really ask some very in depth questions that sometimes scare my staff a little bit when I know, because I, I've implemented almost every, system out there.

which is a little scary. So when, people talk about knowing Cerner or Meditech or Allscripts or even the old McKesson system, spectrum and, Iacs, I don't know if you, I remember Iacs, Orlin and stuff. Mm-hmm. , I've implemented and used all of those systems, so it's, I've so appreciated what the work people have done to get us to the point, what we're at.

When I came outta school, outta my program, at first I thought, I did a fellowship actually at the va and I was really interested in more long-term. Management and I had some real key people say, You're way to, quantitatively, your mind is set, so why don't you go more into it and.

A really good mentor of mine who Walt and a lot of people may remember his name, Walt Menning, who became the CIO at Mayo. He kind of was like pushing me, prodding me, saying, No, let, let's bring you back into it. So I went, back to work at Rush and kind of. My way up. I started out as a manager.

I did, I was an application analyst, got more and more experience, more implementation experience, Went from a, senior analyst to a manager, to a director, to a senior director, to a cio, and just kind of grew from there. And honestly, I never wanted to be a cio. It just was like, it was too, when I saw other people that were in that role, it was like, this is way too much politics.

Mm-hmm. , I don't like it. And, to this day, there's still some things I don't like about it, but I realize it's a necessary evil to getting things done. So I've just worked through it. So I've been at a lot of places in Chicago. So, Resurrection advocate Central Duke, Page Hospital let's see, Adventist.

And then I went up to Michigan, worked at Bronson for a while, then went to Ascension. Ascension. I worked at in several markets. New York, Kansas, Gulf Coast, and then to the system office in St. Louis. So Ben, kind of around the block a little bit. .

Yeah. Yeah. I, What I love, there's, a commonality to everyone's story that they share about their background.

When you've touched on all of it. One is open to new ideas, maybe new roles, new learnings you hadn't thought of. There's a mentor involved. Willingness to move around, which you've done a lot. And then like, you've settled in academia where there's no politics, right? Is that what you love about it?


yeah. Yeah. That's it. That's it. .

But you've got just a wealth of experience then to help navigate that, to do what kind of fills your bucket. So I think that that's wonderful.

I agree. I agree. 📍

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Okay. You and I were talking a couple of months ago and I wanted to take a few minutes and have you share with our listeners around the work that you're leading there at Utah to develop what, to me is a really compelling approach to digital strategy and a digital framework, and in an era where.

those words are so frequently used that they start to lose meaning and, you just get exhausted. And I think people are hungry for, Okay, great, we get it. But you know, we really want some pragmatic, practical approaches or frameworks for then how we would operationalize this. So I would love to have you share with our listeners how you're tackling this at the University of.


So, and, and you're right, to me, digital is just a word. and everything in it is digital. But I'll ride that wave. It's like, if that helps get my message out there, I'll use that word. Now, when I first started, and I tell this story because it kind of did shock me a little bit because it was, I think day two, the current COO came and said, Hey, um, we're gonna have you be in charge of the digital strategy, work with the cmio, here, get that done.

And I'm like, Oh, wow. I, through all the interview process, nobody ever brought up, you had a digital strategy. Tell me just what do you think is the digital strategy? And he said, in all seriousness, he said, Well, it's telehealth right? And I'm like, Oh, oh, okay. So, and, and it, it shocked me a little bit, but that's, That I think is common.

People just think that that's what it is. And I said, Well, I said, But you, you do think it's more than just, he goes, Oh yeah, yeah, but you run with it. And that's all I needed to do. you know, It was looking at, so how do I pull together a governance structure, which we did, but the best thing that came along was, and I tell people and I don't.

a process called the Strategy:

nd then they create these, in:

Then when we started to look at them, we're like, Well, wow, there's digital throughout all of these. And so we met with them and we said, Listen, we don't own your directed step, but what we wanna do is collaborate with you on that directed step. We want to use and understand.

what's Digital and then help us to inform the digital roadmap going forward. And we'll bring it back to the deck and if there's any kind of, classifications, timing of it, if there's conflict, we'll bring that back to you. But we'll work through it and make sure it's on the digital roadmap. And, what was.

really Great about doing this process. It took a lot of time, but one, as a newer executive, it gave me this opportunity to meet with a lot of people and engage with them in terms of what the roadmap looked like and share with them. Cuz in it we said, you know, we're gonna look at this in this framework and the framework we're going to use is knowing that academics is a very provider-centric world, but we know we.

Kind of bridge to consumer. So when we look at these directed steps, we're gonna look at things that may fall under this category of bridging to consumer, but then we also know we have to get to more of a value place market, or how do we bridge to the marketplace? And so there are some things in the directed steps that support that and some directed steps supported.

And then we knew that we had an infrastructure piece that we had to, build out like the digital infrastructure. And so , what were in the directed steps that informed the roadmap. And so doing that, the first year we did it, we came up with like 26, initiatives. The second year we came back.

with like 47 and this year, 47. What all that does for us is, one, it helps us put it into a framework, but it also helps inform then our digital roadmap around. We look at it from, of course, we've got the virtual care, we have access to care, we have outreach. We have our digital architecture, we have our innovation, and then we have experience.

And those six swim lanes make up our digital roadmap. Okay. And so that's, we've used that. We're evolving it more and more. Mm-hmm. , we just came up kind of with like a one pager. Well, if, if he only had one thing to share with somebody, what would be our digital strategy? So we kind of came up with that and,, the governance.

, I've got, chairs and operational leaders and my innovation people there. All I want them to do is make sure I'm strategically aligned with the organization and the roadmap. That's all. I don't want you to get into the tactics of it. That's my job and we'll create product teams to do it, but are we, on the right trajectory?

Cause if I mess that, That's harder to kind of adjust than it is my product teams or the, boots on the ground.

So that's, great. A couple of questions that you spurred in my mind as you were describing that. So I love the, and I can visualize it, you've got these pillars, these domains, you've got these directed steps.

So I'm imagining then, Donna, that you meet with the leaders of these domains and you figure out, what are the digital enablements that I can provide. But at some point then your capacity's constrained. How do you negotiate among different leaders to figure out what you're gonna prioritize and do?

Yeah. And to also maintain relationships and, keep the lines of trust open.

Yeah. So one of the things. That our digital enablement committee is the far reaching or overreaching strategy group. I have three other groups that oversee then the tactical sides to it. So I have an application advisory, I have a data governance, and then I have an infrastructure one and the details.

So the more of the nitty gritty of. it Goes to those areas. Now the other thing I'll I'll say is, it does get a little complex at times, but we try to have that epic first mentality. So when we look at something, if we're looking at access to care, right? That's a big one on our roadmap right now.

Well, I wanna see where Epic is with it. So actually later on today, I have a conversation around Cheers. Mm-hmm. , because I want to be able to, Use as much as Epic. I mean, that's a huge investment. I wanna leverage that investment. So I constantly am gonna push forward on Epic. First, I wanna get away from a lot of the bells and whistle kind of things that are out there.

But I also wanna make sure that the key partners I wanna create out there are engaged in my strategy. And so like we went and we talked with Apple and we talked with Apple and Google and AWS and Microsoft, and we shared our strategy and we said, Now what's your strategy? How does this marry? With ours.

And so how best can you support our strategies? So the Microsoft Azure and what we could be doing in the cloud, You know, we'll, have a, a hybrid cloud strategy, but we're gonna tap into probably a lot of Microsoft pieces and, keep utilizing those services. But there's a lot of things. on their horizon that I wanna kind of combine , and you would think, this is funny cuz I, when you do governance and you have all these initiatives lining up, it's funny how well they do line up.

And , there's not a whole lot of conflict that happens. And one of the other things we did when I first got here was to make sure that the executives knew what was being kind of, asked for under their name. When I would go to my CMO and say, Do you know what projects you're responsible for?

He's like, I don't. know I said, Well, do you know what they're asking for and, and invoking your name? He's like, No. And I said, Well, we're gonna change that. And we did. So he automatically is kind of adjusting. Like if he doesn't believe in something, he tells him, No. and that's.

Really a good step in the right direction to manage the flow and, kind of understand, we only have limited resources have limited people. I can only take on so much kind of, innovation and risk all at once. So help me manage it. . If you tell me though, that this is at the top, we will get behind it and make sure we're delivering it.

But I can't have 20 priority ones. And I think people understand that.

Yeah. Yeah. Absolutely. Last question. Okay. So you, you mentioned a few minutes ago this idea that what you want from your partners is verification of your strategy. Like, does it make sense? Are we aligned? But then don't try and get into the nitty gritty of the digital solutions we're bringing forward.

And then you talked about the epic first mentality. Has that ever been a struggle? Have you had business leaders or partners. They wanna dive right into the solution. Okay. Or they bring the solution forward. Okay. What are some effective ways that you found just to, to navigate that in a way that is true to the way we know it has to unfold, but also doesn't create friction or an adversarial relationship with your partner?

I think first it's having a real good handle on what's the problem they're trying to solve. And if they, can articulate that, then solutioning it right up front, I can start to make the argument of then it's really dangerous to try to solution first before you understand the problem.

Yeah, so let's understand what's the problem you're solving for? Let's leave the solutioning to the right people, because even myself, like do you really want me getting in the middle of a network closet and like plugging and unplugging things? No. I mean, at one time in my life I could have done that, but I don't do that now.

I leave that solutioning to somebody else. So I think having those higher level discussions and sometimes bringing. The whole executive team and our, our true executive team is, made up about six people, is making sure, are you all on board? If we're gonna do this, this is gonna take up this amount of resources and therefore nursing, you won't be able to have that system.

Are you okay with that? Mm-hmm. , let's have that dialogue here rather than, , You know, in the middle of the hallway trying to negotiate it. It's better just to be really upfront of limited resources. What do you wanna have us work on?

Okay, Donna, what a delight to visit with you. Thank you for making a few minutes and just sharing just the experience, the expertise, the great things happening there at the U of U.

Really appreciate you and your time. Thanks. Have a good day.

Yeah, thanks Reid.

I really love this show. I love hearing from people on the front lines. I love hearing from these leaders and we want to thank our hosts who continue to support the community by developing this great content. We also want to thank our show sponsors, olive rubric trellis. Mitigate and F five in partnership with serious healthcare for investing in our mission to develop the next generation of health leaders.

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