The Journey of a CIO With Dr. Lee Milligan: Leadership, Financials, and Growth in Health IT

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Lee Milligan: I think it's really important to learn to write well. Written communication is key, whether it's email or a report to your supervisor, when you write something, that represents you. And when they look at that, that's really your brand you're putting out there. And so focusing on that, I think is a really important thing to do.

A great way to keep up with all the things that's going on at This Week in Health IT is going out and following us on social media. If you want to know about absolutely everything we're putting out there twitter is the [00:01:00] place to be. You can follow us at this week in HIT. @ thisweekinhit. And you can follow me @billrussellhit of course. And we're having great conversations happening over on LinkedIn as well. You can find us at This Week in Health IT. We are touching on the highlights of all the great stuff we're releasing. If you want to talk with me, we can connect on my personal LinkedIn as well at Bill J Russell. I love having conversations with you and sharing perspectives and sometimes I even [00:01:30] get to share your thoughts on the podcast. If you are more of a watcher than a listener, you can go over to YouTube. We post all of our shows there except Today in Health IT which is audio only of course.

We're going to still do that. We're going to go into some detail on some things, but we're also going to have more personable conversations. Get a little bit more insight into the people we're talking to. So today we have Dr. Lee Milligan with Asante Health .CIO for Asante health Lee welcome. Welcome to the show.

Lee Milligan: Good morning, bill. Happy to be here. Thanks for having me.

Bill Russell: I would say welcome back to the show, but it's welcome to the show. So keynote's new for this year and you're sort of the Guinea pig for the show. How do you feel about that?

Bill Russell: I appreciate you doing it. You're also an advisor for the show. So you keep me on the straight and narrow and when you saw this plan, you said, Hey, that looks really cool. And so trying it out on you made a lot of sense. Yeah. So it's real similar to what we've been doing with influence, except normally what I would do is I'd send questions over ahead of time and they would be very focused on, Hey, what are you doing around the staffing shortage?

So as with all the shows, let's start with the basics. Tell us a little bit about your health system. Tell us about Asante Health.

Lee Milligan: Yeah, Asante Health is in Southern Oregon. We serve nine counties. There's three hospitals in our system. It's about $1.1 billion a year in annual revenue of about a hundred thousand ER visits per year and about 70,000 urgent care visits.

We're also adding a pavilion to our flagship hospital. It's going to add about 350,000 square feet. And we are doing some additional medical practice acquisitions as well as additional [00:04:00]community connect. We currently extend our Epic to 10 clinics and another hospital health system. We're an Epic shop. Been on Epic since 2013. And I would say we're moderately mature on Epic right now.

Lee Milligan: Yeah. I wouldn't say we go all the way to the coast. We're a portion of Northern California. We are up to and including Roseburg and then east all the way to Idaho and depending on the actual sub-specialty being served, it may or may not actually overlap with Sky Lakes. So it's very broad.

Bill Russell: Wow. Do you consider yourself having to figure out how to do rural health care as well?

But for those who are way out in the coast or they're a bit more remote, I am concerned about our ability to connect with those folks.

Lee Milligan: No no. We have, well, we have a lot more than that. Southern Oregon has grown up quite a bit since I moved here. I moved here in 2000 and when I got here, there was one airline. Now there's seven airlines and they've expanded the runway quite a bit. And so, yeah, it's definitely grown up quite a bit in the last 20 years.

Bill Russell: It's good to have choices. I've seen your resume and your path was an interesting one to get to this role. How does someone go from I mean, I don't know how far back you want to go. Let's say Erie, Pennsylvania to CIO of Asante.

And, they would take us on hikes through Asbury woods [00:06:30] twice a week as an elementary school. And so, it was really a great place to grow up. In terms of college. I really entered college totally unprepared. You've heard part of my story in the past, I, I ended up taking some time off from college, did a variety of jobs.

Worked at the Gap. Worked at beacons moving corporation. I worked as a brick layers assistance for quite a while. And then it was a mail clerk at a law firm called Lakeman Walk-ins for quite a while. But eventually I stumbled into,

Lee Milligan: Yeah, these are the ones I don't actually usually point out. But what, where I was going with that is eventually I stumbled onto a terrific gig as a summer camp counselor. In a place called camp Quia maca, which is 30 miles east of San Diego. And it was there that had the opportunity to interact with kids who had muscular dystrophy. And really, it was my first opportunity ever to interact with kids who had any kind of medical scenario.

Bill Russell: Wow. The path to the CIO, newcomers always ask me, it's like, what do I need to do today to become a CIO? And one of the things I tell them is the path to getting into that chair are so varied and yours is, is pretty varied as well. I mean, just that portion of it alone is [00:08:00] pretty interesting. You didn't study technology, you didn't study programming or anything to that effect. You, you went the physician route.

Is there a direct path to the CIO chair and talk a little bit about your path.

Lee Milligan: Maybe in some systems? Probably not most. Certainly not in mine. I do think it comes down to the classic three things, people process and technology. On the people front it's really about effectively interacting with others.

And when they look at that, that's really your brand you're putting out there. And so focusing on that, I think is a really important thing to do. I also think speaking effectively is key. And I'm not just talking about big speeches that you give, but really every time you speak in front of your CEO, your re-auditioning for your role.[00:09:00]

And every time you speak to your subordinate and I learned this the hard way, they amplify what you say. So you have to be mindful of what you say and make sure that you're, saying things in a way that that really makes sense. I think from a process perspective Bill, we always have to be curious and always have to ask, are we doing this the right way?

Bill Russell: One of the things I tell people is it's a leadership role. The CIO used to be a technology role. Speeds feeds, ram, all those things. But now it's a leadership role and people say, what's the best thing you can do. I'm like go volunteer somewhere as a leader.

I couldn't do it by compensation. You have to lead by communication, by vision, by connection with people. It's a completely way. But once you learned that, once you can do that, and then somebody gives you a title, you're like, oh, well, I mean, I'm not even going to rely on title because it's not that effective anyway.

And I remember thinking at the time, why would they pay me? First of all, I'm brand new to this. I don't know anything. And second of all, it's a great learning opportunity. I was learning so much about how to conduct a [00:11:30] meeting. I mean just the basics. The politics within a meeting like that high level strategy. And so it really is all about taking advantage of those opportunities to present themselves whether they pay or not.

Bill Russell: Yeah. You come from the physician background. Does the relationship with clinicians change somewhat when you move into administration and then when you move into the CIO role?

The first question is, are you still practicing? And that is really about, that's really geared at identifying whether they could still relate to me, I think. And the second is, do you like what you do? And I usually light up before I even start speaking, I light up and they, and they know that I like what I do.

Bill Russell: It's interesting. You talked do you like what you do. I interview a lot of CIOs. I run into and have conversations with a lot of CIOs. And one of the things that I've known from my career is that generally I stay too long in a position. Like just past when I enjoy doing it anymore kind of thing. And that usually does not end well for me. And I don't think it ends well for a lot of people. And I interview a lot of CIOs and I, I'm not sure I see the joy in your step, in your smile, [00:13:00] in your, your tone anymore. I hear a lot of man, I'm getting beat up a lot. This is really hard. I can't. That kind of stuff. How do you stay sane in this role and how do you stay encouraged and motivated in the role?

Lee Milligan: Yeah. I mean, obviously there's definitely ups and downs associated with it, for sure. I do think comes back to the relationships. No matter how challenging the role is for the CIO, the frontline staff have very challenging scenarios. They're pulled, their whip sawed in a lot of directions.

Bill Russell: Yeah. In a town like like Medford, you're probably the largest employer I would assume. And you're also. Harry and David comes close. Of course. But you're also healthcare. So you, you literally are at the center of the dinner table conversations that are going on in Medford. I would think.

Bill Russell: All right. I want to take you back to the first weeks of being a CIO Asante. Walk us through those, first couple of weeks, like, coming into the role and sort of your thought process as you became CIO.

Lee Milligan: Okay. You tried to trigger my PTSD?

I'm like, you could pray for me cause I have no idea what I'm doing this job. It is so hard. It is so beyond me, I remember saying that it just looks at me and go, aren't you the CIO for this hospital system. I'm like, it's such a big job. I mean, I have to meet with a hundred docs. I have to meet with, I mean, the list of people I had to meet with in those first couple of weeks.

And I go, I'm not from healthcare. I literally don't know what all these things are. Now I know what an oncologist is but they would say some of these practices that I go, what part of the body do these people work on?

And he asked me what I thought.. He didn't want to just ask me to fill the role. He wanted to have a conversation about this and which I thought was smart. And so I expressed to him kind of the characteristics and skill sets I thought were necessary to be successful in this role. And then eventually he asked me to step in on an interim basis. But I didn't accept right away.

And I didn't really have a need, I didn't think for [00:17:00] executive coach. I really wanted a CIO coach, somebody who had been down this road before. Understood the nuances of the role and who I could reality check my world against as I navigated this. And so he to his credit understood that after a conversation and approved both and I agreed and we were off to the races.

Bill Russell: Wow. So you step into that role. Clearly there's a little bit of insecurity in some areas. What areas were you most concerned about your ability to handle the role?

And there's other pieces that you don't to your point that you don't know all that well. You have to do an honest assessment and then put in place a plan for how you're going to shore those. Maybe not, you never going to become, if you're not from clinical, you're not gonna become a doctor, but you gotta learn what the definition of oncology [00:18:00] is right?

You got to learn the basics so that you can navigate that world. I have a plan for doing that. So for me, obviously I wanted to focus on compute storage, networking, kind of hardcore ITS stuff. Plus the financials And I put in place a plan for each. On the hardcore ITstuff. I thought, the, probably the best way to do that is to focus on my team.

My team is crazy smart and they dumb it down for me so I can get a handle on it. And we furthered our relationship that way. And on the financial piece, I've done a variety of things in this space but one of the big things of course has been focusing on our budgetary process, both CapEx and OPEX, and really trying to understand [00:19:00] how we can tell stories from those numbers.

Bill Russell: I'm going to deep dive into the financials, but before we do were you concerned at all? I imagine I know the answer to this question. Were you concerned at all going to your team and saying, Hey, I don't know storage. I don't know networking. I don't understand V lands and routes and that kind of stuff.

I want you to teach me. Was there any concern in 1you doing that or did they respond well to that?

Bill Russell: So I didn't become a doctor when I became a CIO. And you have not become like a [00:20:00] Microsoft certified engineer or anything to that effect. Right?

Bill Russell: Do you think there's a difference between being an ER doc that becomes a CIO versus being a specialist that [00:21:00] becomes a CIO?

Lee Milligan: Yeah, I mean, I would say, I would say for me, there were two main advantages of coming at the CIO role with an ER background. And I don't know this would have applied if I was in a specialty scenario.

By the way, there's a reason why they call them vital signs. And then you may learn the chief complaint. You may add some data you pick up from physical exam. You may add some additional data that you acquire via labs and imaging. You're putting together as planned. You're constantly refining as you're moving forward.

So you can focus your attention on where it needs to be focused. And so, very first thing you do is you say, everybody get up and walk to the right side of the room.

And remember the categories are green, red and black. So green is, I don't have to do anything and they're going to live until the hospital.

So everybody who's left is either red or black. So you got to focus your time on figuring out who's red and who's black and some of the black are alive and you don't work on it. That's a kind of a strange concept, but it's really, it's really important because if you spend 10 minutes on that person who is likely to die [00:23:00] anyways, that's 10 minutes you could have spent on the folks who are in the red category. And it was the very first time I learned the business concept of opportunity cost. So I do think there's a fair amount of applicability from that world that applies directly to this role.

Bill Russell: We're going to cover the ransomware event because it sounds to me like that kind of background and training, where you have limited information, especially at that first phone call.

But even seasoned CIOs struggle to navigate this. And I really love what you've done in this area. You you've really put a good process for framework around it. So [00:24:00] let's talk a little bit, and I know you're going to say I haven't wrestled it to the ground, but let's talk about how you did wrestle it initially to the ground and how it is evolved over time.

Does this product overlap with anything? Are we calculating the cost by volume or numbers or whatever it might be correctly. And what we found over time, if you put this in [00:25:30] place, is that there has been a number of contracts that we're either being overcharged for, or we actually weren't using to the extent we thought we were, that we're able to actually drop.

And so just by doing that one thing alone and then telling that story To my CEO and my CFO, I think really helped improve the relationship between kind of external executives and the IT team.

And we all go through this, right? So when it comes budgeting season and our team just they're there, you can say, see their countenance, just go like, yeah oh, my God, on top of the work we're already doing, we now have to do this and I have to go to this spreadsheet and this spreadsheet and this thing, and this thing, and pull all this together for you.

And this means I'm working nights and weekends to do all this. And you looked at that and said, okay, we're good. We're going to make this better. Talk about that.

So that was the end goal. And then we worked backwards towards creating a single kind of uniform spreadsheet. [00:27:00] Manager can fill out that helps tell that story. So if you look at the spreadsheet, one of the things that asks is, if we don't do this, what will be the operational or clinical impact and, having that clear level of clarity around each thing we're spending money on allows me to ultimately at the end. Have those robust conversations, shall we say with our other executives and have clarity around what the impact [00:27:30] will be of not moving forward with that.

And so, we put together this spreadsheet, huge credit to Alison Graphis, Kate Amadei and others who worked on this for quite a while, and ultimately ended up creating a scenario where we could have all the directors have their individual spreadsheets. And then ultimately those roll up into mine.

So now I can quickly look, sort by director sort by manager and quickly see the, spend the category and the operational impact of not doing something.

Lee Milligan: Well, when I started, we actually have three separate locations where they were putting things. So one of the first things we did was cut that down by, by one. So now it's only two separate and we're actually working on an integration right now where it will be just one hope to get there at some point and then we removed columns that really didn't make sense that weren't part of that storytelling process that were just added noise associated with it.

I wanted them to categorize things in the beginning as green, yellow, and red in terms of cuts based on operational impact, if we don't do it. And so now when I come back [00:29:00] and I say, okay, I'm going to need X number of cuts. They can quickly look and say, okay, is, are we in green territory? Are we in yellow territory?

And I can say, we're in green territory. They say, okay, here are the four things I would suggest moving forward.

Bill Russell: Interesting.

Lee Milligan: One more quick point about that. And just to give you an example of kind of how this stuff ultimately impacts how we spend most recently this last budget season, I was trying to add some additional dollars for impression security, as you might imagine. And I wanted to add three things.

Bill Russell: You used the word better early on in our conversation and I think some people get sort of.I don't know, they [00:30:30] get wound up early on and they look at all the problems that they're facing. You're generally not brought in as a CIO. I'm not saying this about your situation, but generally a lot of CIOs come in under duress, right?

Something happened, CIO left and you're brought in and then they look at all the problems that there are, and they sort of get, just get wrapped around the actual, there's just too many things to solve. But what I hear you saying is triage. It's your ER background, right?

Let's make our InfoSec better next year than it was this year. It's just, everything's just an incremental improvement over and over again. We don't do a lot of like leapfrogging. We just keep making it better along the way. It's nice when we get to [00:31:30] leapfrog though.

Bill Russell: Absolutely. All right. So you participated in our webinar on ransomware, a community connect partner of yours Sky Lakes Medical Center was ransomed. And we had four people on that webinar. So a lot of times when that happens, you only get about 10 minutes to talk.

Lee Milligan: Oh so you want to hear the real story?

Bill Russell: No, that was, that was a great webinar. That was the real story. But the Sky Lake story was really the focus of that. So that was about 25 minutes of the total webinar.

And they call and say, Hey, we've been hacked. We don't know exactly what's going on. All we know it's this thing called Ryuk. And I hadn't heard of Ryuk before. So I'm like everybody else Googling this as I'm talking to the CIO, trying to figure this out. And that my biggest concern was the time delay.

Bill Russell: Is that an all hands on deck kind of event, even though you hadn't been infected per se, the fact that you were in close contact?

Bill Russell: All right. So you start to weight in and I assume again, like your ER background, you start to get more and more details, more and more information as you move forward. So what are you learning as that day unfolds? As the next week unfolds?

Lee Milligan: I think I learned that the process is that , Sky Lakes talked about this. They had some challenges with their scenario around what, what vendor to go with and, looking at their their cybersecurity policy, et cetera.

I also recognize that we have this connect scenario. And it made me think about it differently. I realized that we're extending Epic to Sky [00:35:30] Lakes. Sky Lakes got infected. We could get infected, but if that happened, we could also infect other sites that we send Epic to. The other nine clinics that are on our system.

And so it got me thinking about this whole process differently. At the time we didn't have offsite storage with an air gap. And so, I'm happy to report that. We put a lot of things in place as a result of this, like everything else we've been talking about in terms of incremental improvements.

So it basically allowed us to do this internal reflection that was ultimately good for our system. We got better because of what happened to them. But the other piece that I'll, I'll say it was [00:36:30] kind of fascinating is that I really wanted to understand if something was in our system. And I want it to get to our backups.

How fast would that would that process have happened? It was pretty, pretty quick that that process can happen. So we literally disconnected our backups for a period of time. Right. And I know that sounds a little crazy to folks, but you know, in very simplistic terms, we wanted to make sure there was no possibility that, years and years of our data could be an an encrypted and infected.

It's such a compelling story. We do the webinar and 98% of the people stayed for 56 minutes or longer on a 60 minute podcast. And they're like, you're kidding me. I've never heard of that kind. And I'm like, it's a compelling story. I mean, it's, it's almost like a, it's like [00:37:30] a I dunno, a suspense novel that's sort of unraveling as we tell the story.

And it just happens to have a bunch of educational components in it, but it really is fascinating.

Lee Milligan: It's a John Grisham novel basically.

Bill Russell: It is. And unfortunately it is those events that cause us to step back and go, oh, do we have all the disaster recovery we need? Do we have all the cybersecurity we need?

Do we have the right process, procedures, investments, technology, partners, insurance contracts, I guess is one of the things we learned from this one. All right. Let's focus towards the future a little bit. As you look forward to [00:38:30] 2022. What's top of mind for the role of CIO at Asante Health?

The first is compensation. You got to get this piece right. And one of the pieces we're doing on this is we used to do a, every two year industry assessment and I've worked with HR and now they're willing to do that every six months. And I recognize you can't monetize your way out of a retention issue, but you have to pay enough so that you take the [00:39:30] money piece off the table and you can focus on the other elements associated with it.

One of the pieces that we're trying to get right here is the role around the Epic analyst. In our system. We now have an associate Epic analyst, an Epic analyst and a senior Epic analyst. And we didn't always have a level of clarity around those three roles, particularly the Senior Epic Analyst role.

And so that's been received very well, I think by staff. We're also doing extra stuff. [00:41:00] We provide a LinkedIn learning for example. I think it used to be called lynda.com and LinkedIn acquired it. That's been really well received by the staff and they're using that as well. And then we're trying to encourage advanced degrees for folks and try to support that and actually pay for at least a portion of that.

Bill Russell: So if somebody is listening to this and they go, wow, that sounds like the place I want to work. How do they find out more information about getting an IT job at Asante?

Lee Milligan: I would encourage them to email me directly Lee.Milligan@asante.org. And I'd be happy to point them in the right direction.

It's interesting when we're talking about retention and those kinds of things. I think we simplify it too much and say, are we going to work in the office or work remotely? And is that going to be enough? I like the fact that you put those four factors together, but I do want to focus in on, on, on that aspect of it.

Lee Milligan: Yeah, I mean, it's actually hard for HR to do that. It costs them between 6 and $10,000 to set up the individual state stuff every time we do that. I think we're in 12 states right now. But I think the industry is heading that way. So we have to do that. I do think it's ultimately advantageous to live closer by, but the reality is we have to open up across the board and we're doing that, I think fairly effectively.

Despite the fact that we're in this distributed model right now, and that team is formulating right now, some recommendations.

Bill Russell: Interesting. All right. We're going to close out on the personal side. You appear healthy, you appear, I mean, after a couple of years in the CIO role, I was not nearly as healthy as I was when I started. Just based on social media, you write a fair amount, you spend a lot of time outdoors. I mean, is that sort of your outlet?

We do a fair amount of hiking. We try to hike three or four times a week if we can kind of sneak out a little bit early. We also, interestingly, ride motorcycles. So most of my ER, docs friends give me a hard time about that. But yes, we ride motorcycles. And we do a lot of outdoor things.

And not necessarily critical in terms of the decisions you make. And so things like, hiking and speaking Spanish is it's all good.

Bill Russell: I'm sorry. Did you say you and your wife go out on bikes?

Lee Milligan: Motorcycles. Yeah. And our kids as well.

Lee Milligan: Yes, you will.

Bill Russell: Wow. For an ER doc, I mean, I had heard some of those stories. So our hospitals were in the LA market and those kinds of things, and you could actually split lanes in Southern California.

Lee Milligan: I do, but mind you that I don't ride motorcycles today like I used to. So in the past, when I would ride motorcycles, like my dirt bike, for example, I would ride it. I would look for, holes and jumps and whatnot in order to hit them. And nowadays I look for those same things in order to avoid them.

Lee Milligan: One last thing I'll leave you with Bill, is that, when I first came into the role, I did reach out to a number of CIOs who were awesome. Ed Marks, John Halamka, Michael Pfeffer and others who [00:46:30] gave me some great advice kind of out of the gate. And they were kind enough to share with me their time. If any of your listeners are headed on this trajectory or are newly into the CIO role. I'd be more than happy to spend time with them and share with them personally, kind of some of the tidbits I picked up along the way.

Bill Russell: Fantastic. Lee, thanks again for your time. Always great to have you as a guest.