IT Strategy at an Urban Teaching Hospital

Paul Contino [00:00:00]:

When you look at teams, it’s not all a bunch of the same people. Good teams are gravitating the right skill sets together around a vision, you know, and I think having had the experience of being a single contributor, somebody who’s just doing a particular job and by myself, to being part of a team, to being part of a project, to being part of a department that gives you a perspective that I think is very important. I’ve had to learn and be a good student of the business of healthcare, because as you grow in your leadership, you need to be able to walk.

Narrator [00:00:33]:

Both worlds from healthcare it leaders. You’re listening to leader to leader with John McDaniel sitting in for Ben Hilmes. Our guest today is Paul Contino, chief information officer at University Hospital. In our conversation, Paul shared his philosophy around maintaining the delicate balance between business and technology to improve patient outcomes and care.

John McDaniel [00:00:55]:

I hi, Paul. Welcome to the Leader of the Leader podcast. I’ve followed you for years in your career and enjoyed working with you, the time together in New York City. And I know our audience will be very excited to hear from you, given some of your past experiences and current challenges that you’re facing, that the industry is facing its entirety. I think that the first question I kind of want to talk to you about is tell me a little bit about University Hospital.

Paul Contino [00:01:21]:

Sure. I serve as the chief information officer at University Hospital, not to be mistaken for other university hospitals. This is University Hospital in Newark, New Jersey. So I’ve had a number of people like, oh, wait, Ohio. I’m like, none of us university hospitals. We’re a 519 bed academic medical center. We have a medical staff of about 800 doctors on staff, about 700 residents, and approximately 2000 nurses. It’s a pretty large single hospital.

Paul Contino [00:01:46]:

We’re the primary teaching hospital for the Rutgers New Jersey Medical School and the dental school. We’re the only public hospital in New Jersey, and we have that distinction. We take care of anyone and everyone that comes to us. We’re also designated as a level one trauma center, so we have cases coming in, flying in by helicopter from all over. We’re only one of three trauma centers in the entire state, and we provide tertiary care to the communities of Newark and northern New Jersey. We obviously known for high quality, comprehensive healthcare services, but we focus on the vulnerable populations of Newark, and we’re proud.

John McDaniel [00:02:23]:

Of that, given that it’s an academic medical center. What does your span of control look like? I see it varies from AMC to AMC.

Paul Contino [00:02:32]:

We’re associated with the Rutgers University and the medical school. But my span of responsibility is mainly the hospital itself, and we also cover EMS for the Newark area, so I’m not involved in the school of medicines, but we partner and collaborate closely. I have regular meetings with the CIO from Rutgers as well.

John McDaniel [00:02:50]:

I know you’re relatively new, as I mentioned, to your role there at University Hospital. I’ve followed you for years, as I mentioned earlier. What were some of your initial priorities or challenges that you faced entering that role?

Paul Contino [00:03:02]:

Yeah. So May 16, actually is my two year anniversary at University Hospital, so it just came up. I knew coming on board when I was recruited that there were a lot of challenges and unmet needs at university hospital, significant technical debt, lots of antiquated systems and applications. But I also had strong leadership, support, and commitment to start to make some of those changes. And so when I first got there, my first year really spent a good amount of time juggling between dealing with tactical needs, putting out some fires, maintaining operations, while looking at the sort of short and longer term needs of the organization, and then really laying out what I consider my it strategic plan. More of the digital roadmap for the future. In the last two years, we’ve done thousands of computer upgrades. We’ve put workstations on wheels out on the clinical floors, and basically done a lot of advanced upgrades and improvements to our systems.

Paul Contino [00:03:56]:

But what really needed to happen for the organization were a couple of large strategic initiatives. We moved to Epic hosting in the cloud. We just did that in March. That was a very large migration, but important for the institution because it gave us the ability to have disaster recovery and failover capabilities in the cloud at a much higher level of resiliency that we had locally. We’re in the process right now of implementing EPIC’s resolute revenue cycle system. We’re getting off of a legacy mainframe system that we’ve had for many years called Healthquest. Some of you may know it. We actually have two of the mainframe programmers that originally coded the application on staff supporting us, and they’re ready to retire.

Paul Contino [00:04:39]:

We’re moving to Epic resolute in December, and then we’re doing a very large network infrastructure modernization program, basically redoing all of our network closets, upgrading all the switches and the lan closets, putting in a separate security camera network. And the important thing is we’re separating formally from the Rutgers University network. We’ve been writing on their backbone for quite a long time, since the separation from UMDMJ back in 2013 when we split, and another project that is coming down the pike, we’re in the process right now of doing our due diligence is for a new enterprise resource planning system. So we’re going to be replacing some of our legacy. We have banner, very old legacy ERP system. We’ll be replacing that over the next couple of years. So, I mean, the initiatives I just laid out basically give us the strategy for the next three years. So that’s what I’m executing on.

John McDaniel [00:05:30]:

Given that you mentioned earlier that you’re a public hospital in Newark, and obviously you have a different payer population, different demographic, what kind of challenges does that create for you around some of the technology decisions that you have to make?

Paul Contino [00:05:45]:

You know, I was just on a CIO panel from New Jersey Hymns talking about virtual care and some of the challenges with adopting technology for our patients. Newark, like a number of other cities in New Jersey, like Trenton and Camden, have really vulnerable patient populations. Many of the residents live below the poverty line, and these socioeconomic disadvantaged communities have less access to technology. They have less availability of digital resources such as computers, broadband Internet in their households. And so even though we may want to push forward with technology driven strategies for improving care, you have to take the last mile in the home into consideration, looking to see what they can use and what they can adopt in their households. Oftentimes, we’re finding that the families that we work with, they’re making hard decisions around what they’re spending their dollars on. Even though broadband is readily available from the carriers in Newark, the problem is that for these families, it’s affordability, it’s not access to it. They could get broadband today if they could afford it.

Paul Contino [00:06:52]:

We’re finding a lot of these low income households, they’re making hard decisions about housing, food, and other priorities. We’ve been very cautious about pushing forward with a lot of large technology dependent strategies for improving care because we want to make sure that they can use it effectively. However, the one thing that we have found is that most of our patients have smartphones. The smartphone becomes a lifeline for them. It’s the way they communicate with their families. It’s the way that they can get access to the Internet. So we’ve been driving a lot of our thinking around how do we maximize and leverage smartphone technology, smartphone apps and sms texting and things like that, that can engage the patient without having a heavy technology burden on them. And so our strategy has been like, we’re an epic shop, so we use MyChart.

Paul Contino [00:07:42]:

We’re trying to figure out how to get patients engaged in using that technology over trying to put remote patient monitoring in their home and having to have wireless technology or broadband. We do think that over time, regular broadband for the masses will be available, but in lots of urban and rural areas, you still find that there are many digital divides there. And so again, we’re trying our best to meet the patients where they’re at with their technology. There’s also issues around digital literacy, just patients knowing how to even navigate some of this technology. You could give them a tablet, you can give them lots of technology, but if they’re not going to effectively know how to use it and make good use of it, it may wind up not being as beneficial as you might think. We’re also concerned about that as well.

John McDaniel [00:08:28]:

Given that that’s the demographic situation you’re dealing with, how are you reaching out to those patients from a digital telehealth perspective, or even just a digital health perspective?

Paul Contino [00:08:39]:

We found that there were challenges during COVID that even though we were mandated to switch over to telehealth and it became the only viable means of access for our patients, there were challenges on both sides. I mean, patients with the technology they had available, the variability in the technology, whether we’re using Zoom versus Google Hangouts or whatever, was available to the patient. And then we had challenges on the other side, too, even with our physicians, because this was all new to them as well. I think oftentimes, and as a technologist, oftentimes you think the technology is the panacea, it’s going to make things better, but you really have to think of it in terms of minimum of what your patients can effectively use. And during the pandemic, we did have a tremendous uptick in telehealth and virtual care sessions. But as the pandemic lessened, we found that patients really wanted to have that physical interaction. They really wanted to come in, they wanted to see their doctors, they wanted to get physical care. And so our telehealth program, although still in place, is a fraction of what it was during COVID And I think around the country, you’ve seen that as well.

Paul Contino [00:09:44]:

There’s a very humanistic side to healthcare, where you want to be seen by your care provider and come into the hospital. Although the very valid reasons for virtual care and giving people access and increased capability to get medical treatment, there’s still a very personal side to it where our patients want that connection with their care providers.

John McDaniel [00:10:06]:

You mentioned earlier that you’ve got an ERP initiative underway. I’m curious as to what your selection process might look like. And one of the challenging things I’ve seen in the past is how do you engage across multiple organizations that will be customers of an ERP solution?

Paul Contino [00:10:22]:

Yeah, ERP is an interesting platform because it really touches just about everything in your organization, aside from clinical care. Every business process you have, from HR to finance to payroll, is really impacted by this. And the sort of the guardrails that I let my leadership think about was you’re not making a decision for your department and you’re not making a decision for HR versus finance. We’re making an enterprise selection. And the system that’s being put in has to serve all of these various business needs in one integrated environment. My issue isn’t the technology. My issue is change management. That’s where I see the biggest challenges.

Paul Contino [00:11:03]:

We’re coming off a legacy system. Many of our people know that system inside and out. They can probably recite letter and verse exactly how to like hit the keys and get through the workflow. Getting people skilled and upskilled on a new product that has different workflow is going to be probably the largest challenge because you’re changing a lot of what people do every day. You’re also putting in a system where there’s high touch with your employees, a lot of self service capabilities and tools. It’s getting people acquainted with this new product. I do see once we get it in place, they’re going to see the value of it. A lot of automation, a lot of self service capabilities.

Paul Contino [00:11:42]:

It’s the people side of it that has some of the biggest concerns because you’re changing the way people work. And in terms of our selection process, we’re obviously looking at all the various business domains, making sure the feature functionality of the product meets what we expect it to. But most of the large players in the industry have all that already. It’s figuring out what the sweet spot is, what works well for university Hospital, and what will support our current needs and the future needs of the organization.

John McDaniel [00:12:09]:

One of the items I often hear is the feedback that it’s not the technology that’s our challenge, it’s the change management that’s our challenge. I think you’re spot on. Probably focus. Tremendous amount of your mental energy on is around cybersecurity. Obviously you’re aware of some of the major breaches we’ve had recently. How are you approaching that challenge and how do you prioritize in terms of resource, of allocation to protect the organization from a cyber attack?

Paul Contino [00:12:35]:

Yeah, it’s interesting. There’s been so much attacks in healthcare. It’s amazing that we’ve become a major focal point for cyber attacks. You wouldn’t think people would want to attack hospitals, but in some respect, they think we’re a good target. One, because we’re data rich, we have valuable information, and in many cases, organizations that get desperate in their circumstances wind up paying the ransom for us. We’re doing all the things that every other institution is doing. We’re trying to put as many barriers out there to prevent any kind of an attack. However, as they say, it’s not if, it’s when.

Paul Contino [00:13:13]:

We’re also preparing for the eventuality of there being some level of a breach or a ransomware attack and getting our organization prepared for what we need to do in that eventuality, and looking at our doctor and business continuity plans, looking at our incident management and treating it like an emergency situation. We’re setting up now for doing cyber drills to prepare for not just a multi day, but maybe a multi week, multi month outage. You see what happened with change healthcare and with ascension. These are very large organizations that have much more means than we do, and hopefully we don’t suffer such a fate. But even the most well funded organizations are finding that they can be breached. And so again, it’s the one thing in my industry that I guess would keep me up at night. But we’re trying to be pragmatic about what we can do with the means we have. One of our strategies has actually been our cloud strategy.

Paul Contino [00:14:11]:

We do think that as we work with our partners who are much larger, support multiple clients, and have much more means to secure their cloud environments, that’s a strategy. Instead of us trying to protect it in our four walls, the cloud and the services that we get from those vendors provide a level of security for us. So we’re a Microsoft 365 shop that’s in the cloud. I just said that we moved to epic hosting. That’s in the cloud. Our ERP solution will also be in the cloud. So the major platforms that we use to conduct business are sitting with our vendor partners, and our hope is that they’re doing a much better job at securing their environments than we could do. They have deeper pockets than we do.

John McDaniel [00:14:57]:

And another topic I’m sure you read a lot about. I don’t pick up a newspaper any day that doesn’t have the subject of artificial intelligence in there. What’s your approach with AI?

Paul Contino [00:15:08]:

AI has been around a long time, even though generative AI is getting all the craze and hype right now. I’m a strong believer in the power of it, but I’m also pragmatic about the use cases for it. And right now, when I look at AI, we’ve been using it in healthcare for many years, image analysis and radiology. They’ve been doing AI assisted diagnosis for quite some time. AI in the sense of being used for information consolidation and research. That’s a use case that we’re seeing right now where the EMRs are starting to use it. Epic is actually utilizing Genai to summarize medical information. So if you’re seeing a new patient and they’ve got four medical records from other organizations with lots of complicated history and meds, you can spend a lot of time as a physician having to go through all that.

Paul Contino [00:16:02]:

But what they’re doing now is with the click of a button, being able to assimilate all that information, summarizing it and categorizing it all so that you have a whole HMP for the patient right there. And so that’s a use case that I think generates really good at for a lot of the, I guess the companies that are coming out with AI technology, there’s a lot of smoke and a lot less fire in these companies. Everybody says they have something AI, and you really have to be critical about it and you have to find the right use cases where it makes sense for your organization. We’re not a research organization in a sense, we’re not developing our own AI’s. We’re not in that space. So when we are partnering with companies, most of the AI technology we get will come from those relationships with our key partners. Epic is one of them, Microsoft is another one. But I think one of the challenges we have right now is for the generative AI stuff.

Paul Contino [00:16:54]:

The cat’s really out of the bag. You’ve got chat GPT and you’ve got copilot for Microsoft. Our employees are already using that stuff. I mean, whether we gave them permission or not. So what we’re trying to do now is educate and put policy framework around the use of those tools. What we don’t want is the leakage of private or out on some of these platforms. We want to make sure that people are using this responsibly. And so that’s part of the work I’m doing right now, is looking at sort of the policy compliance stuff and educating our employees.

Paul Contino [00:17:25]:

We don’t want to shut it down. We think that there’s a lot of very useful ways in which the generative AI’s can be used, but there are risks that have to be clearly understood. And so I still think it’s early days, but I’m hopeful that the future is going to be pretty bright with AI.

John McDaniel [00:17:40]:

You mentioned Epic and Microsoft and some of their AI tools. Do you have a process in place to start to evaluate those, to understand the impact they would have on your patients, your employed population?

Paul Contino [00:17:53]:

So two different environments. So on the clinical side with the EMR, we’ve obviously had a lot of discussions with our chief medical officer and chief nursing officer about what’s coming in the product because there is a whole roadmap that Epic has for the AI tools. We’ve been somewhat conservative and slowly starting to look and evaluate how these integrate into workflows. And Epic has been doing this with a lot of companies around the country to really fine tune the tools. The one area that’s pretty mature in the AI space, it’s not generative AI, it’s traditional AI has been all the predictive models. So we’re actually evaluating and we’ve been running tests on a number of their predictive risk scoring algorithms for sepsis and readmissions and falls, risks that can be incorporated into the clinician workflow and help with revealing patients that are potentially at risk for these various factors. Many institutions have already used them for many years. That’s pretty stable, degenerative stuff.

Paul Contino [00:18:49]:

Still trying to make sure we find the right use cases because it can be a little bit of noise in the system, these tools for everything and not being effectively used. So we’re looking carefully at them. On the business side, we’re seeing Microsoft putting copilot into everything. There’s a copilot for every single product they have. I’ve been a little skeptical as to how well those will work for all those different tools. However, I do think that there’s a lot of potential in Microsoft’s copilot in helping to find and surface information that’s available to you in say, your portal, your Microsoft portal, and we’ve been actually playing with that for a couple of months now.

John McDaniel [00:19:31]:

Paul, let’s talk a little bit about your career journey. You’ve had a number of interesting jobs and your background. Extremely interested. As I said earlier, I followed you for a number of years. You’re kind of a self described lab rat. Take us back to those early years and tell us how you found your way into the CIO seat.

Paul Contino [00:19:49]:

Yes, I mean, I’ve always been a science geek. High school and I went to Bronx High School of Science. I wound up studying biochemistry. I’m a biochemist by training. I did about twelve years of bench research, biomedical research at Mount Sinai and was just about ready to head into graduate school for my PhD when I had a very interesting offer. The chair of medicine at Mount Sinai actually came to me and said, hey, look, we want to set up an IT department, and you’re the most technical person I know. Can you help me put together a proposal for what we would need and who to hire? And he let me put that together, and I had a really good time creating sort of the structure for this. And then I went to him and said, I think I’d like to do this.

Paul Contino [00:20:35]:

And he goes, but, Paul, wait, you’re gonna go to graduate school. You want to get your PhD. You’re a researcher. Would you? I said, yeah, I think I’d really like to do this. And it seems like a big switch between being a biochemist and being an IT person, but the research that I was doing was very technical. I did a lot of instrumentation development, clinical instrumentation development. I did a lot of programming and electronics. I developed all the software for the instruments.

Paul Contino [00:20:59]:

As I said, the geek in me, the technical side of me, really gravitated towards the potential of setting up this new department. And so that’s how I got my start, and I wound up creating that department in medicine, their first it department started putting together the staff and started developing the tools that they needed and the applications, and that got the attention of the dean of the medical school, and I wound up getting promoted to director of it for the medical school, and then I became the vice president of it. And then when the hospital and the school merged together, became part of the hospital system, and that’s how I got my early start, and I’ve never looked back. It’s been a fantastic ride for me. I’ve always loved technology, and I’m one of these people that likes the change. Some people don’t like change. I just love what’s coming next. So I’ve been a student of all the science, the technology, and just being in medicine as well has been a gratifying place to be because it’s two fields that come together in an amazing way, ultimately, to take care of patients, and it’s been a great ride.

Paul Contino [00:22:05]:

And so my journey to the CIO position has been one that I don’t think it was planned. It’s just I’ve always looked for the next growth step in my career, being good at being able to put a plan together, be a little visionary about how to make change and talk a good line to people about how to make it happen, and, you know, getting good people together.

John McDaniel [00:22:27]:

Kind of starting at the bottom and moving up to the top. As, you know, as a CIO, how did that kind of influence the way you think about leadership? And as you started to build your team around you, how did that enable your thought process?

Paul Contino [00:22:41]:

So, you know, I think coming up the ranks has a lot of benefits because I’ve had firsthand experience with most of the roles that my staff have. And so it gives you sort of that immediate credibility with the groups that you’re trying to lead. They understand that, you know, their jobs, you know, what they do, and it allows you also to have a better perspective on how to put teams together. When you look at teams, it’s not all a bunch of the same people. Good teams are gravitating the right skill sets together around a vision, you know, and I think having had a, the experience of being a single contributor, somebody who’s just doing a particular job and by myself, to being part of a team, to being part of a project, to being part of a department, that gives you a perspective that I think is very important. Now, the one deficit that I had in that journey is I was very technical, so I didn’t have all the business exposure. And so that’s something over the years, I’ve had to learn and be a good student of the business of healthcare, not just the technology in healthcare, because as you grow in your leadership, you need to be able to walk both worlds. And I’m talking to business leaders as well as technology folks, but being able to walk the line between those two has been incredibly useful.

Paul Contino [00:23:57]:

Yeah. And I’ve enjoyed the path.

John McDaniel [00:23:59]:

Given that, what do you think your greatest strength as a leader is? I mean, you’ve got a lot to build on.

Paul Contino [00:24:04]:

Yeah. Yeah. Well, you know, when I reflect on my career and my leadership journey, I think the strengths that I’ve relied on that have made me successful is that one. I think I’ve just been naturally curious. I’ve always been curious about how things work. I guess it’s an engineering mindset, but the ability to break down complex problems into more basic components. I always tell people I’m good at connecting the dots between the problems that people have and being able to critically think about solutioning. And I think that’s a really important skill set.

Paul Contino [00:24:37]:

It’s also important for getting people not to be intimidated by the problems that are in front of them. And I’m always telling my staff, before you come to me with a problem, please spend some time thinking about what you think is a solution, because then I want to talk it through. But I think that’s been a real strength of mine, just having that engineering mindset and critical thinking. I’ve also spent a lot of time listening and learning from others. I think that’s imperative. I’ve had some really great coaches and mentors over my career. You know, I’ve encountered some toxic individuals, but, you know, you learn from both good and bad. And I think that’s just important to always be a lifelong learner.

Paul Contino [00:25:13]:

And I will say, I think the one thing, my wife credits this to me all the time, having a positive mental attitude. You just there’s highs and lows throughout life, throughout your career, but being very positive and not letting the circumstances around you get in the way of your success. And the one thing I will finish with is I’ve always gravitated towards a servant leadership mentality. You know, it’s putting others first, caring for your team, being involved in the lives of the team that you have. And it could be lonely being the leader. If you’re the one who’s going to make all the decisions and put all the responsibility on your shoulders. It’s a lot more fun when you’ve got a team that you respect, that they respect you and you work hard together and you get great things done.

John McDaniel [00:25:59]:

If there was one attribute you were thinking about that you really wanted to work on from leadership, what would that be?

Paul Contino [00:26:07]:

Balance. I think one of the hardest things is that you can get distracted and being pushed professionally and personally in so many different directions. You’ve got to be mindful about the choices you make and find the right balance in your life. Because at the end of the day, you have to make decisions and you have to make choices, but you have to try to make the right ones. I always reflect on that Peter Drucker statement management is doing things right and leadership is doing the right things. In my life, I’ve always thought, how do you make sure you’re doing the right things?

John McDaniel [00:26:39]:

Paul, thanks for this outstanding conversation. I know our audience is going to benefit greatly from your experience, your knowledge and your wealth of skills. It’s greatly appreciated and I look forward to continuing our working relationship in the future. Thank you very much.

Paul Contino [00:26:55]:

Appreciate the time. Thanks again.

John McDaniel [00:26:57]:

Thanks.

Paul Contino [00:26:58]:

Take care.

Narrator [00:27:46]:

Thanks for joining us. For leader to leader. To learn more about how to fuel your own personal leadership journey through the healthcare industry, visit healthcare it leaders.com. don’t forget to subscribe so you don’t miss any insights and we’ll see you on the next episode.