When I interview chief information officers and other health IT professionals, I sometimes find myself inadvertently using a military metaphor to describe their daily work: "You're the people in the trenches every day," I say.
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It can certainly seem like a daily battle out there, with CIOs and their staffs constantly having to keep up with an onslaught of new regulations, an ever-shifting landscape of care coordination and new payment strategies. Their tight-knit teams make use of new tools and technologies, keeping constant vigilance against security threats while working together to protect patients and safeguard the health of populations.
Perhaps the military and health information technology have more in common than some realize?
[See also: Health IT helps fight the war at home]
The unemployment rate for veterans who've served in the U.S. Armed Forces since September 2001 ticked down a bit in 2013, according to the Bureau of Labor Statistics, but it's still high: 9 percent, compared to a 6.7 percent national average. Some 722,000 former service members were unemployed in 2013.
A 2012 study from the Center for a New American Security found that a chief reason is that many veterans have a hard time translating the skills they learned in the service to private sector work.
"Civilian employers do not always realize that military-specific jobs – such as machine gunner, tank driver or helicopter crew chief – have some components that are directly comparable to civilian environments," the report read.
Many returning vets have skills and leadership qualities that most job applicants could only dream of. Still, the unemployment numbers speak for themselves. As Secretary of Veterans Affairs Eric Shinseki told the New York Times, "Unless we can translate that into understandable business language, it's hard for the employer to get a full appreciation for the skills and knowledge the veteran will bring."
Meanwhile, healthcare is having an opposite problem: Jobs are going unfilled. There's a much-ballyhooed physician shortage looming. There's a nursing shortage, too. And there's an ongoing staffing problem affecting many hospital IT teams.
As HIMSS Analytics analyst Jennifer Horowitz told Healthcare IT News in 2013, that shortage of qualified talent is affecting crucial projects.
"Organizations are, to some extent, having to pick and choose what they're doing," she says. "We for years thought the top barrier to IT implementation was financial considerations. Two years ago, for the first time, I saw IT staffing edging out financial considerations – the fact that folks couldn't get enough IT staff."
Added HIMSS Vice President, Professional Development, JoAnn Klinedinst, "You have hospital boards applying pressure to CIOs to transform care, and yet the CIO doesn't have the talent to do it," she says. "So then what do you do? Spend lots and lots of money bringing the consulting firms in and hope that the expertise and knowledge gets transitioned to the existing staff. Or you delay. Or you move ahead with substandard staff that don't have the skills and/or the resources to do a proper job."
Securing a good future
But what if these were two problems that could help solve each other?
That's the idea behind projects such as the HIMSS Veterans Career Services Initiative, a collaboration with the U.S. Department of Labor's Education and Training Administration and Bellevue College in Bellevue, Wash. The program seems to offer returning service members education and resources related to the burgeoning health IT industry.
The initiative's "vMentors" are veterans with years of experience in IT who can help guide fellow vets by offering insight into their experiences in the field. They represent a "unique mentorship opportunity for our transitioning military and veteran community," said Amy Justice, Veterans Career Services program manager, in a HIMSS press statement. "Participants will be able to ask questions related to career development, military transition and lessons learned from health IT industry leaders who have 'been there/done that.'"
Mac McMillan, chief executive officer of healthcare security firm CynergisTek, is another person who thinks health IT should be availing itself of the unique skill sets of returning service members. Perhaps he's a bit biased, but McMillan says privacy and security is a prime area for many jobseekers to look.
With wars in Iraq and Afghanistan winding down, "There are a lot of vets that are getting out of the service now with tremendous training in either information security or cyber security that are going to be looking for jobs," he says.
"If I were a health system, and I were looking for a good quality ISO with a lot to give, and a lot of discipline and a lot of motivation and know-how, I'd be hiring a vet."
McMillan speaks from experience. He spent his formative years in the United States Marine Corps, serving as a lieutenant colonel and intelligence officer.
"In the Marine Corps, especially in smaller units, the intelligence officer is also the security officer," he says. "So the guy that handles the intelligence and the sensitive material is also responsible for protecting that stuff.
"As I came up through my career and became more operational, where security became important was understanding the threat," McMillan added. "I think a lot of people in the private sector don't really learn an appreciation for threat."
In the military, on the other hand, "they constantly think about threat," he says.
"The military deals with threat in a very real way, every day. With respect to their communications, with respect to their operations, with respect to their own personal and unit safety, etc. Anything can happen. Systems can malfunction, people can do bad things, and you always have to be on guard."
Heather Roszkowski, chief information security officer at Burlington, Vt.-based Fletcher Allen, says her years in the Army similarly taught her the "value of protecting information.
In a war zone, "you don't want people to know where the soldiers are on the battlefield or what equipment they have, because bad things can happen," she says. "That translates over to healthcare. We don't want people to know about that patient unless they're caring for that patient."
And healthcare security can often feel like a war zone.
"With technology changing as quickly as it does, it's a constant battle to keep up with it," says Roszkowski. "New viruses come out every day, and you need to be able to respond to them."
That's why she's thankful for another lesson from her time in the service: an appreciation for structure and team-building that has served her well on the front lines of healthcare.
"There's a very regimented process and structure in the military," she says. "There are regulations we have to follow. We have a very organized chart as far as who reports to whom. And I take all those lessons learned from my time in the service, and I look to apply them to what I do every day. I've created a team with a structure that I feel best fits how we're dealing with our information security."
"In the military it's a life or death situation," says McMillan. "You protect the information or people get hurt. In healthcare, it's also a life or death situation: You protect the information in the systems or people could potentially get hurt.
"Where it differs is in the military it's a very structured environment, we have very rigorous frameworks and controls and methodologies and requirements we have to meet, " he adds. "There's a lot more rigor and discipline – which is a thing, quite frankly, that healthcare could benefit from: a little starch in the diet."
'They get it'
None of which is to say, of course, that privacy and security is the only area of health IT ripe for contributions from former members of the Marines. Or the Army, Navy, Air Force or Coast Guard, for that matter.
Indeed, McMillan says any healthcare CIO would be wise to at least take a closer look at job candidates from any branch of the armed forces.
"There's some great folks out there," he says. "If you look at the communications and computer networks that the DoD has today, the guys and gals who are managing those systems are working with state of the art technology in very complex environments where they're moving data all over the world and to many different environments."
CynergisTek makes a point of hiring veterans, says McMillan. "Probably half our consulting staffers are veterans. Some of the best CISOs we work with in healthcare are former military folks. They get it."
"I'll be honest with you: One of the challenges we have these days is you hire folks right out of college, they have no work experience, they have no job experience, and they have to learn a lot at the same time as they develop their work habits," he says.
"You get a young person out of the military, who's just spent four years in that environment and that training – in that environment you're not worried about whether they're going to get up in the morning and come to work ready to go. They really are a value-add," he added. 'At the same time they bring their service ethic and commitment to their counterparts."
Since the CynergisTek "really, actively started trying to hire veterans," he says, "the workplace – just the feel of it, the camaraderie and everything else has just sort of lifted since we added those folks to the mix."
At the risk of oversimplifying it, "they just have great skills," says McMillan. Veterans with an expertise in information security, haven't just made it through basic training, they've gone to specialized computer schools, too.
"They typically go through a year of training before they're sent to one of the Marine Corps' data centers," says McMillan. "They work in large data centers, in small tactical units. They just have a tremendous amount of experience that the average IT person doesn't get."
When he was director of security at Defense Threat Reduction Agency – the DoD department focused on stopping weapons of mass destruction – McMillan estimates he spent about $10,000 a year on training for his computer security staff.
"They went to conferences, they went to training courses – you see the resumes for these guys when they come out of the government and they've got a list of certifications a mile long; the reason they have that is the government trains them and gives them that information they never would have had otherwise," he says.
"The guy on the private side either has to pay for it himself, or his company does – and a lot of companies unfortunately don't do that."
Long story short, he says, it would behoove CIOs looking for staff that can hit the ground running to take a second look at returning veterans. "You can't beat 'em," says McMillan. "As far as coming in and being able to be serve as project managers, or run a division or whatever you need to do, they're the best you're going to find."
Mission-driven
Coincidentally, Jonathan Manis, chief information officer of Sacramento, Calif.-based Sutter Health was in the Marines at the same time as McMillan, a few years behind him in seniority.
He first enlisted in the Navy, in 1978, with an eye toward eventually becoming a physician. "A military scholarship for medical school was my most likely path to a career in medicine," says Manis.
After serving as a hospital corpsman in the ICU of Jacksonville Naval Regional Medical Center, where he took care of patients for two years, Manis was eventually selected to go to the U.S. Naval Academy.
During those two years, he gained parachuting and scuba diving skills and eventually was assigned to a Marine unit called ANGLICO – Air Naval Gunfire Liaison Company – where he participated in Operation Desert Storm and a number of missions in places such as Haiti and Panama.
Manis' entree into healthcare IT came after his enrollment in Naval Postgraduate School in Monterey, Calif.
"The program they selected me for was computer science and information systems management," he says. "I was a captain at the time, and was assigned to the Pentagon, where I ran the computer systems of the Bureau of Naval Medicine."
In 1994, Manis decided to transition to civilian healthcare, working in IT at Sterling Healthcare in Coral Gables, Fla., Advocate Healthcare in Oak Brook, Ill., and now Sutter Health, where he's been for more than seven years.
Comparing his time in the service to his time in health IT, "It's amazing, at least from my perspective, how similar they are," says Manis.
"A lot of people think of the military in terms of combat operations," he explains. "But really it's more about mission. We did far more on the side of humanitarian relief, and working to take care of people. We worked to accomplish certain missions very much like we do in healthcare."
Much of what he learned in the military has "been a real value to me in my career," says Manis. And much of it is intangible personal skills – "motivation and perseverance, self-discipline and self-confidence, courage and commitment – that are nonetheless essential for success in the challenging environment that is healthcare in the 21st century.
"One of the things I think are most valued in the veterans we bring on (at Sutter Health) is that they're used to very complex environments," he says. "There's a lot going on. There are multiple priorities."
Many people get "overwhelmed or distracted" when there are competing imperatives on the way toward a goal, says Manis. "The military teaches you to thrive in a very fluid environment. To focus on what's important. And to take care of those priorities most immediate – with an eye a little bit downfield to make sure you're prepared for those additional priorities as they come at you."
Moreover, "they teach you the value of an individual effort as well as being part of a team," he says. "Perhaps more than anything, they taught me about leadership and taking care of your people. That means not only the patients we serve, but all of the folks – the physicians, the clinicians, the people here in the information services department."
Qualified candidates
At Sutter Health, "we have a preferential hire for our military veterans," says Manis. "And that's not just here within IS because I lead it. I'm proud to say that Sutter Health actually has a strategic hiring focus for military veterans. We actively recruit them and do everything we can to ensure their success in the civilian world."
They bring a broad array of skills and experience to the table, he says. "We have everything from people who were in the health services within the military – EMTs, nursing assistants, nurses, physicians, ancillary services. We have representatives from every military branch. On the technical side, we have folks who both served and supported healthcare systems – radiology system managers, pharmacy techs, those sorts of things."
Sutter also hires veterans who had little to no medical or even technology training in the service – but who recognized a good opportunity to prepare themselves for the private sector when they got out – "folks who were mortar men and radar operators, who have gone on and received skills, and are interested in additional training, that have come on board and serve us now in our network administration and our desktop support."
For the thousands of men and women returning from Iraq and Afghanistan, hospital information services departments represent excellent job opportunities, says Manis.
"I absolutely do believe that healthcare is a good place for them to start looking," he says. "We typically run about a 10 percent vacancy rate here at Sutter Health IS – that equates to about 100 open positions a month. We often have difficulty finding qualified candidates."
Those veterans who are interested in taking the expertise they gained in the service and "learning additional skill sets in a new trade or technical ability are welcome to apply here, and we give them preferential treatment," says Manis. "Technology and healthcare are two thriving industries, and they make a terrific place for a young veteran to make an impact on their life and the lives of others.
Intangible skills
One former infantryman who made just that type of leap is Dustin Leek, vice president of enterprise technology services at Daytona Beach, Fla.-based Health First.
Interestingly, he says, in the Army, "I didn't do anything with computers at all, other than the GPS devices and cryptology devices from being an infantryman. My experience from the Army wasn't necessarily anything that would translate to IT or to healthcare."
But one day he met a supply sergeant who had a book of Java instruction. "I happened to like computers but didn't know much about them," says Leek. "He gave me one of those, and I wrote my first 'Hello World' program."
If there wasn't necessarily any practical IT experience to be had in the course of Leek's Army service, there was plenty to be learned about the ways of the world – how large organizations work, how effective hierarchies are structured, how healthcare is delivered here and abroad.
"From a leadership perspective, the Army taught me a lot," he says. "From a healthcare perspective, the Army taught me a lot about just dealing with the government, and big, slow burdensome processes."
The VA, for instance, "just having to deal with that from the customer's perspective during the five, almost six years I was there, certainly helped" give perspectives on the challenges of delivering care on a large scale. Also, "getting to experience a foreign country's healthcare – like when I lived in Germany – there were certain things our own Army's healthcare wouldn't do for us."
Leek jokes that "as an IT executive in healthcare, specifically within an IDN, one of the things my army experience taught me to do was to know when to duck and cover when there's different objects coming at you from different directions."
But he's serious when he says that the leadership skills he developed there have served him well in his role at the health system – giving him the tools to be "agile, able to adapt quickly to the changing pace of anything, from meaningful use to ICD-10 to hurry-up-and-wait."
That experience means, "I tend to give veterans' resumes a second look – sometimes a third look," says Leek. "There is this indescribable skill or experience that comes from being part of wartime service – or even non-wartime service – that you can't replicate anywhere else.
"I can't put my finger on it," he says. "But they're onboard 100 percent with the team, they know how to focus on a common goal, know how to focus on a common mission. And to be honest with you, a lot of the people entering the workforce now who have not had that experience, they don't know that. They're more focused on their individual goals."
That's why he wishes more returning service members would give this industry a thought when planning out their job searches. "I feel like veterans probably don't really think about healthcare, and healthcare IT, as an option," he says.
"The Army has a program called from 'Green to Gray.' I got out in 2000, and got a booklet, From Army Green to Corporate Gray, that basically says, 'Based on what you did in the Army, here's what you could do when you get out.'
"So from the very beginning, your ideas about what you're capable of are limited unless you have a good mentor," says Leek. "I was an infantryman. When I got out of the Army, all I could think about doing was joining the FBI, joining the U.S. Marshall's service, being a cop somewhere, or a security guard. Those were the four options this book told me I should be. I felt that's all that my experience (prepared me for)."
Many returning service members need to be reminded, "it doesn't matter that all you did was tote a gun around and threw hand grenades and blew stuff up," he says. "You learn to do a lot of things in the military that don't necessarily translate into a corporate job, or a specific role."
To wit: "How many adults do you know who have been responsible for more than $10 million worth of equipment? Not very many. When it comes to health IT, we're making million-dollar decisions daily."
As healthcare continues to push forward in this national technological overhaul, needing all hands on deck as it does, perhaps it can learn some lessons and get some help from a group of people with a unique set of skills.
"One of the big things in healthcare is the pending labor shortage," says Jonathan Manis. "People are concerned about the talent that we don't have.
"I think the focus really needs to turn now to those returning veterans," he added. "As military units start to downsize, there's a real opportunity there for us to fill our structures with some very qualified and capable young folks coming at us."
For more on this topic, listen to the HIMSS webinar, 'You've Got This! Making the Transition from Military to Civilian Healthcare,' on Monday, May 12 at 2 p.m. CT.
[See also: CISO's biggest fear: 'what I don't know']
