Justin Campbell

Justin is Vice President of Marketing & Strategy at Galen. He is responsible for all activities related to conceptualizing and implementing market strategy and achieving marketing targets. Specific responsibilities include business and market development; market research and planning; strategic direction for promotion and advertising; coordination with sales.

CHIME Interview Series: Paul Brannan, Alabama Health Information Technology Coordinator, Alabama Medicaid Agency

Paul Brannan, Alabama HIT Coordinator

Paul Brannan, Alabama HIT Coordinator, Alabama Medicaid Agency

A champion in the Medicaid arena and now in health information exchange, Paul Brannan, Health Information Technology Coordinator and Director of Alabama’s HIE, One Health Record®, knows how to make quite the connection. His advice to those in the HIE startup/entrepreneurship space is the same he follows himself: create solutions that are easily usable in the provider’s workflow. One Health Record® is intentionally free to its providers and has gained flexibility with how they send records outbound, based on what the system is ready to consume. They are also willing to customize their interface with the provider’s EMR system. No EMR? No problem. One Health Record® provides a portal through a secure website where you can see the longitudinal record of care. Brannan’s future initiatives reflect this provider-centric way of thinking: from working to integrate with Public Health so One Health Record® can become a connection hub for their providers, to reestablishing their connection with Georgia’s HIE, One Health Record® has a robust value proposition and it shows.

CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Here is the next interview in the series:

Key Insights

We’re in the process of expanding into providing a patient portal for patient’s to be able to see consolidated views of their records from the providers who participate in our exchange.

In the state of Alabama, we find a lot of our provider community is rural in nature and may not have a high-profit margin, so we want to be as low cost to them as we possibly can.

The move to value-based purchasing in the healthcare arena is going to make the information that we have, and its ability to improve treatment, of greater value to our large-scale payers.

If providers don’t have an EMR or they’re not happy with how the information being sent is viewed from the EMR, we also provide a portal where providers can access a patient’s longitudinal record of care.

What we find with a lot of our smaller providers is that, without an extensive IT staff, the cost and difficulty of maintaining all the different connections they encounter is becoming prohibitive.

Most providers are still thinking in a fee for service mindset, where they’re looking at the volume of healthcare. If a HIE adds time and effort to the treatment of the patient, there’s going to be resistance even if the HIE adds value.

Campbell: Can you give me a little bit of background on yourself, your organization, and your current role within the organization.

Brannan: My historical background has been with the Medicaid Agency. I’ve been with the Alabama Medicaid Agency for 20 years. I first came on board in the tech support area. In the late 90s, when we were looking to implement a claim processing system, I was drafted to be a part of the team who developed the RFP and did the implementation.  As a result, I was promoted to Deputy MMIS Coordinator. After a couple of years, my boss moved on to another opportunity, I had the chance to take over our Medicaid Claims Processing System as MMIS Coordinator.  Our Commissioner later gave me the opportunity to direct our Project Management Office because of the project management rigor we were using in the MMIS area.  Two years ago I was asked to lead the State’s health information exchange and was named by our governor as the State HIT Coordinator.

Now our HIE’s background: Medicaid has been interested in the electronic health record market for many years. We started under transformation grants, establishing a free EMR for Medicaid providers, focused on monitoring certain chronic conditions. That morphed, when the Affordable Care Act was passed, taking advantage of the funding by helping providers purchase their own EMR system through Meaningful Use as well as establishing a statewide health information exchange. In Alabama,  One Health Record® is the only HIE in the state.  We offer services for all Alabama providers, not just Medicaid.

We’re in the process of expanding into providing a patient portal for patients to be able to see consolidated views of their records from the providers who participate in our exchange, as well as implementing ADT alerting.

Campbell: I appreciate the thorough background. I noted on your website that as of January 31st you’re at just over 2 million patients, 87 connected facilities, 13 connected hospitals, and over a million registered documents. That’s pretty impressive. Tell me a little about the sustainability and, quite frankly, the solvency model for the HIE. I know with public HIEs, some of them are funded through grants, others have a business model centered around the value proposition they’re offering. If you could elaborate on that, that would be helpful.

Brannan: We have intentionally been free to our providers, at least as far as what we charge, to drive adoption. In the state of Alabama, we find a lot of our provider community is rural in nature and doesn’t have a high-profit margin, so we want to be as low cost to them as we possibly can. This means we’ve been funded to date by a combination of: federal funding, state funding through the Medicaid agency, as well as grants from the Department of Public Health, and Blue Cross Blue Shield—which is Alabama’s major insurance provider. Long term, for sustainability, we’re looking at several different funding models.  We feel that sustainability will come from a combination of value to our large-scale providers and our major hospitals in the state providing a large part of the funding. Lesser amounts will likely come from our individual providers, our primary care doctors, and others, with some funding coming from our insurance community as well.  The move to value-based purchasing in the healthcare arena is going to make the information that we have available, and its ability to improve treatment, of greater value to our large-scale payers.  In Alabama, large scale payers make up a good portion of the population under Medicaid.  Therefore, we anticipate Medicaid funding being a part of the long-term solution, and we hope that our major insurers will see value in what we’re doing as well.

Campbell: In terms of the transactions that are taking place, you mentioned ADT’s for the patient portals, but what about for providers? What data do they have access to in the portals? What inbound transactions do you consume today?

Brannan: We can consume any of the ITI-based standards for incoming transactions, and as such we support patient registrations and queries for information.  We are fairly flexible in how we send things outbound based on what the target system is ready to consume. If they want a CCDA, we can do that. If they want a customized interface with their EMR system, as some of our large-scale providers do, we’re willing to work with their EMR vendor to implement that by breaking the CCDs into discrete data elements per standards. If all they’re ready for right now is purely a direct account, we are a HISP (Health Information Service Provider), so we can provide direct mailboxes for them as well. If they don’t have an EMR or they’re not happy with how the information we send is viewed from their EMR, we also provide a portal that they can go in to see the longitudinal record of care. That can be viewed through a secure website, and if their EMR system supports it, we can make that viewable as a window within their EMR system.

Campbell: Switching gears a bit, a lot of the HIEs are swimming in a deluge of data. Can you elaborate a bit on the governance process you use today to dictate data access? Is it federated at all?

Brannan: We are a hybrid. We have some providers who are very interested in having us store their data. For them, we have a data repository where we can store their records. However, we have several providers who feel strong ownership of their information and are not interested in it being stored in multiple locations. For those, we offer a more federated approach where we simply store the demographics along with the pointer information. That information then gets pulled on-demand, but it’s not stored, so it does not persist with us, it goes straight to the provider. We require everyone who is connected to our exchange to agree that they will only provide records for people that they’re actively treating and they will only pull those records for treatment purposes.

Campbell: Is there a particularly compelling use case that you can share, in terms of the HIE being used in the provider community, or more broadly, for public health purposes?

Brannan: The use cases that we support directly with a query-based exchange have a lot to do with emergency situations: someone’s away from their primary source of care, they’re on vacation or somewhere where their records are not easily accessible. We make it so that those records can be made accessible in an emergency.

We had an even more interesting use case recently where a provider referred to a specialist, and the specialist called to get the records. The people who had those records said ‘you need to get on One Health Record® so we can send them electronically, we’re trying to get out of the paper record business.’ Without us even having to contact that specialist, they were calling us saying ‘I’ve had a couple of people wanting us to get on One Health Record® so that we can quit this paper exchange.’ They were interested in what they needed to do to be a part of our exchange so they could remove the inefficiencies involved in sending paper records back and forth.

Campbell: That’s great. When people are coming to you, instead of you having to sell the value, that they’re being incentivized to do so, that’s when you know it’s working. I noted an article published in the Birmingham Medical News in December 2015, featuring Alabama One Health Record®, mentioned you were pursuing initiatives around immunizations and specifically alerting. Can you tell me about any progress or challenges you faced with that initiative?

Brannan: The only real drawback we’ve had in moving forward with those initiatives is getting approval from public health authorities to set it up. They want to make sure the information that is going to be shared is secure. We’re working with their leadership to hopefully make that happen soon because it is something we’ve had provider interest in. Once that occurs, what we envision happening, as part of our value-added service, is being a connection hub for all our providers. Right now, providers must maintain multiple connections. We want to simplify that for them by taking on the connection to Public Health so they can do immunizations reporting, cancer registry reporting, or any public health-related reporting, without having it as a separate connection. We’re even exploring, as a long-term possibility, establishing connections to insurers as well, to allow them to do eligibility inquiries and claim submissions.  What we find with a lot of our smaller providers is that, without an extensive IT staff, the cost and difficulty of maintaining all the different connections are becoming prohibitive. We’re trying to simplify that as part of our value-added proposition to our healthcare community.

Campbell: You hit the nail on the head there, as smaller groups just don’t have the resources. If you have an entity like the HIE it makes a lot of sense: the infrastructures is already there, let it do the heavy lifting and connect rather than having to make a major outlay and investment in IT.

Let’s talk about other initiatives that have your focus in this near term. There is seemingly a purchasing pause in the industry, at least in the provider community, where they’re trying to rationalize their existing infrastructure and investments. It’s not the days of money being thrown into the implementation of new technology via government incentives, but rather there’s a lot of rationalization occurring. That said, tell me what it’s like to operate as a HIE in this climate, and what initiatives that you might be facing in the next couple of months.

Brannan: We’re asking a provider to make an investment of time and for many a capital outlay. We are free but their EMR vendor will likely charge them for establishing the connection as well as charge an annual maintenance fee.  Before they make that kind of investment they want to know what’s in it for them. The obvious selling point for a HIE is having complete access to the record of the individual at the point of care. Part of what we’re marketing now, as more and more payers in the Alabama region are moving to some type of value-based reimbursement, is the importance of them being able to see what’s happening in the provider community and with other people who are treating the patients as well. Our value-add proposition is to provide any data they might need to help manage their population, as well as looking for opportunities to partner with them to improve healthcare practices in those hospitals.

Campbell: Absolutely, if you have access to the data, the power of analytics and machine learning applied to that data is very profound. Switching topics for a moment, has there been anything made aside from just the initial connection to GaHIN (Georgia Health Information Network) or is there active communication today? Was it merely a proof of concept or is it something used in practice to serve the two geographies?

Brannan: It has been used in practice and we’re looking to reestablish it. Unfortunately, one of the drawbacks of being a state entity is that as long as we’re under the state umbrella, we follow state procurement laws, which means we can’t purchase a system that other vendors use on a permanent basis. Instead, we have to periodically go out for bid.  Our HIE backend software had to go out for bid last year, and a new vendor won the bid, which meant we had to replace our HIE software. This required us to reestablish our Sequoia certification which was part of the underlying agreement we had with Georgia.  Because we are reestablishing that certification, we have had to temporarily cut off the connection with GaHIN. We are right on the brink of regaining that Sequoia certification – we expect that happening in the next few weeks – and Georgia has expressed interest in reestablishing the connection as soon as that happens.

It is a very important connection. We have people in the eastern part of the state, who see providers in Georgia. There are also populations who simply cross over to other states and have the need for medical care while they’re there and providers there need to see their records. So, that’s something we’re interested in reestablishing as soon as possible, but it’s not currently active today.

Campbell: I can appreciate that. It is a major forklift going from one major HIE platform to another

Brannan: We have providers actively using the new platform as it stands. We tried to make that cutover without causing any disruption to their current connections, making it as seamless as we can.

Campbell: And all the while you must be mindful to look at what’s in the queue in terms of integration that has yet to be developed. As such, I imagine there was some bifurcating of feeds that were occurring while you were working through that transition.

Brannan: Exactly. We had that going on for a good period of time making the transition as seamless as possible. Ultimately all our connected provider had to move to our new endpoint. It took them a little while to make that transition, depending on what their IT infrastructure looked like. We’ve been able to do it fairly painlessly. Most providers made the move with us, which is something that we’re very pleased with.

Campbell: Very good. Lastly, in closing, given your vast background on the Medicaid and HIE side, what have you learned over the years that you would like to impress on our audience of health IT entrepreneurs and startups. Has there been anyone, mentor or colleague, that’s impacted you? If there’s something you’ve learned in your career, or just based on your experience, and can share that story, that would be great.

Brannan: The key to working in the entrepreneur/startup space is making something that is usable in the provider’s workflow. That’s ultimately where the rubber is going to meet the road. As long as a HIE system is seen as an additional tax on the provider’s time, then it’s going to be difficult to get buy-in, no matter how much value it gives. Most providers are still thinking in a fee for service mindset, where they’re looking at maximizing the volume of patients treated. If what is being provided for them adds time and effort to the treatment of the patient, there’s going to be a resistance. Integrate what you’re doing into the workflow of the provider so that it works somewhat seamlessly or causes minimal disruption to what is already a busy workflow.  Most of the resistance we’ve seen comes from providers who say ‘well I see value in that, I just can’t afford to take an extra five minutes per patient. Because of the way my EMR looks at the records you provide, it requires me going to a whole other screen and making so many additional clicks.’  That’s part of the reason we’re willing to integrate into EMR systems for providers who have the wherewithal to support the cost and effort it takes for the EMR to integrate our records into their system.

About Paul Brannan
Paul serves as Alabama Health Information Technology Coordinator, where he is responsible for managing the $5 million HIT program for the state. He also serves as Director of One Health Record®, Alabama’s State Health Information Exchange.

Paul works with local, state, federal, and private partners to build collaboration with Alabama’s health providers, payers, and patients to improve health information exchange and promote better health outcomes. His vision is to see all Alabama stakeholders connected and securely exchanging data as appropriate to make Alabama a healthier state.

Paul is a graduate of Auburn University, holding a BS in Secondary Education.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration, and optimization of clinical systems. He has been on the front lines of system replacement and data migration is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

CHIME Fall Forum Interview Series: Rich Pollack, VP & CIO, VCU Health System

Rich-Pollack-CIO

Rich Pollack, VP & CIO at VCU Health System

There’s a lot of healthcare history at Virginia Commonwealth University Health Systems, where Rich Pollack is VP and CIO, and not just because their medical school has been in existence since 1838. VCUHS was also the third site to deploy the TDS7000 System, meaning computer provider order entry (CPOE) has been in use for more than 30 years. While that predates Pollack, he has a compelling history of his own. He started out on the clinical side of healthcare as a radiology administrative manager. As the world of health IT started to shift and electronic health records became more prominent, Pollack found his clinical background desired by HIT Vendors, and what might look like a meticulously planned career journey was in fact serendipitous. Pollack’s experience continues to serve him well today as he continually looks for ways to enhance patient care through the merging of two worlds. As far as initiatives that are in queue for the year, we discuss everything from telemedicine to data archival, and all their Cerner solutions in between.

CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Here is the next interview in the series:

Key Insights

It’s a little unusual, you don’t typically find a lot of academic medical centers with a payer organization

We’re going to try and avoid point solutions and instead go for the EMR vendor’s population health solution, partly because of its tight integration into the EMR.

This organization was an early adopter of electronic medical records and CPOE. We were the third site to deploy the TDS7000 System, way back in the late 70s-early 80s.

What was fortuitous for me was that for a long time, health IT was mainly focused on business systems, financial, billing, and revenue. It was only in the late 80s-early 90s that the focus began to shift to clinical systems and the electronic medical record. That’s exactly around the time that I made the transition into health IT.

You need that understanding of what patient care processes are like: what is the world of the clinician and the caregiver?

Campbell: Let’s start out with a little bit of background about yourself and about VCU Health. I know you’ve been there for over a decade. Tell me about your role there and what you folks are working on.

Pollack: I’ve been here for about 11 ½ years. We’re an academic medical center leveraging Cerner EMR, about a $3B a year organization, and we’re fully integrated. In other words, we have a hospital component that has a community hospital and a children’s hospital, with over 900 beds. We also have a large outpatient component where we see about 650,000 patients a year in over 100 clinics, mostly specialty/sub specialty. We also own our 750-physician practice plan. Those physicians practice in all the clinics and hospitals. They’re complimented by 1,500 other providers, mid-levels, residents, and such.

We are a part of Virginia Commonwealth University, which is the largest university in Virginia. The medical school, Virginia Commonwealth University School of Medicine, has been in existence since 1838, so there is a rich history. Another component we added in about 15-16 years ago, is a payer. We have an insurance entity called Virginia Premier. It is a Medicaid HMO, and is the third largest in the state with about 200,000 or so members. That’s a little unusual, as you don’t typically find a lot of academic medical centers with a payer organization.

I run the IT organization, which oversees all the information technology for the entities I previously mentioned. We’re well integrated at the infrastructure layer: we run the same revenue cycle/billing system, from GE, across the inpatient/outpatient environment; and the same EMR, Cerner, services the entire organization. There is a certain amount of decentralization, as you would typically see within an academic medical center, but for the most part, we’re still tightly integrated.

Campbell: That sounds like a vast realm of responsibility for a healthcare information technology leader like yourself. How many applications are you responsible for in the enterprise and do you leverage any enterprise application management software to catalog and manage those?

Pollack: We have about 150-160 applications, depends how you categorize them, which is relatively modest for the size of the organization we are. That’s primarily because we have three core systems that are used by everyone: the EMR, revenue cycle, and ERP. Of those 150-160, some of them are very small applications. You have CBord Dietary Planning Software that runs on a server somewhere and it’s not awfully critical, all the way up to the revenue cycle GE/IDX systems that run on redundant AIX boxes, to the Lawson/Infor ERP, which is remote hosted, as well the Cerner EMR, which is also remote hosted. That’s the portfolio. We don’t necessarily have a formal application management system, but we have a database that we put together that tracks these applications. It looks at: who are the owners, who are the stewards, how old is the software, when’s the next release, when is it going to go out of support, where is it run, how many servers, what location, and those kinds of things. We put that together mainly from a disaster recovery stand-point because we want to know where these systems are, how are they going to be supported from a DR standpoint, what tier they are, and what’s the underlying architecture to support DR for that tier.

Campbell: Thank you for elaborating on that. It’s very insightful. In terms of population health management, how is that managed today? Do you have point solution? Do you rely on the EHR vendor? Do you have a data warehouse that you’re leveraging? Can you tell me a little bit about your approach?

Pollack: Though we don’t have a formal ACO, we are involved in managing population health. As an organization, we’ve been involved in population health management for a long time. We have a large indigent population with a lot of chronic disease patients. We recently stood up a multidisciplinary complex care clinic, that serves our top 5% most costly populations. We use our enterprise analytics data warehouse and our analytics team to help stratify and identify certain populations.

We are looking to deploy Cerner’s HealtheIntent Population Health Platform, primarily the care management aspects of that, both acute and community care management, and secondarily, the smart registries feature. We’re trying to avoid point solutions and instead leverage the EMR vendor’s population health solution, primarily due to its tight integration into the EMR. We are wanting to avoid pushing the physicians, who are the decision makers for these complex populations, out to yet another, or third, application, to try and manage these populations. We wanted to integrate it as tightly in the EMR as we can. That is the place our clinicians live.

Campbell: That makes a lot of sense. I think that’s why Epic and Cerner are in the positions they are today, namely the advantage of native, seamless integration and a singular database across care settings. This approach alleviates the need to harmonize nomenclatures across different care settings. Switching gears again, I know you have a background in medical biology, and you’re a HIMSS fellow as well. Tell me about how you apply your background into your everyday role. Coming from a clinical background, there may be components of it that are valuable to being a healthcare CIO.

Pollack: It’s interesting. In hindsight, it might look like some meticulously planned career journey, but in fact it was anything but. It was pure luck and happenstance that I started out on the clinical side, not on the business and IT side. My first career for 13 years was as a radiology administrative manager. I was involved in: nuclear medicine, ultrasound, radiology, the early days of CT Scanners, PACS, and such. I thought I would stay in that field forever. By chance, I was looking to make a move geographically and ended up going to work for a small health IT company down in North Carolina, that was looking for someone with a radiology background. One thing led to another, and I eventually gravitated into health IT. What was fortuitous was for a long time, health IT was mainly focused on business systems – financial, billing, and revenue. It was only in the late 80s-early 90s that the focus began to shift to clinical systems and the electronic medical record. That’s exactly the time that I made the transition into health IT. My clinical background and experience began to serve me well because of the focus on EMRs; I gravitated towards that. I worked for a couple HIT vendor companies, and then eventually became a CIO. I became attracted to the community hospital setting initially, but then went on to big academic medical centers: MD Anderson, Indiana University Health, and then eventually came to VCU Health.

My clinical background has served me extremely well because that is a bulk of what we do, or a significant part of what health IT is involved in. It’s also the most challenging part. You need that understanding of what patient care processes are like: what is the world of the clinician and the caregiver? I’ve been there, I’ve worked closely with them, I understand what’s involved and the nuances about it. I have a passion for it. All of those things have worked to serve me well. If the industry had gone in some other direction and supply chain was the most important thing, maybe I would be unemployed now… *laughing* At any rate, it just so happened that there was a confluence of forces at work – my background in clinical care with the industries change in direction towards EMRs – and it all came together.

Campbell: Very serendipitous. I imagine having that appreciation, more importantly that perspective, allows you to build trust with stakeholders in clinical positions. Thank you for sharing that background. Let’s discuss CHIME a bit. Tell me about the draw of CHIME for you and what you went there looking for this year. What were the key insights you gleaned from attending the event?

Pollack: The size of the event facilitates networking, which is such a key underpinning and important aspect of belonging to CHIME. I have made incredible contacts, incredible friends and professional relationships through CHIME over the years because it’s focused on networking, connecting peers, and mentoring and supporting each other in many ways. That’s probably the greatest value of the organization.

I find the educational offerings, particularly the track sessions, valuable and engaging. For the most part they’re not vendor presentations, they’re real world experiences from my peers across the country that I can derive some real essence from. That’s tremendously beneficial. I think some of the keynotes have been very inspiring over the years, so I get a lot out of that as well. Those are the key underpinnings: the educational aspects, the networking, and the professional development. I’m CHCHIO certified, which I had to study and take an exam for. I was a little reluctant to do so, but I did manage to pass! I tell people they must’ve had a big curve that year. But I got through that and achieved certification.

The other aspect, which has been particularly important the last several years with ACA and so on, is the voice CHIME brings to the political arena in terms of legislation and regulation. Whether it’s the ONC that they’re dealing with, Congress, the Federal Communication Commission, or the FDA, CHIME has developed a very strong advocacy voice for the world of healthcare IT. They represent our interests and needs extremely well and in a pragmatic way. They bring some of our experienced and senior members in close contact with the people who are setting up and crafting the legislation and regulations, so they can realize what will not work and why, or if there is a better way to go. I’m more of a recipient or beneficiary of that activity from CHIME, but I have a great respect and appreciation for it.

Campbell: In closing, what’s on tap for you this year? It sounds like you’re going to be focused on archival and I imagine integrating the community hospitals will be top of mind for you.

Pollack: We’re building a new hospital and rolling them into Cerner and GE/IDX, that’s our singular, largest project, but we have a lot of others. We have what we call an ERR roadmap, that we update every couple of years, with a lot of subprojects. We’re wrapping up Cerner Oncology implementation, we’ve got Cerner Women’s Health taking off, and we’re looking at adopting the Cerner Behavioral Health module. We’re conducting a lot of optimization, where we go back, revisit and optimize physician and nursing documentation. Those are some of the significant pieces. We also have a lot planned on our infrastructure side. This is one of those years where we’re investing quite a bit into building out our DR capability across our two data centers. We are trying to move forward with VDI at the desktop, which has been a challenge for us in the past, but new technology is making it more feasible for us. The organization continues to grow, the outpatient footprint gets bigger, and we’re opening clinics all over the state. We have telemedicine today but we’re going to go more into the world of virtual visits in a big way, so that’s an exciting venue for us as well.

Campbell: Well, I’ll tell you it sounds like you’re on the forefront of healthcare information technology. This has been most enlightening. Thank you for taking the time to chat.

About Rich Pollack
Rich Pollack is Vice President and Chief Information Officer for VCU Health System. There, his responsibilities include setting the vision for IT, supported by effective strategic and tactical plans that define the best practices in support of patient care and operational excellence.

At VCU Health Systems, his accomplishments include:
* Ongoing successful installation of electronic medical records and computerized physician order entry
* Selection and initiation of a new hospital billing system and enterprise resource planning system
* Contributing to the development of a new all-digital 15 story acute care tower utilizing layers of integrated technology, including wireless, VoIP phones, bedside device integration, mobile access to facilitate effective communication and high-quality care

He also has served as:
* Chief Information Officer for Clarian Health Partners, a $2 billion health system in Indianapolis
* An IT leader at The University of Texas M. D. Anderson Cancer Center in Houston, lastly as CIO overseeing a 500-person information systems organization with projects totaling more than $100 million supporting clinical, academic, research and administrative functions
* Director of Information Systems for Nash Health Care Systems in Rocky Mount, North Carolina, where he and his team successfully implemented a computer-based patient record system for the 450-bed, multi-hospital organization, which received special commendation as best industry-practice

Rich has more than 30 years of health care management experience.

Rich holds a master’s degree in medical biology and is a member of several professional organizations.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration, is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

At the Nexus of HDOs and HealthIT Solutions: A Compass for Market Navigation

Blain-Newton

Blain Newton, EVP, HIMSS Analytics

Interview with Blain Newton, EVP, HIMSS Analytics

We often talk about healthcare’s deluge of data in a negative connotation, but Blain Newton, Executive Vice President at HIMSS Analytics, sees it as innovation in the making. Their global guidelines for health IT adoption gives them a unique perspective on the very specific needs of healthcare delivery organizations.  The data that comes through these framework-based engagements allows them to inform vendors in a way that nobody else can. It gives these vendors a better understanding of how to position themselves in the market and in-turn results in the innovations healthcare organizations need to better patient care. In this interview, Newton discusses how HIMSS Analytics went from a point-to-point data aggregator to a global health IT strategy organization and market intelligence platform; why understanding brand perception is so important, especially for startups; and why data is only as valuable as the solution it creates.  Whether you’re a large healthcare organization or a small startup, HIMSS Analytics has the resources to move you forward.

Key Insights

Being a wholly-owned subsidiary of a global, cause-based not-for-profit allows us a different lens than you would get as a traditional, commercial organization.

Through the relationships, engagements, and conversations that we have all over the world, and because of these standards of excellence, we’re able to speak intelligently to the vendor and consultant community, who are trying to fit the needs of these organizations, about what providers are looking for.

These go-to-market strategies penetrate the noise. For startups, it’s even more important. If you’re an Epic or a Cerner, you have a market position, you have a voice, you have a platform. In the startup community, there’s a lot more clutter and noise.

There’s an 80/20 rule at play here where the single source vendor will likely maintain that large footprint, but may not dip into their niche fringes.

One word of caution: as these technologies are becoming more ubiquitous and more known, we’re seeing a shift towards enterprise buys, as opposed to disparate departmental buys.

Making sure that whatever solution you’re bringing to market is not an extra click, or two, is critically important. It needs to be presented and served up in a way that does not further tax the time or research constraints of the clinicians.

Some of the bigger players have whole teams dedicated to working with our data, but a startup doesn’t have that luxury. Because of that, we’ve begun offering what we call Managed Services, which is essentially an on-call market research team.

Campbell: Please tell me a little bit about yourself and your organization, HIMSS Analytics.

Newton: I’ve been in healthcare software technology for – hard to believe now – almost twenty years. I started on the financial side with Arthur Andersen then moved through the vendor community, at GE/IDX and Allscripts, both here and in Europe. I’ve basically worn every hat; I did finance, accounting, operations, professional services, support, product development, and strategy. I eventually rolled off as CEO of a small market research company that was acquired four years ago by HIMSS and consolidated within the HIMSS Analytics business unit. HIMSS Analytics is a wholly owned subsidiary of HIMSS, which is a global, cause-based not-for-profit, focused on better healthcare IT. We are the market research arm of HIMSS. The role I’m in now is essentially CEO of HIMSS Analytics. We’re responsible for not only market research to support the mission, but market research and intelligence to support our clients, and a suite of maturity models that we use as a framework to help healthcare organizations and health systems around the world understand how to adopt and implement IT to achieve the best possible outcomes.

Campbell: You live on the nexus of healthcare delivery organizations and health IT solutions. How does your value proposition fit into that?

Newton: That’s a great question. Being a wholly-owned subsidiary of a global, cause-based not-for-profit allows us a different lens than you would get as a traditional, commercial organization. We provide value through our maturity models, most notably through our EMRAM model, which has become a global standard of excellence for how to adopt and implement EMRs and related systems. Our analytics maturity model is helping the new age of understanding and making sense of data within the health system and how to use it to improve care, financial outcomes, and patient engagement. Lastly, our continuity of care model acts as a guide to ensure the right technologies, processes and people are in place so HDOs are effectively caring for the patient. Those frameworks are helping individual healthcare systems all the way up through ministries of health understand how to adopt, implement, and leverage technology across multiple care settings.

It gives us a unique perspective on the very specific needs of the healthcare delivery organizations. Through the relationships, engagements, and conversations that we have all over the world, and because of these standards of excellence, we’re able to speak intelligently to the vendor and consultant community, who are trying to fit the needs of these organizations, about what providers are looking for. We gather data on every hospital and health system in the country, about 350,000 practices in the US and Canada, another 16,000 or so entities globally, and growing exponentially. A lot of that data comes through these maturity model based engagements and allows us to inform the vendors in a way that nobody else can. The relationships we have with the provider community are incredibly important. Being at the intersection of helping providers understand how to adopt and implement allows us a view into the true needs of these organizations. That helps us inform the software vendors, the hardware vendors, the consultants with: how they should position themselves, how they should build out their product lines, who they should be talking to, what value propositions they should be bringing to the table, and helps improve their go-to-market plans because of this unique, intimate knowledge we have of the health system.

Campbell: That’s truly profound. Given the audience of HealthIT & mHealth is more startup-based and entrepreneurial – companies in their nascent stages – how can they use LOGIC™ to intelligently approach a market and differentiate their offering?

Newton: LOGIC™ is an integral part of a bigger puzzle. LOGIC™, a market intelligence tool with hundreds of millions of data points provides users data intelligence on who has what technology and how they’re using it, who they’re looking to replace, who the decision makers are within these healthcare organizations, what their financial status is, unused budget, things like that. This market intelligence in combination with an understanding of brand perception, how to position a brand, and how to create tactical go-to-market strategies is where our market insight, thought leadership and research arm comes into play to help complete the puzzle. These go-to-market strategies penetrate the noise. For startups, it’s even more important. If you’re an Epic or a Cerner, you have a market position, you have a voice, you have a platform. In the startup community, there’s a lot more clutter and noise. Even if you look at telemedicine vendors, we’ve seen the number double over the last three years that we’re covering within LOGIC™. Similar story with analytics vendors. Part of that is because these organizations are targeting very niche plays. For example, they’re only covering a very specific type of telemedicine, and telemedicine is a big world. Using LOGIC™ and some quantitative/qualitative research, leveraging the relationships we have, you can begin to cut through the clutter and noise to start to more clearly articulate the value proposition that resonates with the buyer. For a startup, domain knowledge and domain expertise is very important. Our relationships afford us access to the type of domain knowledge that can help a startup’s message resonate in a way that maybe others aren’t. It’s the combination of LOGIC™ and market understanding, with some managed services-type work, which we offer, that can help startups rise above the fray and create a platform and a voice that is heard beyond buzzwords.

Campbell: Absolutely and that brings up an important point. As I talked with several CIOs, as part of our CHIME Interview Series, and got their perspective on what seems to resonate with them, what differentiates in the startup community, the consensus seemed to be that there’s an endless number of vendors approaching the buzzword markets: patient engagement, precision medicine, and the like. These CIOs felt there was an opportunity at the fringes where big vendors like Epic may not have their focus. You see these off-shoots, these companies that have employees—like Galen—that have members who used to work for the large EHR vendor organizations. That said, what do you feel are the best market opportunities if you’re just entering right now? What are the areas that may be in their nascent stages, where maybe they’re investing too much energy prematurely? What are the hot areas around the fringes?

Newton: That take from the CIOs at CHIME is exactly what we’re seeing too. There’s an 80/20 rule at play here where the single source vendor will likely maintain that large footprint, but may not dip into their niche fringes, like precision medicine for example, as you mentioned. It’s a buzzword that everyone’s excited about, but we’re not seeing as much organizational readiness to fully engage at the healthcare organization level. It’s more of a hub and spoke model because of the cost of setting up a truly effective precision medicine program in the workflow. As such, it’s still in the early stages. The point being, as that starts to ramp, there’s opportunities to play in the niche areas. There’s a big focus on cancer and the Cancer Moonshot. That’s an incredibly important piece of work and one that IBM Watson has put a lot of money, time, effort, and resources into, and they’re doing great work around it.

There are other areas precision medicine and genomic medicine can help too. I talked with some folks in Orlando at the HIMSS Annual Conference that are focused on mother-baby precision medicine, and understanding the neonatal/postnatal impact of genetic medicine, targeting that niche. I think it’s safe to say that, that level of understanding, domain knowledge and expertise to drive care in that area is likely not something the Epics and the Cerners of the world will get to.

Telemedicine is another area, and Care Management, especially as we see the shift to value-based-care in the US Market. Healthcare organizations that are at risk with their patient pool or have health plans within their organization, and are part of or have set up an ACO, are prime targets. We track that data so we understand what health systems that pertains to. Those organizations that are ahead of the curve in the shift to value based care are more likely to be buyers of a niche. An example is a telemedicine vendor to manage chronic disease states. Diabetics for rural patients for instance, to bring down the long-term cost of care. Understanding, as a startup, how your solution fits within a given healthcare organization’s mission is critically important. Filling in those niche plays, where you can help reduce the A1C levels, for example, for a rural population of diabetics through innovative care management and chronic disease management could be something of importance. One word of caution: as these technologies are becoming more ubiquitous and more known, we’re seeing a shift towards enterprise buys, as opposed to disparate departmental buys. You can no longer just create a relationship with the head of endocrinology, for example, for a diabetic management tool. It’s now becoming a larger play.

Understanding your path through the decision tree at a hospital, who the right people to talk to are, is becoming more and more important, as is understanding who the likely buyer for your product/solution is. The scatter shot approach is a hard one to take, especially as a niche startup. You need a clean value proposition with a clear understanding of who you should be talking to and when, to position your product appropriately.

Campbell: You brought up several key points there. One, around the enterprise buys – that inherently solves interoperability issues. As these organizations are risk adverse in the terms of the complexity they face and the transition from fee-for-service to value-based care, they don’t want to introduce another point-solution that they’ll have to interoperate within the enterprise portfolio. Another point you mentioned, PHM, population health management, is seemingly a popular buzzword. You gave several use cases of how that can be addressed in the startup community. One of the resounding sentiments or thoughts that I heard at HIMSS, that I thought was very compelling, was the notion of: it doesn’t matter unless the data gets to the point-of-care. Yes, you can do all these fancy analytics and machine learning, artificial intelligence insights, but what does it matter if you’re not reaching the point-of-care? That’s something organizations should think of as well, so thank you for elaborating on that.

Newton: You hit on an incredibly important point. I saw, for the first time in years, some interesting ways startups are finding to embed themselves intelligently and innovatively into the clinician’s workflow, so that the data’s there when you need it. I used to work at Allscripts, and they had a saying at the time: “if the doctor doesn’t use it, it doesn’t matter,” or something along those lines. It’s so true. Making sure that whatever solution you’re bringing to market is not an extra click, or two, is critically important. It needs to be presented and served up in a way that does not further tax the time or research constraints of the clinicians. It’s a very important point to look at and it can get lost as you come out with a fancy new solution that may be the greatest thing ever, but if a doc must go three steps out of their workflow to get at it, it probably won’t get seen. It’s a huge point to consider and an area of opportunity for startups to look at how they can cleanup workflow; some of these systems have been assembled in strange ways over the years.

Campbell: Sound advice. Tell me about the innovation that’s taking place at HIMSS Analytics to increase vendor market intelligence, productivity, and efficiency.

Newton: We have, over the last four years or so, transformed HIMSS Analytics from a point-to-point data aggregator to a global health IT strategy organization and an on-demand, workflow-integrated, market intelligence platform. That platform under the umbrella name is LOGIC™. Underneath that, we have created a very robust set of tools to understand what opportunities you should be targeting, and what territories you should be looking at. You can break that down even further by several factors. You could look at how many procedures a facility does, as it pertains to the problem you’re trying to solve for, so you can target those facilities. There’s a very robust set of customizable tools for you to dig into.

Beyond that, we understand the need to fit into a workflow, especially for a smaller organization that doesn’t have a team of market analysts that can dive into the data. Recently, we launched a Chrome extension called LOGIC Discover. It’s available for free on the Chrome Store or through our website. It allows you, within the workflow of your browser, to understand a hospitals footprint. Through this extension, we share with you the key stats you need to know about a hospital before you make a phone call or send an email. Even though startups are consumer-oriented, we’re still seeing the buyer mainly being a payer or a hospital, as we consolidate the market into this hub and spoke model. That might shift, but right now there’s still a pretty high percentage of buying at the hospital or payer level. This Chrome extension allows you to understand what’s happening in your workflow, rapidly, without having to navigate to another tool. We also have a mobile app in beta that is location enabled. So, if you’re in the Boston area and interested in a certain organization, you can quickly and easily use your mobile app to learn the key facts about them and understand if they are actively interested in solving for a problem which your solution fits.

Additionally, we have some exciting stuff happening with our predictive analytics solutions: understanding where the markets headed and who’s likely to invest in technologies. We’re looking at ways to break down the volume of data and gain further insight. I know I’m treading into buzzword territory myself talking about predictive analytics. It’s overused at times in the health IT space, but being able to sort through data and glean insights, especially for a startup, is key. Because of the volume of new entrants in this space, making sure you’re in front of the right person at the right time is more important than it’s ever been. We’ll have more news on that in the next month or so.

One of the key things that we’ve come out with is due to the recognition that younger organizations may not have—and I say that full knowing that they probably don’t—a team of market researchers at hand. Some of the bigger players have whole teams dedicated to working with our data, but a startup doesn’t have that luxury. Because of that we’ve begun offering what we call Managed Services, which is essentially an on-call market research team. If you’re getting ready to do a big presentation in front of a payer or hospital board buyer, and you need a couple of slides to show market trajectory; or you’re getting ready to put something in front of an investor and you need to show market opportunity; or you’re simply trying to know who your prospects should be but you don’t quite understand the space well enough; make a quick call to us.  We can put together slides for you, we can walk you through how you should be talking to folks, and who you should be talking to. Our Managed Service offering is not innovative from a technology perspective, in fact it’s kind of retro, going back to a time when one arm, one service was important. We’ve seen startup clients get a lot of value out of that. That’s an exciting thing that we’ve been doing in the last several months too.

Campbell: Simply fascinating. Such value for organizations that are looking to enter a market given that they can leverage the authority and credibility that HIMSS Analytics brings. It offers a turnkey solution for these groups. No longer do they have to climb up this mountain themselves, there’s just great resources out there. You mentioned the Managed Services organization and reaching out to them, how else can a budding startup or entrepreneur get started with HIMSS Analytics? What other resources are available publicly to learn more?

Newton: Our newly designed website has a lot of good information on it. We consistently hold webinars. We have a syndicated research publication that’s low cost and high value, called Essentials Brief, on hot topics in the industry. There’s at least one a month, if not more. Those are also available on our website. With the investment in one of those – $1500  – you get time with us to walk through the findings and talk through what’s out there. As a not-for-profit, part of our mission is to ensure that all stakeholders in the health IT landscape, whether they’re healthcare organizations or solutions providers, are well informed. It drives efficiency through the system. We’re more than happy to just have a conversation and spend time working with organizations trying to get into the space. It doesn’t necessarily need to lead to a sale. We need innovation, so the more we can do to offer up guidance, the better. We had a client mention to me at HIMSS in Orlando, that they would describe the way we operate as “approachable intelligence.” We are very invested in the success of our clients. It’s not just a transaction. We get involved and try to find a way to lead you forward. Whether it starts with a basic conversation, the Discover Chrome app, the mobile app, or the Essentials Brief – whatever it is, there’s multiple points of entry. You can find them all on HIMSSAnalytics.org, but again, we’re also happy to just take a call, answer questions, and give some thought and insight.

Campbell: Blain, thanks so much for your time today. Some truly compelling initiatives taking place at HIMSS Analytics. You’re really pushing the healthcare industry forward one insight at a time.

About Blain Newton
Blain Newton serves as Executive Vice President of HIMSS Analytic. Prior to his current role, Blain Newton served as Senior Vice President and Chief Operating Officer of the business unit, with overall responsibility for strategy, sales, and operations for HIMSS Analytics product and service offerings. Blain can be found on Twitter at @Newton_VT and LinkedIn.

Formerly CEO of CapSite, a Burlington, Vt.-based healthcare technology research and advisory firm acquired by HIMSS Analytics in 2012, he has more than 15 years of experience in the healthcare technology industry. He has held leadership roles in finance, solutions management and operations in the US and internationally at companies including IDX Systems Corporation, GE Healthcare, Allscripts, and Arthur Andersen.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration, is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

Is Salesforce Ripe for Partnership with Health Cloud as a Patient Relationship Operating System?

Its human nature to draw analogies from past disruptors and apply to parallels in other industries. After all, we take experiences and lessons from the past to derive inspiration for future innovation. It’s in this regard that pundits have pointed to ATMs as a model to solve for healthcare’s interoperability woes, or present MINT.com and Kayak as a model for the healthcare’s move to retail and consumerization. It’s also in this regard that Salesforce is used as an example for patient engagement for healthcare. However, unlike the other industry-specific disruptors, Salesforce’s model fits healthcare as well. But just because it fits on-paper, that doesn’t mean that Salesforce is ripe to disrupt healthcare. There is certainly a lot of inertia to overcome in healthcare information technology, as Chilmark Research was quick to point out after Salesforce Health Cloud was announced

After several years of circling the healthcare market, Salesforce finally announced its intent to formally enter the market this week with the announcement of Salesforce Health Cloud. Unlike other enterprise vendors who have jumped into this market, with Blue Ribbon advisory panels (Google Health), or series of acquisitions (IBM Watson Health, Intuit) or a mixture of both (Microsoft), this announcement by Salesforce had little in the way of any of these attributes to bolster its announcement.

Salesforce is taking a much more tentative and low risk approach to entering the healthcare market and will look to its expansive ecosystem of partners who will leverage Salesforce’s existing tools to create healthcare specific solutions and services.

-Salesforce Enters the Fray: Will They Succeed Where Others Have Failed? CHILMARK BIGHT, September 2015, Brian Murphy and John Moore

Salesforce touts Health Cloud as a vehicle to acquire and manage patient data from multiple sources, from electronic health records, to patient generated data through wearable fitness trackers. Salesforce has also positioned the application as a communications platform for patient engagement and care coordination, as well as a dashboard for outcomes management and population health. Sound like every other vendor touting themselves as a PHM solution? Chilmark takes a deeper look into strengths and weaknesses:

Salesforce won’t compete with established transactional systems, but rather be a front end, as it’s not interested in being an electronic medical record provider like EPIC. As Salesforce CMO Dr. Joshua Newman told MedCity News, he sees competition from three places: electronic medical records vendors, startups and analytics firms.

EMR vendors may be entrenched, Newman said, but “they’re never going to be Internet-focused and multi-tenant.” A multi-tenant approach typical of a cloud service like Salesforce helps manage patients seen by physicians with privileges at multiple hospitals, according to Newman.

HISTalk also offered an optimistic assessment of Salesforce, declaring Health Cloud “the most interesting product I saw at HIMSS.” Mr. H from HIStalk noted the following advantages Salesforce Health Cloud offers:

  • Existing EHRs and other healthcare software products are way behind the times in meeting new requirements for health systems to treat patients and doctors as customers and to build relationships with them, including patient engagement.
  • It lets health systems that are willing to change their relationships with patients and doctors to do so effectively, with strong analytics and communications.
  • It’s cloud-based and is purchased on a relatively inexpensive per-user, per-month price with no capital outlay.
  • It’s built on the standard Salesforce CRM that has been battle-tested for years, with just those customizations needed to make it work for healthcare.
  • It integrates with the EHR and other patient and provider data sources.
  • The Salesforce open ecosystem allows using third-party apps when needed.
  • It Includes tools that allow users to build their own rules and apps.
  • Salesforce is a juggernaut that can force EHR vendors to open up their systems to obtain the data it needs.
  • Salesforce isn’t Oracle or Microsoft – they didn’t create a healthcare-specific product from scratch or acquire a questionable one, so they have no incentive to rebalance their product portfolio and walk away from healthcare and leave users hanging as big healthcare toe-dippers tend to do.

Given the optimistic outlook, what does this mean for healthcare startups and entrepreneurs Salesforce represents a good horse to attach your cart to. We’ve witnessed a plethora of companies go at patient engagement with their own custom solution. This approach lacks scale, established technology, and is crowded with competition. Not to mention, the path to monetization and profit is muddy at best. Further, Salesforce has built a rich ecosystem of extensibility via its app marketplace. Some could argue that this is exactly what healthcare needs.

The content presented in the Health Cloud Integration eBook suggests that Salesforce is still in the somewhat nascent stages, with limited adoption outside of pilots. Despite this, HCOs who have implemented the platform, such as Cancer Treatment Centers of American (CTCA) have demonstrated tangible benefits. CTCA now uses Salesforce to improve service in three different areas: physician referral intake; a 24/7 contact center; and, patient communities. The result is a 60% productivity boost for their technical team. One of the benefits to patients is their community platform, built on Salesforce Community Cloud, that empowers patients and families to support one another, join groups, participate in local events, find educational resources, and chat in real time. In turn, CTCA benefits from an enhanced referral process that improves customer loyalty and provides another way to communicate with patients.

There are clear gaps to fill. As the saying goes, “if the doctor doesn’t use it, it doesn’t matter.” Insights must reach the point of care and not be disruptive to existing workflows, but rather enhance it. It’s in this vein that partners are needed build the detailed workflows to support patient and care team communications. Salesforce represents a great candidate to partner instead of going at the crowded patient relationship management and patient engagement space alone.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration, is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

CHIME Fall Forum Interview Series: Robert Napoli, SVP, CIO, Planned Parenthood of the Great Northwest and the Hawaiian Islands

Have you ever started a new job with a lengthy to-do list? Robert Napoli, Senior Vice President and CIO at Planned Parenthood Great Northwest and the Hawaiian Islands, can relate. When he first joined the organization three and a half years ago he began a rip and replace of their entire system, and in the end, the only thing that remained was the telecommunication system.  Once he was finished redesigning and replacing, he moved on to strategic initiatives including BI and analytics strategy, mobile health, patient engagement, and more. With experience on both the acute care and ambulatory side, Napoli offers up a unique perspective on the harmonization of clinical data. In this interview, he discusses his organization’s journey through data archival; why integrated solutions are the way to go; and the question on everyone’s mind: what’s happening with the potential defunding of Planned Parenthood? Napoli is a well-seasoned healthcare technologist who’s always aiming to innovate, and we discussed what he’s done and where he’s going.

CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Here is the next interview in the series:

Key Insights

In my experience, I have found that integrated solutions are typically easier to deploy and maintain, provide more predictable and lower TCO, and offer better support for overall organizational workflows.

So long as the data exists, we have a repository that is easily reference-able and accessible.

We ripped out the entire network, redesigned it, upgraded the equipment, installed wireless for the first time, replaced email and moved services to the Cloud.

Given the political landscape and the potential for defunding, we’re looking at ways coalesce those services, perform consolidation, and expand the expertise that some of the individual affiliates have to a broader, more national effort.

There’s hardly a CHIME event that I don’t come back with something that I can either implement or use in my organization.

We were recognized by CIO Magazine IDG for successfully launching the federation’s first mobile health app. This service virtually extends our medical expertise and allows patients either through a smartphone or computer, to have a real-time visit through a secure video consultation system.

Campbell: Thank you for taking the time to chat with me. Can you provide a little bit of background about yourself and about your organization?

Napoli: Sure. I’m the Senior Vice President and Chief Information Officer of Planned Parenthood of the Great Northwest and the Hawaiian Islands. We’re the affiliate that is based in Seattle and operate health centers in Alaska, the Hawaiian Islands, Idaho and Western Washington. We have ambulatory clinics in each of those states, providing both primary and reproductive care for men and women. I’ve been in this position for a little over three and a half years now. Prior to that, I was the IT Director at a mid-size hospital in Connecticut and before that, held CIO accountability at a similarly sized hospital just north of New York City. In that role, I reported to the CFO and oversaw the strategic and tactical direction of the department as well as the operational management of our technology and information systems.  I was in that position for nearly nine years. So, I have both acute care as well as ambulatory experience.

Campbell: Certainly valuable to be able to understand both of those perspectives, especially given the challenges surrounding the harmonization and coalescence of that data from the ambulatory side to the acute side. Thank you for that background. In terms of applications within the portfolio, can you provide an overview of that? Specifically, the applications that fall under your umbrella in your organization? Could you also elaborate on your enterprise portfolio approach – best of breed, integrated, etc. –  and whether you have plans to consolidate in the future?

Napoli: In my experience, I have found that integrated solutions are typically easier to deploy and maintain, provide more predictable and lower TCO, and offer better support for overall organizational workflows. Certainly, this isn’t the case with all information systems and there have been occasions, throughout the years, when we’ve gone with best of breed solutions – cybersecurity tools being one such example. Also, a slightly different question, although related, is what to do when native functionality in systems isn’t as robust or feature-rich as third-party options. Population health and analytics are good examples of this. In these cases, we have no problem implementing third-party solutions to provide additional functionality and capabilities. But as a rule, I tend to push for integrated technologies when possible.

The application portfolio that my group manages is pretty standard and includes all of our clinical and business systems including the EHR and practice management systems. Shortly after arriving, I initiated a business intelligence and analytics strategy, so we support and manage these systems as well. There are a couple of outliers. For example, there’s a Cloud-based learning management system that we provide some support for, but that is managed primarily by our education and training departments. Outside of that, nearly every other piece of technology or software used by the organization is supported by my group. We’re comprised of the technical folks that support our infrastructure, computers, and telecommunication systems as well as the clinical and business analysts and data management teams. As the organization’s Chief Security Officer, I am also responsible for ensuring our organization’s HIPAA and cybersecurity posture, which our technical team supports with assistance from external consultants.

Campbell: Very good. Let’s touch a bit on data archival strategy. Do you leverage a data archival solution today? I know you mentioned the data warehouse, and I’ve talked with some folks where they’ve used the data warehouse for archival purposes.

Napoli: We do, although we haven’t been able to reach a consensus on a specific archival period. Fortunately, we have the capacity to archive all of our data without limitation, so landing on this hasn’t been a priority.

When I arrived at the organization in July of 2013, we didn’t have a report writer or database administrator, let alone a cohesive data management or analytics strategy. I made the decision very early on that once I had addressed our operational issues by stabilizing systems and redirecting staff, that we would need to focus on being a modern, data-driven organization. One of the first strategic initiatives that I proposed to my executive team and board was a comprehensive business intelligence strategy – it was an easy sell. In hindsight, this project was a heavy lift, and our biggest challenge was transforming an organization that wasn’t accustomed to working with a lot of data to one that now had a ton of data available. To realize full value from our investment and effort, we needed to get our business leaders to a point where they understood the data and owned the business results of using the system. Architecting the system was relatively easy compared to the cultural shifts that needed to take place. My goal from the outset was to provide a self-service data platform – I didn’t want our end users dependent on Information Services to understand our business and to get access to the data that is most meaningful to them. Although this work was extremely difficult at first, it has been a huge success.

Our biggest consideration when architecting the system was whether to build a data warehouse (which is better for archiving) or go with an OLTP approach, which is more suited for real-time business operations and better met my objective of empowering our business leaders. We decided on a hybrid approach that includes a data warehouse precisely for its archival capabilities. Our warehouse includes historical and current data feeds from both internal and external data sources for all our business units. So long as the data exists, we have a repository that is easily referenceable and accessible.

Campbell: One of the things I talked about with several of your peers was requests to access legacy data. The archival whitepaper we published addressed some of the concerns and challenges when there are eDiscovery requests for data. Specifically, when you archive that data, the shape of the data is inherently changed. Another consideration is what the chart that the clinician was presented with at the exact time of inquiry. That could differ from the PDF of the chart that is produced from most archival applications. There’s certainly a lot of metadata considerations. If you could elaborate on how your organization approaches that today and any insights you may have, that would be helpful.

Napoli: Fortunately, we haven’t had many eDiscovery requests in the time that I’ve been at the organization. We implemented our first EHR in 2010, so there isn’t a lot of data that I would describe as “legacy.” Other information systems were minimal prior to this. Our EHR vendor provides an archiving module which helps make our underlying storage environment more efficient, but our most requested data is in our repository where our users can access what they need although It’s not uncommon for us to receive requests for ad-hoc reports or custom dashboards. The requests for eDiscovery information typically occurs between the business unit making the request and our data management team, and I don’t necessarily have a lot of visibility into the actual discussions themselves. My team does a great job ascertaining that the data we’re pulling is correct and appropriate for the need.

Campbell: Shifting gears a bit, tell me a little about what keeps you busy these days. Any major organizational initiatives? Perhaps you could touch on some items you went to CHIME looking to find out more about.

Napoli: Right now, things at my affiliate are extremely stable. As I mentioned earlier, when I first got to the organization there were a ton of operational challenges that we needed to address. We spent the first couple of years ripping out and replacing every piece of core technology in the organization, except for the telecommunications system, which was replaced the year before I got there. We replaced every endpoint, server, and storage device including the infrastructure that housed our EHR and PM systems. We ripped out the entire network, redesigned it, upgraded the equipment, installed wireless for the first time, replaced email and moved services to the Cloud. In the middle of all this, we acquired the Hawaii affiliate and had to merge their systems with ours and bring them up on our EHR, so operationally we had a ton going on. We’ve spent the past couple of years focusing on the more strategic stuff – getting the data warehouse and business intelligence environments up and running, releasing a mobile app, implementing population health and patient engagement platforms, expanding our telehealth services, among other things. We’re at a point now where, not only operationally, but tactically and strategically, we’re in a great spot.

Lately, I’ve been focusing more of my time on assisting Planned Parenthood Federation of America with some newer and broader initiatives, such as cybersecurity and a shared services model. Let me quickly explain our relationship to the federation as this can be confusing. The national office provides our branding and accreditation, but they do not operate any health centers directly, which is the responsibility of one of 56 affiliates. Each affiliate is an independent organization with its own executive team, board of directors, budgets, information systems, and internal decision-making process. Given the political landscape and the potential for defunding, we’re looking at ways to coalesce those services, perform consolidation, and expand the expertise that some of the individual affiliates have to a broader, more national effort. It’s exciting because one of my earliest observations was that affiliates could benefit from centralizing systems and services, but there were internal politics and personal interests that prevented these conversations from moving forward. Although I do not welcome the thought that we could lose a significant part of our revenue, the situation is forcing us to be more agile and lean, and this is a good thing.

Campbell: I imagine sustainability and solvency is top of mind for you, providing value added services to create revenue generation in creative ways, and as you mentioned, finding economies of scale, and getting more operationally efficient because you need to. Tell me a bit about data sharing that may occur from a regional level to a national level.

Napoli: That’s one of the areas we’re evaluating. We decided to build our own data warehouse because there weren’t any viable options available through the national office or another affiliate. During the requirements gathering phase of this work, we heard anecdotally from many of our business leaders who expressed a desire to benchmark our measures against other affiliates or even those of other organizations. We’ve recently partnered with OCHIN, Inc. located in Portland, for our EHR template customizations and they offer an extremely robust real-time healthcare-specific data aggregation tool called Acuere that would provide this benchmarking. We’re impressed with Acura’s capabilities and are moving forward with a subscription. However, its ultimate usefulness and value are dependent on our end user adoption and whether other affiliates see the value in a data aggregation tool and participate in the program.

Campbell: Do you leverage any health information exchange technology? Or have you evaluated that? I know with some groups, it makes it easier if there are other affiliates that need to connect, to move to that hub and spoke model. An alternative is asynchronous requests where you web services are leveraged to broadcast out to other affiliates, ‘hey do you have any data that I care about,’ and that request is fulfilled.

Napoli: We don’t. We do share data with OneHealthPort, which is the Washington State HIE, so the interfaces and configuration necessary to exchange that data are in place. However, this is a state requirement if you see Medicaid patients and there isn’t much of a business case for participating without this mandate. There is, however, a huge business need to share patient data across the federation since most patients don’t realize that our affiliates (even those that are near one another) are independent, stand-alone organizations with separate EHRs, unique patient identifiers and completely closed data systems. Our patients are often surprised that their medical record is not universally accessible in all our health centers since we present a unified brand.

The aforementioned OCHIN has a potential solution to this that, although not an overnight fix, provides what I believe is the best opportunity for coalescing our disparate EHRs into a truly portable patient record. I’ll be working closely with them over the next few months as we explore this further.

Campbell: I wanted to get your thoughts on CHIME. I talked to Chuck Christian, VP at  Indiana HIE –  one of the founding members of CHIME – and he just raved about how refreshing it is to be amongst your peers. There is a lot of noise at the HIMSS conference whereas the CHIME forum is much more focused. At CHIME, you’re talking about the things that are meaningful to you and given the multitude of issues and responsibilities that come with being a healthcare CIO, it’s seemingly invaluable. I’ll give you another perspective you may have read in one of our earlier interviews, that was extremely cogent advice, from Dr. R Hal Baker at Wellspan. He mentioned the currency of a healthcare leader is measured in attention units. You want ambitiously desire to accomplish a great deal of initiatives, but your primary job as a CIO is to ensure extraordinary care to the patient population you serve. There’s so many ways where you can get distracted or lose your focus. Without me rambling on too much I’d like to hear your perspective on what CHIME means to you and the value you get out of it?

Napoli: I would agree that there’s a lot of noise out there, especially at the HIMSS Conference, just because of the size and scope of it. In many respects, I find it overwhelming even though I’m a proud member of HIMSS, hold CPHIMS certification, and serve on the HIMSS Innovation Committee. CHIME is an association that I value, and the annual conference is one that I look forward to for a couple of reasons. For starters, there are so many people over the years that I’ve connected with and met through CHIME. Chuck Christian, for example, was one of my faculty at the CHIME CIO Bootcamp that I attended several years back. Having the opportunity to reconnect with people who you invariably meet over the years is vital. Additionally, the content of the program is extremely relevant, and it’s engaging and useful. There’s hardly a CHIME event that I don’t come back with something that I can either implement or use in my organization. I sit on the CHCIO Exam Review Panel and recently agreed to serve as a CHIME Ambassador – these are testaments to the value I place on my membership.

Campbell: That’s great. Certainly, when you get so much out of an organization it’s great to hear that you pay it forward and give back to it as well. Any closing thoughts that you may have? The readership for healthIT & mHealth is primarily health entrepreneurs or digital health startups and in past interviews I’ve tried to inquire to the interviewees about advice they may have for folks in that space or what’s on the mind of your organization.  You mentioned patient engagement, and it’s a crowded space with a lot of apps offered in that area, but who’s moving the needle in a meaningful way? Any parting insights you’d like to leave our audience with?

Napoli: Mobile health is a personal interest of mine. After all these years, I still consider myself a technologist at heart. I helped develop one of the first medical transcription and dictation systems in the early 90’s and still like architecting systems and solutions as time allows. In 2015, we were recognized by CIO Magazine IDG for successfully launching the federation’s first mobile health app. This service virtually extends our medical expertise and allows patients either through a smartphone or computer, to have a real-time visit through a secure video consultation system. I also recently designed a mobile health app that I’m hoping to deploy nationally to all affiliates. It’s an app that patients can use to find our health centers, book appointments, connect and communicate with us. I’ve provided our national office with the design documentation, so that’s something to look for in the future.

It’s an extremely exciting time to be in Health IT. The more progressive organizations understood long ago the value that technologies such as big data, mobility, social media and the Cloud brought to the business. Increasing numbers of CIOs are now viewed as business drivers as opposed to the business enablers or operators of old. In my opinion, the real innovation is happening around technologies such as artificial intelligence, augmented reality, autonomous systems among others, which have the potential to greatly improve patient outcomes. The work around cancer genomics is especially encouraging. We’re not quite there yet, but I believe that we are on the cusp of some significant breakthroughs.

Campbell: I appreciate your perspective. It sounds like a lot of innovation is occurring and that’s something our readers will certainly be interested in.

CHIME Fall Forum Interview Series: Charles Christian, VP, Technology & Engagement, Indiana Health Information Exchange

Charles-Christian-CIO

Charles Christian, FCHIME, LCHIME, FHIMSS, CHCIO Indiana Health Information Exchange

Innovation is high on the mind of Charles Christian, and rightly so. Christian is part of the largest health information exchange in the U.S. and is continually looking for ways to make connecting over 100 healthcare organizations simpler. His view? When all options are exhausted, the simplest solution is normally the best and most cost effective. It’s a unique perspective coming from someone who is doing the connecting rather than struggling for a connection. In this interview, Christian discusses the compelling work his organization is engaged in: From aiding the United Way in their quest to reduce infant mortality rates in particularly lower income areas, to analyzing data to target childhood obesity. Not only is Christian constantly looking for ways to improve healthcare’s information accessibility, but also healthcare’s leadership. Check out his 7 key takeaways from CHIME’s CIO Bootcamp.

CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Here is the next interview in the series:

Key Insights

One of the innovative capabilities we have is a smart search within our repository – likened to a google search.

In the end, we’re not willing to put the privacy and security of the data, for which we are custodians, at risk for the sake of giving someone access.

We have 3 pilots underway, where if a patient shows up in the ER at one of SHIEC’s members, information for that patient is queried to other member HIEs based upon zip code and in the case of a match, a clinical summary for that patient – often times CCD – is returned.

What we’re finding, is that the changing ambulatory landscape is making getting access to the data more challenging.

To me, the whole purpose of CHIME is to weave those networks of individuals regardless of size of organization, longevity in the business, and depth of expertise. It provides the education CIOs need to be highly successful.

Campbell: Let’s start with some background on you, your organization and your role.

Christian: I’m currently with the Indiana Health Information Exchange and have been here about 18 months. I spent 27 years as a healthcare CIO at a couple of different organizations and actually was a customer of the exchange when CIO at a southern Indiana healthcare organization.

We operate the largest health information exchange in the U.S., connecting over 100 hospitals, long-term care facilities, rehabilitation centers, community health clinics and other healthcare providers. All said, we have 140 total data sources, connecting to over 12,000 practices and serving over 22,000 physicians and 12MM patients.

We’ve only been incorporated since 2004. Years before that, the exchange was created out of clinical need in the Indianapolis area. It was actually created by the minds at the IU Health Methodist Research Institute, one of the big health systems in Indianapolis. There was a known need for the ability to share clinical information. We’ve been doing this for over 20 years, and the data in the HIE in some cases is over 30 years old. We currently have over 9B clinical data elements stored in the HIE.

Campbell: That is incredible and impressive. What types of exchange takes place today with the HIE?

Christian: One of our core services is results delivery. We provide the nation’s largest implementation of clinical results delivery and support the Indiana Network for Patient Care, a clinical data repository accessed via IHIE’s CareWeb application.

Results are delivered to participant EMRs in one of three ways – either to a secure inbox, through HL7 integration or through fax. A lot of physician workflows are built around receiving a fax. It’s examined, sorted, indexed and filed.

Campbell: You have quite a few endpoints, which is fantastic. Tell me a bit about the process for participant onboarding.

Christian: We’ve connected to over 250 EMRs. We recently established an HL7 connection to athenahealth. That enabled us to turn on HL7 delivery to over 2000 physicians at one time. Another health system we are working with is moving from fax to electronic delivery. My goal is to have electronic delivery and HL7 for every EMR. Part of the challenge is in resourcing – setting up the feed and building the integration with the EMR. It takes some specialized technical work to execute.

Campbell: Tell me a bit more about the payload of transactions that you receive.

Christian: We currently don’t receive CCD. Instead, we predominately get ADT transactions, results, transcribed documents, or HL7 embedded with PDF. We ingest it into the repository, normalize the data and send it along to subscribing entities. Through normalization, we organize the clinical elements to present to the end users via a portal. In this way, it makes it nice for physicians to use SSO from their EMR of record to the portal, and be able to see a lab result from Methodist hospital, let’s say, sitting alongside a lab result from St. Francis Health.

One of the innovative capabilities we have is a smart search within our repository – likened to a google search. Take one of our ER physicians at Eskenazi, for example. He’s got a search protocol called “chest pain,” which pulls any recent admissions with chest pain as the chief complaint. It also pulls troponin levels, any echocardiograms, or cast studies, and delivers to him instead of the physician having to hunt for them. We are actually working with an EMR vendor to embed this capability within the system of record. In this way, we can embed a search bar and the physician can access saved searches that retrieve information based upon criteria and filters they setup.

That is just one example of the extremely creative initiatives we are working on to minimize the workload for the physicians.

Campbell: With so many sources, I imagine there is a deluge of data you are swimming in. Can you elaborate a bit about the governance processes you employ today to dictate data access?

Christian: We have a seat on the management council for The Indiana Network for Patient Care. The exchange is also a curator of the data. It’s owned by its members and there is governance across that. A group of 20 voting members are elected by the members and use cases of HIE data access are presented to the voting group. The group determines the appropriateness of data access requests and whether they meet HIPAA guidelines. This approach is used for a variety of use cases. With approved requests, a window of access is provided. Participants can always see the data they provide, but the only way full access to the record is granted is if there is a treatment relationship with the patient. We’ve had some physicians present unique use cases where they are seeing a patient, for instance, a consult with an oncologist, and they don’t have a treatment relationship with that patient. Hence they cannot access the data. I get it. If it were my family member trying to consult, there would be frustration with the impediment. However, it’s one of those balancing acts to provide secure access to the data. Same goes for organ procurement, which has about a half a dozen use cases, but we still haven’t figured out how to create the appropriate access safely. In the end, we’re not willing to put the privacy and security of the data, for which we are custodians, at risk for the sake of giving someone access.

Campbell: Thank you for elaborating on the sound approach you are using for data governance, security and access. Do you have a unique compelling use case that comes to mind that you could share?

Christian: United Way has a program – fully funded by them – where they send nurses out into the community for areas that have high infant mortality rates, particularly in the lower income areas. The nurses provide help – whatever they may need. Perhaps get them to the pediatrician’s office, for instance. United Way approached us and said it would be marvelous if they could see the corresponding data – prenatal care, course of events, C-section, those types of things – that would be helpful as part of their outreach. The problem was that they are not a HIPAA covered entity. Our attorneys helped get them covered and we stood up the program. It’s great because of the difference made in those children’s lives, especially considering they are typically low income folks that don’t have the same access others are privileged to have. It’s truly an extraordinary effort to provide help to that population.

Campbell: It’s great to hear stories like this, where health information exchange truly makes a difference in the lives of patients who need it most. What other initiatives is IHIE working on or taking part in?

Christian: We are a member of the Strategic Health Information Exchange Collaborative (SHIEC), whose members are 50 of the sustainable HIEs in the country. Many of the members have different business models than we do. For instance, some are state entities, like Kentucky Health Information Exchange (KHIE), and others don’t persist data, they just transact, as with the Kansas Health Information Network (KHIN) model. Our first annual meeting was in 2015, where about a dozen of us got together to share ideas and have conversations about how we can work together, ways to share services, and how to lower operational costs.  Our country does not have an operational HIE that covers all of the market. SHIEC is the closest we have, and that covers about half of the population.

Take for instance, the Indianapolis area, where 500K people present downtown. They inevitably come to the ER. Unfortunately, the providers treat them based upon what is in the head of the patient or family members. We have 3 pilots underway, where if a patient shows up in the ER at one of SHIEC’s members, information for that patient is queried to other member HIEs. In the case of a match, a clinical summary for that patient – often times CCD – is returned. Once treatment for the patient is finished, it is bundled up with the clinical record and shipped back to the querying HIE. That is a model that can be replicated.

Campbell: That is truly an impactful initiative and I’m excited to hear where it will go – hopefully eventually providing connectivity for all of the population. Let’s shift gears a bit and discuss data persistence. With 9B clinical data elements, and metadata considerations, I imagine that creates a huge demand for storage. Do you purge any data today?

Christian: We persist data forever. We are acutely aware that it costs money to store the data, and costs money to back it up. We take our direction from our general council and we have terms and conditions built within the confines of state and federal laws for participants we receive data from. That said, we don’t have the primary record, rather we have pieces of it. In light of that, is it OK to purge or trim? It’s a good question, but it is not built into the software. We are socializing with members and asking the question “if you are going to delete data, what would it look like.” Our CMIO advisory group suggest that we don’t get rid of any of it. One of the use cases we came up with, is that if you are deceased for 5 years, and there is no new data after 5 years, then the data can be purged. All said, pursuit of purging data is a difficult boulder to push up the proverbial hill.

Campbell: It’s no secret that a lot of HIEs face solvency and sustainability issues. What does IHIE offer its members today as part of its value proposition?

Christian: Healthcare has long been very hospital centric. Hospitals were the ones who first moved to digital solutions and automated. Now we have a large number of physicians practices that are automated. We get data from them, parse that information and store it in our data repository. Consequently, the opportunity truly lies with the innovation occurring on the outpatient side. What we’re finding, is that the changing ambulatory landscape is making getting access to the data more challenging. You have urgent care offices popping up, telemedicine is gaining traction, and a lot of educational institutions use their own health clinic.

One of the initiatives we are working on is targeting childhood obesity. We are analyzing the data – such as height, weight, and age – to produce insights. Most of that data is located in the physician office record. Children have more access to physician care in a practice, particularly infants that are seeing the doc.

Campbell: Shifting gears again, let’s talk about CHIME. Tell me a bit about your experience attending this year. What did you get out of it? What were some of the things that drew you to the event?

Christian: I am actually one of the first charter members of CHIME. When I was with a small hospital in Southern Indiana, I received the call for an invitation, and thank God for it. A lot of my success in that small hospital was the result of having the privilege of standing on giants – John Glaser, Jim Turnbull, Bill Reed, Skip Hubbard. I got to know them and it was invaluable to call on them as a resource. Whenever I had a question and would send an email, they always answered it. The thing that differentiates CHIME from organizations like HIMSS, for instance, is that with HIMSS, I sit at a table with engineers, folks from telecom, people from different disciplines, whereas with CHIME, I sit down with all CIOs, and I know a lot of them very well. I only get to see my good friends once or twice a year, and it is vital to collaborate with them and gain their perspective and opinion.  It’s truly a privilege being on the faculty. In fact, it reminds me of a story. Buddy Hickman, a faculty member as well, and close personal friend of mine, is someone I know I can go to if I’m struggling with life or a work issue. We got together one Friday night as we were about to begin CHIME boot camp, and we got to talk about a personal issue. We huddled and shared each other’s stories. It’s really consultation group therapy. I left that critical conversation ready to rock and roll.

To me, the whole purpose of CHIME is to weave those networks of individuals regardless of size of organization, longevity in the business, and depth of expertise. It provides the education CIOs need to be highly successful. There is no fantasy that members take all the advice offered, however, if 1/10 of it sticks, they’ll be in great shape. As I mentioned previously, the beauty of it, is that I look at these people who work in prestigious organizations – some of the most noble men and women – and they are more than willing to give time they don’t have. CHIME has been accused of being a fraternity or sorority of sorts – an exclusive club – and my response is “And….?” To me, that is the draw and the beauty of CHIME. I remember being on the board for the first time in the early 2000s and I was in charge of membership where we were struggling to get to 900 members. We’re now up over 2000 members.

Campbell: You certainly have a wealth of experience and expertise surrounding pertinent healthcare information technology issues. Given the broadness of the field, is there a particular area of initiative you are working on to advance information technology in healthcare?

Christian: I’m working on a piece around predictions – many around interoperability. I have this feeling of the sirens calling me to a shipwreck. My view is that when all other options are exhausted, the simplest solution is the best and will cost the least. However, I have no delusions that I have a biased opinion, that’s to say, I have a view of the topic that is different. When you typically read about HIE – both the noun and the verb are used interchangeably, and that isn’t appropriate. A friend of mine, Dr. Josh Vest, Associate Professor of Health Policy & Management, IU, is conducting research on HIEs, classifying them: Are they private/enterprise? Are they a state entity or a community-based? He was originally shopping around the idea to fund it, but as happens all-to-frequently, there is not that much money when you are researching. He instead decided to take the research on pro-bono even though he has very well-funded research. I remain very interested in the results he finds.

About Chuck Christian
Charles Christian, serves as Vice President of Technology and Engagement Indiana Health Information Exchange, which provides the nation’s largest implementation of clinical results delivery in the country (DOCS4DOCS Service).  Christian has spent 40 years working in healthcare, including 26 years as CIO at Good Samaritan Hospital in Vincennes, Indiana, where he led the development and implementation of an EHR system and other IT initiatives. He also worked for Compucare and Baxter Travenol, in both management and implementation roles. Prior to his current appointment, Christian was vice president and CIO of St. Francis Hospital in Columbus, Ga.

Christian is a charter member and 2015 Board of Trustees Chair of the College of Healthcare Information Management Executives (CHIME), and served as Chairman of the Board of Healthcare Information and Management Systems Society (HIMSS) in 2008. In 2010, Christian was recognized by CHIME and HIMSS with the industry’s most prestigious honor: the John E. Gall Jr., CIO of the Year Award.  He was also honored by the Indiana Chapter of HIMSS with an award in his name: the Charles E. Christian Leadership Award. 

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration, is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

CHIME Fall Forum Interview Series: Susan Carman, CIO, United Health Services

susan-morreale-cio

Susan Carman, CIO, United Health Services

Susan Carman is no stranger to the fast-paced change of the healthcare IT world. United Health Services, where Carman is currently CIO, is in the process of overhauling their IT strategic plan, including a potential replacement of their best of breed EMR/EHR for an enterprise solution. Since the current inpatient EMR was only implemented 3 years ago, Carman is faced with the tough decision of yet another system replacement, both from a fiscal and employee fatigue point-of-view. She discusses the implications behind their review of the enterprise; why being best of breed and having a data warehouse doesn’t always jive; and her key takeaways from CHIME.  She also provides sage advice to those startups and digital health organizations trying to get their solutions in front of healthcare IT decision makers.

CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Here is the next interview in the series:

Key Insights

When I first came in about a year ago, there was no true inventory of applications. We used a number of avenues to figure out exactly how many we actually had.

We’re a best of breed shop, the kind you don’t see much of any more. It’s causing us a lot of issues because we have about 200 interfaces running information back and forth. It’s very resource intensive and expensive to run.

We’re trying to figure out if we can connect directly to our data warehouse as opposed to connecting to the source systems directly. That’s a big question mark for us right now.

With this information the IT governance team decided that the best approach was to develop a 3 to 5-year Strategic Plan.  The most important component of that plan was to decide on a future EMR roadmap.  Our biggest challenge is meeting our integration goals but doing it in a fiscally responsible manner.

Sitting around the table with other CIOs—gathering the information about where they’re at with their application portfolio, best practices, and things of that sort—was immensely helpful to me. I think it’s mutually beneficial because clearly the vendors are doing this to get some information for their business.

Campbell: Can you give me a little background about you and your organization?

Carman: We have about 380 physicians, 4 hospitals – 2 of which have over 200 beds – 2 smaller hospitals, and 62 clinics.  One of the biggest things we’re working on is our IT strategic plan, so a lot of the questions I’ll be answering today will, unfortunately, be changing over the next year or two.

Campbell: No problem, that’s to be expected. Along the lines of the strategic plan, how many applications does the organization have within the portfolio and how do you manage those today? Do you have an enterprise portfolio management system or is it managed by spreadsheet?

Carman: That’s a great question and going back to talking about being in a state of transition, this is something we’re working on, and spending a lot of time on right now. We have approximately 175 applications that we run. When I first came in about a year ago, there was no true inventory of those applications. We used a number of avenues to figure out exactly how many we actually had. It was sort of an unknown, but I certainly knew there was quite a few of them.

We’re a best of breed shop, the kind you don’t see much of any more. It’s causing us a lot of issues because we have about 200 interfaces running information back and forth. It’s very resource intensive and expensive to run. The application portfolio is basically being kept on a spreadsheet.

Another initiative we’re going to be starting next year is we’re purchasing an ITSM system. A lot of our application portfolio should be kept in that system once it’s implemented rather than keeping it on a spreadsheet. We’re bringing in a consulting company for the first half of next year to help us work on adopting ITIL best practices. The implementation of the ITSM system will be about midway 2017. We’re hoping for some great things as far as doing a better job of keeping track of our applications, providing better customer service, and improved change management.  The last step will be application rationalization to sunset and retire anything that we no longer need.

Campbell: Very good, and speaking of application rationalization, do you leverage an archival solution today? Do you have a data warehouse that it’s shipped off to? Or are you simply taking a copy of the database and storing it on your servers? Could you elaborate on that topic?

Carman:  The business intelligence and analytics software is overseen by the CMIO at UHS.  It is not part of the Information Services department.  Our CMIO is not only a practicing cardiologist, he is an expert in the development of applications and business intelligence. A lot of what we have at UHS is homegrown.  We have a separate Business Intelligence department. We utilize a lot of students from Binghamton University that are working toward their Master’s degree or PhD and need a real life project. We do have a data warehouse.  We are striving to get to a point where our data warehouse is our one true source of information.  We are currently working on our data accuracy via a new data governance model.

Campbell: Right, a lot of organizations are dealing with that, those point solutions, especially if you’re best of breed. How do you integrate that ETL process with the data warehouse?

Carman: We just purchased Watson Health as a population health solution, and we’re going to be implementing that next year as well.  We’re trying to figure out if we can connect directly to our data warehouse as opposed to connecting to the source systems directly. That’s a big question mark for us right now. This would require ensuring all the data is accurate before it gets into the data warehouse and that all of the data is being sent and in a timely fashion.  We don’t have all the data normalized and some things don’t go to the data warehouse at all for various reasons. Sometimes it’s limitations of the applications, but there’s a variety of reasons why not everything is going there right now. We would like to avoid connecting to every source database but we will likely have no other choice.

Campbell: I can appreciate that. You want that data warehouse to serve as the hub, but oftentimes there may be data that’s missing in the ETL process from the source system. I know you spoke of potential replacement of the EMR/EHR. How long has the organization been on the current EMR on the inpatient side and the EMR on the outpatient side?

Carman: We’ve been on NextGen for 12 years and it has outlived its usefulness. It is no longer supporting our physicians in an efficient manner. It’s come to a point where the writing is on the wall with NextGen. We need an ambulatory information system that is more adaptable to the differences in our specialty practices.

As far as the inpatient side, it’s only been 3 years since Soarian was implemented. Now of course we got the bad news that Cerner is only going to support the Soarian Clinicals for 5 more years and we’re 2 years into that.  When I first came on-board, one of the things I was charged with was to survey the ambulatory information system and gather information from the physicians as to whether they wanted to enhance the current system or replace it. Overwhelmingly they wanted to replace the current system.  Since we had just gotten word from Cerner that Soarian Clinicals would only be supported for a maximum of 5 more years, it made sense to review our entire enterprise. With this information the IT governance team decided that the best approach was to develop a 3 to 5 year Strategic Plan.  The most important component of that plan was to decide on a future EMR roadmap.  Our biggest challenge is meeting our integration goals but doing it in a fiscally responsible manner.

Campbell: Right and, to share with you, that’s the sentiment I heard from several folks while at CHIME. There’s just a lot of ‘where’s the money coming from?’ ‘Sure the organization wants to invest in a new application or maybe replace the EMR, but show me how we’re going to be solvent in whole once we do that.’

Carman:   Our Senior Leadership team mostly agreed that we need a fully integrated solution.  Our first step in that process is an EMR Financial Feasibility study.  We need to see exactly what we are up against when it comes to total cost of ownership.

Campbell: Shifting gears to CHIME, tell me about your experience. What did you look get out of it? What were some of the things you appreciate about the event?

Carman: I loved it. I can say overall, I thought it was fantastic. I got more out of the focus groups than anything else. Sitting around the table with other CIOs—gathering the information about where they’re at with their application portfolio, best practices, and things of that sort—was immensely helpful to me. I think it’s mutually beneficial because clearly the vendors are doing this to get some information for their business. Out of the entire week, that was where I felt I got the most information.

I certainly had a lot of questions about converting to an enterprise wide solution from best of breed, I spoke to a lot of different people about their situation. I even spoke to the #3 person at Cerner about customers who have transitioned from Soarian to Cerner.   I left there with a good feeling that we were performing the correct analysis. It was a great validation for me, and a very worthwhile trip.

Campbell: That’s excellent to hear. Aside from the networking aspect, like you said, you’re able to test hypotheses and synthesize strategies. Perhaps you could offer some insight to our audience at Health IT & mHealth, which is primarily focused on startups and digital health companies – a market that is overwhelmed by patient engagement solutions. For your organization that’s traditionally been best of breed, and maybe looking to an enterprise wide solution, tell me a little bit about how you would ever consider a digital health startup solution? What would be your criteria for evaluating that?

Carman: Target what the bigger companies don’t have or don’t do well. I think what you’re going to see is, if you’ve got a Cerner or an Epic Enterprise solution and they’re selling that same product, you’re not going to win because CIOs will gravitate toward their core vendor. They want to just go to one person; they don’t want to have numerous vendors that they have to deal with on a daily basis because it takes up so much time for a CIO. If there’s some sort of niche that you can find, where the vendor has either done a lousy job of providing the solution or they don’t do it at all – and certainly Epic has several things that they don’t do – concentrate on those areas. When you’re coming to the table you can say ‘look, you don’t have this currently, you’re not able to get it from your core vendor, and we have a great solution.’ I think that’s how you get CIOs to listen to you.

Another piece of advice I would give is always come to the table with how you’re going to make that CIOs life easier. First and foremost, what are you going to do to solve the problem that organization is experiencing?  Investigate who is in need of the solution before you go and invest your time.  Make sure to target your audience in that way. I get dozens and dozens of emails a day about things that aren’t relevant to me.  I think, ‘goodness these people are wasting a lot of time, I’m not responding and so on and so forth’. I think a lot of the smaller vendors need to do a better job of targeting their audience. Every now and then I get an email and I say ‘hey you know what I am going to respond. I don’t normally respond, but this person really got my attention, it’s something I need, they clearly understood my business here and what we do.’ It wasn’t a generic email.

Campbell: That’s a great point and great advice for anyone in the space. Any other closing thoughts you wanted to offer around the CHIME event or any organizational newsworthy items?

Carman: At this point, one of the big things we are grappling with, is what do we do with MACRA and MIPS and how do we transition. There’s no more PQRS, and MU is fading away. It’s a big question mark for us, and now with the new administration coming into play I think we’re all kind of scratching our heads saying ‘what does that mean for healthcare IT?’ With Obamacare up in the air, I’m sure a lot of CIOs are sitting back and saying ‘does that effect MACRA, MIPS, and everything else coming down the pipeline? What’s going to change?’

CHIME Fall Forum Interview Series: Daniel Morreale, Senior Vice President/CIO, Hunterdon Healthcare System

daniel-morreale-cio

Daniel Morreale, Senior Vice President/CIO, Hunterdon Healthcare System

Consolidation is big on the mind of the CIO Daniel Morreale, of Hunterdon Healthcare System. After inheriting the multi-system environment two years ago, he has been evaluating a rip and replace initiative, moving to one core system. That’s not the only change Morreale hopes to make at the healthcare system. He’s inspired by the world of social media and the connections it can extend. In this interview, Morreale talks about the “membership model” for healthcare he’s looking to implement; the ups and downs of data archival and storage; and Hunterdon’s current data governance strategy. He also shares his personal predictions for the future of healthcare and bringing the focus away from the toys and back to the people.

Be sure to register for an upcoming healthsystemCIO.com All Stars Panel Daniel is participating in on January 19th: “How to Ensure Your Business Continuity/Disaster Recovery Plan is HIPAA Compliant.”

CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Here is the next interview in the series:

Key Insights

If you’re in my system longitudinally, can I get rid of those lab results you had 8 years ago? No, and I think that’s a problem.

Then again we have to ask ourselves, how long do we keep our EMRs and is anybody running an EMR they were running 20 years ago? Chances are no.

But then in the event of legal action, if I have it I have to produce it, it’s discoverable. I would rather only present for discovery that which I’m required to present for discovery. If the data had been purged by policy and no longer there then I’m no longer responsible for producing it.

Most health systems tend to grow by buying physician practices or expanding their market, which is a pretty traditional means of doing that work. However, I think an extraordinarily strong mobile presence and web presence can start to attract the 20 and 30 year olds who aren’t really using healthcare now, who I want if I’m in a shared risk environment.

At the end of the day I’m doing healthcare and that’s about people. How do I make the experience easy for you and me, or family, and deliver quality, convenience, and access?

Campbell: Let’s start with a little background. Tell me about your organization and your responsibilities.

Morreale: Hunterdon Healthcare is the only hospital in the county, [located in Northwest New Jersey]. It was started in 1956, in an effort to improve the health of the population and community. As an organization we kind of have a 60-year head start on population health. It’s still a standalone facility, we have just under 200 inpatient beds, and do just under a million ambulatory visits a year.

Campbell: What are some of the initiatives you’re working on right now? What are some of the reasons that drove you to CHIME in terms of the learnings you expect to hear from your peers?

Morreale: The initiatives we’re working on in the healthcare system right now are dedicated to two propositions. One is to improve usability; how do I make the variety of systems we have more user friendly? And secondly, a consolidation effort; looking across our vast number of software tools and trying to consolidate them. Prior to my arrival at Hunterdon two years ago, every department bought whatever they wanted. As a result, I have 5 document management systems, 6 faxing software applications, etc. We’re trying to consolidate and replace with enterprise level tools when we can. Next year we’re going to start doing core replacements around our financial systems, and that’s going to be a rip and replace. We’re planning an initiative around creating an access center, i.e. one telephone call to concierge level service with the health system.

Campbell: Tell me a little about where archival fits into this. With the systems you look to replace, have you gone through that evaluation of migrating versus archiving?

Morreale: We have not, and for several reasons: A majority of the healthcare tools that are out there don’t have a good process for archiving, deleting, or massaging patient records, at least at the patient level, which is always a challenge. However, we do have criteria for retaining data, predicated on state and federal mandates. Right now everything is in a tiered data structure. Our more transactional data is on a state drive, our deeper archival data is on EMC, some IBM storage in the middle, but my intent is to go pure solid state. This will add cost, but increase retrieval speed and simplify the environment. But even in that environment I’m just continually adding and saving data. I’m never really deleting anything. So there are records that are 25 years old, that I no longer need, and I have no means of getting rid of them.

Campbell: Have you evaluated any archival solutions that are healthcare specific? Tell me about the challenges you see in the vendor marketplace for archival solutions.

Morreale: Well on the technology side, I think there’s a wealth of tools, but their weakness is in the healthcare applications. In my EMR I do not have the capacity to delete a record. I absolutely do not have the capacity to delete part of a record. If you’re in my system longitudinally, can I get rid of those lab results you had 8 years ago? No, and I think that’s a problem. It costs me money to store it, manage it and keep it secure. But then in the event of legal action, if I have it I have to produce it, it’s discoverable. I would rather only present for discovery that which I’m required to present for discovery. If the data had been purged by policy and no longer there then I’m no longer responsible for producing it.

Campbell: As part of the overall portfolio strategy, do you see yourself consolidating applications and migrating from one EMR to another?

Morreale: Eventually I think we’re going to have to, and we’re targeting 2020 or 2021 as the year to make that jump. That is my opportunity, and only opportunity, to clear records.

Campbell: Is there hope that in that time there are some advancements made?

Morreale: I think it would be nice, but I don’t see it happening, I don’t hear any vendors talking about providing tools that do that. Then again we have to ask ourselves, how long do we keep our EMRs and is anybody running an EMR they were running 20 years ago? Chances are no. I think over that course of time we generally take all we can from a product and at some point we start looking for additional functionalities, newer user interfaces, and more bells & whistles

Campbell: Shifting gears, what is your data governance strategy within the organization?

Morreale: Data governance is pretty straight forward. We have our applications tiered for priority, and as a result of that, the data is tiered. We ask the primary departments to be the titular owner of that data, in that the patient is the real owner. We look at IT services as being the police – the ones who stores it, protects it and keeps it under lock and key. When there is a challenge around data, it always manifests in reports: what is the length of stay in system A, is it not the same as in system B? With great effort, a year ago, we undertook building out a data dictionary. To this regard, I know that when I’m using field MX4233 in my EHR, I know it’s a patient address and that it is defined in this way. Then we’ve carried that across to the other clinical systems that have that data. It is by no means complete, it’s a continuous effort, and it’s massive with the 160 different systems. We really concentrated on those items that people are regularly reporting on. As such, when I produce an end of day admission report in system A it’s also the same in system B.

Campbell: What’s the vehicle or mechanism that you’re using?

Morreale: This is one of the examples where we built our own tool. We went out and created a data lake: we’re taking a snap shot of the data, putting in the data lake, normalizing it, and then consolidating all our reporting out of the data lake. So, at least my reports are more consistent than they were prior.

Campbell: Where do you see an opportunity for innovators in the vendor space?

Morreale: I think there’s opportunities in home health, which is pretty much owned by a few big companies with technology that’s a little dated.

I think there is a whole field of healthcare to be discovered in social media. How do we capture that? How do we integrate into that world? How do we use that to attract future patients? Most health systems tend to grow by buying physician practices or expanding their market, which is a pretty traditional means of doing that work. However, I think an extraordinarily strong mobile presence and web presence can start to attract the 20 and 30 year olds who aren’t really using healthcare now, who I want if I’m in a shared risk environment. Use that as a tool to create that sticky relationship between you and my health system so that when you do need our services, we’re the natural choice.

I think the value proposition around that has to be very high, but it’s certainly difficult to compute. We’re putting a lot of effort into that arena. My development team is looking at creating what we’re calling a ‘membership model’ for the health system.  It’s essentially taking the concepts around Netflix and American Express: you become a member, and incorporate that into how I deliver care. If I can convince you to be a member, I can give you one telephone call scheduling; I can stop leakage out of my physician offices by scheduling your next appointment as you’re walking out the door; or schedule that x-ray or that minor surgery you might need. I can broadcast educational information to your mobile or home device. I can create social platforms for you to talk to other people with your disease state. I can do all of those things as a background product, but at the same point I’m creating that sticky relationship between you and my health system.

We’re also looking at integrating wearable data. We are fortunate enough to be the in the healthiest and wealthiest county in New Jersey, so we think there’s the capacity to offer the service to our community: let us monitor your Fitbit or your wearable device data, tell you how you’re doing on your health effort, and give you an opportunity to earn points. We have a points program in our membership model – buying broccoli instead of bread; going to the gym –  those sort of things. And I think that kind of stuff is going to be more of my future than buying physician offices.

Campbell: There seems to be a diminishing return there or rather a saturation to that model.

Morreale: I think so. How many physician offices can you have in a community? How far can your reach go? If I’m doing it through mobile and social media, my reach is greater. I’m not limited to 20 miles or 25 miles. I can be attracting or engaging people who are 50-60 miles away. I can help you take care of your parents who live in Phoenix or back in Boston, I can do all of those kinds of things. We think there’s some potential there. It’s going to be one of our big investments in 2017 – to further define that model and see if we can make it fly.

Campbell: Certainly enlightening and inspiring.

Morreale: I think it’s just a different way of looking at what we do. I don’t like to get caught up in the technology. I know a lot of CIOs who get caught up in the technology and the toys, and the toys are cool. I mean let’s face it, but at the end of the day I’m doing healthcare, and that’s about people.  How do I make the experience easy for you and me, or family, and deliver quality, convenience, and access? I think that’s where a large portion of our future has to be.

This interview has been edited and condensed.

About Daniel Morreale
Daniel Morreale is CIO at Hunterdon Healthcare, a community hospital based in central New Jersey. He has held CIO roles at a number of organizations, including Riverside Healthcare System, Kingsbrook Health System, and Atlanticare. A CHIME fellow, Morreale was the recipient of CHIME’s’ Innovator of the Year’ and ‘Collaboration of the Year’ Awards, and was recognized by Computerworld Magazine as one of the ‘Premier 100 IT Leaders.’ He also received the Safety Net Award from the National Association of Public Hospitals, and the Smithsonian Center of Innovative Technology Honors Laureate Award. Morreale is past-President of the New Jersey Chapter of HIMSS.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

CHIME Fall Forum Interview Series: Jeff Weil, CIO, District Medical Group

jeff-weil-cio

Jeff Weil, CIO, CHCIOe, CPHIMS, District Medical Group

There is no shortage of projects going on at District Medical Group, where Jeff Weil is CIO. From an integration engine implementation to clinical, business and infrastructure upgrades, and implementation of workflow optimization technologies, Weil and his team certainly have their plate full for 2017. However, for someone who has worn almost every hat in the industry, you would expect nothing less.  Weil talks about population health initiatives and how Technology Leadership approaches have changes over the past year; the inexpensive side of data storage; interoperating between different practices with different systems; and how in some cases it is working with records that are literally still in boxes.

CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Here is the next interview in the series:

Key Insights

Eventually the ROI is going to turn in our favor if we’ve got staff in house to design and develop interfaces and if we purchased an integration engine as opposed to outsourcing this work to our Vendor Partner.

We really didn’t have a robust infrastructure from which to have an appropriate foundation to expand our business. That was my primary mission when I came in, and I’m finally starting to feel that we’ve accomplished most of that mission.

The thing that really stuck out to me at CHIME this past year was the difference in attitude toward population health technology. Last year, most CIO’s felt they needed all the technology. This year, since people have started to get into these initiatives already, and have started to actually practice some of the data gathering and some of the reporting around population health initiatives and value based care contracts, they took a much more conservative approach.

I think we’re moving into a very interesting time. We still haven’t quite figured out how to optimize our electronic health record systems. We still have physicians struggling with utilization of these systems, yet now we’re being asked to add on new technologies whether it’s connected health or population health initiatives.

Campbell: First and foremost, if you could tell me little bit about yourself and the organization, what EMR application that you use and some initiatives that you’re working on.

Weil: I’ve been in this business a little over 20 years. I sort of fell into it and have worked on large scale engagements in engagement management, mostly with multi-facility or academic health systems. I’ve worked on the provider side in both the acute and ambulatory space, as well as on the vendor side for a little bit, and I’ve done my share of consulting. A couple years ago, I had an opportunity to come here [District Medical Group], from a health system in Fort Worth, Texas and decided it was the right time for this move.

We are primarily a large physician practice, and we also have a couple of our own clinics. About 70% of our revenue is based on the fact that we supply all the physicians and mid-level providers–CRNAs, physician assistants, etc.—to Maricopa Integrated Health System here in the Phoenix area. We also head all eleven departments over there as well as oversee residency programs for the University of Arizona College of Medicine. We just recently made an announcement that we’re going to be working with Dignity Health and Creighton University to train some of their residents as well.

We have two of our own clinics right now. One is a behavioral health clinic in the East Valley. We have a very large multi-specialty pediatric practice for special needs children through a contract with the state and United Healthcare. We also have a partnership with a behavioral health organization here in the valley, where we’re providing physical health to complement their behavioral health. We’re looking to do more in partnerships and with population health cooperatives in the coming years

Campbell: In terms of the technology that is being leveraged from an EHR and EMR perspective, does that vary from physician to physician or is there an enterprise standard? Tell me a little bit about how you’ve acquired physicians in the past and perhaps the need to migrate data into the system.

Weil: Usually we start from scratch in determining the technology requirements for each one of our partnerships. There will be requirements for clinical documentation as well as practice management. For instance, we do the bulk of the professional billing for the physicians that are at Maricopa. As such, when there’s an encounter that happens over there, Maricopa does the facility billing and we do the professional billing for that physician’s charge. We have an interface with them and their Epic system. All of the clinical work they perform is in MIHS’ Epic system.  In terms of own internal systems, for our clinics, we have GE Centricity EMR as well as GE Centricity Business for our practice management system.

Campbell: Are there challenges around interoperating, maybe between different care settings – acute care versus outpatient care – and are there any technologies that you’re leveraging to facilitate that?

Weil: There are because we’re working on these partnerships activities. For instance, with the behavioral health provider partner here in town, we have to bring in the billing information from a different EMR and practice management system into ours, so we always have to get creative in working on integration strategies. Moving into this next fiscal year, we’re investing in our own integration engine, as well as bringing on staff to support that initiative. If you think about it—and I’ll just throw out the normal budgeting number—but every single time we do an interface it may cost $15,000 and take 90 days to develop. Eventually the ROI is going to turn in our favor if we’ve got staff in house to design and develop interfaces on our own integration engine platform. We’re getting ready shortly after the first of the year to start our implementation on that.

Campbell: Interoperability is a topic that’s near and dear to me. We actually hosted an interoperability panel last year with some folks representing HIEs, some representing government, and some representing practices. It was eye opening to say the least. I imagine you’ve got the short list of vendors out there. Are you going through the selection process now?

Weil: We already went through a bit of a selection process. What it came down to was the fact that our analysts need to wear multiple hats and even though I may bring in an interface engineer, they may also be doing a bit of database administration for our healthcare systems. That’s why we decided to go with Corepoint, because it offers an object-oriented programming interface, as well as a modular build approach.

Campbell: Absolutely. We’ve heard great things about Corepoint; rated top of KLAS and they offer some great thought leadership. They have a great community and resource center, so it’s no surprise that they would be at the top of the list. I imagine, coming from a diverse background where you’ve actually worked on the consulting side of it before, you get it and you understand from the vendor perspective the things to look for and the things you want to do your due diligence on.

Weil: We’re a fairly small shop. I’ve got seventeen people in all of IT, and that’s both on the applications and technology side, supporting almost 1100 employees. We’ve got quite a bit going on so I do need people to wear multiple hats and if I can make it a little bit easier for the person working on the interfaces to do their job to build and maintain, then so be it.

Campbell: Tell me how integration works today for the medical group. Is it point-to-point as opposed to hub-and-spoke, and will you be replacing that current model?

Weil: Everything is point-to-point. The plan is to deploy the new interface engine and move to a hub-and-spoke model. Any new initiatives would be implemented first on the new platform with the goal being that by end of June, we will have migrated all of the legacy interfaces over to that platform.

Campbell: And the good news is, at this time, there’s really a lot of interface libraries to leverage out there. It’s not like in the early days of EMR adoption when it was a challenge, based on the APIs that were available. Today, given the communities that are out there, it should make for a more efficient deployment of integration across the enterprise.

Shifting gears, a bit, tell me a little bit about archival, is that a topic that’s relevant to your organization? Do you ever face legacy application retirement? Tell me about the strategy within the organization in terms of managing the application portfolio, if that’s something that falls underneath your purview.

Weil: When they brought me in two and a half years ago, my primary mission was to build a robust infrastructure from which we would have an appropriate foundation to expand.  That was my goal when I came in, and we finally got to the point where the infrastructure is in a good place. We haven’t had to retire any systems yet, but what we did do was implement more of a cloud-based archive strategy. We have an appliance on-site and everything gets backed up to it on a schedule. If we need to restore, we can do quick restore. The appliance actually archives to the cloud and replicates so it gives us multiple layers of redundancy that we really need.

Campbell: Absolutely. We actually recently supported a client with our business continuity product called VitalCenter. They had a downtime situation and VitalCenter allowed them to continue to document through the downtime. It’s like an insurance policy – you have to have it.

What are your thoughts on data retention requirements? What is your policy in regards for retaining data whether that’s in paper form or electronic form? Have you had eDiscovery inquires in the past where you’ve had to furnish and produce a patient chart based upon an inquiry?

Weil: You can imagine that with a large number of providers, record inquiries occur quite often, so we’ve had to do quite a bit or eDiscovery. We do a combination of things, depending on the situation. For instance, at the large special needs children’s clinic, all of the legacy medical records have been scanned in to the system. We basically have a database of scanned documents that we have to use if there’s older information we’re trying to pull.

For the most part, as part of eDiscovery process, we either take some sort of an export out and send it to file or we have to print a whole bunch of stuff. We end up looking through all of our databases. We also provide medical directorship to some nursing homes/long term care facilities and other facilities here in the area. They don’t – as I’m sure you well know – necessarily have EMR systems and as such many records are in boxes in basements or over at Iron Mountain. We have to go to wherever they store their records and pull that information out.As you might imagine, it’s not an easy task.

Campbell: No, certainly not. I can imagine just the amount of effort that’s needed and that detracts you from other organizational objectives. It’s not as easy as one thinks when it becomes electronic because then you have to pull from different systems, you an audit trail to maintain. A lot of the time the metadata is the most important component because it tells you what happened, when and why. You have to protect the integrity of that patient record and be able to show why the care was provided in a certain way for that patient.

Closing out that topic, one of the challenges Galen finds when working with clients is that, when we’ve migrated them from, let’s say Allscripts to Epic, we archived a lot of the data. What they don’t get sometimes is they think it’s simply a matter of using one of the industry agnostic vendors, but healthcare’s’ a lot different. Fundamentally, when you archive that data you may be forced to change the shape of. You’re moving it out of the system and the shape of that data could change. In addition, when you present that data for viewing, you could also be changing the shape of it. There’s just so many considerations and as you can tell, it’s been a focal point for us.

One of the things I’ve talked about with your peers is the purging of data. What is your policy on retention? Do you hold data forever? I imagine that takes up boxes, and that takes up storage space.  Tell me a little bit about the organizational policies and maybe future strategy in regards to that.

Weil: My understanding is that it’s seven years and then for pediatrics it’s until they’re 21. We haven’t gotten to the point yet where we feel like we have to get rid of anything just because storage is fairly cheap at this point. For now, we’ll keep on storing and storing until it seems like it’s worthwhile to move things off to something, which I don’t know what that would be yet. It’s an interesting topic because it used to be much more relevant than it is now. The cost of storage has gone down so much. Years ago you used to have information life cycle management and based on the type of data you used to do this that and the other thing, but that isn’t necessarily as relevant anymore.

Campbell: Now the issue is that it’s the volume of the data. As so many people can appreciate, with the deluge of data, how do I get at the data I want and how do I derive insights from that. That’s the promise and premise of population health.

Let’s talk about initiatives for next year. I imagine the deployment of the interface engine technology and development and delivery of those interfaces is going to consume a lot of your time next year. Do you have a plan as to when you anticipate completing that project? Are there other population health initiatives that you have on the agenda for next year?

Weil: There are a couple of population health initiatives under discussion. We just started a value based contract with one of our payer partners. We’ve got the Corepoint implementation. We’re talking about two factor identification for our remote access portal. We’re going to implement an across the board email archiving strategy. We just updated to Exchange 2013 and that has its own robust archiving strategy, and we want to be able to handle the archive activities for our users. We’ve got a decent sized EMR upgrade coming, that will be done hopefully sometime in the first quarter. We will likely replace some of our ancillary clinical systems with a cloud based solution.  We have a SharePoint upgrade scheduled.

Campbell: So no shortage of projects in the next year!

Weil: No and if you know me this is pretty typical, I don’t necessarily like to remain stagnant too much. This years’ workload is actually less than it has been in the past couple of years so my team feels like we’re going a little bit easy. This years’ projects are smaller in scope and size and will allow for focus on optimization activities.

Campbell: Let’s circle back to CHIME. Tell me why you chose to attend the event? Were there key themes that stood out to you this year? Was there a focus group that struck you? A presentation that was compelling?

Weil: From my standpoint, it’s where can you go and collaborate with close to a thousand people that have the same interests and challenges that you do. That’s why I enjoy being a part of CHIME and always get a lot out of it. I feel energized when I come back to the office from a CHIME forum. When you’re around the industry for as long as I’ve been, there’s a lot of benefit to being able to visit with and network with old friends and colleagues to be able to share ideas.

Security was up there. I have to say I think in the past two years I’ve come to learn more about security than I would have ever known.  I’m also the organization’s chief security officer, and we’ve implemented intrusion detection and protection systems. We have pretty sophisticated endpoint protection for both malware and viruses, and we have endpoint encryption. The only thing that we’re missing, that I really want to put in place, is SIEM technology. We are logging, but to actually get anything of value out of the logs is a monumental task right now.

The thing that really stuck out to me at CHIME this past year was the difference in attitude towards population health technology. I went to one focus group that was done by Cerner that I had attended last year. We run through an exercise where we are given $10 million dollars are provided the programs objectives, types of contracts, and the costs for all the different kinds of resources that may be needed including human capital, systems, and technology. We teamed with three other CIOs to determine what we thought the best plan is. Last year, everybody said I need a data warehouse, I need this, I need that, and blew all their money on the technology. This year, there was a stark difference in how the group approached the exercise. It seems that since people have started to get into these initiatives already, and have started to actually practice some of the data gathering and some of the reporting around population health initiatives and value based care contracts, they took a much more conservative approach. They were bringing on health coaches; bringing on a data scientist to look through the CMS data to do manual risk stratification; bringing on care managers and care coordinators. Then in year two or three, they begin to implement their pop health solution, when you see what you’re getting in from an incentive stand point. It’s sort of guarding that ROI in a much more conservative approach. I actually thought that was extremely interesting to see the difference in approach in just a year.

Campbell: Fascinating. It still remains a very fragmented pop health and analytics market. John Moore, of Chilmark Research, pointed out that people are still dipping their toes in the water, and like you said, what they want to do is understand the incentive and reimbursement side of it, and make sure that the dollars and cents are making sense, before they make a substantial investment in technology. As such, we’re seeing a lot of point solutions, such as spreadsheets, taking the place of adopting an enterprise population health management solution that is marketed as solving all problems, but certainly comes with a huge price tag.

Weil: As with any of these technologies when they first start out, there probably isn’t any one of them that has everything that you need. You notice people sort of piecing together little best of breed plugins as opposed to going with a single enterprise solution. That’s been typical of this industry over the time that I’ve been in it. When things start out people tend to go with a best of breed approach, and have to integrate the systems. The vendors eventually catch up and offer either all-in-one solutions or they end up buying and putting together suites of solutions.

Campbell: Right that makes a lot of sense. It seems the path to realizing true ROI is by approaching a slice, and solving for a particular problem, as opposed to trying to boil the ocean.

I certainly appreciate your time here in speaking with me and for the tremendously salient and cogent insights that you’ve provided. Are there any closing thoughts before we conclude?

Weil: It’s very interesting to speak about these things. I think we’re moving into a very interesting time. We still haven’t quite figured out how to optimize our electronic health record systems. We still have physicians struggling with utilization of these systems, yet now we’re being asked to add on new technologies whether it’s connected health or population health initiatives.

This interview has been edited and condensed.

About Jeff Weil
Jeff is an experienced Healthcare IT Executive with over 20 years of experience leveraging the use of technology to meet the needs of Healthcare Organizations in the Acute Care, Academic, Public and Ambulatory domains. He brings with him a wealth of experience in leading teams in the implementation and support of multiple vendor EMRs, Vendor Neutral Archives, Medical Imaging Systems, Ancillary Clinical Systems, Perioperative Systems, Supply Chain Management Systems, Solution Design and Disparate System Integration.

Prior to joining DMG, Jeff held the Role of Project Director at John Peter Smith Health Networks in Fort Worth Texas where he was responsible for the delivery of Information Technology and Reporting needs required to support the startup and sustainability of the organization’s 26 DSRIP (Delivery System Reform Incentive Plan) projects.

Jeff holds a Bachelor of Science in Business Administration from Ramapo College of New Jersey and is a Certified Professional in Health Information Management Systems and is Certified Healthcare CIO eligible. He has been an active member of the Healthcare Information Management Systems Society for over 20 years where he currently serves on the board of the Arizona state chapter as Director of Health Information Exchange, Interoperability, Privacy and Security. Jeff is also a member of the College of Healthcare Information Management Executives, also known as CHIME. Jeff serves on the Arizona Health-e Connection Board of Directors, which is a statewide non-profit organization driving the adoption and optimization of health information technology and health information exchange.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

CHIME Fall Forum Interview Series: Dr. R. Hal Baker, Sr. VP Clinical Improvement & CIO, WellSpan Health

david-runt-cio

Dr. R. Hal Baker, M.D. FACP, WellSpan Health

Dr. Hal Baker is in a unique situation as a CIO who is also still a practicing physician at WellSpan. As his organization finalizes their Epic transition plans, he recognizes the importance of having an integrated patient record across the system and creating new workflows to accommodate the 5 hospitals and over 100 practice locations that are all coming together. In this interview, he talks about his organization’s community-focused, health data retention practice, his plans for legacy application support, and the value of attention units in the healthcare industry.

CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Here is the next interview in the series:

Key Insights

We quickly experienced the value of an integrated patient record across offices, which highlighted the previous disconnect between maintaining two separate records in an inpatient and outpatient setting.

We’re bringing over seven years of laboratory and clinical information for our patients. We recognize that’s more than typical, but we think there’s value in having that depth in the record for our community.

I’ve been through enough of these to know that everything looks good in a demo and you need to get through the first couple of weeks before you figure out what have been the great wins and what have been the great challenges you didn’t appreciate until you got there.

The reality is that the most significant innovations arise out of smaller startups who then become large. However, a majority of small startups aren’t successful, and most legacy systems persevere.

The currency of the business of healthcare is dollars, but healthcare is applied in a currency of minutes and each minute a doctor or nurse spends doing one thing is a minute they’re not spent doing another.

Campbell: What has your focus these days?

Baker: To provide some background, we’ve had a couple of mergers or acquisitions into WellSpan, that we are trying to consolidate. We have McKesson, MEDITECH, Cerner, Allscripts systems that we’re migrating to Epic.

Campbell: That’s a good launching point. I presume that decision was made to simplify the portfolio and to move forward with an enterprise standard for an EHR. Can you elaborate on your decision to consolidate applications, and maybe also elaborate on how your organization manages applications within the portfolio today? Do you have further consolidation plans in the future?

Baker: From an electronic health record perspective, we went live in ambulatory and inpatient in a best of breed approach for legacy WellSpan. At the time, it was hard to appreciate the value of an integrated medical record, when you had disintegrated paper records at each office. We very quickly started to see the value of an integrated patient record across offices, which highlighted the disconnect that occurs between the two separate records in an inpatient and outpatient setting. As we had other communities join WellSpan we recognized the need to consolidate around a corporate-wide solution. It didn’t make sense to further propagate our non-integrated solution—a different billing system vendor, and a different EHR vendor on the inpatient and outpatient side. That’s how we came to our ‘Project One”, of coming together with one record for all of WellSpan.

Campbell: Related to the topic of consolidating data, what are your thoughts on health data retention? I talked to some of your peers at CHIME and they had concerns over ‘hey I have to store this data for the patient but I may not care about a lab result for a patient that’s 8 years old, but I also have no way of purging that data.’ Is that something that you have an opinion on or you could perhaps go in a different direction with that topic in regard to the eDiscovery inquiries you get and how your organization manages that?

Baker: We are converting seven years of clinical data in our migration – we’re bringing over seven years of laboratory and clinical information for our patients. We recognize that that’s more than normal but we think there’s value in having that depth in the record for our community. We have an archival strategy put in place to retire our legacy applications.  With the absence of a rigorous purging strategy, the entire database record needs to be maintained for the longest patient whom you have a record retention requirement for. In our state that, would be last baby born on the old record plus 21 years plus 7 – so 28 years. Our statute of limitations is age of majority plus 7.

Campbell: That makes sense. In talking with another one of your peers, who’s migrating over to Epic as well, he discussed the considerations and challenges with migrating data from a legacy application over to Epic.

Baker: Right. There are three buckets to my mind: there’s the data you need to import into the database; there’s perhaps a subset of that, which is data that you don’t want to import in bulk, but you want the ability to import selectively as needed later on; then there’s the data that you need to have access to for when you need it. For example, I need to go back and look at the past reports from 15 years ago, but I don’t necessarily need to move every pathology report from 15 years ago into the record— rather I need to have access to it from your archive system. Then there’s the metadata that you either may need for population health or business purposes in the future that you haven’t recognized you need. This could be due to requirements from a legal medical auditing perspective or for quality or for billing purpose under statute of limitations for regulations.

Campbell: I imagine the legacy systems are going to have to have some sort of application support, how are you approaching that? Are you going to dedicate all your existing staff to the new application and seek outside back-fill to support the back-end, or are you taking the approach of have some people support the legacy application while others in their departments learn Epic?

Baker: We staffed up for Epic with a combination of experienced IS staff, experienced operational staff, and a few outside people. We got everybody trained and certified. For the staff who continue to support the legacy application who did not move into the Epic team, we generally supplemented vacancies there with contracted staff from some of our contract partners. A critical element was implementing a very tight change control for the legacy systems and limiting any nonessential changes.

Campbell: Very good. What’s been the sentiment around Epic? Being a provider and talking to the other providers, I’m sure you have a keen awareness. Is there a lot of excitement of moving to the application, given the seamless nature with which you’re likely to be able to access data across care settings in the new environment? Are there any apprehensions they may have?

Baker: I think any move of this magnitude is both exciting and challenging. Our providers are looking at this thoughtfully and are actively involved in it, but we’ll know more when we get into training and go-live. I’ve been through enough of these to know that everything looks good in a demo and you need to get through the first couple of weeks before you figure out what have been the great wins and what have been the challenges that you didn’t appreciate until you got there.

Campbell: Let’s discuss data governance as it relates to the migration. There are different departments and specialties that will have different nomenclatures and dictionaries that they need to manage. How is WellSpan Health going about managing those dictionaries and deciding on potential adjustments to workflows to accommodate the new system?

Baker: We’re designing new workflows in the Epic process because we’re bringing together 5 hospitals and over 100 practice locations, many that were on different electronic records.  We’ve had a conjoined effort to find new workflows that everyone will be moving towards, and it has been around data governance principles, having single points of truth, and standardizing nomenclature. The expectation is that all traditional behaviors are going to need to be worked into the new workflows and those traditions will need to change to accommodate the workflows.

Campbell: Very good. Let’s shift gears to CHIME a little bit. Tell me about your impressions this year. Was there a particular session you attended that resonated with you? I know that CHIME is valuable from a networking perspective but what were the themes you witnessed this year, and in talking with your peers, what were the common topics?

Baker: The most interesting parts of CHIME are hearing people figure out how to creatively leverage the data. I went to a talk with a doctor from Mercy Health, who shared their approach to leverage data topography to understand correlations occurring in their system that are clinically meaningful, but would otherwise not be recognized. For instance, they discovered that a diabetes nerve medicine use seemed to correlate with an earlier discharge for a knee replacement. That was a hypothesis that arose from the data that’s being validated rather than one that was thought of and queried. I think it’s going to get very interesting when we look at how can we leverage these databases to generate information, opportunities for improvement, and for when the data becomes the source of hypothesis versus it all being contemplated.

Campbell: For the startup audience that follows the Health IT & mHealth, what catches your eye when it comes to smaller organizations or vendors? CIOs tend to be risk adverse and they’re attracted to something that solves a problem for them and a vendor organization that’s sustainable. Tell me why you might consider a smaller startup and/or what are the areas that you see as an opportunity for them to address the market incrementally?

Baker: I think it’s honestly a calculated gamble on whether to strategically bet on a small innovator or a major vendor. The reality is that the most significant innovations arise out of smaller startups who then become large. However, a majority of small startups aren’t successful, and most legacy vendor systems persevere, but get caught in some degree of inertia that makes innovation harder.

Campbell: While at CHIME, Blain Newton, Executive Vice President, HIMSS Analytics, shared with me that one of the more profound discussions he had with you was on the topic of currency for healthcare information technology leaders. Can you share that story with us?

Baker: The currency of the business of healthcare is dollars but healthcare is applied in a currency of minutes and each minute a doctor or nurse spends doing one thing is a minute they’re not spent doing another. We’re worrying about the percentage of the time available in day that is spent at the keyboard versus the bedside; the amount of time holding a mouse compared to the amount of time holding a hand. We want to be judicious with how we spend the currency of minutes of our staff so that it balances the needs of the business – the information systems, and the communications that the records provide – with the needs that the human beings who need our care and attention receive.

As a leader, the currency of my work as a manger and executive is attention. I have to decide where to spend my attention units and be judicious with that because there’s the same opportunity cost.  That’s why I have great sympathy for startups because it’s very hard for me to give up attention units to them that I could devote to my organization – to listen to a cold call pitch on a product solution. It’s also very difficult to try to dissect through the presentation to understand what the true opportunities of the product might bring – how it compares to its competitors, and what are the risks and unintended consequences that it might have. There’s a real challenge there because most of us don’t have enough time to spend with all the people who need our attention inside our organizations. So those who are outside, who are not currently our partners, and asking for 15 minutes are challenged because we all have to be very judicious in how we give up that time. One thing I will add is that it’s my opinion that the most persuasive approaches for a vendor is to have a credible client who has an enviable success that they’re willing to talk about with their colleague.

Campbell: Sound, candid, and sage advice & insight. Thanks again Dr. Baker.

This interview has been edited and condensed.

About Dr. R. Hal Baker
R. Hal Baker, M.D. FACP, serves as senior vice president for clinical improvement and chief information officer for WellSpan Health, a regional integrated health system that serves four counties in central Pennsylvania and northern Maryland. In this capacity, Dr. Baker leads quality and safety initiatives as well as the use of information technology as a means to create a reliable patient experience across the health system’s hospitals, physician practices and ambulatory facilities.

Dr. Baker joined WellSpan York Hospital in June 1995 as associate program director of the WellSpan York Hospital Internal Medicine Residency Program. He has also served as the lead physician at Apple Hill Internal Medicine, which is part of the WellSpan Medical Group. Dr. Baker came to York after completing a general internal medicine fellowship at Johns Hopkins Hospital and a residency at the Hospital of the University of Pennsylvania. He holds a bachelor’s degree in biology and a medical degree from Cornell University.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.