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: Brian D. Patty, VP, CMIO, Clinical Information Systems, Rush University Medical Center

Brian D. Patty MD, CHCIO Eligible, VP & CMIO, Rush University Medical Center

Brian D. Patty MD, CHCIO Eligible, VP & CMIO, Rush University Medical Center

Physician burnout is a significant issue, one that not only affects provider well-being but patient care as well. Brian Patty, CMIO at Rush University Medical Center, is determined to do something about it. He’s working to implement a task force aimed at increasing physician efficiency and satisfaction. In addition to this task force, he sits on a committee whose sole mission is physician well-being at Rush and determining what sort of support they can provide. In this interview, Patty discusses how benchmarking surveys have allowed pinpointing where physician efficiency issues reside, what the seven domains are to address physician burnout, and how an NLP engine is changing the game for sepsis prevention. Additionally, he touches on telemedicine and how Rush has found success in the areas of Movement Disorder and Psychiatry. In his words: the EHR was just the beginning.

Key Insights

We are using Physician Efficiency Profiles, which are reports from our EHR, to identify the physicians that we’re specifically focusing on to help them spend less time in the EHR, be more efficient in the EHR, spend more time with patients, and get home on time, not doing work late at night and on weekends when they’re not scheduled to be working. Those are big factors in physician burnout.

In the areas where we have our associate CMIOs/physician builders, we’ve seen that physicians are reporting that they feel more efficient, so it’s been a very successful program that we’re planning on expanding, in addition to expanding our support team for providers.

The issue with sepsis is it’s a sensitivity and specificity challenge. You can set up an alert that measures blood pressure, heart rate, temperature, and things like that, but the sensitivity is very poor so alerts are firing way too often. We are working with Wolters Kluwer to help develop and deploy a sepsis “engine” with sensitivities and specificities in the 90s to improve the identification of sepsis and decrease alert fatigue for our providers.

We’re helping physicians with their efficiency by using the NLP engine in the background, querying their notes, and assisting them in adding items to the problem or medication list and teeing up orders.

I’ve been doing this for almost 20 years and when I started my job description was basically get physicians to use CPOE and then it was, get the full EHR up and running, and getting physicians to use the other features of the EHR. Now, it’s improving the quality of care, improving efficiency, and really making sure the EHR is working for our providers, for our nurses, for the organization, rather than being an added burden to them.

Campbell: As we start preparing for 2018, from your perspective as a CMIO, what are the top things you’re focused on?

Patty: I am working in strong partnership with our new CIO, Dr. Shafiq Rab, and we’re working on getting our base infrastructure and base Epic build optimized. Then, this coming year, we’re looking at what we can do around innovation, and specifically, around provider efficiency and decreasing provider burnout. That’s a big focus for the coming year.

Campbell: If we can delve into that topic, a little bit more, what components of provider efficiency are you exploring? I noticed that you recently adopted Wolters Kluwer’s POC Advisor, but are there additional clinical documentation improvement initiatives that you’re pursuing? You’ve mentioned in past interviews that to reduce the burden on providers they should explore whether other caregivers upstream can take on some of that administrative burden. Can you elaborate on that topic? Is it around clinical documentation improvement? Is it more around restructuring workflows? Is it retraining?

Patty: Its all of the above. We’ve got a big effort on the ambulatory side right now, of going back out and retraining physicians, specifically focusing on efficiency tips and customizing their Epic profile, and working with them to show them how they can do certain tasks faster and more efficiently. One of the nice things that Epic does is provide us with is what are called provider efficiency profiles. It’s a snapshot of the physician’s use of the EHR over the last six to eight weeks, and it gives us a good sense of, what are the tasks that they’re doing that they spend a lot more time in than other providers, and when are they using Epic. How much of their time in Epic is outside of their typical clinic hours or hospital hours? So, we’re able to see who’s struggling with what and how much extra time they’re spending. Those are the physicians that we’re specifically focusing on to really help them spend less time in the EHR, be more efficient in the EHR, spend more time with patients, and get home on time, not doing work late at night and on weekends when they’re not scheduled to be working. Those are big factors in physician burnout.

That’s one of the big things we’re doing right now as far as training initiatives. We’re also looking at increasing our training staff. At my previous organization, I had a dedicated physician experience team of about eight experienced nurses who were deeply trained in Epic, Dragon, physician workflows, and all the other applications that physicians use. They did all the initial physician training, follow-up training, and rounding on physicians. They then became our physician help desk. When a physician called the help desk, calls were routed directly to this team 24/7, so physicians we’re getting someone who knows all the physician tools, knows the physician workflows, and can help them immediately. So, we basically said, in the hospital from 6am – 6pm, we’d have someone at your elbow within five minutes, if they can’t resolve your issue over the phone. They also had the ability to log into a physician’s computer remotely to see what they were struggling with. We were resolving physician issues very quickly and issues that we couldn’t resolve, rather than having the physician take the time to put in a help desk ticket, that group would put in the tickets for them, track the tickets, then circle back with the provider when the ticket was resolved. Because of this, our provider satisfaction was very high, and we were markedly improving our physician efficiency and use of Epic. I’m the process of building a similar team here at Rush, based on those same principles.

Campbell: That is fantastic approach yielding demonstrable results. Speaking to this point of addressing burnout and provider satisfaction, I love that you’re taking a data driven approach. What was especially profound to me, attending CHIME this year, was the new clinical informatics track, and the presentation that Bryan Bliven and Dr. Tom Silva of Missouri Healthcare gave. Can you touch on surveying and how frequently you may survey end users to understand their satisfaction?

Patty: We’re surveying our providers about twice a year right now, and going forward. One of the surveys that we use is the new KLAS EMR Collaborative Survey, which KLAS has renamed the Arch Collaborative. Basically, it’s an externally benchmarked survey that examines physician engagement, physician efficiency, and a physician’s perceptions of the EHR that they’re using. So, we get a lot of internal data about what our providers think of our instance of Epic, but we can also benchmark our providers efficiency, engagement, and use of various tools to other organizations who have taken the same survey, and its highly valuable information. The other thing that we’re doing, and we’re in the process of rolling this out as part of an annual survey, is to use Stanford’s Provider Wellness Survey, looking at multiple domains, which will give us information on the level of burnout in our providers, and what are the specific areas that we need to work on. Combining that with our EHR survey gives us a good indication of what we organizationally need to work on from a burnout perspective.

We look at about seven domains as we review physician burnout. One is simply assessing burnout, which we’re doing with both of those tools. Another is optimizing the care model, making sure the right people are doing the right things in our EHR and not putting it all on the provider. Starting from the patient, we send out pre-visit surveys so they can start filling in some information, anything that might be new, corrections to their medication list, corrections to their problem list, and any other issues they have directed at the visit and that can actually become, once it’s validated, some of the initial documentation on that patient’s visit. In this way, it alleviated the need to have it be entered by the provider. Then our medical assistants, nurses and admitting staff also contribute to the chart. Once the chart gets to the physician, they’re doing their physical exam, assessment and plan, and a lot of the documentation necessary to comply with regulatory and reporting requirements for various contracts and things like that have already been documented by the rest of the care team so that extra administrative burden isn’t landing on the physicians. So, we assess burnout; we’re optimizing our care model; we’re doing enhanced workforce management, which is around that training piece; we’re decreasing their administrative burden, which falls in line with optimizing the care model and making sure the right people are designing the right things, and also designing Epic in such a way that it’s doing the billing, coding, authorization, and things like that in the background and not requiring physicians to do a lot of that work. The fifth domain that we look at is around clinical efficiency, and some of the work we’re doing with the physician efficiency profile. We’re looking at who, specifically, isn’t efficient and we can go out and retrain them and give them some efficiency tips, but if there’s a global area where we’re seeing that, compared to other organizations, our physicians in general are spending too much time in documentation or more time than other organizations, then we know we have a global issue, a systemic issue, that we need to address by evaluating our documentation tools, or whatever the area is. Other areas are more on the organizational side around engaging physicians both in communication and aligning incentives, making sure they’re really engaged in organizational strategy development; and finally, looking at comprehensive well-being support. We have a physician group, we initially called it Physician Burnout Committee, but we’re now calling it Provider Wellness Committee, looking at what we can do to enhance physician spiritual, emotional, & mental well-being, looking at all those areas to see what kind of support we can provide.

I have some good partners here at Rush on the medical staff and in leadership that are all very supportive of this work. My part of it is focused on primarily what we can do with improvement of our EHR training and support, and others are working on some of those other domains. It’s a very comprehensive program we’re looking to develop here and put into place to improve provider well-being and provider retention. We know that a good portion of our turnover, probably 30%, is just due to burnout. People are either leaving practice, or leaving to another practice site where they have decreased responsibilities so they’re feeling more engaged in their medical practice. We want Rush to be that place that people come to, so we’re looking at what we can do to improve our overall well-being of our providers.

Campbell: Absolutely, a couple things I want to comment on: you came from an environment at HealthEast Care System where it probably wasn’t as competitive so you didn’t have to worry about providers moving to other facilities, so there’s increased competition now. The other thing is, as a self-identified data geek, I love the fact that you’re harvesting operational data from Epic to identify those areas that may be inefficient but also validating via external benchmarking. I think KLAS Arch Collaborative is phenomenal in that it allows you to understand where you fit in comparison to similarly sized groups and organizations.

Patty: The work that Taylor Davis is doing with that Arch Collaborative over at KLAS is just amazing and it really validated some of the early work that we were doing. I brought six associate CMIOs into IS from various areas, internal medicine, general surgery, pediatrics, emergency medicine, and primary care, and when we did our Arch Collaborative survey, the results showed that those were the exact areas where we were significantly differentiating ourselves from the median in physician self-reported efficiency.  When we brought in those associate CMIOs, they were all trained in the Epic physician builder course, so they had a deep knowledge of Epic and could work with the analysts closely to change things. In the areas where we have our associate CMIOs/physician builders, we’ve seen that physicians are reporting that they feel more efficient, so it’s been a very successful program that we’re planning on expanding, in addition to expanding our support team for providers.

Campbell: That is fantastic. If I could switch gears, I want to touch on some more specific topics around telehealth. Is there anything you’re doing in terms of e-visits right now using Epic? As you try and differentiate yourself from competitors in the region, patients may prefer a different type of appointment, not necessarily at the first appointment but perhaps a virtual appointment later on down the road. Could you comment on any telemedicine initiatives within Rush?

Patty: There are a number of things we’re doing around patient engagement and improving our patient experience, and one of them is e-visits. We have two different e-visit platforms that we’re considering, both the Epic e-visit platform and then a commercially available e-visit platform. We’re kicking the tires on both of them to see which one our patients and providers prefer. We’re currently offering e-visits to our patients in two different markets here at Rush. We also have a telemedicine program up and running. The best site for that right now is our movements disorders clinic. As you can imagine, we have a large catchment area for that clinic and since these patients have a movement disorder, they typically aren’t able to drive, so when they need to come to a clinic visit it takes two people out for the day in travel time, since their spouse, relative, significant other, or caretaker has to drive them as well. With our movements disorder clinic, our neurologists have found that a good portion of the visits can be done via telemedicine because they can observe tremors and things like that remotely and not require patients to come in every time for a visit. They’ll have to come in on occasion, but this markedly decreases the amount of times patients have to travel to Rush for their follow up appointments to see how things are progressing.

We are also using a fair amount of telepsychiatry. We’ve found rather than just doing phone psychiatry, which a lot of organizations have done for years, our psychiatrists really like video capabilities because there are a lot of nonverbal cues that they can pick up with a video conversation that they’re not picking up on a phone conversation, and as such, we’re rapidly expanding our telepsych capabilities.

As I previously mentioned, we do a fair amount of patient pre-visit questionnaires, so patients are filling out information prior to coming in for a visit, or in-between visits just to follow up and see how they’re doing. We also offer the ability to schedule and communicate with providers via secure email through our portal.

Campbell: Thank you for elaborating on that topic. Another topic that I wanted to discuss with you is sepsis surveillance. After reading the 2017 KLAS report on sepsis, what was staggering to me is that you would think there is ubiquitous adoption but certainly there’s a lot of opportunity left on the table, that can be attributed to the inherent functionality and technical step function that you have to get past within the native EHR.  Can you comment on the approach you took in deploying a sepsis surveillance solution?

Patty: We’re still in the process of pre-deployment with Wolters Kluwer POC Advisor. The issue with sepsis is it’s a sensitivity and specificity challenge. You can set up an alert that monitors blood pressure, heart rate, temperature, and things like that, but the sensitivity can be very poor, so alerts are firing way too often. As much as we tried to refine alerts on our own, we were still only having a sensitivity and specificity with our sepsis alerts in Epic in the upper 60s. So, as you can imagine, a little over 30% of the time, when the alert fires, it’s not sepsis, and a little over 30% of the time, when there is sepsis, the alerts not picking it up. What we really liked is some of the early published data around the Wolters Kluwer POC Advisor where they’re in the low 90s, both sensitivity and specificity, so alert fatigue is reduced and you’re picking up more sepsis cases earlier. We’re combing that with a technology from a company called Hiteks that has a NLP engine where they can pull non-structured data out of the EHR to also feed the POC Advisor engine, so we fully expect it will be much more accurate.

We’re also using that same NLP engine in a number of other areas. Epic has a functionality called Note Reader, where at the end of a note a physician can have a computer read the note with an NLP engine. In the background, the solution will query documentation, retrieve diagnoses, medications, problems, and things like that and then compares that to the problem, medication, and allergy list to say, ‘hey I noticed that you mentioned that the patient is on azithromycin. We don’t see that in the medication list, do you want us to add that?’ or similarly, ‘we noticed you mentioned the patient has diabetes, do you want to add some more specificity to that and add it to the problem list because we don’t see it there.’ We’re helping physicians with their efficiency by using the NLP engine in the background, querying their notes, and assisting them in adding items to the problem or medication list and teeing up orders. We have that in our production environment now with a limited group of physicians testing it and we are refining the algorithms, but plan on rolling that out early next year when we roll out Dragon and some other efficiency tools.

Campbell: Extremely compelling innovation through leveraging cutting-edge health IT solutions. Before we wrap up, I wanted to touch on a topic that I heard echoed over and over again while at the CHIME Fall Forum and other conferences: the transition away from the CMIO being the implementation lead and convincing providers to use the EMR. I think you articulated this best when you said, that was just the beginning, using the EMR was step one; there’s a whole slew of other things to focus on once the EMR has been implemented. There would seem to be a large amount of responsibility for the CMIO to be the ‘glue person,’ as you have to liaison between leadership, administration, with clinicians, with IT. As such, I’d imagine there’s a lot of negotiation and communication that takes place. I realize that that role has evolved, but if you could comment on that and how you’ve learned to adjust in your approach as a result of that evolution.

Patty: I’ve been doing this for almost 20 years and when I started, my job description was basically get physicians to use CPOE and then it was, get the full EHR up and running, and getting physicians to use the other features of the EHR. Now, it’s improving the quality of care, improving efficiency, and making sure the EHR is working for our providers, for our nurses, and for the organization, rather than being an added burden to them. We want to get to the point where we’re improving their efficiency, letting them spend more time with their patients, and letting them spend more time with their family at home. That’s the goal right now, improving the quality of care, improving the efficiency of care, and improving our provider/nurse satisfaction with their overall job and specifically with the EHR.

About Brian D. Patty

With over 20 years of experience in healthcare informatics, Patty is currently VP of Clinical Information Systems and Chief Medical Informatics Officer (CMIO) at Rush University Medical Center where he oversees the optimization of Epic and related clinical and revenue cycle applications. He is charged with setting the strategic vision for clinical care and population heath from an IT perspective. He chairs the Clinical Communication Steering Committee, the Telemedicine and Patient Technologies Steering Committee and the Clinical Informatics Committee. Patty also oversees a team of six associate CMIOs responsible for innovation and optimization across the continuum of care. He was named as one of 30 leading CMIO Experts by Health Data Management magazine in June of 2016.

Prior to coming to Rush in March of 2015 he served for 10 years as VP and CMIO at the HealthEast Care System in St. Paul, Minn. As the CMIO at HealthEast he was responsible for championing clinical applications and the use of technology to serve patients and improve the quality of care, leading computerized provider order entry (CPOE) and electronic health record (EHR) implementations system wide. His final project at HealthEast was as the executive lead for the “Big Bang” implementation of Epic’s entire suite of clinical and revenue cycle applications across the four hospitals and 31 clinics of the HealthEast Care System.

Patty’s long-standing quest to promote quality improvement through evidence-based medicine led to an Association of Medical Directors of Information Systems (AMDIS) Award in 2005 for his success in a CPOE implementation at a community hospital and ultimately to his role as the CMIO for HealthEast. In 2011 Patty received another AMDIS award for his championing the EHR’s role in the quality improvement efforts at HealthEast. He was also named to Modern Healthcare’s Top 25 Clinical Informaticists in that same year. And most recently was the winner of the 2012 Healthcare Informatics/AMDIS IT Innovation Advocate Award.

CHIME Fall Forum Interview Series: Doug Dietzman, Executive Director, Great Lakes Health Connect

Brian Sterud, CHCIO, FACHE

Doug Dietzman, Executive Director, Great Lakes Health Connect

There are two parts to the health information exchange value equation: how do you add to it, and how do you demonstrate that value? Doug Dietzman, Executive Director at Great Lakes Health Connect, knows this all too well. Leading Michigan’s largest HIE means listening to what providers and organizations need, and creating solutions they can easily integrate to create more connected communities. In this interview, Dietzman discusses how being a nonprofit has made GLHC more in tune with their consumers; why he welcomes the scrutiny that’s put on HIEs; and the unique approach GLHC takes to demonstrate the value of their services. Dietzman also touches on top of mind topics such as the recent hurricane disasters and how HIEs are a vital part of our emergency preparedness.

Key Insights

There’s nothing about HIEs that have a right to exist just because we’re HIEs. We should only exist if we are indeed adding value, like any other business or organization would have to do.

CommonWell, Care Quality, and other networks connect EMRs and there is a strong role there but what’s the plan during a disaster when a good Samaritan clinician from Missouri is now in Houston and they want to look up a person’s record who has walked into a shelter with thousands of other people? Do we have to give them access to all the EMRs in town? As a practical matter, an HIE is really the right solution.

One of the things that makes us unique from many is we have not developed ourselves, or built, our operations, even to this day, and going back to the beginning, from any state or federal dollars. We had the mindset coming into it that if we can’t develop solutions and services that the stakeholder community is willing to pay for, that actually solves a problem, then we’re going to go out of business someday when the grant money dries up.

When we get into the community health record, this is probably true for a lot of my peers as well, nobody argues that a longitudinal record is a bad thing, everyone thinks it’s great, but if a hospital is going to pay increasingly scarce dollars for access to this longitudinal health record, how do we measure the value of that to them?

Campbell: I am flattered and humbled to interview you as part of this HIE series that we’ve been running, there’s no better example of the value of an HIE than Great Lakes Health Connect. Certainly, there’s been some scrutiny put on HIEs, there’s been some sentiment that HIEs don’t show the value for the effort or money put into it. Broadly, what is your perspective on the current state of HIE?

Dietzman: A couple of initial thoughts. To your point on scrutiny, my perspective would be, it’s very appropriate, there’s nothing about HIEs that have a right to exist just because we’re HIEs. We should only exist if we are indeed adding value, like any other business or organization would have to do. I think what we will continue to see is those that haven’t figured out how to do that well will be challenged. There may still be some consolidation, or HIEs that cease to exist, if they haven’t put a sustainability model together. That shouldn’t mean that the whole concept is wrong, just that, like in any business, some work and some don’t.  For example, there are some that know how to run a book store and some that don’t, and the bad book stores go away and the good ones continue to exist. So, I welcome that scrutiny and what it will mean for what we’re doing to enhance care coordination and facilitate cost optimization.

Campbell: That’s a great point. Tell me about some of the initiatives currently taking place within GLHC that contribute to sustainability.

Dietzman: There are a couple things percolating or that are of interest. One would be the recent hurricanes. There’s been press reporting on how HIEs uniquely helped there in the midst of the immediate aftermath. We are focused on how an HIE like Great Lakes Health Connect provides a unique value beyond some of the other national networks or other ways EMR vendors are talking about connecting with each other. You would not be able to deal with 1,000 people in a shelter, all coming from a wide variety of different places and have a uniform record for those nurses or care workers who are coming in from all over the country to help in the disaster, absent having the HIE there to provide that visibility. It’s a perfect use case for me, and when those crises come up, the HIE plays a vital role.

Campbell: That point can’t be underscored enough, and that’s just one of the value propositions for an HIE, but it’s a profound one because what alternatives do you really have? Can you expect someone to bring their record on a device? They probably don’t have it in those circumstances. Depending on the practice, you may not have access to that information, and otherwise, to transfer those records, so, the HIE is critically important in those scenarios.

Dietzman: CommonWell, Care Quality, and other networks connect EMRs and there is a strong role for that but what’s the plan during a disaster when a good Samaritan clinician from Missouri is now in Houston and they want to look up a person’s record who has walked into a shelter with thousands of other people? Do we have to give them access to all the EMRs in town? As a practical matter, an HIE is really the right solution. From an emergency preparedness standpoint, we stock pile beds, we stock pile supplies, we stock pile all sorts of things. Should a facility need to be evacuated or there’s a crisis across the country, what’s rarely thought about is: how do we prepare the clinical data and the records in a way that we can actually care for the people when those things happen? I’m hoping the continued push on this will put more of a spotlight on the need for seamless information sharing as part of how we prepare for these sorts of events, rather than always being caught off guard and then wishing we had.

Campbell: Right, a business continuity and disaster recovery plan is vitally important.

Dietzman: So that’s one, another is the patient centered data home activities we’re heavily involved with in SHIEC (Strategic Health Information Exchange Collaborative) and the Heartland Project, which is connecting seven HIEs here in the Midwest and working with the other regions to connect those together into a national network as well. It’s all activity that’s currently live. We’re actually exchanging ADT (admissions, discharge and transfer, data) with those other states today, and are working on adding the query capabilities. That’s pretty exciting for us and something that people have been requesting for a long time.

The last point I’ll mention is, we have added another non-profit organization under our corporate umbrella. Making Choices Michigan is specifically focused on advance care planning. We have partnered with them regionally for a while as the electronic repository making documents available once the conversation had occurred. But we recognized we could have greater impact if  our organizations were aligned to expand our collective capacity across the state. This would give us a consistent process, consistent tools, and a consistent state-wide delivery mechanism for those documents to really try and make difference in advance care planning and culture conversation. That’s another initiative that’s new for us and that I’m pretty excited about.

Campbell: Great, thank you for sharing that. That’s something that I actually talked to Todd Rogow about at Healthix in New York. He talked about their use of advance directives and defining the different value areas, maybe it’s in disaster prevention preparedness, or in the wake of those disasters, you’re providing access. Advance Directives is another area where HIEs can provide value, beyond just exchange of CCD (continuity of care) documents, results, or other clinical information.

Dietzman: Yeah, I was thinking about the concept of patient data a little bit more broadly. I mean, we’ve been focused, since our inception, on making sure a patient’s data gets where it needs to go to support care, and patient wishes are a portion of that. To that extent, as I see a lot of very small, pocketed, fragmented efforts all trying to create this culture, and through that fragmentation it’s losing some of the gravitas it could have. I’m hoping Great Lakes Health Connect, with our state-wide network, and the capabilities and trust we’ve created to this point, can help elevate that conversation and make it something that folks across Michigan start to tune in to. If most healthcare expenses are incurred late in life, it seems to me that increasing the percentage of the population who have advance care documents in place, and readily accessible can’t do anything but honor their wishes better and care for them according to what they really want. This can significantly lower the cost of healthcare for things people don’t want, and also save families from significant disagreements and heartache when those wishes are unknown.

Campbell: Certainly. So, if I may, I’ll present you with a loaded question, something that I’m interested in. I’ve asked a few of the other folks who I’ve interviewed as part of this series, what’s been the biggest differentiator for Great Lakes Health Connect? I know you folks are very advanced in terms of both the public and private HIEs, but whether it’s strategy, culture, technology, time. We’ve spoken with Maine HealthInfoNet, and for them, they’ve been around for so long, started early, and now they’re really advanced in their use of predicative analytics, where others may still be grappling with onboarding and participants. I know that GLHC is very deeply penetrated in the participant market, with those people who you provide value to, it’s not just hospitals and clinics but also community and mental health, public health, behavioral health, so I know you’ve really expanded that footprint. If you could provide a few points about what’s been the key differences in terms of how you manage your money, how you provide governance, I would be appreciative.

Dietzman: One of the things that makes us unique from other HIEs, is we have not developed ourselves, or built, our operations, even to this day (and going back to the beginning) from any state or federal dollars. We had the mindset coming into it that if we can’t develop solutions and services that the stakeholder community is willing to pay for, that actually solves a problem, then we’re going to go out of business someday when the grant money dries up. While I would’ve loved having $15 million dollars to play with, not having it focused us pretty intensely on the things that we needed to do to  be of value to our stakeholders. The point that I keep bringing up is, there’s a lot of basic blocking and tackling, exchange work, that is still a pain in the neck. Hospitals and other providers need to have those tasks taken care of for them. For all the standards that have been developed, and all the talk about interoperability, nobody is talking about how we make it so that a result message from a lab can automatically go into any EMR without having to do any sort of integration work. We still do a lot of that, and our participants are willing to pay us for it because they don’t want to have to deal with it themselves. That’s one of the key points for us, being very in tune with our customers, what are the tangible problems and needs that they have? How do we position ourselves to meet those needs and scale in a way that allows us to be sustainable?

Campbell: Right, that’s a great point and it’s hard to wean yourself off of grant money too. I’d spoken with Todd Rogow of Healthix, who are supported with a lot of government money. Once you’ve incorporated that into your business model, it’s awfully tough to substitute it, once you’ve gone down that path.

Dietzman: The tricky thing is, once a customer has gotten something for free, it’s hard to get them to pay for it later. So, it’s not so much the problem with the HIE, and one type of fund or another, but once you’ve given something away, to come back after a couple of years and say ‘well now you’re going to have to pay for it,’ when the mindset for those folks probably is ‘hey this stuff should be coming down in cost,’ or, ‘this is something I’ve never had to pay for before,’ that’s a hard conversation to have.

Campbell: That’s a great point, I’m glad you revised that for me, the point I was trying to make, but taking it from the angle of the participants. That’s so true. Speaking of subscriptions or pay-for-service from your participants, how do you report value to them? How do you show them the value that you’re providing for the funds they’re paying? I’m talking about just from a reporting perspective, and maybe saying, ‘hey these are the number of transactions, these are the ways we’ve intervened, this is how we’ve impacted your patient population from a public health perspective, or these things on the roadmap.’

Dietzman: It’s a good point, and on some level, a challenging one for us. The reason that we built our model in a menu set is we wanted those menu items that the providers are paying for to tie more directly to the value that they are receiving so that it would be clearly visible. If there is just one big fee to join an HIE and you get all this stuff associated with it, it’s harder for me to articulate exactly what they’re getting for their investment. If they only want 25% of the solutions, but they have to pay for 75%, then it makes the whole value-dollar dynamic really squishy. We established a core participation fee when you join, just to encourage further participation and active use of the exchange, but then additional solutions are broken out separately. So, results delivery would be an example item, and you pay for that. It’s easy to go to them and say, here are the number of offices for which we have built interfaces, or are getting your results through inbox, that sort of thing.

Translating that into how much that saves the organization from doing it themselves, or the exact value proposition, is where it gets  hard. Most  provider organizations haven’t developed a baseline, or know what it was costing them before. We are performing tasks that are outside of their core business, and that frees up there internal resources. From one perspective, the associated costs our participants are willing to pay is a reflection of the value that we’re delivering to them.

When we get into the community health record, this is probably true for a lot of my peers as well, nobody argues that a longitudinal record is a bad thing, everyone thinks it’s great, but if a hospital is going to pay increasingly scarce dollars for access to this longitudinal health record, how do we measure the value of that to them? The value depends on how much it’s actually used within the workflow and what it means inside the organization. We don’t control the relationship with the patient. That’s where it gets even more squishy with  ROI. That’s why we highlight use case examples  like emergency preparedness, and ask “what would you do in that situation?”. It’s happened in New York, when they had the ransom-ware attack and were able to use the HIE data to continue serving patients; otherwise their clinical data would’ve been locked up inside their EMR. Those are more subjective illustrations that  demonstrate value, rather than through an objective ROI. But it is very clear in a rapidly evolving value-based reimbursement model environment that those at risk MUST know what is happening to their assigned population when outside the 4-walls of their enterprise.  The longitudinal health record is going to be a core success platform in the coming years.

CHIME Interview Series: Brian Sterud, CHCIO, FACHE, VP of IT/CIO, Faith Regional Health Services

Brian Sterud, CHCIO, FACHE

Brian Sterud, CHCIO, FACHE Faith Regional Health Services

What’s top of mind for Brian Sterud, VP of IT/CIO at Faith Regional Health Services? Security and Networking. Sterud believes that it is a privilege to be entrusted with patient data and as so organizations should do everything in their power to protect it. From policies, to protocols and procedures, we discuss Faith Regional’s approach to tackling security. Technology transition in your future? You’re not alone. Sterud emphasizes how important word-of-mouth is when making big decisions, and just how invaluable networking can be. Learn from others who have been through it before. Any healthcare CIO can relate to the values and challenges that Sterud discusses in this interview.

Key Insights

There’s probably some inefficiencies from a cost perspective, but the biggest thing, again, are the fragmented databases, in terms of not having continuity of care driven by a centralized database.

We simply don’t have the data at the speed in which we need it and the detail that we need it right now, and when we move to another platform that definitely needs to be a part of the package.

It’s hard to quantify the value you might get networking with peers or attending a conference where you network with peers and frankly, that’s probably been one of the best ways for me to make good decisions and save money.

Word of mouth is very powerful. Someone else has lived through it, they can provide the good, the bad, the ugly, and whether it’s worth it. In a sales process, you typically only get the good, you really don’t know the potential pitfalls until you encounter them. I think it’s extremely important to network with colleagues and attending the CHIME forums is a wonderful place to do that.

We can effectively have both those things at our fingertips, someone who is CPR certified and know where an AED is, and then be able to respond with those things very quickly.

The guiding principle I always tell folks is that, if in doubt, or if you’re not sure what the best way to treat that data is, think about: how would I treat it if it was mine? That will guide you most of the way there, on almost any type of question or initiative.

Campbell: Please tell me a little bit about Faith Regional and your role within the organization.

Sterud: Faith Regional is a HIMSS EMRAM Stage 6 hospital and serves a population of 156,000 people. We have a number of EMRs right now: we have Soarian on the inpatient side; NextGen on the ambulatory side; a different EMR in our home health; and a different EMR in our nursing home. I don’t know that we’re necessarily alone in this situation, but it’s definitely not an ideal scenario. We are going through a process of evaluating a move forward to potentially centralize many of those on a new platform.

Campbell: I imagine with different vendors, as you mentioned, it’s not unique that you’re going through this. A lot of organizations – as they have different applications across care settings – are having to normalize and harmonize that data. Tell me a little bit about how that has impacted your workflow and adoption. I know you folks are fairly advanced in terms of your progression on the EMRAM scale, but tell me a little bit about the challenges it poses having those disparate systems.

Sterud: It’s difficult. There’s very little data that traverse across the systems, so it creates silos of data, which isn’t good for anyone. Not to mention the challenge it creates in terms of supporting multiple disparate systems, as you can imagine. There’s probably some inefficiencies from a cost perspective, but the biggest thing, again, are the fragmented databases, in terms of not having continuity of care driven by a centralized database.

Campbell: Right and it’s almost like the clinicians are presented with chunks of the chart rather than a complete picture, if that’s the case. As you approach a new consolidated, or centralized, solution, have you thought about how many years of data you’d likely migrate and what your strategy would be to sunset some of those legacy systems?

Sterud: Somewhat. I don’t know that we’ve necessarily determined the amount of data that we’ll bring forward. Certainly, the more recent and detailed clinical data. The older the data is, the less detail is likely, but those are some things that we have yet to completely tackle. We also know that when we go live on a new system, there will be a period of time where we’ll need to access, very quickly, data that’s recent. So, we haven’t really thought all those things through yet, partially because we need to have a better understanding of which platform we’re moving to.

Campbell: And there’s certainly different capabilities depending on what platform you move to. For instance, if you were to move to Cerner, perhaps, it would be a little more native since they have acquired Soarian from Siemens, versus if you’re going on a net new product, so I can appreciate that decision. It touches on a point that you made in a prior interview, that it was your position that you shouldn’t switch products before 5-8 years so you can realize the full potential. I imagine the same thing must hold true now, as the last thing you want to do is 5-8 years from now, or even quicker than that, is saying ‘Geez, maybe we should’ve gone down this path in choosing this vendor.’ I can understand and appreciate why you’re systematically and methodically going through that vendor selection process and doing your due diligence.

Sterud: Yeah, we need to get to something that we know we can be on for the long term, that’s for sure.

Campbell: Excellent. Switching gears for a bit, KLAS recently published a report about sepsis prevention and it was sort of staggering to me that capabilities exist, but aren’t leveraged by HDOs. They touched on some MEDITECH hospitals, where it’s possible to provide those systematic interventions for hospital acquired infection prevention. Can you elaborate on what you might be doing from a surveillance dashboard perspective within your current applications?

Sterud: We’re not doing a ton using our software. We do have a Quality Department that pays close attention to the record and then follows up relative to whatever that condition might be, but that’s about the extent of it.

Campbell: While we’re on the topic of population health management, how much is PHM factoring into your decision for a new EMR, or is the EMR selection driven purely by the desire for a single database solution? If you could shed some light on some of those decision criteria, understanding that the PHM solutions are starting to flesh out a little bit more in what is a fragmented market.

Sterud:  That’s a great question. It’s a huge part of what we’re doing, making sure that we can get data, and who we can collaborate with, to be able to analyze data in our region. Certainly, exploring areas where we can exchange patients with other facilities and methods in which that can be done, and how easily, in terms of an interoperability perspective. We need to get to that next level where we can get good at actionable data and things that we can do relative to population health management, in the time frame that we need to do it. We simply don’t have the data at the speed and the detail that we need it right now. When we move to another platform that definitely needs to be a part of the package.

Campbell: In terms of purchasing decisions, you had discussed at CHIME how meaningful the CIO boot camp was for you. Could you provide some insight into how purchasing decisions are made at Faith Regional? How much does word-of-mouth matter? What collaboration takes place with you, in terms of other CIOs, and getting a reference case and talking to them, potentially other peers who are in similar situations and what experience they’ve had with the software. If you could elaborate on that and touch on if you leverage any third-party solutions from KLAS, to BlackBook, or HIMSS Analytics.

Sterud: All of the above. We like to look at some of those resources from KLAS, HIMSS Analytics. Word-of-mouth is a big deal. It’s hard to quantify the value you might get networking with peers or attending a conference where you network with peers and frankly, that’s probably been one of the best ways for me to make good decisions and save money. It helps to talk to peers. Word of mouth is very powerful. Someone else has lived through it, they can provide the good, the bad, the ugly, and whether it’s worth it. In a sales process, you typically only get the good, you really don’t know the potential pitfalls until you encounter them. I think it’s extremely important to network with colleagues and attending the CHIME forums is a wonderful place to do that.

Campbell: Attending CHIME last year, I noticed that whenever you have a targeted audience, where everyone’s in the same role, speaking the same language, having similar levels of responsibility, its extremely empowering. You gravitate towards people in similar situations, with similar experiences, and gain a lot through osmosis, being face-to-face, that supplements having the undivided attention of someone, so that’s critical. Are there particular focus groups that you’re planning on attending in November?

Sterud: I have another conference that I have to attend this year, so I won’t be able to go. The focus groups, though, are awesome. They’re great for interaction among peers, to hear the challenges that others have, to hear what a vendor might have on their road-map; those focus groups are very valuable.

Campbell: Yeah, there’s no hiding right? I mean for the sales person, it’s not a dog and pony show. You need your true subject matter experts, someone who’s, preferably, been through the trenches where you can dig into issues. You go to HIMSS, and I think there’s a lot of screen shot sharing and a lot of prescribed demonstrations, whereas you’re able to deeply and more meaningfully collaborate with some of these more focused conferences.

I want to switch gears again to innovation, tell me a little bit about the sudden cardiac arrest app. I found that fascinating and noticed Faith Regional had just recently launched that.

Sterud: Yeah, it’s cool. We did not develop the app, but the way that it works is: If you know CPR, you would download the app and “opt-in,” then if there’s a scenario where someone in a public place needs CPR and it’s been called in, you can get notified that someone within walking distance needs the help. You get a notification on your phone that this person is at a location and you can respond and provide that first responder type of support for that patient. There’s also another app that can notify you where the closest AED is, in the event that its needed. We can effectively have both those things at our fingertips, someone who knows CPR and where an AED is, and then be able to respond with those very quickly. Our community has embraced it, we were able to raise the money, and it is beginning to move forward.

Campbell: Its always fantastic any way you’re able to demonstrate an impact. It’s a very focused and niche area, and the best innovations are found in areas that are often overlooked. It makes a lot of sense and it was refreshing to see that the community had embraced it and it had gained some momentum. I look forward to seeing the results of it.

Well, great, that covers the gamut of questions that I have today. Are there any organizational initiatives, outside of this vendor selection process, or specific topic, that you would like to touch on? Whether it’s security and privacy, or patient identification matching?

Sterud: One of the biggest things that we’ve worked on is security. We’ve had a tremendous amount of importance placed on the establishment of our security program. Not a lot of this has been through acquisition of software, or anything like that, but for the most part building out the program, making sure we have the right policies in place, the right procedures, the right type of governance. Almost everybody is focused on that nowadays, as we should be. We’ve placed an extreme amount of effort on it, and just recently performed our updated risk assessment. We don’t have the results yet but we’re very anxious to see what kind of improvements we may have made there.

Campbell: When you’re the steward and custodian of that data, so much importance is placed on it, and I think, as you touched on, it’s not always a technical issue, it’s an awareness and educational issue. Just the other day, the physical aspect manifested itself, where Aetna sent out bills where the envelope window was proportionately too large for the document inside. While there are some technical components to it, there’s also a QA component to it, there’s a human aspect of it, and just raising awareness about it, and having the right protocols, polices, and procedures in place, it can’t be underscored enough. It’s going through those exercises of the assessment to identify any vulnerabilities, because what’s at stake is hugely important. At the same time, you’re trying to provide quality of care, you need to make sure you’re doing that in a safe and secure fashion.

Sterud: I totally agree. You hit the nail on the head. The way we try to look at it is, we’re been entrusted with that data, we are stewards of that data, as such it should be taken seriously and we do. The guiding principle I always tell folks is that, if in doubt, or if you’re not sure what the best way to treat that data is, think about: how would I treat it if it was mine? That will guide you most of the way there, on almost any type of question or initiative. I think you hit that spot on, we absolutely treat that data with the utmost respect and thank our patients for trusting us with their data.

About Brian Sterud

Brian Sterud has served as Chief Information Officer at Faith Regional Health Services since 2012. He came to Faith Regional from Brookings Health Systems where he was the Director of Information Management since 2008. Prior to this, Sterud had built a strong knowledge of the technology needs and initiatives within the healthcare industry, including the position of Network Analyst, Remote Systems Engineer and Consultant and Data Systems Engineer.

Sterud received his Bachelor of Science degree in Mathematics from South Dakota State University in Brookings, SD in 2001. In 2011, he graduated from CIO Boot Camp at the College of Healthcare Information Management Executives. Sterud is a Certified Healthcare CIO and Certified Professional in Healthcare Information and Management Systems. He received his Masters of Business Administration degree (MBA) with specialization in Health Services Administration in 2014 from the University of South Dakota, in Vermillion, SD.

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.

Using Epic Cogito Data Warehouse For Population Health Management

Epic’s data model is highly complex, with Cache-based Chronicles offering 95K+ data elements, it’s Clarity Reporting suite housing 12k+ tables and 125K+ columns, and Cogito BI & Analytical Reporting Data Warehouse consisting of 19 fact tables and 76 dimensions. Epic’s PHM initiative, Healthy Planet, includes Cogito – a comprehensive approach to supporting the needs of analytics users. Its data model encompasses transactional data (Chronicles), an operational data store, and an EDW (Caboodle). It uses these data sources to supply reporting and analytics to a wide range to a variety of user types. Healthy Planet also has an integral care management application that relies on Cogito data. For non-Hyperspace users, Epic provides much of the same data and functionality via its EpicCare Link (Healthy Planet Link) clinician portal. Cogito is broader than PHM since Epic customers use it to improve clinical, financial, administrative, and operational workflows and processes in other contexts as well.

Epic Enterprise Intelligence Suite

Cogito is Epic’s enterprise intelligence suite, which includes everything related to Epic reporting and analytics (Clarity, Radar, Reporting Workbench, data warehouse, Analytics). The trade name is from the Latin phrase “cogito ergo sum” – “I think, therefore I am.”

The Cogito Data Warehouse can help report more easily on a variety of topics from allergies and procedure orders to billing transactions and hospital admissions. The data warehouse is meant to bring together Epic and external data to allow users to create reports to meet their own needs.

Epic Population Health Management

Leveraging the Cogito Data Warehouse enables the integration and aggregation of Epic data with external data, for use in reporting and analysis including inclusion/exclusion rules and the population metrics. Furthermore, data stored in Cogito can be integrated back into Epic Chronicles and is available and actionable at the point of care. The data can also be leveraged and made available in the disease and wellness registries, and reported on within care management or via Epic Radar reports.

Epic Cogito DW Overview

  • Cogito Data Warehouse DimensionsAn analytical database combining Epic and Non-Epic Data
    • Pre-defined healthcare data model
    • Seamless flow of Epic data from Clarity database
    • Extensible to include non-Epic data
  • Common data model across Epic Customers
    • Facilitates collaboration with other Epic customers
  • Target Markets
    • Academic Medical Centers, Health Systems, Clinics
  • Pricing Model
    • Included for Epic EHR customers with data feed fees and PMPY to include non-Epic EHR lives.
  • Uses
    • Research
      • Sophisticated cohort selection (RDB)
      • Quality and clinical research
    • Population Health
      • Combining clinical data with external clinical, claims and patient satisfaction data
    • Performance Improvement
      • Monitoring clinical and operational metrics for Epic and non-Epic data
    • Streamlined reporting for Epic data
      • Highly simplified version of Clarity

In mid-2016, Epic renamed the data warehouse portion of the suite “Caboodle” and CEO Judy Faulkner is now working on Kit – as in Kit & Caboodle. “Kit is making everything very open,” Faulkner said. For more intensive data needs, users with Epic’s Caboodle enterprise data warehouse can now use Kit, a companion tool, to authorize access to approved entities for research, population health management, or clinical decision making. “Kit is a veneer over Caboodle that takes all the data entered into Caboodle and lets authorized users access it that way instead of having to do those interfaces, CCDAs, and APIs,” Faulkner said. “All the data is there.  They can just go at it.  So an organization such as Health Catalyst or Watson can go into the data and do what they’re best at doing with it.”

Epic’s Healthcare Analytics Market Analysis

As part of their recently publicly shared 2017 Healthcare Analytics Market Trends Report, Chilmark Research evaluated Epic’ analytics suite in the scope of the broader market:

Chilmark Research Analytics Market Trends - Epic

Among their findings:

  • 1/3rd of Epic customers currently use predictive analytics models, which are shared across the Epic community.
  • Healthy Planet PHM initiative includes Cogito & its data model encompasses transactional data (Chronicles), an operational data store, and an EDW (Caboodle).
  • Cogito is broader than PHM since Epic customers use it to improve clinical, financial, administrative, and operational workflows and processes in other contexts as well.
  • Caboodle consists of an LPR populated by clinical, claims, and other local and remote data sources. It use Epic Care Everywhere to ingest Epic and non-Epic data from participating provider organizations.
  • Epic provides visibility into the status and performance of customer data feeds with a product called Stargate.

Chilmark Research Healthcare Analytics Vendors Types, Product Capabilities, and Vision

Healthcare Analytics Strategies & Options

As Epic customers weigh analytics data warehouse options, or consider ways to improve or optimize existing data warehouse and clinical intelligence capabilities, it’s important to consult a definitive evaluation matrix Health Catalyst published to the right. In all, Epic Cogito supports the analytics functions needed in the various elements of Healthy Planet, but it is also a general-purpose data warehouse and is being used more widely to support important clinical programs and financial goals that may not directly relate to value-based healthcare.Health Catalyst Strategy Analytics Options

CHIME Fall Forum Interview Series: Todd Rogow, CHCIO, Senior VP & CIO, Healthix

Todd M. Rogow, MPA, CHCIO

Todd M. Rogow, MPA, CHCIO Healthix

Healthix is the largest public health information exchange (HIE) in the nation, serving the most comprehensive range of organizations in New York, from the largest hospital systems to the smallest community health centers and physician practices. Healthix delivers data of more than 16 million patients to participant organizations that include hospitals and health systems, provider practices, behavioral health organizations, long-term and sub-acute care organizations, health plans, other public HIEs, and private HIEs. Todd Rogow, Senior VP & CIO, recently led the organization’s move from an outsourced resource model to an insourced technical team, including the implementation of a robust security program and SOC 2 Audit. In this interview, Todd elaborates on the benefits of building a mission-driven internal team to support the HIE, including improved scalability, nimbleness and responsiveness, but also cost effectiveness and innovation. Todd also shares his perspective on HIE funding models and sustainability, innovative approaches to patient identity and matching, leveraging predictive analytics to drive insight to the point of care, and the responsibility of the HIE in ensuring security and privacy.

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 joined Healthix two and a half years ago, I observed that we were losing ground because we were getting 11K new potential patient matches every day that required manual review.  With such a high volume, we couldn’t possibly keep up using a manual approach.

Having direct relationships with our vendors – whether they represent an application we leverage, hardware we run, or a service provider we work with – expedites the process of getting results by removing unnecessary overhead.

Insourcing the IT work has allowed us to become experts and facilitated a mission-driven, dedicated team that stays on top of our operations and growth. Being in this unique niche of healthcare IT and health information exchange really makes this approach advantageous.

Of key value to residents of New York is giving them access to their healthcare data. It’s something that we’ve taken steps to deliver through APIs made available to any of our participants that wish to tap into Healthix.  This enables them to make Healthix data available to patients through their own patient portals.

We believe that federal and state funding will continue to be a part of our sustainability model moving forward, although we can’t be sure of funding levels.  We are always exploring other revenue streams.

As a steward of PHI, Healthix understands that it is critically important to secure the data that we are entrusted to hold.  Technically, we do not own the data; it comes from a variety of participating organizations such as providers, payers, behavioral health, pharmacies, or in some cases Medicaid. It is therefore our obligation to protect it to the highest security standard we can offer.

Campbell: Tell me more about your bio, background, career trajectory, the organizations you’ve worked with, and the technologies they use.

Rogow: I’ve been involved in healthcare information technology for 15 years. I got my start working with electronic health record systems while as a contractor at Northrop Grumman, working for the Department of Defense. I helped to build their unique custom EHR, which was used by DoD, and spent several years enhancing that EHR product, from seeing its client-server application evolve, to helping create its first cloud hosted model. I then moved into the HIE space, spending over 5 years at HealthInfoNet, the statewide HIE for Maine. I was among the first five employees engaged there and saw the organization grow to a staff of 27. I led the redesign of the HIE from a technology perspective. One of the first things we did was to evaluate best-of-breed vendors to design an effective HIE solution for collecting data and providing real-time services to the participants, who are really the customer base.  The participants were comprised of clinicians in Maine’s healthcare community.

HealthInfoNet really shaped me and set me on a good path for what we’re doing here in New York. Going through that rebuilding experience and tackling scalability, having scaled the Maine HIE to be truly statewide, was impactful. In terms of the data we were collecting, the organizations we worked with ranged from behavioral health, with HIV sensitive data, to the common clinical data you would expect from reference labs or from hospitals or private practices.

When I joined Healthix, it was really to redesign the HIE, and begin a program to insource operations. For several years before I joined, the IT department was outsourced. One of the major tasks I was given was to build a team to handle the complexities of this business. We talk about Healthix as the largest public HIE in the nations. We really measure not just for the number of connections or data feeds we have built, but rather the size of the population we serve. At this point, we’re well over 16 million unique identities which contain clinical information. We have a lot of people who come in and out of New York City from all over the state, the country and even the world who may end up in our healthcare system.

On average there are 46 million messages coming into the Healthix system.  Over the last few years we’ve really focused on pushing data out. Like HealthInfoNet, Healthix is a real-time HIE, and that is where a lot of the value lies.  We have close to a half million real-time clinical alerts each month and push out over one hundred thousand continuity of care documents. In many cases, we build a tight integration into the EHR product, especially in those cases where the participants don’t have that capability, depending on the vendor they use.

Campbell: A well-rounded overview. I appreciate you reinforcing some of the high-level statistics you publish and highlighting some of the advanced work that’s occurring within the exchange today. If we could dive into one topic in particular, you mentioned managing more than 16MM lives. I want to touch on identity. You provided some detail around how a patient search is accomplished through demographics and MRN. Tell me a little bit about Healthix’s patient matching and identity management strategy, how exceptions might be handled, and what solutions you may leverage.

Rogow: I’ll provide you with another number. If you think of the variety of data sources that feed into Healthix – behavioral health, private practice, and hospitals – we get different medical record numbers from each of those organizations. As such, we have just over 58MM MRNs that we’ve brought in for the 7-8 years of data that we have. The challenge, as you pointed out, is really knowing that Todd Rogow is the same thing as T Rogow or just Todd Rogow who has gone to a different organization and has another unique identifier associated with him. We’ve been able to boil that down to close to 16MM unique identifiers and we have a couple of technologies in play that facilitate patient identity. We use IBM’s product, which was built by Initiate.

In addition, the velocity of matching associations wasn’t fast enough for us. We had a lot that fell into a gray area where we think they’re the same person, but they really need to be manually reviewed. As you can appreciate, this is extremely laborious. When I joined Healthix two and a half years ago, I observed that we were losing ground because we were getting 11K new potential patient matches every day that required manual review.  With such a high volume, we couldn’t possibly keep up using a manual approach. To automate the process, we contracted with Verato, a company that has a service that does something unique. They realized a while ago that there are a lot of public records for Todd Rogow. For example, I have an electricity bill, so there’s a public record of me and my address. There could be a credit agency that also has my name and my address and could include other things like a social security number, home phone number, or my date of birth. All of this is publicly available. They built an application that we reach out to as a service through an API, and we provide two identities for who we think may be the same person. We’re not certain, so we reach out to them and we ask them to query their public datasets from credit agencies, public utilities, etc., and come back with a recommendation on identity matching. Basically yes, maybe or no. It’s similar to what IBM is doing, but it’s another pass with more data that we don’t have access to.

With that, we have seen tremendous improvements. Not only have we dropped our manual approach of auditing these records individually, but we were able to go back and revisit our full backlog – anything which was a potential match. We were able to further collapse, by several million identities, and consolidate clinical records. From a clinician’s point of view, we’re now bringing extra clinical value around the proper identity of the patient and all of his/her records through that service. That’s been a really big improvement that we’ve made since I joined Healthix, and represents a new vendor that we’re working with very effectively.

Campbell: From sitting in on a New England HIMSS HIE advocacy panel event put on in early spring, outside security and privacy, identity is top of mind for HIEs. Thank you for elaborating on that. Shifting gears, you mentioned that you had out-sourced and then moved to an in-sourcing model. What challenges occurred with that, and what benefits did you realize as a result of moving to that model?

Rogow: I’d like to spend more time on the benefits, but let’s start with some of the challenges of moving from an outsourced to insourced resource model. A lot of companies go through the opposite – moving from insourced to an outsourced model. They think that outsourcing is better, only to swing the other way and insource. Just before I was hired, Healthix realized we needed more direct control over our destiny. What I mean is Healthix wanted to be very responsive to its customer base, and found that this was hard to do through 3rd party intermediaries. Having direct relationships with our vendors – whether they represent an application we leverage, hardware we run, or a service provider we work with – expedites the process of getting results by removing unnecessary overhead.

The other aspect is that Healthix didn’t feel that the growth we wanted to undertake could be accomplished without a change. Specifically, we didn’t feel that an outsourced vendor could keep pace with the scalability and amount of security required. Given the scope of the PHI stewardship responsibility of the organization, we felt that it was important to have that control.

As such, the organization engaged me to build a team and tasked me to insource our operations. Based on my prior experiences with HealthInfoNet in the state of Maine, I had familiarity with IBM Initiate for EMPI, and we leveraged Orion for the clinical data repository and clinical portal front end. However, Healthix implemented InterSystems HIE, so there was a little bit of a learning curve for me. The approach I took was to evaluate our system support needs and build a team that would address those needs. Certainly, there are some core roles you know you need to fill right out of the gate, but beyond that, there was examination of where resources were needed internally to be as responsive as possible to our customer base.

Once the core was in place, we directed focus on building new features and evaluating what resources we needed to tackle those initiatives. All-in-all, this approach offered tremendous benefits. We’ve witnessed enhanced scalability and quicker response times; a result of the direct relationship with our vendors. A major side benefit was the overall cost reduction we observed. We knew that if we were to try to scale to the same level where Healthix is today with an outsource arrangement, the costs would be too high. Insourcing the work allowed us to become experts and facilitated a mission-driven, dedicated team that stays on top of our operations and growth. Being in this unique niche of healthcare IT and health information exchange really makes this approach advantageous.

Campbell: I couldn’t agree with you more. It emphasizes the point that Ed Marx made at the NYSHIMSS meeting in that, it’s all about culture, and the ability to tap into that passion through a mission-driven team. The tough part is surely getting up to speed on a platform you aren’t necessarily familiar with, and identifying those roles you need to fill – whether its data governance and harmonization, or security and infrastructure. It’s great to hear that you were able to recognize some cost efficiencies as a result.

Rogow: Interestingly enough, we went through the same thing in Maine when I first joined HealthInfoNet. As I previously mentioned, when I first joined, I was among the first employees hired, and at that point, we had outsourced the IT portion as well. I brought that in-house. Being mission driven in this niche of healthcare really does attract the best people, and there is a lot of dedication that follows.  Ultimately, we are impacting patient care.

Campbell: I imagine you have countless stories of facilitating care coordination where key insights derived from the HIE are driven to the point of care as a result of the exchange.

Rogow: Absolutely. Both at HealthInfoNet and Healthix, I’ve heard stories where our staff goes out to visit with sites and they tell us how they are treating complex patients and how our service is being used to push insights out to them. It drives the point about mission home, and even though my staff are focused on keeping the system up and adding new capabilities and functionality to make it a more useful service, they believe, and I believe, that we are really saving lives. Not only saving lives, but also helping to improve healthcare for patients. That’s why we’re here and in this business. To have our staff get exposure to that is impactful when it comes to our mission.

Campbell: That covers the value proposition of HIEs quite well, but what about sustainability and solvency? Funding is an issue that comes up over and over again for both public and private HIEs. Whether it’s a subscription-based model that is used, or perhaps grants in play to prop up the HIE. What does sustainability look like for Healthix? You touched on having a series of clinical notifications planned, but how is that value funded?

Rogow: The state of New York is extremely supportive. The governor made a decision to support a statewide HIE through the use of federal funds that come in through CMS as well as state matching. Just before I joined, we entered into a period of 3 years where the state had allocated funding for us. 90% of our operational funds come from either federal or state funds. Before that, it was very similar to the model for Maine’s HealthInfoNet, where each participant, whether it be a hospital or private practice, would pay their portion of a service fee that would help fund the operation. We believe that federal and state funding will be a part of our sustainability model moving forward, although we can’t be sure of funding levels.  We are also exploring other revenue streams.

We’ve introduced new services, such as predictive analytics, focusing on the top 5-10% of the population that could be, or are the highest cost patients. We aim to get in front of the cost curve, and be proactively impactful, giving the care management teams of healthcare organizations an indications as to who the individuals are that we believe are likely to present in the ER or another inpatient setting, or have the potential of having a chronic condition. We highlight these patients so clinicians can effectively reach out to highest need patients. That is a Healthix service which customers are paying for today.

Other areas we’ve been exploring are customized real-time clinical event notifications. We offer a lot of the basic trigger events. For instance, if a patient presents in the ER, that will trigger an alert. However, if we’re able to provide a chief complaint, and other key data within that alert, that provides greater value to the provider or care manager.  Increasingly, we’re able to identify   services that our customers’ value and are willing to pay for. Healthix received funds for grants from various agencies, some at the New York City level, where we work on specific projects. As such, the grant money is really project-based and not a significant source of income.  Many feel that HIE shouldn’t rely on local city, state, or federal government picking up the entirety of the bill, but they do feel that there is a role for them to play in terms of funding. We’ve always thought of the three-legged stool in terms of funding – providers paying a service fee, the payers or insurance companies paying a fee, and the government contributing the remainder. The public services that we offer comprise the majority of our expenses, but we’re trying to make it a model where funding is more diversified across those we serve.

Campbell: It sounds like a very sound model. As you said, the point can’t be underscored enough in that it is truly a public service. What Healthix is doing is facilitating healthier New Yorkers, and healthier populations.

Rogow: We feel that there is a lot of untapped potential with delivery of services around predictive analytics and engaging providers or communities.  As they’re receiving a direct benefit from it, we can monetize those services. We certainly aim for a diversity of revenue stream, but having the backbone of government funding is critical. It’s helped us to mature as an organization, and to really show our value.

A critically important public value is giving the residents of New York access to their data. It’s something that we’ve taken multiple actions to deliver through APIs available to any of our participants that wish to tap into Healthix, so that they’re patient portals can make the data available for patients. Of course, all of this is contingent upon patients providing their consent, which is heavily controlled.

Campbell: That’s a great point. Being mission-driven, the most important entity in all of this is the patient. I myself use the MAHIway, and can appreciate the utility of having my chart available and being an active participant in my health. This is especially pronounced if you are managing many chronic conditions; having the HIE to lean on can be critical.

Rogow: It’s so important. We have a lot of HIEs across the country that are doing well overall and the service is getting more valuable as time goes by and technology improves. However, what’s really going to be a game-changer, is putting that control in the hands of the patient; when you’ve got a mobile device that provides you access to your records and allows for your records to be transportable. We are on the cusp of witnessing the patient really taking control of their records and leveraging that control to change healthcare. Not just the access to their clinical data, but providing awareness and contextual information around where to go for the best treatments, for instance.

Campbell: It certainly seems like there is a convergence taking place that will lead to data liberation. We know that the patients are clamoring for it given what’s at stake. Shifting gears a bit, at the NYSHIMSS meeting, the collaboration that occurs with other HIEs in New York through the SHIN-NY was highlighted. Can you touch on that and perhaps speak to other registries that you may integrate with?

Rogow: Starting at the highest level, we are connected to the Sequoia project, which is really the framework to exchange clinical information across the country. We’re also close to going live with the Veteran’s Administration for bi-directional exchange of clinical data with VA hospitals and ambulatory organizations. In terms of the SHIN-NY, it’s really a statewide clinical information exchange that’s comprised of each of the HIEs in the state. Right now, there are 8 of us serving the upstate and downstate regions. Since I’ve joined Healthix, we’ve witnessed a great deal of consolidation, which is a good thing. We know that people work, travel, reside and receive healthcare across geographic regions. Recognizing the size of the state’s population, and also the large geography, we have to collect data on behalf of the residents, regardless of the boundaries. This can be challenging, but there are services in place to identify that resident across the entirety of the state. This allows records to be exchanged within the state boundaries, and really offers a statewide support structure. Even though Healthix’s primary territory is New York City and Long Island, those boundaries go away when patients and providers retrieve data.

Going down to the next level, you mentioned attaching to different registries. We support several public registries. One in particular is the New York City Department of Health AIDS Institute. Their mission is to monitor the health and treatment of HIV+ individuals in our community and retain them in care. We identify HIV+ persons and the care they are receiving, so NYSDOH can focus public health surveillance efforts to ensure linkage to care, retention in care, antiretroviral therapy, and viral suppression.

Another registry we support that is kind of unique to New York State is what’s called eMOLST, around an end-of-life legal document. MOLST is a clinical process that emphasizes the discussion of patient’s goals for care, including shared medical decision-making between health care professionals and patients who are seriously ill or frail. The result is a standardized set of medical orders documented on the MOLST form that reflect the patient’s preferences for life-sustaining treatments. Our partnership with Excellus BCBS gives providers access, through the HIE, to the medical orders and wishes for an end of life patient.

We support a New York City Dept. of Health and Mental Hygiene service called NYCEPS – the New York Emergency Patient Search program. – After a mass casualty incident, a key concern is locating and assuring the safety of loved ones who may have been affected and cannot be easily reached or located. NYCEPs queries real-time patient data through Healthix, particularly information from encounters at acute care hospitals and nursing homes – all with the intention of facilitating family reunification. NYCEPS staff can help search for a missing person who may have been treated at a New York City hospital, thereby giving families’ one place to inquire about a family member. This potentially reduces the overwhelming number of phone calls to individual healthcare facilities which are already overburdened in times of crisis.

Campbell: Thank you for elaborating on those initiatives and advanced HIE use cases. It’s fascinating and compelling to see the many tentacles coming out of the HIE and the numerous entities that directly benefit. Any final thoughts you’d like to offer?

Rogow: I’m going to settle on security as the final thought, though it’s always at the very top of our minds. We will be undertaking the HITRUST certification by the end of next year. We’ve taken a lot of steps towards that third-party certification and have undertaken other measures, including going through a SOC 2 compliance and achieving that certification. These are critical when handling volumes of PHI.

As a steward of PHI, Healthix understands that it is critically important to secure the data that we are entrusted to hold.  Technically we do not own the data; it comes from a variety of participating organizations such as providers, payers, behavioral health, pharmacies, or in some cases Medicaid. It is however our obligation to protect it to the highest security standard we can offer.

With the recent press around ransomware attacks and digital security threats, Healthix takes this extremely seriously and dedicates a fair amount of resources and operating expense to implement the technology as well as secure the data. It’s an important message for people to understand: we consider this one of our highest priorities.

We talked about obtaining the patient’s consent in order for providers to access their record for treatment and quality improvement. The model we’ve implemented in New York State is consent to access (similar to an opt-in model).  This is what enables a clinician to look up a patient’s record. Typically, consent is obtained during the registration process. We have the proper technology in place so that we are able to control contextual access to the data, which could be sensitive, to ensure it is properly accessed by authorized and authenticated users.

Campbell: It’s reassuring to know that those safeguards are in place. It’s also refreshing to hear how serious Healthix takes their role as being a custodian of the data, especially in light of all of the other initiatives and operational functions. Considering the volume and velocity of the data, it must be top of mind, so it’s great to see that you folks are a leader in that area.

Rogow: When I came onboard, it was critical for me to bring on a Chief Information Security Officer. Our participant organizations and leadership continue to make this a priority.

Campbell: Thank you for taking time to speak with me. This has been extremely enlightening, and I am appreciative of you sharing your experiences, insight and wisdom.

About Todd Rogow

Todd M. Rogow, MPA, CHCIO joined Healthix in 2015 as the Senior Vice President and Chief Information Officer, where he is responsible for providing the vision, strategy and day-to-day operational leadership for all technical aspects of the company. Todd brings a wealth of knowledge and industry experience and has worked in the health information exchange space for over ten years.

Todd joined Healthix during a period of rapid growth and innovative change. He has fulfilled a critical role of building and leading Healthix’s Information Technology function, migrating its technology development and operations in-house through the implementation of next generation application software and completing the technical systems merger of several HIE organizations that now make up Healthix. He has driven a comprehensive security program at Healthix that includes the onboarding of a Chief Information Security Officer and achieving SOC2 security.

Before joining Healthix, Todd served as the Chief Technology Officer at HealthInfoNet, Maine’s State HIE. With 20+ years of experience, primarily in directing technical projects, he has provided business and consulting services to a range of Fortune 100 companies and many government agencies including the Department of Defense. Todd has served as a subject matter expert at conferences and on national and international panels and at conferences on the subject of healthcare technology. He has also authored a number of publications and case studies.

Todd has a Master’s in Public Administration and a BA from the University of Vermont. He is a certified Project Management Professional (PMP) and a 2012 graduate of the Hanley Center’s Health Leadership program. In 2016, he became one of only a few hundred Certified Healthcare CIOs in the nation.

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 Interview Series: Sue Schade, Principal , StarBridge Advisors, LLC

Sue Schade, CIO, MBA, LCHIME, FCHIME, FHIMSS

Sue Schade, CIO, MBA, LCHIME, FCHIME, FHIMSS Starbridge Advisors, LLC

#HealthITChicks show up and stay fierce, and Sue Schade may just be the epitome of that. A nationally recognized health IT leader, Principal at StarBridge Advisors, LLC, and current interim CIO at Stony Brook Medical Center, Schade has over thirty years of collective health IT management under her belt along with a plethora of awards and recognitions from HIMSS, CHIME, and other leading health IT organizations. Now part of a consulting, coaching and interim management firm, Schade has sage advice to share with other CIOs. In this interview, she talks optimization versus replacement, population health management solutions, how to measure success, and the benefits of knowing your application inventory. Sue Schade is paving the way for women in health IT everywhere.

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

My approach, or my philosophy, that I’ve worked with organizations on is when you’re adding new components, you first start with the core vendor: can the core vendor do it today?

Usability and number of clicks is clearly something that we hear over and over from clinicians

The main point with workflow is: do you adopt your workflow to the product or do you adopt the product to your workflow?

Vendors are looking at how they can be more user configurable to adapt to the uniqueness of an organization and their specific workflows.

Just inventorying your application portfolio can be painful. You have a lot more disparate and duplicate applications than you ever realized

I’ll be the first to say that many organizations don’t have something they can pull up and say ‘here’s our inventory.’ They should but they don’t.

Campbell: Tell me a little bit about your background, organizations you’ve worked with, and StarBridge Advisors.

Schade: Let me start with StarBridge Advisors. It’s a new health IT advisory firm that I started in the Fall of last year with two colleagues, David Muntz and Russ Rudish. We provide IT consulting, interim management, and leadership coaching, targeting the C-suite and healthcare organizations around the country. We have a network of seasoned experts and advisors that we are able to bring on engagements depending on particular client needs. I currently serve as the interim CIO at Stony Brook Medicine on Long Island, where I have been since March of this year. We are actively recruiting to fill that position with a permanent CIO.  Prior to that, I served as interim CIO at University Hospitals in Cleveland for over eight months, when I first started down this path of consulting and interim management and left the permanent CIO world. Before I went to Cleveland, I was the CIO at University of Michigan Hospitals and Health Centers in Ann Arbor for a little over three years. Prior to that I was the CIO at Brigham and Women’s Hospital, part of the Partners Healthcare System in Boston for almost thirteen years. Take all of that plus the years before that and I have over thirty years in health IT management and a lot of experience in the provider world. I also spent some time working for one of the large consulting firms, Ernst and Young, as a senior manager in their healthcare IT practice, as well as with a startup vendor in the health IT space.

That’s my background. I can tell you the experience when it comes to EHRs is different at every one of those organizations. At Stony Brook Medicine, we’re basically a Cerner shop for our clinicals, both ambulatory and inpatient; we have revenue cycle through them, and the old Siemens product, Invision. At University Hospitals, it was an Allscripts shop for clinicals on the ambulatory and inpatient side, and Cerner Soarian for the revenue cycle. At the University of Michigan, I helped them move the ball towards a total Epic environment as an integrated solution, for inpatient, outpatient, and revenue. At Brigham, we had mostly internally developed systems, which were inherited from a rich history at Brigham of leading the way in the 90s with CPOE. As part of the Partners system, there was a mix of internally developed core systems as well as some vendor products. Prior to my departure at Brigham, we had decided that all of Partners would go onto Epic, and move away from the disparate systems at each of the hospitals. They are just about done at this point, having moved most of their hospitals onto Epic. I’ve worked with the major EHR vendors and certainly have a perspective on the importance of integrated solutions.

Campbell: What an extremely decorated career with a tremendous amount of experience and wisdom gained along the way. Tell me a little bit more about integrated solutions. There is a lot of replacement occurring in the market as folks look to have an integrated system bridging the inpatient and outpatient care setting. What is your view on that? What have you steered organizations to in the past? There’s a lot of opinions between optimizing what you have versus replacing, is the replacement truly worth it?

Schade: I think so! An integrated solution from a core vendor, is optimal. You can argue that core vendors may not be as robust in all areas or specialties,  which is where some may have started from and then built upon. However, at the end of the day you’re dealing with one major vendor that can provide all of those solutions, has a roadmap, and is continuing to build out other modules that integrate into that core system. From a user perspective, there’s one system to learn how to navigate, you have much more seamless workflows, and much better data integration. I think there’s a lot to be said for that.

My approach, or my philosophy, that I’ve used in working with HDOs, is when you’re adding new components, you first start with the core vendor: can the core vendor do it today? Is it on their roadmap? Will they be able to do it, say in the next 12-18 months, or is it not even a thought of theirs? If it’s nowhere today, or not on their roadmap, then you look at a niche vendor that may have that product. If you’re so far ahead of the market in what you’re trying to do that there’s not even a niche vendor that’s looking at it, then you would consider developing it and trying to integrate it into your core system. That’s my philosophy, that’s the approach I will take. Obviously, you may go into organizations, or I may now as an interim CIO, that have a different outpatient system from inpatient, or a different revenue from clinical. You must take into account where an organization is in terms of investment, where they are financially, and where they are in their lifecycle on their contract. It’s not a one-size-fits-all answer. I do see a lot more organizations trying to move to an integrated solution.

Campbell: Sure, and if we take integration between the care settings for instance, I know there’s some sunk cost and unique IP that’s baked into the organization, and embedded into the workflows, quite frankly. As such, it’s a big forklift to be able to move that to a new platform. In terms of core EMR and EHR vendors, what is your perspective in how they are addressing population health management —a term that is admittedly very broad and often overused? It’s seemingly a fragmented market. Do you see that solution coming from core EMR vendors or do you think that they’re best suited for the transactional nature of the records they support and it’s going to be an outside vendor perhaps for population health management?

Schade: I think that some of the stronger vendors in this space are probably somewhat niche and not the core vendors, though the core EHR vendors do have offerings. For instance, we are utilizing Cerner’s HealtheIntent product at Stony Brook Medicine for the work we’re doing with what’s called the Delivery System Reform Incentive Payment Program (DSRIP) in the state of New York. There is a potential for that to be used more broadly as our population health platform, but I think it’s still too early to make that determination. Sometimes it’s vendor readiness and it may also be the organization’s readiness. Some of the population health initiatives are probably driven, very much driven, by those parts of the organization such as operations and administration, not IT, and rightly so. People get to a point where they have to make a change and can no longer wait for IT, who may still be consumed by their core EHR implementation. They stay on the lookout for solutions from niche vendors. It hasn’t quite shaken out yet, but considering what you’re fundamentally working with in terms of patient data, it makes sense that it could be driven from your core EHR vendor, if they can keep up with those solutions.

Campbell: Right, that makes a lot of sense. Speaking of the core EHR, I feel like, and maybe you can comment on this, organizations need to treat it more than a transactional system and rather a strategic asset. EHR and EMR optimization should be a continual process following implementation. Perhaps you can touch on optimizations that you’ve participated in. From the discussions we’ve had with healthcare CIOs and leaders, the toughest part seems to be determining ROI. In terms of drivers for optimization – whether it’s usability, workflow efficiency, number of clicks – what were the areas you focused on and how did you measure success?

Schade: I think you hit the big ones. Usability and number of clicks are clearly something that we hear over and over from clinicians, more so for physicians, but I think it’s an issue for our nurses as well. The main point with workflow is: do you adopt your workflow to the product or do you adopt the product to your workflow? I think there’s some happy medium there and what you don’t want to do is a lot of hard-coded customization,  because every time you get a new upgrade from the vendor you’ll have to do all the retro fitting; Organizations are trying to do less of that so that they can work within the base product. Vendors are exploring how they can be more user-configurable to adapt to the uniqueness of an organization and their specific workflows. This is where your CMIO, CNIO, informatics folks, and clinical analysts are critical in partnering with end users to make sure that the solutions that we deploy make it better for them and not worse. You commonly hear that clinicians understand and accept EHRs are here to stay but still acknowledge how cumbersome certain features are. I’ve been involved in different optimization efforts at organizations post-implementation, and I will say we haven’t focused so much on ROI as we have workflow and user satisfaction. You often get into a situation with a big implementation that at a certain point you must get it done and start creating that list of things that are going to be in the next phase of optimization. Once the go-live is complete and you’ve stabilized, you start looking at your growing optimization list. It’s important that you have clear governance and, again, that you have a partnership with your clinicians and IT so that your clinicians, with support from leadership, are driving the high priority changes that are needed in that optimization effort.

Campbell: Right and you hit the nail on the head there. I’m co-authoring a white paper with Jim Boyle, VP of IS at St. Joseph Heritage Healthcare, as they are going through an optimization initiative, and as you mentioned, there must be a partnership between IT/Administration and clinicians. At St. Joe’s Jim mentions they have established dyad relationships between administration and clinician leaders, and as such, there is perspective and vested interest from both sides. I appreciate you sharing that viewpoint.

Schade: One point I also want to highlight about optimization is training. I think the training piece is critical, as you have to connect those two to the extent that for what you do roll out, your users have to be very well trained, they need to know how to use all the functionalities, and they need to know how to use it efficiently. Sometimes when an optimization or a change is requested, when you really look at it, it could be a training issue, in that the users don’t know how to do something or lack awareness into something that is possible within the system. You should have those two tied very tightly together. I’ll use the example without mentioning specifics, but we have a go-live this week at Stony Brook Medicine introducing a couple new major enhancements and modules. Keeping tabs on how it’s going, one of the issues that’s coming up is training: did everyone go through the training that was made available or not? When you have training available, but not mandatory, you start running into issues of, people aren’t sure how to do something, what’s possible, and they might ask for it to be different, but again then it goes back to let’s make sure we have comprehensive and complete training.

Campbell: That’s a truly salient point. Recently, three prominent Boston-area physicians just contributed an opinion piece to WBUR, “Death By A Thousand Clicks”.  They postured that when doctors and nurses turn their backs to patients in order to pay attention to computer screen, it pulls their focus from the “time and undivided attention” required to provide the right care.  Multiple prompts and clicks in an EHR impact patients – and contribute to physician burnout. That said, if providers lack proper training, they may not know of the systems capabilities or have awareness of a more efficient way of accomplishing a task.

Schade: Exactly, do you use Outlook, for example, or what’s the main software you use?

Campbell: Yes, Outlook.

Schade: So people like you and me, who do not use an EHR as the system of record, we’re in Outlook all day for calendar, tasks, and email. Someone may watch over your shoulder as you do something one day and go ‘Oh! Didn’t you know you can do xyz?’ and you go, ‘Oh! No I didn’t!’ and they go ‘Here click on that.’ Suddenly you learn a quicker shortcut or method to accomplish something but in the meantime you’ve been doing it the way you’ve always done it with significantly more clicks and steps. Again, it comes back to training and people understanding what’s possible and how to do things. That’s not to say there aren’t opportunities to make the software work better for our clinicians.

Campbell: I wanted to touch base on one more broad question around application rationalization and consolidation. I’m sure it’s been different from organization to organization, but as CIO, what applications are under your purview outside of the EHR? Have you taken part in a consolidation effort in the past where you may have duplicative functionality brought on by a best of breed approach to system adoption? And did you leverage an application to do that or certain practice? If you can elaborate on your experience with that I think it would be helpful for other organizations who are looking at eliminating the technical debt legacy systems create.

Schade: We had started down that path at Michigan, before I left, so I can’t say that I took it all the way to completion. It was one of the opportunities identified as part of an overall value and margin improvement effort in attempting to reduce costs within the organization. I’ll tell you, just inventorying your application portfolio can be painful. You have a lot more disparate and duplicate applications than you ever realized, but step one is to get your hands around that current state. Let me just say this, application rationalization is something that often goes hand-in-hand with implementation of a new core EHR because you may be implementing a common system where there have been disparate systems at multiple facilities and that common system can replace a lot niche applications. The current state inventory of applications is a critical initial step. I’ll be the first to say that many organizations don’t have something they can pull up and say ‘here’s our inventory.’ They should, but they don’t.

About Sue Schade

Sue Schade, MBA, LCHIME, FCHIME, FHIMSS, is a nationally recognized health IT leader and Principal at StarBridge Advisors providing consulting, coaching and interim management services.

Sue is currently serving as the interim Chief Information Officer (CIO) at Stony Brook Medicine in New York. She was a founding advisor at Next Wave Health Advisors and in 2016 served as the interim CIO at University Hospitals in Cleveland, Ohio.

Sue previously served as the CIO for the University of Michigan Hospitals and Health Centers and prior to that as CIO for Brigham and Women’s Hospital in Boston. Previous experience includes leadership roles at Advocate Health Care in Chicago, Ernst and Young, and a software/outsourcing vendor.

She is active in CHIME and HIMSS, two leading healthcare IT organizations. Sue was named the CHIME-HIMSS John E. Gall, Jr. CIO of the Year in 2014 and holds the following recognitions:

  • “Most Powerful Women in Healthcare IT” – Health Data Management, 2016 & 2017.
  • “50 Top Healthcare IT Experts” – Health Data Management, December 2015.
  • “11 Hospital IT Executives You Should Follow on Twitter” – Health Data Management, August 2015.
  • “50 Leaders in Health IT” – Becker’s Health IT & CIO Review, July 2015.
  • “Top 10 Most Influential Healthcare CIOs on Twitter” – Perficient, April 2015.
  • “100 Hospital and Health System CIOs to Know” Becker’s Hospital Review, 2013, 2014, 2015.
  • “10 CIOs You Should Follow on Twitter Today” – FierceCIO, April 2014.
  • “Top 10 Women ‘Powerhouses’ in Health IT“ – Healthcare IT News, April 2013.
  • “8 Influential Women in Health IT“ – Fierce HealthIT, October 2012.

Sue can be found on Twitter at @sgschade and writes a weekly blog called “Health IT Connect” –  http://sueschade.com/

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 Interview Series: David Parker, CIO/VP of IT, Magnolia Regional Health Center

David Parker, CIO

David Parker, CIO/VP of IT, HIM, & Ambulatory Informatics Magnolia Regional Health Center

Magnolia Regional Health Center, where David Parker is CIO/VP of Information Technology, is taking physician engagement to the next level. An annual physician retreat helps the health center gather information on what the providers need to perform the best care possible. In this interview, Parker shares how their providers drove the decision for a new EHR; how the MEDITECH platform has changed over the years; and the benefits of total provider engagement in a transition process. He also discusses the issues that arise with legacy systems and how archival is top of mind for the organization.

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 our community, we enjoy our autonomy and do not want to get into the hip pocket of another big healthcare organization.

We followed the Ready program that MEDITECH offered to us and that significantly helped us achieve a successful implementation.

When we were running the MEDITECH Magic system, we had Magic on the acute side and GE Centricity on the ambulatory side. We had lab and radiology report interfaces, but aside from that, there was very little other integration between those systems.

Although physicians typically don’t want change and appreciating the monumental project that comes with replacing systems, they recognized this is the way for us to progress forward. 

That was the intent of the retreat – the findings from those breakout sessions. We took that and and determined how to start addressing this for the physicians. That’s what drove our selection process.

We know we can save our hospital money if we can pick an archival solution and sunset these legacy systems.

Campbell: Please tell me a little about Magnolia Regional Health Center?

Parker: Magnolia Regional Health Center is in the northeastern corner of Mississippi, about an hour and a half east of Memphis. We serve seven counties, with a population base of about 200,000 people. We’re licensed for 200 beds but operate 171 beds. We have roughly 200 physicians within our organization.

We have a graduate medical education program here, so we’re able to raise our own physicians, which has been very valuable for the past decade that the program has been in place. We’ve had one or more members from every graduating class either choose to continue their residency here or complete their residency program and then choose to set up shop with us; it’s been quite a blessing for our community. We are a city and county owned hospital, meaning we’re not associated with any other health organizations; we’re a standalone system. Our closest competitor is roughly an hour away. We’re fortunate we don’t have heavy competition in our neighborhood, although that’s starting to change. We’re starting to see a little more encroachment in our community from other healthcare systems. We’re all being pressured from different angles and trying to find ways to grow our systems; we must adjust and adapt.

Campbell: Great, thank you. What EMR system does MRHC currently leverage? With usability and productivity deficiencies currently driving replacement activity in the EMR market, do you have any plans to migrate platforms?

Parker: We’ve been a customer of MEDITECH since the early 90’s. Last year, we implemented MEDITECH’s 6.1 – their latest platform – on the acute side and this year, we’re implementing MEDITECH’s web ambulatory product; we’re a MEDITECH customer across the board. We have almost every single module that MEDITECH offers as it’s a good fit for a hospital of our size.

During the vendor selection process, several of our physicians wanted us to look at Epic as they had trained at much larger hospitals and knew the Epic platform and liked it. However, it was just not in the cards for us, as it was too expensive. Epic doesn’t sell to directly to community based hospitals like us, so the only option we had was to partner with another Epic hospital. We took that message back to our physician base. Here in our community we enjoy our autonomy and do not want to get into the hip pocket of another big healthcare organization, so we decided that was not an option.

The MEDITECH Magic platform has been a good product for us. We used it until it was getting long in the tooth. The younger doctors did not like the look and feel of Magic platform, so, we started visiting with MEDITECH and learning how they were moving forward. Their R&D dollars were not going towards Magic, but rather, they were going towards their new 6.x platform. As such, we selected that as our go-forward platform. We implemented that with MEDITECH’s Ready  methodology that they’ve put in place. It’s a project timeline and guide to follow with best practices for choosing your consultants; making sure those consultants know the system – they’re trained and certified; determining what teams to put together internally; how to backfill for them; and how to allow those teams to fully focus on the implementation. We followed the Ready program that MEDITECH offered to us and that significantly helped us achieve a successful implementation.

Campbell: It sounds like you made an outstanding decision to stick with the platform that you’ve long been on and served itself well to you. MEDITECH is well known for their stability and it’s great to hear that you’re advancing your use of their platform and adopting even more features through it. To that regard, tell me a little bit about how that decision was made in the context of interoperability demands? A lot of groups consolidate and move to a single solution so they don’t have to worry about interoperability within the enterprise, especially between care settings. Could you touch on your experience with that and how that’s handled within MRHC?

Parker: When we were running the MEDITECH Magic system, we had Magic on the acute side and then GE Centricity on the ambulatory side. We had lab and radiology report interfaces, but aside from that, there was very little other integration between those systems. As we moved forward, the doctors expressed the desire for one platform. When MEDITECH came on-site to do their demos, they also showed how this new product they were working on that would be fully integrated. The doctors who saw it could see the benefit of it. Although physicians typically don’t want change and appreciating the monumental project that comes with replacing systems, they recognized this is the way for us to progress forward.  Meaningful Use is here to stay and we decided we must continue plugging away at that and other anticipated regulatory measures. Our physicians recognized they’re going to require more and more use of electronic health records and having those systems integrated so we can harvest the data for reporting and analytics is critical to our success.

I’m very proud to say that our physicians drove us to make this move. We have an annual physician educational retreat, where we meet off-site and break into sessions. Out of all those different breakout sessions, there was the resounding sentiment from the 80 or so physicians who attended to replace MEDITECH Magic. It wasn’t that they pushed for a particular system, but they said, ‘We have used Magic for many years, we have made Meaningful Use Stage 1 and 2 with MEDITECH Magic, but we’re very frustrated with it. It’s time to go look for something else.’ That was the intent of the retreat, the findings from those breakout sessions. We took that and determined how to start addressing this for the physicians. That’s what drove our selection process for the next six months or so of 2014. We looked at the options including Epic, Cerner, McKesson, and MEDITECH. We made the doctors a part of that process and solicited their feedback. We also solicited input from all the other departments that it would affect.

Campbell: It’s truly profound that the providers drove the selection process, where you have engagement and they feel like they’re a part of it. Shifting gears a bit, can you tell me about data you migrated from GE Centricity? Did you abstract the data into the new system? Was there a data migration that took place? Is the GE Centricity system still running?

Parker: That is the one thing that’s been a little frustrating in this whole process, as MEDITECH does not have a migration path from Magic or any external system, so it was not an option to migrate data into the system. We still have GE Centricity running, as well as the Magic system, so we can still access historical data in those systems. MEDITECH 6.1 contains a link that allows you to contextually SSO to Magic, which is helpful, but we still need the icon for Centricity on the desktops for the users. Our plan over the next year is to start looking at how we are going to archive all of the data and retire the legacy systems. We have MEDITECH Magic data, we have MEDITECH Homecare Hospice product from years in the past, we have GE Centricity records, and we’ve got some other little systems that we need to archive. We need to be able to retire those legacy systems because right now we still maintain those servers and pay some licensing to keep the systems running.

Campbell: How does archival fit within the overall project of system upgrade and replacement?

Parker: We’ve been very focused on the 6.x implementation for the last two years. We kicked off at the beginning of 2015 with an implementation of the acute side, and that was roughly a 16-18-month project. Once we were live, we spent several months fixing things then shifted our focus to ambulatory. Now that ambulatory is live, we’ll probably spend a few months on enhancements and additional optimization opportunities. Then we’ll start looking at how to get rid of the technical debt that’s looming out there. We know we can save our hospital money if we can pick an archival solution and sunset these legacy systems.

Campbell: That sounds very logical. Shifting gears a bit, what is MRMC’s plans for population health management? Are you leveraging a solution today or do you have plans to? Or is it even something that’s applicable to your organization today?

Parker: It’s not too applicable right now. We do have the surveillance dashboards MEDITECH offers and we’re building them now, but don’t have them live yet. We’re evaluating incorporating those dashboards into the workflow, and we have an internal committee pursuing that initiative. Sepsis prevention is the big area that we’re focusing on right now. Once we get our arms around that, we’ll move onto other population health initiatives. We’re in discussions with a big hospital that’s about an hour south of us regarding collaboration through health information exchange. As we move that forward we’ll look at getting more population health data out of MEDITECH and into this bigger group of hospitals that’s forming a larger community.

Campbell: It’s how you survive in this value-based world. The data sharing must happen and that’s why data blocking is such a huge topic. The patients are demanding that the data follow them, but the infrastructure may not be in place to allow it to happen. Do you have a comment on any other projects that might be ongoing at the organization once you’ve completed the implementation?

Parker: One of the next big large initiatives we plan on tackling is clinical documentation improvement. We recently purchased Nuance’s Clintegrity product and we’ll soon be focusing on getting that up and going. We think that’s a game changer for us and our physicians have been clamoring for something like this. We survived the switch over from ICD-10, but there’s so much more that we could be doing to improve documentation, to code our charts better and to accurately reflect the health of our patients. We were very disappointed in our health grade score, which surprised us, but as we started digging into the data it was clear to us that we are not doing a good job of documenting just how sick our patients are. It looks like they’re not very sick, and they come in and get much sicker, or pass away, and we haven’t done a good job to document that these patients were very sick when they presented at the hospital to begin with. The CDI program that we’re putting into place with Nuance will take us roughly six months to get it in place, but we think it will be a positive change for us.

About David Parker
David Parker serves as CIO/VP of IT for Magnolia Regional Medical Center, a non-profit, city owned, HIMSS EMRAM Stage 6, 200-bed acute care hospital located in Corinth, MS. Mr. Parker leads an IT team of 24 employees and is responsible for IT management, project leadership, budgeting, & strategic planning. Mr. Parker currently oversees upgrading of platforms and operating systems as a part of MRHC’s initiative to become a HIMSS EMRAM Stage 7 hospital.

Prior to his current position, Mr. Parker served as an IT director for a smaller health care system in Oklahoma for 10 years. Mr. Parker has also held positions where responsibilities included support of a local hospital finance system and electronic medical records implementation at a health care facility.

Mr. Parker holds a BS in Finance from Texas A&M 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 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 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.