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.

HealthIT CIO Interview Series – Ahmad Sharif, MD, MPH, CMIO, Fresenius Medical Care

Ahmad-Sharif, CMIO

Ahmad Sharif, MD, MPH, CMIO Fresenius Medical Care

More than 660,000 people in the U.S. have a diagnosis of End Stage Renal Disease (ESRD). Routine treatment with dialysis therapies or kidney transplantation are the key options for ESRD patients and are required to sustain life. The majority of patients receive dialysis treatments three times a week for about four hours at a time, for the rest of their lives or until they receive a transplant. Fresenius Medical Care North America (FMCNA) is the leading provider of dialysis in the U.S. and have one of the largest collections of clinical data on Chronic Kidney Diseases (CKD) & the largest dataset on dialysis patients, treatments, and outcomes, in the world. In this interview, Dr. Ahmad Sharif, CMIO, shares how FMCNA has found ways to leverage data to predict and prevent negative outcomes. At FMCNA, multiple efforts are underway to identify patients who need extra attention, and Dr. Sharif is focused on making these efforts provide useful and insightful information for clinicians. In his words, “success is iterative”, as they learn and improve analytics over time.

Key Insights

I think of my role as a translator; I’m a bridge between the clinical world and our information technology world.  I help the clinical side understand how the technology works and at the same time help the technologists build products that more efficiently and effectively help our staff further the mission of our organization to deliver superior quality care. Another goal of mine is to leverage technology and data to enable next-generation clinical and operational decision making.

Leveraging data from more than 1 million patients and 250 million dialysis treatments, we successfully develop, test, and implement statistical models to predict which patients are most and least likely to be hospitalized, miss scheduled treatments, or have a decline in their functional status, and thus improve patient outcomes by timely intervention.

The estimated average cost to Medicare for  End-Stage Renal Disease (ESRD) care is more than $85,000 per year and nearly 20 percent of dialysis patients are under some form of risk-based care.

UX (user experience), and UI (user interface) to an extent are my top priorities. For several reasons, including meaningful use, I’m of the opinion that in healthcare we have not given enough attention to the UI piece.  In my role, I make sure that we center innovation, optimization, new design, and new projects around users.

 One of the primary things I want to do is create a better and simple interface for our physicians to be able to round in dialysis facilities.  To do this, we are creating a mobile application in conjunction with our product management using advanced usability approaches and leveraging FHIR resources. Our goal is to ensure that the interface is reliable, fast, and nimble so physicians can view historical and current data, in a very user-friendly format and document their notes and care delivery.

Campbell:  Tell me about your organization, your role, and your background.

Sharif:  I work for Fresenius Medical Care North America. We are a vertically integrated company providing chronic disease management and renal services.  We have over 2,400 Fresenius Kidney Care dialysis centers and 80 Azura vascular access centers across the country. Beyond that, we have a risk product through which we manage a subset of our patients under a total risk or total cost of care accountability. We also have a renal specialty lab and pharmacy. We are also providers of largest nephrology based EMR system called Acumen. And finally, we have companies called Med Spring and Choice One providing urgent care services in various states.

FMCNA includes the Renal Therapies Group, RTG, which is a products company manufacturing dialysis machines, dialysis peripherals, dialyzers, and other dialysis supplies.

We’re an international company with our world headquarters in Bad Homburg, Germany, and our domestic headquarters in Waltham, Massachusetts.  Internationally we do of lot other things as well, but I’ll just focus our conversation to the North American region where I work.

My role is that of Chief Medical Information Officer. I think of my role as a translator and enabler; I’m a bridge between the clinical world and our information technology world.  I help the clinical side understand how the technology works and at the same time help the technologists build products that more efficiently and effectively help our staff further the mission of our organization to deliver superior quality care. Moreover, I ensure that IT is collaborative with the business.

I have been in health IT for over a decade. I am a general surgeon by training and have degrees in public health and advanced project management. My background is diverse from different disciplines. I was a technology geek since childhood, but as soon as I got in the practice of medicine and after doing my master’s program, I had the opportunity to interact with some of the EMR systems and view some of the content on a granular basis. I realized that there was a lack of physician engagement and input.  That was pre-Meaningful Use era where applications were primarily designed for billing purposes or to check some of the boxes. I saw that opportunity early on to close a large gap between the physician role and health IT.  Ever since I’ve had a focus on user-centered design for clinical IT systems.

Campbell:  It sounds like you were one of the early pioneers of physician engagement. What is your perspective on the usability of clinical systems?

Sharif: Doing seemingly trivial things such as changing a font, a color, adding a checkbox, altering the design to support clinicians can go a long way to bettering engagement and efficiency. These types of very granular adjustments can facilitate more intuitive and efficient use of clinical decision support tools. Creating better data flow, visibility and data connections can significantly impact the lives of hundreds of thousands of patients at one time. That’s what keeps me motivated and driven to delivering on the promise of health IT improving outcomes.  My goal is to provide the tools to our clinicians so that they can deliver quality health care effectively and efficiently.

Campbell:  That is a powerful sentiment in that what may seem inconsequential can lead to true impact. Can you share insight into Fresenius’ enterprise clinical system portfolio? How are clinical decision support, advanced analytics, and data warehousing enabled in the enterprise?

Sharif:  There are a few layers to it. We have a base EMR solution, eCube, and point of care system, Chairside, along with an ancillary application ecosystem deployed in over 2400 clinics in seven different time zones. The data we generate on our patients goes into our single data warehouse and we’ve put together an HIE in the middle, where we perform enterprise patient matching and normalization of the data from internal and external sources.

Leveraging data from more than 1 million patients and 250 million dialysis treatments, we successfully develop, test, and implement statistical models to predict which patients are most and least likely to be hospitalized, miss scheduled treatments, or have a decline in their functional status, and thus improve patient outcomes by timely intervention. When one of our patients misses a treatment, that has a ripple effect that can cause significant degradation in patient care, lead to hospitalization, and certainly adds additional cost as well. For example, we can predict with very good accuracy, which patients will be potentially missing a treatment and then design interventions to meet immediate patient needs that might help avoid hospitalizations and readmissions.

Campbell: It sounds like you have an elaborate infrastructure in place to facilitate care coordination and interventions. What other type of surveillance occurs in your patient population?

Sharif: In certain markets, we are expanding services so that as soon as patients land in any of the ERs, we get a real-time alert, which allows the nephrologist to be immediately informed and engaged. The nephrologist can communicate with the ER physician or hospitalist and decide whether outpatient dialysis treatment is an alternative to an inpatient or ICU admission.  By doing that we can navigate more effectively and help our patients avoid treatment in a higher acuity setting that could potentially complicate their care further. That leads to better outcomes for patients, and generally for the health system as well.

Another initiative in place is with fluids management, which is key to good patient outcomes. Through our point-of-care system, we run underlying analytics and provide different suggestions to our staff members to support helping every patient achieve an optimal weight. We do some retrospective modeling as well, looking at the variations of the patient’s weight to provide prescriptive suggestions for the clinicians to manage that patient at the point of care.

Campbell:  That’s extremely fascinating and compelling. It sounds like you can intervene at a granular level fueled by the predictive analytics infrastructure you’ve put into place. As we move to value-based care, how is this transition being managed for patients that require a constant regimen of dialysis that generally occurs daily to three times per week? Are you leveraging social determinants of health (SDoH) as part of this transition?

Sharif:  The estimated average cost of caring for End-Stage Renal Disease (ESRD) patients is more than $85,000 per year and nearly 20 percent of our dialysis patients are under some form of risk-based care. That said, when you are responsible for total cost of care for a patient, you have more leverage in terms of gathering the data that fuels out of the box thinking and innovative interventions. One thing that we are doing outside of our ESRD bundle payment framework is to begin to incorporate social determinants of health. We’ve found that one of the impediments for patients to receive treatment was transportation. As such, a large opportunity exists to provide transportation when it is not available through traditional means. It’s amazing how much we have missed in healthcare in terms of the importance of social determinants of health.

Campbell: Absolutely, you mentioned earlier the most trivial things, in this case patient transportation can have such a huge impact.  It is often overlooked for the glitz and glam type of initiatives. Switching gears, as a CMIO, you need to act as a broker between IT, clinicians, and administration. Talk a little bit about usability and how you represent the physician community that you’re responsible for. Can you share the process that you use to deploy new features or new initiatives?

Sharif: Sure. UX (user experience), and UI (user interface) to an extent are my top priorities. Due to several reasons, including meaningful use, I’m of the opinion that we in healthcare have not given enough attention to the UI piece.  One of the things I have been doing in my role is to make sure that we center innovation, optimization, new design, and new projects around users. One way I accomplished that was working with our UX and UI teams within our IT department which our CIO had the foresight to create, which from my experience wasn’t really a norm. We have one UX or UI resource to support any major initiative we are working on.

I lead several councils in different areas of our organization, where we have a group of physicians, nurses, dietitians, social workers, and nurse practitioners or the Physician Assistants. We engage them in the design and development of any technology initiative very early on.

To deploy new capabilities, we’ve experimented with different types of change management. Historically, we were typically like anybody else, in that we leveraged a waterfall methodology.  We are moving away from that using an iterative approach based on sprints framework.  We engage our end users for feedback with every iteration. Even so, sometimes end users will tell you “this is what we want”, and if you don’t holistically study that and determine how it fits in the overall architecture, you just produce a tool for them that also lacks the adoption because it does not fit with the rest of their workflow.

Using this approach and soliciting end-user feedback, we deliver a solution which is user-centered, meets the user’s needs, and we enhance the user’s experience as well.  It may be cliché, but I like to think that any IT solution, tool or utility should be a joy for the clinicians to use.  We are committed to identifying and creating the tools, pathways, and structures so that we can break the mold or traditional archaic healthcare UI design.

Campbell:  It’s so true. You see some of the user interfaces that clinicians are presented with and it’s not elegant. It emphasizes the need to get back to simplicity to help alleviate the burden on clinicians. Thank you for sharing that perspective. One more question to ask: With the plethora of initiatives that are taking place in 2018, what is it that you’re focused on for the next quarter in delivery for the organization?

Sharif:  One of the primary things I want to do is to create a better and simple interface for physicians to be able to round in dialysis facilities.  To do this, we are creating a mobile application in conjunction with our product management team using advanced usability approaches and leveraging FHIR resources and APIs. Our goal is to ensure that the interface is reliable, fast and nimble so the physicians can view current and historical data, in a very user-friendly format and document their notes and care delivery. We have gathered end-user requirements, determined what physicians need in rounding at dialysis facilities and created an application tailored to those needs with consistent user input.

Another initiative I am working on is our partnership with Epic. Fresenius is also an EMR vendor, as we have a subsidiary, Acumen Physician Solutions, which provides an EMR solution to nephrology practices we don’t own. We have the largest market share in the country in the nephrology EMR space and are now collaborating with Epic to leverage the power of their tools to improve usability and enhance data sharing capabilities for our physicians and clinicians.

About a year and a half ago, we were at a crossroads where we had to make the decision as to whether we continued evolving our in-house built application, which was a fully meaningfully use certified EMR. We had to decide if we should continue to put in a lot of effort, money, and resources into the back-end plumbing of the application and making it a more sophisticated and elegant EMR system. The alternative was to partner with somebody who does this for a living in the interest of patient care coordination, population health management and so forth.

As such, Acumen 2.0, which is powered by Epic, provides our nephrology practice customers with improved access to a longitudinal and comprehensive view of patient data to help make more informed and timely decisions. Our Acumen team with its deep nephrology practice experience continues to “nephrologize” the content and workflows and provide best in class service to our customers. As we roll-out this partnership solution, our customers will be provided with the ability to connect through Epic’s feature-rich tools, tailored for their practice and patient needs by Acumen team and their nephrology peers.

Campbell: That sounds very promising and I look forward to following the progress of the partnership in the coming months.

About Dr. Ahmad Sharif

Ahmad Sharif, MD, MPH, is Senior Vice President and Chief Medical Information Officer at Fresenius Medical Care North America. Dr. Sharif has extensive experience in health information technology, consulting with over 25 health systems across the country and abroad, implementing and optimizing electronic health records, clinical practice management and technology solutions for multi-facility large academic institutions and smaller community and critical access hospitals.

For more on the topic of patient data, read Dr. Ahmad Sharif’s whitepaper “Connecting Patients with Their Health Information.”

HealthIT CIO Interview Series – Bob Sarnecki, CIO, Children’s of Alabama

Bob Sarnecki, CIO

Bob Sarnecki, CIO, Children’s of Alabama

When it comes to healthcare, kids are different. They need healthcare focused on their unique needs, care that involves parents from start to finish and is delivered in child-centric, healing environments. Children require extra time, monitoring, specialized medications, specially trained health care providers who are compassionate and understand kids of all ages. They also need institutions that champion health care practices and policies to continually improve pediatric care, making it affordable and accountable. It’s this premise that has driven Bob Sarnecki, CIO, Children’s of Alabama, to make a career out of delivering information technology solutions that support care delivery for children. Children’s hospitals aren’t just buildings – they are key pillars of the community, providing services available to all children through urgent and emergency care, primary care and wellness, injury prevention and child abuse prevention, community fairs and in-school health services. In this interview, Bob shares his leadership philosophy of taking care of the kids and doing it the right way, use of Medical Logic Modules to deliver enhanced clinical decision support, providing improved efficiency and quality, and future plans to engage community practice affiliates.

Key Insights

One of the things that’s always intrigued me about children’s hospitals is that they do not see themselves as “treating young adults”; there is a whole different level of care required and parent involvement is critical.  The volume of data that can be generated from birth to age 18 is vast, and provides great insight, both for care and for research.  Specialized pediatric care in rural areas is always in high demand.

Our goal is to build MLM-based clinical decision-making capability through our development team, engineered for reusability and clinically significant.  We have a strong group of programmers that meet regularly with our chief medical officer; the goal is specifically to build out our systems and technology capabilities so that we are our stepping up to the need to provide meaningful interaction with the physicians.

We have a simple mission statement in IT.  We are here for the kids, and the people who take care of them.  We do the right things, the right way.

Identifying first with the kids and the clinicians helps me to remember that my first job is to listen, not to have a position, but to listen. We can bring the technology to bear, but if we bring great tech and it’s not really helping the Children’s mission, I’m not sure that it’s really doing the right thing the right way.

Campbell: Please tell me a little bit about yourself. What is your background and what drew you to the position at Children’s of Alabama?

Sarnecki: I have over 30 years of healthcare IT experience in healthcare, including consulting and hospitals, specifically. I’ve been in Children’s of Alabama for about a year now. I came in as a consultant and was asked to stay permanently in July of 2017. There are a lot of things that attracted me to the opportunity, but one thing I desired was a role with a focus on community and children’s hospitals are my “first love”.

The technology is in great shape at the Hospital. Alabama is a state with a lot of challenges; there are a lot of needs, and the state is doing its best to try to meet them creatively. It’s one of those places that’s just attractive because there’s a commitment and there are plenty of challenges. I’m happy to be a part of it.

Campbell: Thank you for the background. Speaking of the responsibilities of a CIO at a Children’s Hospital, can you talk us through what’s different? I know you’ve been on the consulting side, but what’s different about a Children’s Hospital specifically?

Sarnecki: What is always fun and intriguing about a children’s hospital is that for most kids, and any kids with any chronic care issues, we are stewards of their first 18 years of medical history. These are formative years where you can make a huge difference on the impact of the quality of their life long-term.  We’re at the front line of what you can do with genetics information.

I enjoy working in children’s hospitals because kids are not “mini adults”; the physicians who care for kids have very unique data needs. The care is so specialized, and in high demand in rural areas especially. Opportunities for telemedicine, population health management and patient-centered medical care—All those things are at the forefront of what children’s hospitals wind up getting involved in. It’s a way to stay busy and for the technology to really leverage what the business is trying to do.

Campbell: Can you discuss community affiliate practices, the organization’s relationship with them, and how you interoperate with them. The hospital deals with high acuity, but what about the pediatric clinics and practices that surround the area?

Sarnecki: It’s a very different model here than when I worked at other hospitals, where many primary and specialty practices were acquired and owned by the hospital.   At Children’s of Alabama there are some owned primary care practices, but overall, the Hospital favors working with independent practices. We have our own primary care physicians, a small group of about thirteen practices. We also have an affiliation with University of Alabama Birmingham in their practice groups for providing acute pediatric care.

The practices use both a variety of EMRs and fax machines to connect to other providers or hospitals. In their world there’s a lot of moving back and forth between fax machines and EMRs.  One of the focuses that we’ve been working on with the independent physicians is tying them in by communicating directly back to their electronic medical record. Typically, if you’re an Epic health system or a Cerner health system, you have a strong vertical organization where all data is transmitted within a single-database EMR application used enterprise-wide. The challenge with independent practices is that they have disparate EHR systems; we’re actively working with these practices to deliver information about their patients directly into their EMR so they’re only managing the patient in one place.

It has been challenging, but very well received out in the community. They like to know that that their affiliated hospital is aggressively pursuing making that available to them. That’s been a big chunk of our work with the community practices right now. We’re also trying to begin to open the data stores a little bit so that they can understand a little bit more about the populations that they’re responsible for providing care for. Population health management with big data is really a problem that exists for bigger organizations, but it’s the practices that are at the very base level that are providing the care and need to know it as well.

Campbell: It must be challenging trying to interoperate, harmonize and normalize data between different systems and care settings. It seems like you’ve given the practices relative independence and autonomy to choose their own EMRs, but has there been discussion or evaluation of moving the practices to an EMR the hospital would host for them?

Sarnecki: We have talked to a couple of places about it, and the reception level is mixed. In some cases, they’re concerned that they’re going to give up data. Right now, the bigger focus is on collaboration and integration in the hope that we get to the point where we can pull the data together and make it more useful and meaningful.

We focus on providing bi-directional communication, and eliminating manual faxes and scanning into their record.  But we recognize “it’s a trust thing”. I think we’re at that point where people are becoming more interested in a community-based shared hosted model when they trust that you can provide the technology needs that they need to run their practice through the EMR of their choice, and that you’re going to be able to cover the bases for them from a support standpoint. There are a couple practices where we host their EMR in their data center.

Campbell: It must be tough in that in most cases, you are beholden to the source system vendor to get access to the data and stand up integration to the practices. That said, as someone shared about you via LinkedIn, “Bob is the type who measures twice and cuts once.” It seems like you are exhibiting patience and thoughtfully crafting a plan to do what is right for everyone involved. If we can shift gears a bit, I’d like to touch on your use of Medical Logic Modules, or MLMs in Sunrise Clinical Manager (SCM). How do you make use of those within the hospital?

Sarnecki: It’s something that we are working to take clinical decision making to the next level at Children’s. You get some basic MLMs out of the box with SCM. What we are working on is the best of two worlds – Developing Medical Library Modules (MLMs) for our system that are clinically useful and engineered for reusability and further development.  We’ve teamed our developers with a group of clinicians to build a reusable and powerful library that we can extensively build on.

Campbell: That’s fantastic and the fact that you’ve been able to broker the relationship like that between IT and clinicians is just outstanding. It’s great to hear your harnessing and leveraging advanced capabilities within the EMR. Could you tell me a bit about the state of population health management initiatives underway at the hospital? I understand the hospital purchased DbMotion. Are you using it today for that purpose?

Sarnecki: DbMotion was purchased about a year and a half prior to my arrival. I’ve kind of left it on the shelf for the time being until we got some of the basics covered. Starting in Q2 of this year, the goal is to charter a more formalized big data strategy.  Once we have that further defined, we will consider DbMotion further.

In addition, Children’s of Alabama has a great relationship with the University of Alabama, and we need to leverage that interaction. I’d like to see if there’s an opportunity to collaborate with UAB and other regional health care providers and bring our data together for the value of the state and the region. The competitive component in this market is not the same as it was in Phoenix. Phoenix Children’s is the real objective is to help a population.

Campbell: That speaks directly to something I really wanted to talk to you about. You clearly can have an appreciation for and articulate the business case, but also understand and appreciate the clinical case. Understanding that overlap, can you tell me a little bit about your approach to leadership as a healthcare CIO? The role has certainly evolved where you must broker with administration, a board, clinicians, and IT. How have you evolved in your career as the responsibilities of the role have increased?

Sarnecki: I go into all my conversations with four tenets we discussed previously. They’ve are principles that we developed in the Phoenix Children’s IT Department, and I’ve kept with me.  When I approach any conversations with the Board, physicians, administrators, staff, etc., I look for opportunities to reinforce the things that drive us to stronger collaboration. Typically, in a children’s hospital we can agree on these first two things – We are all “here for the kids, and the people who take care of them”. Technology is just the medium the IT Department works in.  I’m not here to press a technology agenda. I’m not here to press an agenda on big data. I’m not here to press this into the latest offerings by Vendor X, Y, or Z.  Our goal is to help the kids and to help the people who take care of them.

Campbell: That is so profound. A lot is at stake. You’ve got a tremendous amount of responsibility. With nearly 700,000 outpatient visits and 14,000 inpatient visits, and as you said it’s not like Phoenix where you have multiple competitors in the market. It’s the third largest pediatric medical facility in the U.S. That’s a lot of responsibility to the entire state. Bob, thank you for the good work that you’re doing, and thank you for sharing with us some of these insights and perspectives.

About Bob Sarnecki

Bob Sarnecki serves as the Chief Information Officer at The Children’s Hospital of Alabama. Bob has held technology roles in healthcare for several years, having most recently been general manager of professional services for ClearDATA Healthcare Cloud Computing in Tempe, Ariz. There, he was responsible for healthcare-specific security risk assessments, security remediation, professional consulting healthcare/cloud services and web development. Previously, Sarnecki was chief information officer of Phoenix Children’s Hospital, Kingman Regional Medical Center and Ernst & Young management consulting. He has also held several interim CIO roles in the healthcare provider field, aligning IT with clinical, business and technology needs. Bob’s background includes several IT leadership roles, project management, applications development, management consulting, data analytics and database design.

Sarnecki earned a bachelor’s degree in biology from Mount Saint Mary’s College and a master’s degree in healthcare information technology from The Johns Hopkins University Carey Business School.

HealthIT CIO Interview Series – Mathew Gaug, Lima Memorial Hospital

Mathew Gaug, CIO

Mathew Gaug, MSIS, ITMLE, Executive Director, Information Technology, Lima Memorial Hospital

Lima Memorial Health System was founded in 1899 as Lima City Hospital by the citizens of the Lima, Ohio community. The hospital is a not-for-profit health care organization with more than 1,500 employees, and 25 facilities in their 10-county service area in the region. Lima’s CIO, Mathew Gaug, works hard to ensure that technology enables a convenient, efficient and high-quality experience to that same patient community that was originally responsible for the founding of the organization. Like many other healthcare delivery organizations, Lima Memorial is challenged with a non-integrated ambulatory EHR and EMR. As such, driven by its physician community, it is pursuing adoption of Meditech’s web-based ambulatory product to replace eCW. Ultimately, this will offer a streamlined solution to improve provider efficiency and consequently, patient experience, while providing a foundation for additional patient engagement and telehealth services to be offered.

Key Insights

From a historical context, our organization took a best of breed approach where we went MEDITECH for the acute side, but eClinicalWorks for ambulatory practices. We recently embarked on a new strategic direction, where we are looking to consolidate applications and making a patient-centric decision to have only one record across care settings.

An integrated system enhances the historical context, as the ambulatory side wouldn’t necessarily always have access to the acute side. It greatly simplifies things, as there is only one medication, allergy or problem list to maintain. From a provider perspective, harmonization of different nomenclatures isn’t as burdensome.

We rolled out the ideas of a consolidated ambulatory practice, had demos, and evaluated products. We were vigilant in ensuring it was a physician-based decision rather than being driven by IT. Our physicians drove the evaluation as to keep the status quo or to adopt a new workflow and mentality with the technology used to practice medicine.

 A lot of the communities we serve are rural and telehealth will allow for our patients to have better and quicker access to care. Our goal is to have it integrate to our new patient portal, which will make visits for our patients that much more convenient.

Campbell: Tell me a little bit about Lima Memorial, your role within the organization and your background.

 Gaug: Lima Memorial is a community hospital in Northwest Ohio. We have roughly 1500 employees and 25 facilities in 10 county service areas. We are an affiliate of ProMedica, but at the same time we are the furthest south, so we kind of stand on our own when it comes to medical and clinical decisions, and decision-making processes. In terms of my role here, I’ve only been at the organization for about 1 year now. I came to Lima via the Cleveland Clinic as a promotional opportunity. I was looking to spread my wings a little bit, as I’d spent 20 years at the clinic. My formal title is Executive director / CIO, and I have a team of 56+ with everything IT-related rolling up through our group, which includes technology, development, biomed, communications and informatics.

Campbell: Coming from Cleveland Clinic, obviously you come with the perspective of an organization that’s typically on the forefront of healthcare information technology adoption and it’s probably doing some innovative things that may be ahead of what the broader marketplace is doing. In terms of the application portfolio that you manage tell at Lima, can you tell me a bit more about that mix. Namely, the mission-critical applications, the history of those applications within the organization, adoption rates and any optimization you may be pursuing today?

Gaug: Our main application within the hospital today is MEDITECH. We upgraded to 6.15 a month after I started in the organization, and as such, the project was well underway when I got involved. The team did a fantastic job of getting that implemented. From a historical context, our organization took a best of breed approach where we went MEDITECH for the acute side, but eClinicalWorks for ambulatory practices. We recently embarked on a new strategic direction, where we are looking to consolidate applications and making a patient-centric decision to have only one record across care settings. As such, we are looking to adopt a new ambulatory platform with MEDITECH’s web-based ambulatory product. We’re looking to adopt that same mentality and go that way with our platforms.

Campbell: The sentiment of having an integrated, single record is one that has certainly been echoed amongst the CIOs who have participated in this series and given how the MEDITECH web-based ambulatory product has evolved from a UI perspective. It seemingly limits complexity as providers have a familiarity on the acute side and more capabilities can be offer on the ambulatory side based on some of the innovation the web-based ambulatory product has offered with syndromic surveillance, population health management, and facilitation of coordination of care. I’m sure that approach is supported even more so due to MEDITECH’s acute product being well embedded at Lima?

Gaug: The hospital has been on MEDITECH in one for form or another since the first install in 1994. An integrated system enhances the historical context, as the ambulatory side wouldn’t necessarily always have access to the acute side. It greatly simplifies things, as there is only one medication, allergy or problem list to maintain. From a provider perspective, harmonization of different nomenclatures isn’t as burdensome. In addition, the providers no longer have to familiarize with two different user interfaces, workflows, etc. Most importantly, from the patient’s perspective, via the portal, they are provided a comprehensive view of ambulatory and acute visits.

Campbell: Tying into managing multiple applications across care settings, can you touch on provider satisfaction within the organization. Recently KLAS introduced the Arch Collaborative to benchmark provider satisfaction, and the new clinical informatics track at the CHIME Fall Forum was well received as it highlighted provider engagement methodologies. How do you approach provider satisfaction within the organization today?

Gaug: We have a subset of the team from my informatics group that round, visit with and train providers as one of their sole or main responsibilities. We have a 24 hour a day, 7 day a week physician hotline where providers can call and get in touch with one of my team members directly. That goes a long way in terms of provider satisfaction because the last thing we want is a provider being stuck and have it potentially impacting patient care. We are focused on providing exceptional services and response so we avoid problems with technology or issues with the electronic medical record preventing our providers from being able to make clinical decisions. Another thing that we have most recently done is separated the role of Vice President of Medical Affairs and CMIO. It was previously a single role with dual responsibilities, and it has enabled increased energy and focus for the two areas.

When we rolled out the ideas of a consolidated ambulatory practice, had demos, and evaluated products. We were vigilant in ensuring it was a physician-based decision rather than being driven by IT. Our physicians drove the evaluation as to keep the status quo or to adopt a new workflow and mentality with the technology used to practice medicine. I think that’s key with driving the success of any type of implementation of a new application. Ultimately, we want to make sure that as a result of our decision, patient care is more convenient and it’s more efficient for the providers.

Campbell: Great. Thank you for providing some color around that. Let’s talk about population health initiatives within your organization. I imagine rollout of capabilities will be eased in having an integrated platform. That said, what initiatives are taking place today? Do you maintain any chronic disease or wellness registries? Have you evaluated or adopted technology perhaps within Meditech or externally to address the potential need?

Gaug: Thus far, the adoption has been within eClinicalWorks. As such, we are really focused on the future with the Meditech ambulatory application and what capabilities we can introduce with the integration of the two platforms. There are some exciting things that we’re anticipating coming forward, but for the time being we use care navigators and our offices to make sure that our patient scorecards are being maintained and they identify opportunities for intervention.  We also have a physician group that’s within our organization which oversees all population health and care navigators that are going on in the practice today.

Campbell: It sounds like there are some innovative initiatives on the horizon regarding population health management and it should enhance what may be a manual or patchwork process today. I recently read that you achieved EMRAM Stage 6, a recognition that’s bestowed upon hospitals for achieving higher patient safety through improved documentation. Tell me a bit about that clinical documentation improvement initiative.

Gaug: That opportunity manifested itself when we upgraded to Meditech 6.1.5. We made sure that not only were we going through an EMR upgrade, but we also analyze and pursued clinical workflow optimizations. With the testing that was taking place to upgrade MEDITECH, in parallel, we went into all the clinical and ancillary departments, evaluated workflows and implemented improvements. That went a long way to eliminate non-electronic workflows and improve existing workflows as we pursue stage 7 recognition.

Campbell: Related to PHM, are there any initiatives you might be introducing to better engage patients? I recently read an article published on the Lima Memorial website that was more marketing focused, addressing how patients should plan a well visit. What other types of things are you dabbling in regarding telemedicine and telehealth?

Gaug: It’s interesting you bring this up as I recently authored an article on telemedicine’s role in advancing patient care.  One of our primary strategic initiatives in 2018 is to have telehealth and telemedicine capabilities implemented and offered if not in all the practices, at least all the types of specialties we have. Telehealth may not be achieved in every family medicine practice, but we want to have at least one of those practices using telehealth. A lot of the communities we serve are rural and telehealth will allow for our patients to have better and quicker access to care. It will also enable us to offer different services we may not have today. Our goal is to have it integrate to our new patient portal, which will make visits for our patients that much more convenient.

Campbell: Absolutely. It closes the loops they have a comprehensive view of the interactions with their provider to complement the clinical record. That’s the bevy of questions that I had for you. Thank you for sharing your perspective and insights and best of luck to you with the transition.

About Mathew Gaug

Mathew is a highly accomplished IT business professional with more than twenty years of executive experience guiding the strategy and execution of mission-critical technology infrastructure and support for large-scale health service providers. Mathew is experienced and has expertise in integrating newly acquired facilities and establishing system-wide compliant technologies as well as migrating data centers. Serving as Executive Director,  Information Technology at Lima Memorial Hospital, he successfully orchestrated the implementation of multiple technology initiatives, touching every aspect of health care operations, significantly reducing costs and increasing efficiencies within an aggressive time frame. Mathew holds a MS in Information Systems and a BS in Computer Science from Baker College. 

CHIME CIO Interview Series – J. Joshua Wilda, CIO, Metro Health – University of Michigan Health

As a community healthcare organization, Metro Health values the ability to engage the community at a local level. Joshua Wilda, CIO, ensures the organization is nimble in its approach to patient and provider engagement, offering innovative solutions by creatively partnering with local employers to offer additional flexibility to the communities they serve. Joshua offers candid and shrewd advice for blossoming healthcare IT professionals as they seek to grow and advance. He also shares acuity surrounding the meaning and importance of health information technology. In his words, “we are not IT professionals in the health care industry we are health care professionals in the IT industry.”

Key Insights

Historically, we have focused on the provider experience which is extremely important. However, if we make the patient experience seamless and successfully address that aspect, providers will have their experience change as well and the entire care team will be able to leverage technologies to drive better patient outcomes and satisfaction.

We evaluate how the technology can be used to manage the care by the entire care team and how that team can support and utilize the information, as opposed to having the burden be wholly on the physician as the entry point and manager of that information. Just as the I.T. industry is tasked with managing big data, providers have been tasked with the entry, management and output. A daunting task when their value is being with the patient. By enabling technologies that allow providers and their care team to manage and interact with the patient at the center, more of the information can be used to better treat our patients.

We must consider what are our payers are going to reimburse us for and that’s been a struggle. There are many technologies that can be leveraged to treat a patient but if there is no reimbursement for the use of these technologies, smaller organizations can be hindered by what they can take advantage of due to cost.  

We are not IT professionals in the health care industry we are health care professionals in the IT industry. Metro Health isn’t an IT organization, its focus is and needs to be on quality patient care. I.T. is only a vehicle to be driven where healthcare can go, and I’m all about instilling that mission and passion in my folks.

Campbell: Thank you for taking time out to speak with us. Please tell me more about Metro Health and your background

Wilda: In healthcare, we tend to describe ourselves as the size of our beds. As a community based hospital, we have a 208-bed village campus and we have a large number of neighborhood centers where different services are geared towards outpatient care. Several years back, our organization had the foresight to transition from sick care to health and wellness management, in the communities where the patients live, not solely in a hospital. We have invested in outpatient centers and clinics, specifically with primary care services. We now own and operate 17 outpatient facilities where we have a multitude of services, mainly rooted in primary care and outpatient specialties.

From an IT perspective, we describe ourselves with the EMR that we use. As a small mid-market hospital we understand the value I.T. can bring to the patient experience and have invested heavily in I.T., more than most organizations our size. We were one of the first of our size on Epic, with a full enterprise deployment. We’ve been a Most Wired hospital for 10 years running and have very much made I.T. part of our strategy. We have been a HIMSS stage 6 organization for both Ambulatory and Inpatient for the last 5 years, with our stage 7 assessment coming soon! We have been part of a very large competitive market, and with Metro being the smallest, our CEO focused on positioning Metro to be the top choice in the market. We used technology to help drive that choice, whether it be with our provider base or with our patient base.

Campbell: Metro Health formally affiliated with the University of Michigan in 2016 and it was shortly thereafter that you were promoted to CIO in April 2017. Please tell me what CHIME means to you as a result of that promotion.

Wilda: I’ve been with Metro for the past 11 years and originally came on board as a systems analyst. I started my career working on the Epic implementation here at Metro and got the opportunity to rise through the ranks to now being the CIO. I am an alumnus of the CHIME Bootcamp from back in 2009. Our previous CIO, William (Bill) Lewkowski, is still with Metro Health as our Chief Strategy Officer. Much of what we’ll talk about in this interview is attributed to the framework of what Bill built over the past 23 years, anticipating where healthcare was going. A lot of my strategy is based upon honoring that history and advancing and innovating it to the next level. At 37 years of age, I’m considered a young CIO, and I’m fortunate to have gotten the opportunity to lead a healthcare organization.

In terms of the value of CHIME, it’s such an invaluable resource to be able to ask for advice and perspectives from folks who have been pioneers and peers who are considered future thinkers.  Healthcare IT is a vast industry with many facets, opportunities and challenges to overcome. CHIME is a tremendous resource. I considered myself part of the next generation of healthcare I.T. leaders driving what technology means. In attending the CHIME forum this fall, it was interesting to hear where some of my peers are (as far as their career) and to hear their struggles of how they are still trying to get themselves to the table with senior leaders. They are trying to change the perception of I.T. as being a commodity, providing operations and maintenance, and instead having it viewed as a valued capability to driving and shaping organization’s missions and strategies. I am fortunate to be at an organization where they understand our capabilities and continue to invest in our growth. CHIME is a resource which helps me understand what capabilities our team may need to focus on, where we may have gaps and provide valuable resources in how to stay ahead of the curve. Metro focuses on how we can leverage digital transformation to represent the brand of who Metro is to support patient focused services and create loyalty among our patient base.

Wilda: My background and formal training is on the healthcare sciences side. I received a Bachelor’s in Biomedical Sciences and a Master’s in Public Administration with a Healthcare emphasis, I am not the typical information technology professional nor claim to be a true technologist. I’ve had to learn the technology portion of this, so I have a unique perspective there as well. Technology for the sake of technology is never well received in the healthcare industry. We often use the word disruptor.  Disruptor, while a well-intentioned buzz term, can have a negative connotation to end users. I like to say technology is a differentiator and a vehicle to drive healthcare to new areas with a focus on meeting the triple aim plus one!

Campbell: When you can bring that multidisciplinary approach, you sometimes have opinions or views that are skewed already. That leads me to a big topic that was echoed time and again at the CHIME fall forum – physician satisfaction & efficiency and EMR usability. Can you touch on that a bit? Specifically, things you may be doing with telemedicine to help alleviate some of the burden on providers?

Wilda: Historically, we have focused on the provider experience which is extremely important. However, if we make the patient experience seamless and successfully address that aspect, providers will have their experience change as well and the entire care team will be able to leverage technologies to drive better patient outcomes and satisfaction

Technology is perceived as a burden on the provider/patient experience, and that is an area we are focusing on. We are gaining better understanding of the relationship and expectations between providers and their patients; crafting a digital experience as a benefit to that relationship rather than administratively burden providers away from their focus on their patients. To that end, we have a program with our CMIO Dr. Brad Clegg and Medical Informatics Directors Dr’s Lance Owens and Srinivas Mummadi around understanding where the physicians are spending their time with the technology. As part of the program, we partner with providers, assessing productivity and providing them with tips and tricks. Another approach is having an appreciation that technology is perceived as a disruption, there is that word, so when we introduce new advances we go to great lengths to provide engagement opportunities and education of how the introduction of new technologies will actually reduce that burden.

We evaluate how the technology can be used to manage the care by the entire care team and how that team can support and utilize the information, as opposed to having the burden be wholly on the physician as the entry point and manager of that information. Just as the I.T. industry is tasked with managing big data, providers have been tasked with the entry, management and output of that same data; a daunting task when their value is being with the patient. By enabling technologies that allow providers to manage and interact with a care team, with the patient at the center, more of the information can be used to better treat our patients, the providers can focus on the patient and not the technology! We don’t want the physicians to have to manage every single informational input, but rather, we want a team around the patient so we can leverage the collective skillset in managing patient populations. We are heavily focused on unified communications across the care team and remember, patients are a part of the care team. Our focus has been to make sure that the right information is getting to the right member of the team, whether it be the care manager, a nurse, a physician, or a PA/NP and provide communication tools to have the teams seamlessly interact with the patient and each other. This is a current gap. We have siloed technologies implemented, it is now our goal to connect them, increasing patient/care team engagement.

Campbell: Along those lines, Metro Health was one of the early pioneers in delivering remote access, allowing providers to be more efficient and get access to the point of care information in different settings. Can you elaborate on that a bit?

Wilda: Early on, we leveraged the VDI (Virtual Desktop Infrastructure) experience because we didn’t want our organization to be limited by the bricks and mortar of a PC. We wanted the care team and support services to be able to have information when the patient needed them to have that information, not when they had access to it via a bricks and mortar type of workstation.

Campbell: What is your mix of payers and what mix of value-based care is there today with your patient population?

Wilda: Like any community organization we are managing those models with a mix of government, commercial and private payers. This is another convoluted area as each has their own documentation requirements, sometimes overlapping, often having their own nuisances. We are spending too much time designing the system for their needs and not enough time focused on what the patient needs but it is how we stay in business. Just like most in the industry we must consider what are our payers are going to reimburse us for and that’s been a struggle. There are many technologies that can be leveraged to treat a patient but if there is no reimbursement for the use of these technologies, smaller organizations can be hindered by what they can take advantage of due to cost so we need to be tactful and impactful, leveraging the entire investment we do make in technologies. Larger organizations may be able to invest in different overlapping technologies. Often, value is left on the able with a large portfolio of services and capabilities. Metro sustains by being purposeful and understanding we do not have the luxury of best of breed to support all areas of technology but leverage the interoperability and value that comes from best of suite integrated solutions.

We are in an extremely competitive market. Metro’s goal is to remain a community organization which prides itself on the family culture and personal interactions we have with patients. To that end, we strive to provide choice in the market. We are partnering with local employers to do something different to drive down the cost of care. We do not have our own payer program, but we provide direct contracting and risk sharing models with local employers in town. It takes out the middle man and puts the responsibility on us as an organization to keep these employer’s staff healthy. We are directly servicing the community, we are engrained in that community and have put skin in the game.

We all have read the benefits of telemedicine. One of those is providing convenient care for patients, reducing the time away from work, away from families. The employee has got to come into the office to see the provider and often, that requires a day off and less productivity. We are examining how we can, with these direct contracts, put telemedicine into the employer’s offices and make it so that employee doesn’t have to leave or take a day from work or inconvenience their family with a disruptive office visit.  It is our belief that having immediate access at their place of business will provide convenient access to employees, increase productivity and decrease costs for employers and ultimately aid in increasing the health and wellbeing of our community. Its sends a message to the community Metro understands what a patient needs to go through to see a provider and we are focused on helping the patient manage that experience, reduce disruption in their lives and can help add flexibility. We feel like this is going to help our patient mix and managing the healthcare experience.

Campbell: I appreciate you sharing the innovation that’s taking place on a localized level. If we could shift gears, I’d like to touch on the topic of population health management and anything you may be doing with Epic’s Healthy Planet module to that regard. Are you currently conducting any sepsis detection or surveillance initiatives or perhaps taking data from the HIE to get alerts about your patient population?

Wilda: We were an early adopter of Epic’s Healthy Planet module. We are one of those organizations that always seems to be on the bleeding edge. From a patient/payer perspective, we partnered with the state of Michigan on programs which gave us a spring board to adopt a progressive care team model around the patient. That model includes a team of care managers and pharmacists which provide support to our providers in managing the wellness of our population. Epic’s module allows us to use analytics to recognize those patients which may be at great risk or need more attention and then act on those patients with greater efficiency and quality. As I stated, technology is a great vehicle to allow our care team’s great accesses, more information and deeper abilities to treat more patients. We’re an osteopathic organization, so population health is ingrained in us, the complete focus on the patient’s health and wellbeing. It’s not just about being sick care but about treating the patient holistically, from root cause to illness to changes in lifestyle. That’s what osteopathic medicine really is rooted in. We are at the table with Epic trying to design the next wave of what that means for a small organization like us to sustain that model.

We also do have a sepsis program though not as robust as a lot of the larger healthcare systems, it is serving our patients extremely well. This is one of the reasons why we partner with the University of Michigan in that we have a lot of great ideas, but we don’t have the scale to do it. Now with the University of Michigan being a partner of ours, we have a lot more access to resources to grow our programs.

We are heavily engaged with our regional HIE, Great Lakes Health Connect. Metro was one of the founding members of our HIE. Around 10 years ago, a number of healthcare organizations came together and agreed while we may be competing for patients, we should not compete on the data around the patients thus forming one of the nation’s most successful HIE programs. Over the past 10 year, Great Lakes Health Connect has grown in its members thus growing the amount of information our providers have access to. Again, HIEs information is being engrained directly into the care workflows, allowing the care team better access, a more robust picture of the patient’s care allowing us for more prescriptive care plans.

Campbell: Very good. In closing, I’d like to ask you a question around your career trajectory. You have a compelling story, having worked on the vendor side for two years and then moving to the analyst side at Metro, being developed and groomed in-house. Folks who have created their own destiny are motivational. That said, what advice do you have for the budding health IT professional? What were the key things that got you to where you were today?

Wilda: One thing I tell anyone who’s starting out in their career is to make your ambitions known. Don’t just expect that by putting in sweat equity, people will know what your career aspirations are. I went out on a limb when I first came here and I scheduled a meeting with the CIO at the time. I told him what my career goals were. Did I envision myself as CIO? Not necessarily, but I’ve have a desire to grow as a healthcare leader and I told him that. He then set a path forward, setting the expectation that he wasn’t going to hand me a seat at the table, it needed to be earned. He knew that I was hungry and gave me the opportunity to succeed and opportunities to fail and learn from my failures. You need to take time to reflect and understand what you want out of your career and make your passions known.

It goes without saying I.T. professionals need to understand their business they support and not think that they are smarter than their customers are. In healthcare I.T., we have many vehicles we support, HR, finance, facilities, direct patient care, and more. It’s a very interesting industry, because we service all those entities and it’s about building the relationships and getting out there to know our customers and partner with them on crafting solutions that increase their services and delivery. You must show that you have emotional intelligence and empathy to understand what their business is, not tell them what their business is. You must really get to understand them and be open minded.

Understanding the people that manage technologies is critically important. We have to understand how to manage people. We often focus on the technology itself, how to manage technologies, but we also must appreciate and understand the inner workings of the organization. We have to put the right team players in the right team settings to make those technologies work. I tell our department all the time, we are not I.T. professionals in the healthcare industry we are healthcare professionals in the I.T. industry. Sometimes, leaders with a pure I.T. background and perspective come at solutions with just taking into account data, the networking, the bare metal, without an appreciation for the healthcare end-users. How will that technology impact, improve, disrupt, delight or disengage the users? It is important the entire I.T. organization of any healthcare system take the time to understand and get to know the business of healthcare.

I focus on our pure I.T. professionals, taking them for occasional walks around the organization, to get them aligned behind the “Why” of what we do.  Many do not understand how the impact of their work, that phone they deployed which they may think is mundane, has a mission, is delivering some critical information to a patient. It might be used to deliver some good news, it might be telling somebody unwelcome news. It might be connecting care teams. But, if that phone isn’t working when that patient needs it to work, it’s useless and you are impacting that patient’s life. That’s the impact we have from the most robust clinical application, the most inconspicuous piece of technology, like a phone.

Metro Health isn’t solely about I.T. Technology is a vehicle to where healthcare can go, and I’m all about instilling that mission and passion in my folks. In fact, it is hard to get away from that mission. My wife is a provider at Metro and I make the joke all the time that not only do I support end-users at work, I live with one and get intimate insight when/how the technology is helping and sometimes hindering patient care. I can’t escape it nor do I want to. It provides for nice dinnertime discussion.

Campbell: What a powerful message around emotional intelligence and empathy. The perspective you bring is truly inspiring. Thanks for taking time to share.

CHIME Fall Forum Interview Series: Shane Pilcher, CIO, Siskin Rehab

Shane Pilcher, CIO

Shane Pilcher, CIO, Siskin Rehab

The role of the Healthcare Chief Information Officer is changing. Shane Pilcher, CIO at Siskin Rehab, knows it’s important to be on the front lines and understand how every aspect of the organization operates. As Siskin’s first CIO, he paved the way for IT to have a place at the executive table, and now he’s finding new ways to make sure all technology is optimized to fully meet physician needs. In this interview, Pilcher discusses reassessing workflows when implementing new technology, why Siskin needs more than an acute-care-based EMR, and how telemedicine is affecting rehab. He also touches on the CHIME CIO code and the true importance of peer-to-peer connections.

Key Insights

It has been a wonderful combination for the organization, as we’ve witnessed significant growth over the past couple years that I’ve been here. IT has helped enable a lot of that growth, as well as invested significant effort eliminating legacy systems and to update and optimize existing systems.

The longer you spend with any EMR, the more invested you get, and the harder it is to make a change. But, while you get invested with customized content, optimized processes, and those types of things, when you decide to make a change, it’s important to not get caught up in trying to take your old system and fit it into the new system.

We need to spend time looking at how we do our business, optimizing those things, and then wrapping technology around that to enable it.

Not only is that information really important, but the peer-to-peer relationships that you create are critical. You cannot put a dollar value on that, it’s priceless.

I’ll also say, a good resource to have a provider that’s totally against the system as well. Through the process of engaging them, getting them involved, and making them a part of the building process, if you turn them into a supporter, you have a huge resource that will then help the other physician population come on board as well. 

In some cases, I would even suggest that the CIO is very close to having to have the same level of vision that a CEO has in an organization because you cannot focus directly on IT, you must understand the organization as a whole with all of its nuances so that you can help lead them and their technology strategy.

Campbell: Coming from a consulting background, and now working on the healthcare delivery end, you bring a unique perspective to the CIO role. Tell me a little more about Siskin, how you came to be an organization and what your role is today.

Pilcher: We are one of the few remaining, independent, inpatient, acute care, rehab hospitals in the country. We’re just under 200 beds and have been established in Chattanooga, Tennessee for 25 years now. We’re one of the primary sources for rehabilitation care in the area. I came to Siskin in July of 2015.  At that point, they had never had a Chief Information Officer, and certainly IT was never part of the Senior Leadership team. It was a fantastic opportunity to take them down a new direction and finally have IT at the table where decisions were being made and strategy was being developed. It has been a wonderful combination for the organization, as we’ve witnessed significant growth over the past couple years that I’ve been here. IT has helped enable a lot of that growth, as well as invested significant effort eliminating legacy systems and to update and optimize existing systems.

Campbell: Very good. If you’ll allow me to inquire, what are the primary clinical systems that you use today within the organization for EMR and potentially care coordination?

Pilcher: We are a McKesson Paragon shop. We’ve had Paragon in place for a little over ten years now. We are actively pursuing a different EMR, and we’ve narrowed it down to a couple of vendors. We expect a significant EMR implementation in our future within the next calendar year, so its exciting times. Paragon covers most of our areas, especially inpatient care coordination, but we also use an outpatient ambulatory EMR called TheraOffice, it’s one of the few out there that is heavily focused on therapy and rehabilitation care.

Campbell: Thank you for providing background and insight into your pending EMR replacement project. You bring a unique perspective, given that you’re a registered respiratory therapist and served in the United States Navy. Given this, tell me a little bit about how that clinical expertise has benefited you in your career and moving into healthcare information technology.

Pilcher: Absolutely. I have definitely had a varied career path. I do things unusually, in most cases, and my career path is evidence of that. I became a respiratory therapist in the Navy. I spent eight years on active duty and thirteen years in the reserves. After coming off of active duty, I joined Erlanger’s Children’s Hospital in Chattanooga and spent a few years there working as a therapist in the pediatric ICU, the neonatal ICU, the ER, and other areas. They had an opening in the IT department. They were just looking for someone with clinical experience that had an interest in Electronic Medical Records and they were willing and open to train that clinical person to build and optimize the system. So, I found my first opportunity in healthcare IT and spent a few years doing that. I then started consulting, and spent about fifteen years doing that. I was doing all sort of projects from, initially, EMR implementations, optimizations, through strategic planning and interim leadership.

Campbell: That reminds me of the career of Dr. Dale Sanders from Health Catalyst. I attended the Healthcare Analytics Summit a few years back and he talked about applying his diverse career, including command posts at the US Air Force, and how that military background can serve some purpose in offering structure to, what can be, a very overwhelming healthcare IT space, so thank you for that.

Can you tell me a little about any IP you have invested in Paragon today? I imagine having it in place for ten years there may be some technical debt in that system in terms of, perhaps, clinical rules, or documentation. If you could elaborate on the challenges of cataloging those different types of IP in systems as you plan on moving. A lot of healthcare delivery organizations today are moving from a system that is more comprehensive to an Epic or a Cerner, and I assume that is part of your decision making process.

Pilcher: Certainly. The longer you spend with any EMR, the more invested you get, and the harder it is to make a change. But, while you get invested with customized content, optimized processes, and those types of things, when you decide to make a change, it’s important to not get caught up in trying to take your old system fit it into the new system. It’s a beneficial opportunity to be able to reassess what you’ve been using for that period of time and determine if that’s really what you want to bring forward. It also allows for evaluation of established clinical workflows that you’re wrapping technology around. One of the key mistakes that organizations have made for the projects that I’ve been a part of, and even here if we’re not careful, is we try to take a current process and wrap technology around it. If the process and workflow is flawed, or inefficient, we’re just going to exacerbate that and make it worse. We need to spend time looking at how we do our business, optimizing those things, and then wrapping technology around that to enable it.

With Paragon, we have a lot of customized content in it, a lot of our assessments are there. However, because of our unique situation, we are McKesson’s only rehab client, at least up until the last year—I think they got a smaller rehab client that they’ve implemented Paragon with. So, while we have required functionality that Paragon provides us, based on CMS’s Data Regulatory Requirement feature, additional functionality really hasn’t materialized in the last ten years. We’ve had to do a lot of manual processes outside of the system to be able to overcome those gaps. While we have a lot invested in the system, it’s going to be easier for us to make that move than other hospitals only because we’ve had to do so many things outside of the system or used bolt-on third party applications to try and overcome some of the limitations within the system. Now we’re looking for systems with predefined rehab content. We don’t anticipate getting into a situation where we’re the only rehab client that the vendor has, where they don’t have specific functionalities for rehab. That’s due to the fact that while we’re an acute care hospital, we’re also rehab, and we don’t do everything like an acute care hospital does; we need something more than just an acute-care focused EMR.

Campbell: Thank you for elaborating on that. Switching gears, a little bit, can you tell me about your payer base in your market blend, and how that may be unique?

Pilcher: We’re very heavy with Medicare/Medicaid, quite a few of our patients fall into that bucket. We have a variety of other insurance providers, partnerships with organizations as well, for their workman’s comp and other injuries.

Campbell: Is there a good mix of value-based payment occurring, specifically with Medicare Advantage? If so, I imagine there might be a focus for you on HCC – hierarchical condition categories.

Pilcher: I see there being more opportunity. We partner with a few of our referral sources and their value-based programs, but as far as specifically, that’s about the only impact that has with us. Due to our payer process we get daily stipends, if you will, a certain amount of reimbursement per day from our commercial insurance partners and from Medicare. A lot of the value-based purchasing efforts in the acute care hospitals aren’t directly impacting us except as we partner with them to provide care to fit into their value-based purchasing programs.

Campbell: Tying into that, you have a state of the art facility that provides treatment for brain injury and stroke. Do you have any initiatives in place for shifting some of that rehab to home rehab, or incorporating telemedicine, or perhaps patient centered medical home? If so, can you elaborate on that?

Pilcher: The type of patients and the overall population that are presenting to inpatient acute rehab as well as our subacute rehab, is drastically changing. The typical orthopedic patients are being shifted to home health and outpatient therapies, and we’re there to help with that. Inpatient wise, we’re seeing patients with higher and higher acuity levels; they’re sicker than they’ve ever been and require a lot more care. While a lot of the orthopedic and nonmedically significant care is being shifted to home health, our focus has been to ramp up our brain injury, stroke, and neuro programs, as we’re seeing a significant increase in demand for that.  Also, we have patients coming in directly from the ICU requiring rehab, so we’re seeing sicker patients, and many of those that are not being shifted towards the home health and outpatient environment.

Campbell: Thanks for elaborating on that. That’s a very compelling point, you are acute care so obviously you’re going to deal with those who have an inpatient stay. With that said, is it mainly limited to the surrounding areas or do you get out-of-state patients who seek you out because you’re a center of excellence?

Pilcher: We do have patients who come from across the country. The majority of our patients are locally and regionally based. We get referrals from as far as Nashville and Birmingham, but most of our patient population is more local than that.

Campbell: Shifting gears again, what pop health initiatives are in place today? Do you have any care coordination that’s occurring between the acute care setting and home health, easing those transitions of care? Are there initiatives in terms of referrals and/or handing off your portion of the patient record, perhaps through an HIE or any other means?

Pilcher: All of that is in transition at the moment. We have some coordination with our two largest referral sources, the two largest hospitals in the area. They have some specific population health initiatives that we factor in with some of their patients. For some of the orthopedic patients that are not candidates to be discharged, we have programs with organizations to bring them into our organization. As far as very formal sharing of information, that’s not happening much in this area yet, but our two largest referral sources are in the process. One just went live with a new EMR that would give them that ability, and another one is planning on doing it shortly and would change out their system to a system that would support sharing of data. Then, of course, with ours, that’s a key component to whatever system we put into place, to greatly enhance the sharing of data in our area. As far as a formal HIE, that’s not present.

Campbell: Great. I want to touch on your experience at CHIME as well, and gather some of your impressions from it. I know I personally valued the new clinical informatics track this year, which focused on the topic of physician efficiency and engagement. If you could elaborate on your goals with going to CHIME and how you may approach EMR replacement based upon things you may have learned at CHIME, specifically getting clinicians to use a new system and learning the nuances of that.

Pilcher: I think CHIME is an invaluable resource to CIOs in our market space. I was actually part of the planning committee for the fall forum this year, so I’m very pleased to hear that you liked what you saw. We spent a lot of time trying to make sure that the educational content contained value and I certainly think it did. Not only is that information really important, but the peer-to-peer relationships that you create are critical. You cannot put a dollar value on that, it’s priceless. It’s those individuals that are willing to take your call at a moment’s notice so you can bounce an idea off them, and determine how they handled things. When I was transitioning from the consulting side to the CIO role, there were numerous CHIME members that I had developed relationships with over the years, and they were readily available for me to call at any time—and believe me I did—to be able to get advice from. That’s something that, while we get hundreds of calls a day, and can’t take them all, if a CHIME member calls another CHIME member, that call is usually taken. I really value that with our fellow CHIME members.

Being able to get information on how they engaged their clinicians is key because, as we know, that’s not an easy population to have completely adopt an EMR platform, and having them engaged is critical. My advice is that engaging clinicians from the beginning, early on, and frequently throughout the process is a key piece to that adoption. They have to understand that the EMR doesn’t always bring efficiencies, like it was once touted. In some cases there are some, but it usually takes physicians longer to do what they need to do versus when they did it on paper. Understanding why we’re doing it, the safety implications that come from it, and then making sure that they’re part of the process of designing the system that they’re going to use is key. Finding a physician who is leaning towards being able to use the system well is a good resource to have. I’ll also say, a good resource to have is a provider that’s totally against the system as well. Through the process of engaging them, getting them involved, and making them a part of the building process, if you turn them into a supporter, you have a huge resource that will then help the other physician population come on board as well.

Campbell: That’s a great point, to focus on those outliers and not necessarily the low hanging fruit. I agree with your sentiment around CHIME, and kudos to a job well done coordinating that event. Like I mentioned, I witnessed CIOs who are always so gracious with their time. There’s just a deep amount of trust built up among peers and that’s invaluable especially when you’re in a tough position. As you mentioned, the healthcare CIO position today has morphed, as they are the quarterback and the glue within the organization to tie information technology to administration to. I’ll also mention too that the session Bryan Bliven and Dr. Tom Silva from Missouri Health presented was profound. They shared key insights with the way they engaged physicians, making sure that there’s rounding occurring, ensuring there’s -training that is occurring right across from the break room. Those pragmatic and novel approaches were well received.

Pilcher: I completely agree with you on the rounding part. As a CIO, you cannot stay hidden. You have to spend your time out there and that’s where you are able to develop a lot of trust with your end users and not just your senior leadership team. It can be kind of scary and dangerous to get out there because you’re going to hear what doesn’t work, but if you’re committed to getting it fixed, rounding is huge. Just to follow-up on what you were saying, as far as the transitioning of the CIO role, I know a lot of those educational tracks dealt with the transitioning of the CIO and the role we play. In my opinion we are one of the few leaders on the senior leadership team that truly has to understand every business sector of our organization, every business line – understand what they do, how they do it, why they do it, where their pain points are – so that we can then help them put technology around that. In some cases, I would even suggest that the CIO is very close to having to have the same level of vision that a CEO has in an organization because you cannot focus directly on IT, you must understand the organization as a whole with all of its nuances so that you can help lead them and their technology strategy.

Campbell: Absolutely. It must be multidisciplinary, and you must be able to fortify partnerships with your clinician peers. Thank you for sharing these cogent insights and for providing sage advice.

About Shane Pilcher

Shane has more than 25 years of healthcare and healthcare IT experience. He brings to Siskin Hospital his strong healthcare, military and corporate experience in leading teams to align IS strategy with corporate strategic plans.

Shane became a Registered Respiratory Therapist in 1995 while in the United States Navy where he served as a Respiratory Therapist, Navy Corpsman and EMT. In 2003, he converted to an Intelligence Specialist where he served time in Iraq and was the leading Chief over the Naval Intelligence Reserve Region Southeast’s Reserve Intelligence Training program. Shane retired as a Chief from the United States Navy with more than 20 years of active and reserve service. He has also received his Fellowship designation from Healthcare Information and Management Systems Society and holds a BS in Business Administration.

 

CHIME Fall Forum Interview Series: Doug Dietzman, Executive Director, Great Lakes Health Connect – Part 2

This is the 2nd part in a two-part interview. Read part 1 here.

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.

The establishment of patient identity needs to originate at registration within the provider organization, where care is being delivered.  It will always be more difficult and messy to fix it on the backend.

We need industry consensus around a single security certification process that will satisfy all healthcare participants. 

As a neutral community-focused organization, HIEs sit in the middle of the health plans, hospitals, primary care offices, public health, and all the other physical, behavioral and social service organizations involved in healthcare.  There are compelling reasons why and simple ways how these industry stakeholders can all work together to do the right thing for the people we all serve.

Campbell: I’m going to shift gears, to a topic that’s of interest to a large audience, and certainly has a lot of differing opinions and confusion around it: Patient Identification. What I’d like to get at is how that’s managed within the HIE today, what tools you might leverage, what ideas you have. Mike Gagnon, from Nevada HIE, spoke about some of the vendors he’s talked to about facial recognition, as that’s become more ubiquitous, and whether it’s on private industry to solve, or the responsibility of government. Keeping politics aside, I’m more interested in how it’s technically facilitated at Great Lakes Health Connect and some of the advanced things you’re doing in that regard. Could you touch on any patient matching issues that you may have, and how those are automatically or manually resolved?

Dietzman: I don’t know that we’re doing much that’s different from everyone else.  Medicity remains our virtual health record platform; the MPI that we’re using is through them as well. We don’t have resources dedicated to maintaining or fixing patient identity issues, as we don’t encounter a great deal of those issues on a daily basis. As such, from an administrative and use standpoint, what we’re hearing from our customers is it’s not a huge problem that’s getting in the way of what they need to do. There’s a lot of work we can do in the HIE that doesn’t even require an MPI to be involved in the first place. We do have an analytics environment where we’re doing some patient matching for those purposes, but overall, not a huge issue for us.

It’s interesting that some are trying to solve the problem on the backend. It seems to me that when we talk about patient identity, it needs to originate and start at the registration within the provider organization because that’s where the care is being delivered. If we’re trying to fix it on the backend, it’s always going to be more difficult and messy. In my mind, we’re giving the wrong people the wrong care, potentially, if the patient is misidentified. Palm scanners, facial recognition, and other biometric devices would be the easiest way to solve this. From a social standpoint, there may be some problems with that. We need to make sure we’re treating the right person at the point of care. If we’ve accurately captured it at that point, the backend reconciliation should be much more straightforward. As such, I don’t see this necessarily as an HIE problem.

Campbell: That’s a great perspective. Thank you for sharing. Switching topics again, SHIEC held an annual conference at the end of August, and I was curious of insights gleaned and takeaways from the event.

Dietzman: I’m on the board of SHIEC (Strategic Health Information Exchange Collaborative), and was recently re-elected to a second term, so I’ve been involved with the organization for a while. The conference itself was great. The conference was bigger than the year before. I was encouraged by the energy and the sharing of ideas. It wasn’t just about us getting together and drinking our own Kool-Aid. The ONC was there for all three days, and a number of vendors came to show their support, and have meaningful conversations with the group, which was great. I heard a lot of positive feedback on the quality of the content and conversations. I thought it was another good step forward for the organization. We’ll have some big expectations to fill next year down in Atlanta.

Campbell: That’s fantastic. What were the themes that dominated the event and what problems were tackled at this year’s conference?

Dietzman: Patient Centered Data Home (PCDH) was a big topic; specifically how PCDH can serve as a mechanism for how we can connect SHIEC Member HIE networks on a national level. This was important conversation for helping people understand how SHIEC Member organizations are demonstrating success within our regions. Another was a series of updates on how various organizations are doing things. For instance, Dan Chavez of San Diego Health Connect led a session on how his group is supporting emergency medical services, and how other HIEs can replicate their program. In the breakouts, there were a lot of topical presentations that gave provided ideas and helped us understand behavioral health use cases. Some of the folks from the Nebraska Health Information Initiative (NeHII) shared what they’re doing around prescription drug monitoring programs (PDMPs) with controlled substances and medication databases. Exchanging ideas, collaborating, and being able to have meaningful conversations with industry peers is always helpful.

Campbell: Thank you for elaborating on that. Sounds like it was an invaluable event. I look forward to next year’s conference. That said, I always like to weave in practical stories of use cases where they’ve been impactful. I know you probably share those among staff to develop an understanding of the true impact of the HIE. If there’s one that comes to mind that you could share with us about how Great Lakes has made a difference in the lives of patients that would be great.

Dietzman: Let me give you two quick ones. We’ve been working with a community mental health organization here in Michigan, over towards Ann Arbor, and their use of our Virtual Integrated Patient Record (VIPR). We’ve been challenged with the consent laws and other legal frameworks to accept behavioral health data into our virtual health record. What we did in this case was to make sure their behavioral health care workers were provided with physical health information on their patients. There is no regulatory restriction there, and having access to that information informed their ability to care for the folks they were seeing in the CMH. The Director, Mike Harding, talked about one particular lab test that they would order on a regular basis for their patients. Once they gained access to the community health record, they could see the results of past testing, eliminating the need to run an additional panel. He estimated that their organization was able to eliminate about 200 tests a month because the necessary results were already in the record. This translated to a savings of $72,000 a year for them!

The other example is a center in Grand Rapids that works with a complex population; folks that have physical, behavioral, substance abuse, or other issues that drive frequent visits to the emergency room. We implemented the community health record with them as well. Their workflow and process was for the entire staff to meet as a team first thing in the morning, before patients started arriving. They could then review the records of everyone scheduled for that day to get a sense for each patient’s status and needs. On one occasion, a woman was scheduled for an appointment, and had requested a referral for a CT scan to help identify the cause of some head and neck pain she was experiencing. When they looked in her record, they realized that the previous week she had presented to all three emergency rooms in town on successive days, and had received CT scans during each visit! On one hand, this is not a great story. It highlights the work we have yet to do to inform different care settings and avoid unnecessary, redundant, and potentially dangerous treatments. But also, in this case it empowered those providers with the information they needed to intervene and quickly identify that there was something more going on with this patient. They were able to bring behavioral and social resources to bear on her behalf, and address the root cause of her complaint, rather than continuing to blindly treat the symptoms of her complaint.

These are just a couple of examples of how tools provided by the Health Information Exchange are being used to help people do things differently.

Campbell: Great, thank you for sharing those. Wrapping things up, I know earlier in the year you received a HITRUST distinction for security and privacy and that’s a topic that you take very seriously as an HIE. Could you touch on that topic, maybe conversations at SHIEC to that regard or any insights or points you want to make, regarding security and how that’s managed, and how you continue to evolve, as cyber threats manifest?

Dietzman: GLHC has a responsibility to be just as diligent about data security [if not more-so] as any of the large health systems that we work with. Gaining the HITRUST designation provided us with the assurance that we’re doing the right things where security is concerned. More importantly, this demonstrates to our participants that we can pass that highest level of scrutiny from an independent third party organization, considered the gold standard in this area. It doesn’t guarantee anything. As you said, the threat changes on a continual basis. But HITRUST shows we’re doing all we can to stay in front of those threats. One of the challenges, and some of the conversation that we’ve had within SHIEC and elsewhere, is the lack of a standard industry-wide security certification. There are some health plans, for example, that require HITRUST while others say HITRUST isn’t sufficient and require a different certification. HIEs are in a position, depending on their participants, to have to “check all the boxes” in order to be compliant. This is very expensive, and frankly not realistically possible. So, from an industry standpoint, I’d love to see some kind of coalescence around a particular security standard that we could all align behind. It’s not the security requirement that’s hard, they’re all essentially the same. Going through the process multiple times is a challenge. Having to do it six to eight times to get through all the different varieties is exhaustive.

Campbell: Certainly, there’s a lot of effort that’s involved in penetration testing, just to ensure you’re whole and don’t have any paths to exploitations. One topic that we didn’t touch on that I’d like to conclude with, is a little bit of bio about yourself, how you came to Great Lakes, your background, and how you got into healthcare IT.

Dietzman: Well, I got into it by happenstance. When I graduated, my dad was in retail and I went to work for a retailer for about a year, then I moved to another part of the country and got linked up with Anderson Consulting. When I showed up, I was a green rookie, and they said, ‘you know what, we need people that can breathe down at Aetna in their employee benefits division,’ and I qualified. I started working on some projects there, doing PowerPoint presentations as a young guy, and at some point the partner came up, after a little bit, and said, ‘you know what Aetna’s buying these things called HMOs down in Texas, we’re not sure what this managed care thing is, so go down, spend 30 days in the library and learn everything you can about managed care and all these terms that they’re throwing around and come educate the rest of the team so we can provide better service.’ And I did, and once I spent 30 days pouring through the details of the industry it kind of became my thing. I was hooked.

I spent most of my career, from that point, in managed care, mostly in health plans. I worked for a couple different health systems serving in different capacities: Project Management; IT; Management Consulting. I then worked with Spectrum Health, in Grand Rapids, MI, helping them develop connections to the providers in the community, delivering results and doing other things that they needed. A conversation started with other hospitals in town who were using the same technology about how we could do things better and collaborate around this clinical data exchange. They asked me to facilitate the conversation and then, once we decided to become a real entity and incorporate in 2010, they asked me to lead the effort and see if there was a business model and how the organization would go forward from there. It was just me, and so from 2010 forward it’s just been growing one person at a time, to try and solve problems, and figure out how we can build a model that will sustain itself. For me it was cool, I’d been in health plans, I’d been in hospitals, I’d been in primary care offices. It seemed to me that there was a way for all three legs of that stool to work together in a way that could advance healthcare outcomes. As an exchange, we get to sit in the middle and work with all the legs of the stool to figure out how we can share data and do the right thing for patients. It’s a great way to bring all of that experience together.

Campbell: That is so profound. Thank you for sharing. It’s always fascinating to learn of the turns and twists in someones career, and how that shapes, not only who they are, but the organizations that they lead.

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