CHIME CIO Fall Forum

Health IT CIO Interview Series: David Muntz, Principal, StarBridge Advisors, LLC

StarBridge Advisors provides interim management, advisory services, IT consulting, and executive coaching. Their approach is described as “practical unbiased, open, and plain speaking with frank and honest opinions offered based on real-world experience.” We had the opportunity to speak with Sue Schade, Principal, a year after StarBridge had formed, and while at the 2019 CHIME Fall Forum, David Muntz, Principal, graciously sat down to speak with us about how the firm has grown and evolved.

Key Insights

Our philosophy is that the best way to get future business is to do a great job and produce high quality work for the engagement and tasks that are in front of you.

Experience has taught me the importance of two concepts – patience and serendipity.

The role of healthcare CIO has evolved from a traditional one responsible for setting up network infrastructure and providing back-end support to a data-centric role more focused on information science

Campbell: Leading a firm of C-suite consultants likely comes with its fair share of challenges. Managing any consultancy must address utilization of staff, management of a bench and tending to the specialties, strengths, and fit of staff to engagements. How does StarBridge manage these potential challenges? How are you different from healthcare CIO placement firms?

Muntz: The company structure consists of three principals – Sue Schade, Russ Rudish, and me – and 30 interim CIOs operating as independent LLCs. In this model, we don’t have to worry about a bench as each advisor serves as its own subsidiary. Our philosophy is that the best way to get future business is to do a great job and produce high quality work for the engagement and tasks that are in front of you. If our staff had to also worry about their next engagement, and prospecting for new opportunities, they wouldn’t be able to devote their all to the task at hand. We encourage our folks not to look up, but look down, and focus on doing an outstanding job for the work that they are currently contracted to do. As they say, god bless the crooked road – best to live it more and plan less.

Campbell: Isn’t that a saying to live by! That is a great approach and we can appreciate the methods you’ve used to mitigate bench risk, but also to ensure your advisors are focused on providing a superior experience to the clients you partner with. Tell me more about how you leverage that experience to coach and mentor the next generation of CIOs and provide advice to your peers.

Muntz:  Experience has taught me the importance of two concepts – patience and serendipity. I’ll share a story from my time as CIO at Presbyterian Healthcare System in Dallas. We hung a banner with “Patients First! Patience Always!” in the data center. The intent was to inform or remind everyone who entered where to focus and how to conduct themselves. We needed this anchor to help steady us in the turbulence that defines our workplace. Technology is a contributing factor and when we are stressed, we are not as cool as we want to be or should be. Along those same lines, I used to teach the CHIME boot camp and would impress upon candidates that serendipity, luck to some, opportunity to others exists in great quantity – most people are surrounded by it but can’t see it. The point is that nobody can read minds and unexpressed opinions are awful. When providing staff with career planning, it’s important to encourage expression of interest where it will be met, being direct, but respectful as well. Folks in IT tend to be introverted and shy. As a leader, we must pull it out of them to let them express themselves, but not be too judgmental in response. A question often serves better than a quick response, such as, why did you make that statement? A lot of strong leaders will ask why an employee came to a particular conclusion. This helps to protect the integrity of the individual and encourages everyone to be more open. Moreover, it’s important to know your audience and when it is appropriate to open decision making up to a group. The wisdom of the group often coincides with my thoughts and sometimes convinces me to seek a different path.

Campbell: This speaks to the culture you foster at StarBridge. Can you elaborate on how you ensure your staff has a sense of fulfillment with their work and how you go about assigning advisors to particular engagements?

Muntz: Honestly, I see our organization as a lifestyle company. There must be a good life-work balance. As such, the other principals and I play the role of matchmaker. We have to manage the profile of the organization when placing interims and advisors and identify where there would be good chemistry. Organizations should be very careful in picking their clients to make sure they are the right fit. We’ve been fortunate in getting the clients we work with. Not everyone you dance with is going to be the one you marry.

Campbell: As you manage a team of CIOs, how do you see the role changing going forward? How are you preparing your team to adapt to ensure they are best suited to meet the needs of the organizations you partner with?

Muntz: The role of healthcare CIO has evolved from a traditional one responsible for setting up network infrastructure and providing back-end support to a data-centric role more focused on information science and digital health. In addition, new titles are appearing in the C-suite: CAO (analytics), CDO (digital), CHIO (health). CIOs who evolve and collaborate will succeed. Those who cannot will be replaced or find themselves reporting to someone else in the C-Suite or to one of the titles that traditionally reported to them. As such, we underscore the importance of collaboration, coordination and communication to our advisors.

David Muntz is a Principal at StarBridge Advisors, LLC. David began his career as a biostatistician, then became CIO, and ultimately rose to the position of CEO at Wadley Research Institute and Blood Bank in Dallas, TX. He returned to health information technology at Texas Health Resources, where he functioned as SVP & CIO for 15 years. He then worked for 5 years as the SVP & CIO at Baylor Health Care System. In 2012, David accepted a White House appointment to serve as the first Principal Deputy National Coordinator at ONC (Health and Human Services’ Office of the National Coordinator) and was also Chief of Staff and CIO through 2013. David returned to the private sector as CIO of GetWellNetwork through 2015 where he served as a member of the Board of Directors until its sale in 2018. During his career, David has served on 22 other Boards.

In his career, David has led talented teams as large as 770 with budgets of more than $500M to author, acquire, and implement many forms of health information technologies including EHRs from all the major vendors. Under his leadership, his teams managed more than 180 project go-lives annually. Due to his teams’ efforts, he was honored as CHIME’s Innovator of the Year for his achievements with two different employers. His organizations were recognized nationally for innovation in information technology for more than 25 years in a row including his time in the federal government. In 2014, the CHIME Board presented him its CIO Legacy Award.

David has served on the SMU, TCU, UTD, Most Wired, and many other Advisory Councils and Boards. He is currently an Adjunct Professor in the Baylor University EMBA program. He has Fellow and Life status at CHIME where he served on the Board and led Advocacy efforts. He holds the CHCIO (Certified Healthcare CIO) credential from CHIME. He has also been active with HIMSS at all levels and enjoys Fellow status.

David received an MBA from Southern Methodist University in Dallas, Texas and an AB from Columbia College in New York City. David attributes his accomplishments to collaboration with incredibly talented people and strong support from his family.

Health IT CIO Interview Series: Jorge Grillo, AVP/CTO, HonorHealth

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any other agency, organization, employer or company.

Jorge Grillo is perhaps best known in healthcare information technology circles for his MEDITECH 6.0 diary series on healthsystemCIO. After many years as CIO of Canton-Potsdam Hospital, a 99-bed hospital located in northern New York state, just south of the Canadian border, Grillo now serves as AVP/CTO at Honor Health, a $2B non-profit and community focused health care system in metropolitan Phoenix. In this interview, Grillo discusses the transition from CIO to CTO, his perspectives on prioritization of applications as part of decommissioning, and his broad view of the healthcare marketplace in light of increased consolidation.

Key Insights

In a non-healthcare environment, the CIO is responsible for daily ops while the CTO is responsible for deciding what tech to invest in. However, in healthcare, the CIO is the strategist and the CTO is the operationalist.

Aged technology is one of the factors that impact the high cost of healthcare. From my perspective, every organization has legacy hardware, applications, and data.

If there is in fact a broad move to a form of socialized medicine, payers will be under pressure to diversify into the provider and care delivery arena.

Campbell: After a decorated run as a CIO and MEDITECH 6.0 evangelist at Canton-Potsdam Hospital, you are now with HonorHealth in a slightly different role, as CTO. Can you explain the difference in the two roles, specific to healthcare information technology? How has the transition gone?

Grillo: The hardest transition is from a CIO to a CTO. I certainly benefited from experience from a former CISO role. In a non-healthcare environment, the CIO is responsible for daily ops while the CTO is responsible for deciding what tech to invest in. However, in healthcare, the CIO is the strategist and the CTO is the operationalist. For healthcare specifically, in terms of a military analogy, the CTO is the general in charge of defining strategy and the CTO is the tactician for that delivery. Thereby, the CTO is responsible for legacy debt remediation and technically enabling transformation in the interest of transparency and enhanced patient experience.

Campbell: Speaking of the technical debt that legacy systems present, can you elaborate on your experience with enterprise portfolio management? Are you currently going through this exercise in your new role as CTO?

Grillo: Aged technology is one of the factors that impact the high cost of healthcare. From my perspective, every organization has legacy hardware, applications, and data. We do in fact have an EPMO initiative in progress to retire legacy systems but retain legacy data. We have a cross-disciplined team that focuses on three main factors – retention, access, and compliance. There are many different categories of applications, and the retirement strategy pursued must make sense for the data associated with an application. As such, we have a three-fold strategy we use: First, use VMware to virtualize the application and make it hardware agnostic. Second, use a data archiving platform. Third, put it off network or inoculate it.

Campbell: You mention many categories of applications. How do you go about prioritizing which applications to decommission?

Grillo: First and foremost, it comes down to how long the data must be retained, which for the patient legal medical record, of course, varies from state to state. An analysis of which data needs to be kept must be performed, and it really boils down to a risk analysis. What are the odds that the data will be needed, and in what timeframe will it need to be furnished, balanced against the regulatory requirements associated with that? As part of the analysis, you must determine where you invest cycles and storage. An application is much more likely to be sunset if it is outside of core applications.

Campbell: Shrewd insight in that risk and compliance play just as much of a role in system retirement as HIM and clinical ops. Looking outside of your organization, what are you seeing in the broader marketplace? From your viewpoint, is the exercise of application portfolio management and legacy system retirement pervasive throughout the industry?

Grillo: In my opinion, we are seeing rural and critical access hospitals – smaller hospitals – that can’t afford integrated electronic medical records. As such, they are prime for getting bought, or seeking a hosting arrangement with a larger entity – especially with the rise of Cerner CommunityWorks and Epic Connect. We are also witnessing attrition of hospitals – if they don’t serve as a community safety net, they are not always going to be bailed out by the state. Moreover, the big have gotten bigger. Five years ago, a $5B system was probably ripe to get bought. The threshold has increased, so now it’s a $12B system that is ripe to get bought. This is an artifact of continued consolidation.

Campbell: Certainly. Consolidation is part of the maturation of any market to deliver efficiencies. What is your broader view of the healthcare marketplace in light of consolidation?

Grillo: Well, you are starting to see the insurance industry and other industry verticals (like Amazon) get into the healthcare delivery marketplace, buying hospitals to get at the data. An advantage of an insurer owning the hospital is that they may not have to negotiate rates, its part of the contractual basis. Geographically, insurers have the footprint to make an impact, and with more data, actuaries can improve wellness across the board. Of course, also affecting the insurers’ approach, this being an election year, it could very well be that we see some form of socialized medicine, and, as a result, a change in reimbursement models. Because of this possibility, insurers are investing in the provider space more and more because they are sitting on cash. If there is in fact a broad move to a form of socialized medicine, payers will be under pressure to diversify into the provider and care delivery arena. Payers will also look for ways to stay solvent by reducing rates and increasing transparency. We are already starting to see early movers, but it’s still predicated on the result of the election and policy that may emerge.

Jorge Grillo is AVP/CTO for HonorHealth, a $2B non-profit and community focused health care system in metropolitan Phoenix with 5 (soon to be 6 hospitals), encompassing more than 3,400 expert physicians, 11,600 dedicated employees, and more than 3,000 caring volunteers working in partnership with a commitment to wellness management. Prior to joining HonorHealth, Jorge was CIO at Canton-Potsdam Hospital, cited by Hospitals & Health Networks for being among Healthcare’s Most Wired hospitals in 2017. Prior to joining Canton-Potsdam in 2010 he served as CIO of the Bermuda Hospitals Board for four years. Grillo has written about the Canton-Potsdam’s Meditech journey, his experience working overseas, and the evolving role of the CIO, among other topics.

HealthIT CIO Interview Series – Harun Rashid, VP of Information Services & CIO, Akron Children’s Hospital

Harun Rashid is passionate about the impact of health information technology for pediatric care, and sees his position being extremely rewarding in improving quality and safety, patient satisfaction, innovation and outcomes. In his past role at UPMC, with the help of telemedicine, he brought the level of care that healthcare delivery organizations were able to deliver domestically to other countries. He’s also leveraged patient engagement technology to reduce administrative burden on nurses and transform the pediatric waiting room experience at the hospital. And while he gets excited in delivering impactful technology to healthcare, he understands the huge concern of cybersecurity threats and the vigilance required to ensure the organization is in a defendable position to protect its assets, people and patients. In this interview, Rashid discusses physician burnout and efforts underway to evolve the EMR past being a billing system to be more intelligent and allow caregivers to make decisions properly, reducing alert fatigue, and enabling them to focus on the highest risk areas. He also discusses how population health management is very much front and center and initiatives in progress to incorporate Social Determinants of Health (SDoH) to identify community resources and amenities available to patients.

Key Insights:

I learned a lot from that experience as a data processing operator, running the back-end systems for a hospital in Meridian, Mississippi. You name it, I did it – the applications, load disks and tapes, run mainframe jobs, print patient bills, endpoints, and reports. I witnessed first-hand the complexity that is involved in running a hospital. EHRs were only used in less than 30% of hospitals in US at that time. Most non-healthcare businesses have maybe ten to fifteen systems they are running, whereas that is representative of just a particular department (i.e. laboratory, cardiology) in healthcare.

As with most healthcare delivery organizations, population health management is very much front and center for us, specifically with PCMH (Patient Centered Medical Home). Epic’s Care Everywhere plays a role in facilitating healthcare interoperability and the exchange of information between different institutions. It has alleviated the need for request for records, which in the past were delivered via fax or mail and were incomplete. It’s also allowed us to have a broader view of the patient’s medical history so that the appropriate level of care can be given regardless of how the patient has transitioned in or out of our hospital.

We can do a lot of the service recovery through patient engagement in the hospital if they have a negative experience. We are creating environment that is different, where we are leveraging patient engagement as a distraction technology to focus on the wellness aspect.

I’m a big believer that within five years or so, basic care will be given everywhere except in patients offices. There will be virtual care, patients will go to CVS or Walgreens to get their flu shots, maybe even for a well visit checkup. We’re really going to decentralize the model of care and the future of medicine as we know it is going to be very different in the next five years than it is today, especially with artificial intelligence, chat-bots, and virtual care gaining traction.To make matters more complicated, on one hand, the government and other entities say you need to share information, but on the other hand, if you have a breach, you  may be penalized severely. It’s a double-edged sword as you want to enable interoperability and health information exchange, but on the other hand, you have a responsibility to make sure that it is highly secure. It’s a challenging time when it comes to security and sharing, and we just have to find that happy medium.

Campbell: You have a very decorated background, as you’ve served in leadership capacities at Children’s Hospital of Pittsburgh of UPMC (University of Pittsburgh Medical Center), Rush Health Systems, Gateway Health Systems, Jefferson Regional Medical Systems, and now at Akron Children’s. With this background, can you tell me a little bit more about yourself and how you got into healthcare information technology?

Rashid: Right out of college, my first job was in healthcare and it was unbeknownst to me to at the time that I would be in healthcare for such a long time. I learned a lot from that experience as a data processing operator, running the back-end systems for a hospital in Meridian, Mississippi. You name it, I did it – the applications, load disks and tapes, endpoints, print schedules and bills, run mainframe programs, and reports. I witnessed first-hand the complexity that is involved in running a hospital. Most non-healthcare businesses have maybe eight to ten systems they are running, whereas that is representative of just a particular department (i.e. laboratory, cardiology) in healthcare. I learned a lot from that experience and it helped me grow within the organization to be Director of IT within four and a half years.

I subsequently took on a role at Gateway Health Systems in Clarksville, Tennessee and one of my chief responsibilities was the evaluation of an EMR and PACS solution. We put in place the first EMR and PACs system at the organization, which came with a lot of challenge. For instance, we had a radiology department that wasn’t fully bought-into a digital PACS. They hadn’t embraced technology, as films were the way they had done things traditionally and weren’t trained to leverage the technology or have IT so embedded in radiology systems. They came on board over time and loved it once we were live, ultimately taking control and ownership of it.

And so, the journey took me from there to doing Health IT strategic consulting, which allowed me to see the other side of how healthcare operates. Not with the day-to-day operations but looking at it from a strategic perspective as a consultant, helping CEOs and CIOs understand how to do analysis and strategically position IT to leverage its value to meet business objectives. A core philosophy I’ve always held is to align IT strategies with organization-wide strategies to make sure IT is supporting organizational mission and vision.

Campbell: You’ve also led the expansion of Children’s Global Health Program (Children’s Pittsburgh of UPMC) in several countries including Colombia, Mexico, Ecuador, Brazil, Kazakhstan, Dominican Republic, and the Middle East. Can you elaborate on your role with that organization and how it got you to your current position at Akron Children’s Hospital?

Rashid: When I joined UPMC, I started out as the CIO of Children’s Hospital of Pittsburgh that subsequently grew into managing the Children’s international program. I helped build their telehealth program in several different countries that allowed us to manage intensive care units or see patients in ICU units directly from Pittsburgh, without having to put physicians on the ground. It was a groundbreaking initiative, because at the time in 2010, physicians domestically didn’t view telemedicine to be revolutionary, and looked at it as unnecessary, thinking that patients preferred in-person visits.

I subsequently moved from that role into a corporate role, serving as Vice President for International Business Development and Telehealth at UPMC. My focus was going around the world and working with other health systems or government agencies to embed healthcare solutions or healthcare practices that would be at the level of standard that is in the United States. A lot of these government agencies or private entities were looking for partners to identify how they can improve their healthcare through utilization of U.S.-based physicians and using U.S.-based protocols in their local community to improve outcomes. We partnered in two ways – some physical presence on the ground, and through telemedicine as a vehicle to improve the outcome for transplant, oncology and other disciplines that were lacking in those countries. Instead of sending those patients overseas for treatment, we attempted to keep them in the community and only bring them to UPMC should they need care beyond what is possible locally.

This experience helped me tremendously in that it enabled me to better understand how to use technology to leverage the gaps in those communities, and how to take what they had in terms of EHR or other functions and bring that back in a fashion such that we’re able to integrate that into our guidelines and protocols. What was revealing was that most people thought that countries like Ecuador and Colombia were looking for high-end, specialty medical care, and they instead were looking for basic medical care and support. To provide a higher level of care, coordination was needed and so we performed physician technical training via video conference or other mechanism that IT setup to be able to enhance the experience. Through this use of telemedicine, our physicians were able to reduce post-surgical mortality by 8%-12% over the course of 24 months in Brazil and Colombia.

I then came to Akron Children’s Hospital, which is a very progressive, the largest independent hospital in north-east Ohio. Our organization has an end-to-end Epic EHR product and we have a vision of growing our IT to be the gold standard of the industry. I came here and along with our executive team, put the vision together to identify how we could leverage IT to meet the strategic goals of the organization.

Campbell: Speaking of achievement, you led Pittsburgh Children’s to HIMSS EMRAM Stage 7, the first pediatric hospital to achieve that and are on course to achieve the same at Akron Children’s What’s been your approach to physician adoption in leading the organization to that standard?

Rashid: We were awarded the HIMSS EMRAM Stage 7 at Akron Children’s in October.  I’ll talk about the methodology used when Pittsburgh Children’s went through the HIMSS EMRAM stage 7 journey in 2009. Things were very different back then. The goals and protocols were very different. It was more about the ability to digitally convert information from paper and certainly more focused on CPOE adoption. The requirements are much more stringent now. There were a lot of nursing adoptions and physician collaboration that needed to take place to be able to demonstrate that we were working as cohorts in improving the care of the patients, and quality and safety. There is continuous collaboration between IT nursing informatics, physician informatics, IS, and other departments. Analytics and innovation play a key role in the current requirements for a successful adoption.

Campbell: Outside of EMRAM criteria, a large area of focus in the move from fee-for-service to value-based-care, and certainly a focus of healthcare policy, is interoperability. In terms of facilitating care coordination through interoperability, can you touch on how you connect with affiliate practices in the community?

Rashid: We have a referral network of affiliated practices, some of which have a robust EMR, where we’ll offer them the opportunity to connect with Ohio’s HIE to get our data and vice-versa. If the practice is a standalone independent physician practice, we work with them to determine if they are interested in the Epic Community Connect Model supported by Akron Children’s Hospital IT. There are a few that are still using fax, which we are trying to move away from and connect them electronically.

Campbell: Population health is most certainly a part of the care coordination strategy. Could you touch on population health initiatives that are taking place within the hospital and particularly use of Epic’s Healthy Planet? Are there subsets or niche areas of PHM that are a specific focus for you, perhaps with the use of social determinants of health?

Rashid: In terms of social determinants of health, we recognize that 52% of our patients are Medicaid patients. As such, its critical for us to have insight into the social determinants for those patients and have a better understanding of how to address some of those elements where there are gaps. Our VP of Population Health, Dr. Steven Spalding has been working with other organizations, health systems, and community sites to make sure that patients have awareness of and access to the resources available to them, whether they need transportation, food, home care, shelter, etc. We recently adopted a system that allows us to identify community resources and amenities available to patients electronically. Our care coordination group uses the system to connect with those community organizations so that the patients are getting the proper level of support when they go back to their homes and communities.

As with most healthcare delivery organizations, population health management is very much front and center for us, specifically with PCMH (Patient Centered Medical Home). Epic’s Care Everywhere plays a role in facilitating healthcare interoperability and the exchange of information between different institutions. It has alleviated the need for request for records, which in the past were delivered via fax or mail and were incomplete. It’s also allowed us to have a broader view of the patient’s medical history so that the appropriate level of care can be given regardless of how the patient has transitioned in or out of our hospital.

Campbell: That point really resonates and is common to those healthcare delivery organizations taking part in PHM initiatives. You’re able to segment out those who may be at risk and assign them a care coordinator who identifies community groups and resources publicly available to them, and potentially prevent the patient presenting in a high acuity setting.

Rashid: That’s the thing. If we intervene ahead of some serious adverse event, we’re going to be able to do just that. That’s where telemedicine and other vehicles come into play, providing the ability to address the at-risk population and enable consultation for prevention. I’m a big believer that within five years or so, basic care will be given everywhere except in patients offices. There will be virtual care, patients will go to CVS or Walgreens to get their flu shots, maybe even for a well visit checkup. We’re really going to decentralize the model of care and the future of medicine as we know it is going to be very different in the next five years than it is today, especially with artificial intelligence, chatbots, and virtual care gaining traction.

Campbell: Absolutely and that decentralization would seemingly magnify the importance of centers of excellence in providing specialty care, whereas more general care is being commoditized. Shifting topics, how is technology playing a role in patient engagement efforts at your organization?

Rashid: We’ve delivered real-time integration with the EMR and caregiver, allowing the patient to engage with the care team to understand and identify ways to engage each other. We partnered with TVR (PCare) to manage our patient engagement. For instance, let’s say we have a child that presents at the hospital with asthma. We provide waiting area engagement such as TV, gaming, and a tablet for the parent with PCare on it. Based upon admission diagnosis of the patient and predefined guidelines from clinicians, the system can send videos that parents can engage in, so they can assist in better care of the patient once discharged. Once they do those things, that information can automatically be fed back into our EMR, thereby minimizing the amount of time the nurses spend documenting what is captured from the parents. We can do a lot of the service recovery through patient engagement in the hospital if they have a negative experience. We are creating environment that is different than the traditional systems. Our patient engagement is being used as a distraction technology to focus on the wellness aspect.

Campbell: You’ve touched on patient engagement, telemedicine, population health and social determinants of health. That said, what other initiatives are front and center for you that you hope to finish up or achieve before the end of the year?

Rashid: One of the things that’s very important to not just me, but all healthcare delivery organizations is cybersecurity. We’re tightening the belt more and more on what we must do. It is a very important initiative for us to ensure that we are resilient and vigilant in how we react to breaches as they take place. Every month I get reports of XYZ hospital that are being penalized for lack of proper security practices or negligence. Most of the security pitfalls are within the organization and its people that accidentally do something which creates problems for the organization.

We’ve already moved some of infrastructure to cloud technology as we couldn’t sustain the level of on-premise not only due to the greater costs associated with that approach, but because of cybersecurity as well. We just put our entire ERP on Amazon Web Services and we’re evaluating our portfolio to identify which solutions could potentially reside in the cloud to not only facilitate scalability, and reduction of cost, but also hardened security.

Another area of focus is analytics, specifically predictive analytics and artificial intelligence. The infusion of this capability is going to be a game-changer for our organization. When I talk about analytics, I’m talking about how we develop intelligent EMRs, not solely focused on billing. Evolving the EMR so that it allows our caregivers to make decisions properly, assists in clinical documentation, reduces alert fatigue, and enables them to focus on the highest risk areas. The documentation and charting associated with EMRs is creating significant burnout, and analytics and AI can play a role in engaging the physicians to address that issue and transform our EMR. For instance, Google is investigating doctors using natural language via Google mini in the exam room and having that get transcribed into a note. We are looking to pilot some similar concepts at Akron Children’s in the near future.

Campbell: Going back to the original point you made on security, you had authored a white paper with five steps for responding to hospital ransomware attacks. You mentioned having bad actors within the organization and a real easy thing to do is to send out a phishing email from the IT department. For those who do click, you can use it as a learning opportunity. What other advice can you impart?

Rashid: That is a technique we use. We continuously train our staff, but you’ll be amazed at how trusting people are sometimes. They have good intentions, just bad execution. They trust and click when we instruct not to. It must be a continuous cycle of education, practicing and repeating so that it becomes reflexive to check the originating email address and make sure none of the advanced flags are triggered. That said, attacks adapt and become more personalized where it is extremely difficult for a user to decipher the attack medium being used. HIMSS has also shifted their EMRAM standard to make it more rigorous in terms of the security aspect with Stage 7, and the cybersecurity aspect can’t be underscored enough. To make matters more complicated, on one hand, the government and other entities say you need to share information, but on the other hand, if you experience a breach, you may be penalized severely. It’s a double-edged sword as you want to enable interoperability and health information exchange, but on the other hand, you have a responsibility to make sure that it is highly secure. It’s a challenging time when it comes to security and sharing, and we just have to find that happy medium.

Campbell: A salient point to end on. Thank you so much for all the compelling insights that you offered up and best of luck with the remaining projects your wrapping up before year end.

About Harun Rashid

Harun Rashid serves as the Vice President of Information Service and Chief Information Officer at Akron Children’s Hospital where he is responsible for providing oversight and strategic planning services to Information Technology, Clinical Engineering, Health Information Management, Enterprise Data Warehouse, Clinical Informatics, Telecommunication, IT Clinical and Telemedicine. Rashid has over 19 years of experience in the information technology field of which 15 years have been dedicated to the healthcare industry.

Rashid has held several chief information officer positions in large scale healthcare integrated delivery networks at Children’s Hospital of Pittsburgh of UPMC (University of Pittsburgh Medical Center), Rush Health Systems, Gateway Health Systems and Jefferson Regional Medical Systems. He has also served as the Senior Vice President over Rural and Community division for Phoenix Health Systems hospitals nationwide.

Rashid has been essential in the expansion of Children’s Global Health Program (Children’s hospital of Pittsburgh of UPMC) in several countries including Colombia, Mexico, Ecuador, Brazil, Kazakhstan, Italy, and the Middle East. Under his leadership, the telehealth program has grown regionally and internationally and includes agreements in Latin America and Europe. Children’s was one of the first to establish a telemonitoring service with an international hospital for eICU.

Through his work, Rashid has assisted health systems in achieving various national recognitions/designations. Rashid received a prestigious award from CIO Magazine as one of the Top 100 CIO in the country for the most innovative use of technology to support patient-care. In 2016, Children’s achieved the prestigious HIMSS Davis award for the use of electronic medical records (EMR) and analytics to enhance safety and quality. In 2018, Akron Children’s received HIMSS 7 award under Rashid’s leadership.

Rashid holds a Bachelor of Science in computer science and business management and an Executive Masters of Business Administration.

HealthIT CIO Interview Series – Tom Andriola, VP & CIO, University of California

The University of California (UC) is the premier public research institution with 10 campuses, 6 health systems and 3 national laboratories. Each year it serves more than 270,000 students, conducts billions of dollars of sponsored research, and cares for more than 5 million patients across the state of California. Tom Andriola, University of California VP & CIO, based at the University of California Office of the President (UCOP), oversees the IT function across the UC system, which includes 9,000 IT staff. To foster innovation within an organization of that size and scale, he believes it is key to engage and collaborate across locations, applying lessons learned and leveraging strengths and focal areas. While Andriola’s perspective is shaped by his experience as a global business and technology executive, he is pragmatic in his approach to the pursuit of innovation and collaboration at the university. In this interview, he discusses UC’s continued pursuit of cloud technology, exit from the data center business, and utilization of commonalities across campuses to drive efficiency and scale. He also shares his approach to consistent communication using social media and a blog, and his view on how best to tackle the broad area of population health management.

Key Insights

One of the things that my global experiences gave me was a great understanding of diversity and that environments aren’t better or worse, they’re just different. In all the situations I’ve been presented with, I’ve taken the approach of identifying the best pieces available and putting them together in ways that create unique competitive advantage.

The fact that we have six semi-autonomous health enterprises that are also collective on some level, allows us to collaborate on initiatives while pursuing them in a timeframe appropriate for each institution. We collaborate on vendor selection criteria, but it may be at different points in the road map for each entity. One institution then can pave the road for another, so the others can follow with less friction.

There is also the element of getting that story to the rest of the system and outside world to inform and educate our executives, customers, students, and patients. It reinforces our message that IT is not just a cost center, but in fact is a strategic enabler for the university and its mission.

Population health is not just a way for us to manage care and dollars, it’s also a means for us to find where we need to energize the level of innovation.

Campbell: You come from a background at Philips and joined the University of California as vice president in 2013. You’re very active on social media and very active in the community, especially with the upcoming conference. With that, can you provide background about yourself, what brought you into health information technology and some of the initiatives you are working on?

Andriola: As you mentioned, I worked for Philips globally, where I built an IT services group running a global transformation program and running IT operations across three continents. The program was essential, after a series of acquisitions, to bring the business back in-line with profit expectations for their $6B medical device business. From there I moved into a General Manager role leading the company’s largest healthcare informatics business at the time. It was at the point that healthcare finally decided that it was an information-centric industry and started to move away from its focus on better and faster medical devices (in our case scanners) and concentrate instead on the value they were creating for clinicians and patients with the data coming out of the scanner.  Then I focused on new business development and built a portfolio of IT software and services businesses in growth markets such as Brazil, China and India. Philips is a very global company, and these roles gave me the opportunity to not just travel the world but live in other places and build teams in completely different cultures.

In 2013, I transitioned to the University of California, the world’s most prestigious public research university. UC is a $33B organization that contributes in the areas of teaching, research, healthcare and public service. It consists of many entities – 10 campuses and 6 health systems, with more than 220,000 employees and 270,000 students, and $11B in patient revenues. It also co-manages 3 national laboratories. My experiences with Phillips provided me with the opportunity to step right in and help the academic medical centers figure out how the digital healthcare world was going to affect them. It also allowed me to show UC how to take advantage of the unique capabilities that academic medical centers have in terms of tertiary and quaternary care for the most complex patient populations and leverage not just technology but also, more importantly, the data to improve the quality of medicine, improve patient access, and drive down the cost of care.

Campbell: I appreciate that background. In terms of your global experience, and coming from the vendor side, how did that shape you as a healthcare leader. You’ve previously shared your philosophy on the importance of communication and collaboration. If you could, elaborate on that and speak to how that’s leveraged in your role with UC.

Andriola: One of the things that my global experiences gave me was a great understanding of diversity and that environments aren’t better or worse, they’re just different. In all the situations I’ve been presented with, I’ve taken the approach of identifying the best pieces available and putting them together in ways that create unique competitive advantage.

In joining the University of California, I have encountered great people and assets in the healthcare enterprise. We have deep domain expertise in the system, and it allows us to leverage that expertise to address our most challenging situations. In response to the challenges in the healthcare industry, we’ve created a coalition allowing six health systems and the Office of the President to come together, and look at things both at local and enterprise-wide levels. For instance, one of our locations has deep expertise in digital health, while another’s focus is on gene therapy. It’s a complementary rather than competitive arrangement, and allows us to approach 3rd party partners by putting forward our best-of-the-best along with the UC brand.

Campbell: It sounds like a unique situation for collaboration, and thus offering a competitive advantage. In fact, a recent article featured how six CIOs connected to the University of California, of which you are the group facilitator, have been producing strong results through broad strategic collaboration. That collaboration resulted in the first time ever that two US academic medical centers have linked up to be on one instance of Epic. Can you provide some background on that project in which UC Irvine Health and UC San Diego Health share the same Epic instance?

Andriola: You hear about moving to the new world of healthcare, moving to the cloud, and getting out of the data center business. We are living it. We have one instance hosted by Epic for UC Irvine, UC San Diego, and UC Riverside. The other health centers – UCLA, UC Davis, and UC San Francisco – are looking at their strategic roadmaps and determining when would be the right time for them to decide about going in a similar direction.

The fact that we have six semi-autonomous institutions, that are also collective on some level, allows us to collaborate on initiatives while pursuing them in a timeframe appropriate for each institution. We collaborate on vendor selection criteria, but it may be at different points in the road map for each entity. One institution then can pave the road for another, so the others can follow with less friction.

Campbell: That’s remarkable – the fact that you are leveraging each other’s strengths and using each other’s experiences to buoy the collective whole. That is what makes CHIME so great, that is, the ability for CIOs to collaborate amongst peers and share best practices. You are doing this on a micro level across the health systems, which is compelling.

Andriola: We do have somewhat of an advantage because there is a single governing body. Linkages, like shared financial incentives, also help align those activities.

Campbell: Absolutely. Shifting gears for a moment, The Huffington Post featured you as one of the most social CIOs on Twitter. You are also an avid blogger, bringing awareness to events, awards and news within UC. Tell me about the importance of having a social media and blog presence, and how it helps you to communicate key initiatives, both raising awareness and also potentially soliciting feedback from the IT staff.

Andriola: Our social media strategy serves both an internal and an external purpose. I’ll start with the internal. We are blessed to have 9,000 IT people across the university who come to work every day and try to make this the best darn research university and healthcare enterprise in the world. That’s part of the reason we use social media – to ensure people know that. We highlight the great work that people do, especially the most innovative practices that are going on. The blog and other communications strategies offer a mechanism for our people to learn from each other. Anecdotally, this could be someone hearing about an initiative at UC San Diego, when they’ve been talking about something similar at their own institution, and so being inspired to engage some UC San Diego folks to help solve the issue they are tackling. It facilitates peer-to-peer learning and reduces the time-to-value of technology efforts.

There is also the element of getting that story to the rest of the system and outside world to inform and educate our executives, customers, students, and patients. It reinforces our message that IT is not just a cost center, but in fact is a strategic enabler for the university and its mission. My job is to make sure that the outside world knows about what we’re doing – whether its healthcare, education, or research funding. I see my role as raising awareness about how UC is one of the most innovative places to work and how technology is a huge part of how we are innovating. The fundamental research we conduct changes the way in which domains are perceived and the way that we take care of patients. I use social media and communications as a means of telling the story of IT and sharing the great work that our people are doing. Everyone likes to have their story told, and that also supports engagement and retention.

Campbell: While on the topic of innovation and knowledge share, can you provide an overview of the University of California Computing Services Conference (UCCSC) that recently took place?

Andriola: When I came here almost five years ago and learned that UCCSC existed, I thought it was a great vehicle to drive collaboration. One of the things I was trying to figure out was a good strategy to connect the 9,000 folks we have in IT. At that time, UCCSC involved roughly 200 to 250 people, and was very grassroots oriented. The CIOs didn’t attend. I thought we needed to invest more into the grassroots conversation, but also bolster the impact of the event through executive presence. And so, we really shifted over the last 5 years as we’ve tripled the size of the event, with close to 700 people attending this year, including 11 CIOs. We took it from being a small event for the same people each year to a true communitywide activity, complete with swag.

It speaks to this collaborative fabric we have now across the organization – the realization people have that, “If I’m struggling today, there is likely someone else in the university who is probably struggling with the same thing. How do I connect to them quickly, and how do I extend my network to solve the problem more efficiently and effectively?” While we have tools in place like Slack, which 4,600 of our IT professionals use daily, the conference provides an in-person experience for sharing insights, best practices, and innovation outside of day-to-day tactical issues. This year I challenged the team to use the network to find colleagues and save 30 minutes out of their week.  It seems like a doable thing for most people. And at 9,000 people, recovering 30 minutes is equivalent to hiring more than 100 new people.  That’s the power of networking.

Campbell: Speaking to this collaborative fabric, an article was recently published on the UC IT Blog providing an overview of the results from a survey UCSB CIO Matthew Hall conducted of the UC location CIOs, asking them to prioritize issues for IT leadership and the university. Can you elaborate on some of those priorities for healthcare, specifically around population health?

Andriola: Population health is one of those initiatives where there is no silver bullet, and it’s not one size fits all. We are moving away from a stance on population health that’s been very individualistic across our UC health enterprise. That doesn’t mean one-for-all population health deployments for all UC institutions. Some of them are multi-billion-dollar enterprises and may have three or four different population health plays. Some extend Epic; others use third-party tools to connect into Epic. We’re trying to take a step back and look at the population health needs in the changing landscape of reimbursement and patient distribution. We are tailoring our population health strategies to allow us to use the data we have, now that we’re fully digital, to make more timely and intelligent decisions.  It’s a challenging space. Epic is certainly a large part of it, but it’s not the only part. There are a lot of other systems that have relevant information about patient conditions and experience that we want to pull into repositories so we can generate insights into how to better reach patients.

Campbell: You share the sentiment of a lot of healthcare CIOs, in that they want to steer away from the boil the ocean approach, and instead address specific use cases. There are components that go into making use of the data, access being one of those, but also transforming the data into the format that’s needed and governance as well.

Andriola: One of the other things that is of benefit to us is that, as academic medical centers, we have a teaching and research component to our enterprise. Some of the insights provided help inform us about where we should be innovating more quickly, and where we should be doing pilots. Those pilots are leading us to work with different types of partners who support home centric care models, for instance. As such, population health is not just a way for us to manage care and dollars, it’s also a means for us to find where we need to energize the level of innovation.

About Tom Andriola

Tom Andriola joined the University of California in 2013 as vice president and chief information officer (CIO) for the system. He provides leadership across the university working closely with campus and healthcare leaders to explore opportunities for technology and innovation to enhance the UC mission of teaching, research, patient care, and public service.

Andriola brings over 25 years of experience as a global business and technology executive, having served as a business transformation leader for a multi-billion-dollar enterprise, a global CIO with staff around the world, and the first employee of a brand-new business.

Throughout his career Andriola has been a champion of change inside organizations, as well as a leader for innovation in the marketplace, having brought first-of-kind solutions to market and led the creation of several new businesses.

Andriola is active in higher education and healthcare associations and serves on several boards, including the Corporation for Education Network Initiatives in California (CENIC), OCHIN, the Pacific Research Platform, and the Risk Services Software Company.

With his background in technology and innovation, Mr. Andriola maintains relationships with UCSD’s California Institute for Telecommunications and Information Technology, UCSF’s Bakar Institute for Computational Health Sciences, UCSF’s Center for Digital Health Innovation, the UC Berkeley Haas School of Business. He is a sought-after speaker on a variety of technology topics in healthcare, higher education, and the changing CIO role.

Andriola holds a bachelor’s degree from The George Washington University, a master’s degree from the University of South Florida, and completed the Stanford Executive program.

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 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.

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

Todd M. Rogow, MPA, CHCIO

Todd M. Rogow, MPA, CHCIO Healthix

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

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About Todd Rogow

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

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

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

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

About Justin Campbell

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

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

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

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

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

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Campbell: Yes, Outlook.

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

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

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

About Sue Schade

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

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

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

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

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

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

About Justin Campbell

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

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

David Parker, CIO

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

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

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Paul Brannan, Alabama HIT Coordinator

Paul Brannan, Alabama HIT Coordinator, Alabama Medicaid Agency

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

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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