CHIME Fall Forum Interview Series

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.

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

Shane Pilcher, CIO

Shane Pilcher, CIO, Siskin Rehab

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About Shane Pilcher

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

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

 

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

Rich-Pollack-CIO

Rich Pollack, VP & CIO at VCU Health System

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

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Charles-Christian-CIO

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

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

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

susan-morreale-cio

Susan Carman, CIO, United Health Services

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

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

daniel-morreale-cio

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

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

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

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Campbell: Certainly enlightening and inspiring.

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

This interview has been edited and condensed.

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

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