When it comes to healthcare, kids are different. They need healthcare focused on their unique needs, care that involves parents from start to finish and is delivered in child-centric, healing environments. Children require extra time, monitoring, specialized medications, specially trained health care providers who are compassionate and understand kids of all ages. They also need institutions that champion health care practices and policies to continually improve pediatric care, making it affordable and accountable. It’s this premise that has driven Bob Sarnecki, CIO, Children’s of Alabama, to make a career out of delivering information technology solutions that support care delivery for children. Children’s hospitals aren’t just buildings – they are key pillars of the community, providing services available to all children through urgent and emergency care, primary care and wellness, injury prevention and child abuse prevention, community fairs and in-school health services. In this interview, Bob shares his leadership philosophy of taking care of the kids and doing it the right way, use of Medical Logic Modules to deliver enhanced clinical decision support, providing improved efficiency and quality, and future plans to engage community practice affiliates.
One of the things that’s always intrigued me about children’s hospitals is that they do not see themselves as “treating young adults”; there is a whole different level of care required and parent involvement is critical. The volume of data that can be generated from birth to age 18 is vast, and provides great insight, both for care and for research. Specialized pediatric care in rural areas is always in high demand.
Our goal is to build MLM-based clinical decision-making capability through our development team, engineered for reusability and clinically significant. We have a strong group of programmers that meet regularly with our chief medical officer; the goal is specifically to build out our systems and technology capabilities so that we are our stepping up to the need to provide meaningful interaction with the physicians.
We have a simple mission statement in IT. We are here for the kids, and the people who take care of them. We do the right things, the right way.
Identifying first with the kids and the clinicians helps me to remember that my first job is to listen, not to have a position, but to listen. We can bring the technology to bear, but if we bring great tech and it’s not really helping the Children’s mission, I’m not sure that it’s really doing the right thing the right way.
Campbell: Please tell me a little bit about yourself. What is your background and what drew you to the position at Children’s of Alabama?
Sarnecki: I have over 30 years of healthcare IT experience in healthcare, including consulting and hospitals, specifically. I’ve been in Children’s of Alabama for about a year now. I came in as a consultant and was asked to stay permanently in July of 2017. There are a lot of things that attracted me to the opportunity, but one thing I desired was a role with a focus on community and children’s hospitals are my “first love”.
The technology is in great shape at the Hospital. Alabama is a state with a lot of challenges; there are a lot of needs, and the state is doing its best to try to meet them creatively. It’s one of those places that’s just attractive because there’s a commitment and there are plenty of challenges. I’m happy to be a part of it.
Campbell: Thank you for the background. Speaking of the responsibilities of a CIO at a Children’s Hospital, can you talk us through what’s different? I know you’ve been on the consulting side, but what’s different about a Children’s Hospital specifically?
Sarnecki: What is always fun and intriguing about a children’s hospital is that for most kids, and any kids with any chronic care issues, we are stewards of their first 18 years of medical history. These are formative years where you can make a huge difference on the impact of the quality of their life long-term. We’re at the front line of what you can do with genetics information.
I enjoy working in children’s hospitals because kids are not “mini adults”; the physicians who care for kids have very unique data needs. The care is so specialized, and in high demand in rural areas especially. Opportunities for telemedicine, population health management and patient-centered medical care—All those things are at the forefront of what children’s hospitals wind up getting involved in. It’s a way to stay busy and for the technology to really leverage what the business is trying to do.
Campbell: Can you discuss community affiliate practices, the organization’s relationship with them, and how you interoperate with them. The hospital deals with high acuity, but what about the pediatric clinics and practices that surround the area?
Sarnecki: It’s a very different model here than when I worked at other hospitals, where many primary and specialty practices were acquired and owned by the hospital. At Children’s of Alabama there are some owned primary care practices, but overall, the Hospital favors working with independent practices. We have our own primary care physicians, a small group of about thirteen practices. We also have an affiliation with University of Alabama Birmingham in their practice groups for providing acute pediatric care.
The practices use both a variety of EMRs and fax machines to connect to other providers or hospitals. In their world there’s a lot of moving back and forth between fax machines and EMRs. One of the focuses that we’ve been working on with the independent physicians is tying them in by communicating directly back to their electronic medical record. Typically, if you’re an Epic health system or a Cerner health system, you have a strong vertical organization where all data is transmitted within a single-database EMR application used enterprise-wide. The challenge with independent practices is that they have disparate EHR systems; we’re actively working with these practices to deliver information about their patients directly into their EMR so they’re only managing the patient in one place.
It has been challenging, but very well received out in the community. They like to know that that their affiliated hospital is aggressively pursuing making that available to them. That’s been a big chunk of our work with the community practices right now. We’re also trying to begin to open the data stores a little bit so that they can understand a little bit more about the populations that they’re responsible for providing care for. Population health management with big data is really a problem that exists for bigger organizations, but it’s the practices that are at the very base level that are providing the care and need to know it as well.
Campbell: It must be challenging trying to interoperate, harmonize and normalize data between different systems and care settings. It seems like you’ve given the practices relative independence and autonomy to choose their own EMRs, but has there been discussion or evaluation of moving the practices to an EMR the hospital would host for them?
Sarnecki: We have talked to a couple of places about it, and the reception level is mixed. In some cases, they’re concerned that they’re going to give up data. Right now, the bigger focus is on collaboration and integration in the hope that we get to the point where we can pull the data together and make it more useful and meaningful.
We focus on providing bi-directional communication, and eliminating manual faxes and scanning into their record. But we recognize “it’s a trust thing”. I think we’re at that point where people are becoming more interested in a community-based shared hosted model when they trust that you can provide the technology needs that they need to run their practice through the EMR of their choice, and that you’re going to be able to cover the bases for them from a support standpoint. There are a couple practices where we host their EMR in their data center.
Campbell: It must be tough in that in most cases, you are beholden to the source system vendor to get access to the data and stand up integration to the practices. That said, as someone shared about you via LinkedIn, “Bob is the type who measures twice and cuts once.” It seems like you are exhibiting patience and thoughtfully crafting a plan to do what is right for everyone involved. If we can shift gears a bit, I’d like to touch on your use of Medical Logic Modules, or MLMs in Sunrise Clinical Manager (SCM). How do you make use of those within the hospital?
Sarnecki: It’s something that we are working to take clinical decision making to the next level at Children’s. You get some basic MLMs out of the box with SCM. What we are working on is the best of two worlds – Developing Medical Library Modules (MLMs) for our system that are clinically useful and engineered for reusability and further development. We’ve teamed our developers with a group of clinicians to build a reusable and powerful library that we can extensively build on.
Campbell: That’s fantastic and the fact that you’ve been able to broker the relationship like that between IT and clinicians is just outstanding. It’s great to hear your harnessing and leveraging advanced capabilities within the EMR. Could you tell me a bit about the state of population health management initiatives underway at the hospital? I understand the hospital purchased DbMotion. Are you using it today for that purpose?
Sarnecki: DbMotion was purchased about a year and a half prior to my arrival. I’ve kind of left it on the shelf for the time being until we got some of the basics covered. Starting in Q2 of this year, the goal is to charter a more formalized big data strategy. Once we have that further defined, we will consider DbMotion further.
In addition, Children’s of Alabama has a great relationship with the University of Alabama, and we need to leverage that interaction. I’d like to see if there’s an opportunity to collaborate with UAB and other regional health care providers and bring our data together for the value of the state and the region. The competitive component in this market is not the same as it was in Phoenix. Phoenix Children’s is the real objective is to help a population.
Campbell: That speaks directly to something I really wanted to talk to you about. You clearly can have an appreciation for and articulate the business case, but also understand and appreciate the clinical case. Understanding that overlap, can you tell me a little bit about your approach to leadership as a healthcare CIO? The role has certainly evolved where you must broker with administration, a board, clinicians, and IT. How have you evolved in your career as the responsibilities of the role have increased?
Sarnecki: I go into all my conversations with four tenets we discussed previously. They’ve are principles that we developed in the Phoenix Children’s IT Department, and I’ve kept with me. When I approach any conversations with the Board, physicians, administrators, staff, etc., I look for opportunities to reinforce the things that drive us to stronger collaboration. Typically, in a children’s hospital we can agree on these first two things – We are all “here for the kids, and the people who take care of them”. Technology is just the medium the IT Department works in. I’m not here to press a technology agenda. I’m not here to press an agenda on big data. I’m not here to press this into the latest offerings by Vendor X, Y, or Z. Our goal is to help the kids and to help the people who take care of them.
Campbell: That is so profound. A lot is at stake. You’ve got a tremendous amount of responsibility. With nearly 700,000 outpatient visits and 14,000 inpatient visits, and as you said it’s not like Phoenix where you have multiple competitors in the market. It’s the third largest pediatric medical facility in the U.S. That’s a lot of responsibility to the entire state. Bob, thank you for the good work that you’re doing, and thank you for sharing with us some of these insights and perspectives.
About Bob Sarnecki
Bob Sarnecki serves as the Chief Information Officer at The Children’s Hospital of Alabama. Bob has held technology roles in healthcare for several years, having most recently been general manager of professional services for ClearDATA Healthcare Cloud Computing in Tempe, Ariz. There, he was responsible for healthcare-specific security risk assessments, security remediation, professional consulting healthcare/cloud services and web development. Previously, Sarnecki was chief information officer of Phoenix Children’s Hospital, Kingman Regional Medical Center and Ernst & Young management consulting. He has also held several interim CIO roles in the healthcare provider field, aligning IT with clinical, business and technology needs. Bob’s background includes several IT leadership roles, project management, applications development, management consulting, data analytics and database design.
Sarnecki earned a bachelor’s degree in biology from Mount Saint Mary’s College and a master’s degree in healthcare information technology from The Johns Hopkins University Carey Business School.