Health IT

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

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Key Insights:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About Harun Rashid

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

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

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

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

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

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

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About Tom Andriola

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

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

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

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

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

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

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

Ahmad-Sharif, CMIO

Ahmad Sharif, MD, MPH, CMIO Fresenius Medical Care

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About Dr. Ahmad Sharif

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

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

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: 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: David J. Runt, CIO, Contra Costa Health Services

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David Runt; CIO, FHIMSS, CPHIMS, Contra Costa Health Services

One Patient. One Record. That’s the philosophy at Contra Costa Health Services, where David Runt is Chief Information Officer. Their uniquely structured health department has everything health-related under a singular patient record, all fueled by Epic. They’re most healthcare organization’s dream. Runt considers himself fortunate to be a part of it. In this interview, he discusses CCHS’s transition from build to buy, including the sunset of a large amount of legacy systems; their data warehouse good fortune; why their data retention standard is “forever”; and how CHIME stands out from other industry events.

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

Our philosophy is one patient, one record.

Use those talented internal development resources to build niche product for customers that you can’t buy.

However, that served as the foundation to feed data into Epic. All of our data is going into the warehouse. It’s fantastic, the amount of data we have at our fingertips now. It’s revolutionizing our capabilities.

Our philosophy is to retain the data forever. Given our model, we don’t lose patients, so to speak, to our competitors.

Don’t be everything for everybody. Pick your niche. Get successful there and make a name for yourself there.

Campbell: Please tell me a bit of about yourself and your organization.

Runt: I’ve been with Contra Costa Health Services for eight years. I was in Arizona for ten years prior to that. Contra Costa Health Services is a county health department.  We are probably the only one in California that’s structured the way we are, in that everything “health” related falls under one patient record. This means that, public health, mental health, EMS, hazmat, health plan, hospital clinics, everything falls under one health officer. We provide health in five jails across the county as well. In our organization, public health reporting falls under one umbrella, with health services & traditional hospital clinic structure falling under the other umbrella. As a result, we have a lot of flexibility in managing health across the enterprise.

Our philosophy is one patient, one record. Whether that patient is seen in our hospital, our clinic, in our psych emergency room, in the jail, in public health – we know everything about them. We’re fortunate that we have that data in one location and we don’t have to coerce the data out of a perceived competitor such as the health plan or public health, like the other county health IT departments have to do.

Campbell: What platform do you leverage for the EHR?

Runt: We’re leveraging Epic across the enterprise. We’ve got it in the five detention facilities, as well as in our health plan. We’ve deployed it in behavioral health, in our own behavioral health clinics, and made it available to our network providers as well. We’re not selling services, but rather we’re giving the providers portal access for their patients. In this next year or so, we are rolling it out more into the public health space.

Campbell: That’s exactly where your peers want to be. In talking to a lot of other folks, they have one system on the outpatient side, and a different system on the inpatient side. As a result, harmonization of nomenclatures and dictionaries between the two systems, as well as reconciliation of the data poses to be an ongoing challenge.

Runt: Not to mention your health plans on another system! I could not imagine trying to get payer information on your own patients with that model. My counterparts are just pulling their hair out and feel fortunate to be where we are.

Campbell: It allows you to focus for sure. Speaking of that focus, tell me a little bit about your application portfolio, outside of EHR. How big is the portfolio? Are there legacy systems that are sort of sitting in the corner?

Runt: Everybody has the legacy systems. When I got there, we were a cat and dog shop. We were a development shop and I had 50 developers on staff. They were actually writing—which got killed before I got there—a patient appointment system. Really that’s a commodity, you buy that, so a lot of these things were sunset when I got there. We turned the organization into a buy instead of a build. We had a LOT of cats and dogs, best of breed systems. We were the poster child for the best of breed shop. As a result, bringing in Epic proved to be tremendous, as we sunset somewhere around 75-100 systems. Some of these were just little Access databases sitting on someone’s PC, but we were able to sunset a lot of that and reduce a lot of the ongoing licensing, maintenance and support costs.

We’ve gotten out of the “build your own stuff” mentality except for specialty areas such as environmental health, where you have an underground storage tank inspection system for instance. You can’t buy applications like that, so we build those. We use those talented internal development resources to build niche products for our customers that we can’t buy.

I am very fortunate that we’ve had a data warehouse for well over 15, maybe 20, years. It wasn’t very populated, in fact it was primarily financial data, because of these cat and dog systems. However, that served as the foundation to feed data into Epic. All of our data is going into the warehouse. It’s fantastic, the amount of data we have at our fingertips now. It’s revolutionizing our capabilities.

Campbell: Data liquidity cures all. Now when you went through that consolidation process, did you archive the data into that data warehouse?

Runt: Most of the data was already there. Those cat and dog systems, the ones that were sitting on somebody’s desk, we probably didn’t need that data anyway. It was Excel spreadsheets, or Access databases – those really didn’t have an impact on the business overall. Some of those systems that we sunset, we just took the data, imported it into SQL and populate it into the warehouse.

Campbell: That’s a critical point. The archival strategy whitepaper we discussed examines the tradeoffs, when you extract data from a legacy system and you store it because inherently you’re changing the shape of that data. You’re changing the shape of it to store that data; you’re changing the shape of it to present that data. There’s also metadata and audit trails considerations.  All that said, looking back on what was your archival strategy and how did you handle it?

Runt: We did not have an EHR. We had MEDITECH primarily for billing and ADT functions, and consequently, we didn’t have much clinical data in there. A year after I got there, CCHS finished a painful implementation of ED, and that’s the only clinical data we had. That was already in the data warehouse – we took it from MEDITECH and populated the warehouse. Other than that, it was billing information from our third party billing systems. We really didn’t change the shape of the data that much.

Campbell: Shifting gears a little bit, I’d like to get your perspective on data retention requirements. I’ve been talking to some of your peers about the fact that most states require persistence of the data for 7-10 years. A lot of EHR vendors don’t allow the ability to purge and there may be some instances when you do you want to purge that data. For instance, when that patient is no longer yours, you’re no longer seeing that patient, yet you still have their data so there’s still some liability associated with that if there’s an eDiscovery request.

Runt: Our philosophy is to retain the data forever. Given our model, we don’t lose patients, so to speak, to our competitors. Being the county, we serve a unique, well-defined, patient population. Yes, some people will flow in and out of the system, depending on their economic or social background, but for the most part we retain our patients. So we want that birth to death record to be available, wherever that patient may present. The patient could move around the county, but they’re still going to be seen in one of our clinics.

Campbell: And does Epic natively allow for ease of eDiscovery if you have an inquiry for a record? Or do you go to the data warehouse?

Runt: We go to the data warehouse for that.

Campbell: Shifting gears again, let’s talk a little bit about CHIME. Certainly the networking aspect alone is unparalleled. Tell me a little bit about how long you’ve been coming to CHIME and what you are looking to get out of it, specifically, this year as it relates to your initiatives.

Runt: I’ve been in healthcare IT for 36 years and have been a CHIME member for about 15 years or so, maybe longer. It’s much better than other industry events in that you have the one-on-one interaction with your peers. CHIME gives you the opportunity to reconnect with peers whom you have a relationship, and also connect with the important vendors. Other events have 20,000 vendors there and half of them won’t be around the next year; half of them aren’t relevant to the types of things I’m focused on.

It seems that only the “cream of the vendors” are associated with CHIME. It gives you the opportunity to interact with them, have meetings and meals with them, social interaction with them, which for me has been a benefit. Unlike CHIME, I don’t go to other events for the sessions, I go there to talk to vendors. The sessions at CHIME are different from a lot of industry events and conferences in that they are educational and not sales driven.

Campbell: It’s just more focused here.

Runt: Exactly. It is more focused, and I wish there were more organizations like CHIME for non-healthcare because there are a lot of good ideas out there in the marketplace around data, around PMO activities, and other things that are not purely healthcare-related.

Campbell: Lastly, focusing on HealthIT & mHealth’s audience, which are startups and entrepreneurs, do you have pieces of advice for them? How does a niche, small, little-known startup- vendor capture your attention? A lot of these startups are jumping into the fray with patient engagement solutions and if you really look at it, are they really solving a problem for their end customers? This is a very broad question, but if you have any piece of advice for startups and entrepreneurs entering into the healthcare space what would it be?

Runt: Don’t be everything for everybody. Pick your niche. Get successful there and make a name for yourself. We’re doing business with some small vendors who were probably startups five years ago. They’re small, they’ve got their niche product or their niche service, and they don’t want to be everything to everybody. Stay true to your initial idea and your initial concept. Answer the questions of ‘Why did you go into business? What need does your services or solution address?’

This interview has been edited and condensed.