Health IT

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

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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.

CHIME Fall Forum Interview Series: Perry Horner, CIO, Adelante Healthcare

Perry Horner; CIO, Adelante Healthcare

Perry Horner; CIO, Adelante Healthcare

As a CIO of major healthcare system, one of the most important lessons Perry Horner learned was when he found himself personally forced into the complicated world of connected health. With his new motto of ‘keep it simple,’ Horner is taking on the connected health world full force, implementing new and affordable technologies, always looking three years ahead. In this interview, Horner talks about Adelante’s EHR transition from Vista to Nextgen; his data governance strategy; and what he’s looking for in a practice management system solution. He also discusses his compelling personal story with the healthcare system and the improvements he’s pushing for to make solutions simpler and more affordable to all.

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 first interview in the series:

Key Insights

I never used to be an agile project management style person, but over time I’ve changed and I see the same thing with software. Gone are the large monolithic products, where they do everything. Stick with your core competencies. If you’re doing something well, partner with someone who’s doing the other part well. Make one conglomerate product. That’s where I’m hoping to see things go.

I was in the ICU for 10 days, and when I got out I had 5 months to recover before I could go back to work. During those 5 months I went through the ringer as far as what a patient experiences, and I was taking notes. Mental notes and physical notes as to what I was seeing, how things were being treated, keeping a focus on technology. When I got back, I wrote a 5-year plan for Adelante and I infused into it what is now called “Connected Health”.

I’m tired of hearing “I have an app for that.” I’m experiencing app overload. I’m kind of reversing thoughts, back to making it simple.

Forget about trying to capture the whole supply chain. Find your place on the supply chain and just focus on it. Do the best you can there.

Campbell: Let’s start with a little background. I saw that you actually come from the vendor side, that’s probably a helpful perspective to have when working for a provider organization. Tell me a little about yourself and where you’re working at now.

Horner: In my previous life I spent 17 years at ASU, I was the Head of the Library Systems, Technology Support and Development department. I jumped into healthcare with Adelante Healthcare because they intrigued me with a position opening, a Linux network administrator—which there is no such thing, so I was curious about what they were doing. The CEO immediately gave me an offer to head the entire technology operation there so I took that.

I inherited their EHR at the time. At that time Adelante had 7 locations. The first site they brought up using the open sourced version of the VA Vista EHR, and with the success of launching that site, we received a HRSA HIT Rapid Grant. Two Grants actually: one to form a HCCN, and the other to implement an EHR for all those members. Two other community health centers joined us and we became an HCCN and implemented Vista for all of them including Adelante, which was a member of HCCN. I was then hired by the network, which was called the Community Health Open Source Network, as their CIO. I hired three others and we developed out our support department for all the members. That lasted 18 months and then our largest contributing member pulled out and it was not sustainable anymore, so we decommissioned everything.

Adelante Healthcare was on Vista and I knew we could do better, even though as a technologist I was in love with the Vista system. It’s a MUMPs database, which is basically a flat file database, beautifully written, I’m amazed at it. As far as the end product and the application, for us, there was a little of the square peg round hole that had taken place. When Meaningful Use, the whole Accountable Care Act, etc, came about, Vista kind of squeaked by. My crystal ball said that this is going to give us problems all the way down the road with stage 1,2,3, and having to actually develop all the little kludges around it, because there are no companies that are doing it. So I started a sunset on Vista and we RFP’ed for a new EHR.  We settled on NextGen as our EHR.

Before my time, when they were working on implementing the first site with Vista, it was done in a garage development style. The EHR that Adelante was using included traces of experimentation from the beginning and there wasn’t a demo or learning system created. So both the CMO and myself were not comfortable with bringing over the data into NextGen. Instead, we transferred over about 12 key demographics for each patient over into NextGen and left the entire chart in Vista. For the next year, providers would go back to Vista when they saw a patient that had a NextGen record and extract certain elements out of their chart and put them into NextGen. The whole patient cycle included about 38,000 unique patients.

When that was done we started on the sunset project for Vista. It was too expensive and cumbersome to maintain the operational server. So I had to get all that data out of there and into a system diagnostics machine-readable format. I wanted everything to be indexed using four different identifiers, so you could do reverse look-ups using: date of birth, last name, social security number, and the medical record number. I wanted the format to be in discrete XML – specially in a CCD format. Every single patient record needed its own directory with sub-directories of all the imaging data and any other files. We needed two formats: the XML and then a presentation mode – everything in a PDF. In order to accomplish this, I contracted with a programmer, who over two years, finalized the extraction. Vista is so complex with its filing system hierarchy within that database. The referencing and finding the linkage of every piece of that patient’s record was challenging, as it’s scattered everywhere.  I was quite impressed that we were 100% able to extract everything, reformat it and make it useable.

That was our EHR at that time. At that time too, our practice management system was GE Centricity Practice Solutions, so there’s my next project next year, getting that data out. Luckily that’s a SQL database, much easier than doing it with MUMPS.

Campbell: Tell me a little about data governance in your organization and how that is handled

Horner: We’ve got a plan for 2017: creating an information governance committee. In the meantime, everything is more specialized—a privacy committee, security committee, the various others around compliance, quality assurance—we want to bring all of that up into the next level of the leadership decision-making body and have an overarching Information Governance Technology Steering Committee.

Campbell: Do you have challenges at all with interdepartmental nomenclature, mapping? How is that handled?

Horner: Very wild-wild west style. We are small enough at the moment where we can still talk to each other and accommodate. Ten years from now we won’t be. We definitely need to have common definitions, common protocols. That’s why in 2017 the information governance will form and set the framework to start development from there. I’m pretty pleased that AHIMA has really taken the lead in producing a lot of resources around information and data governance.

Campbell: And speaking of the portfolio, how many applications do you have in it today? Do you leverage any portfolio management applications or is it small enough where it can be optimized?

Horner: Small enough at the moment.  Right now, except for our HR system and a credentialing application, everything is on premise. In two years, we will have outgrown our corporate headquarters, so we’re building a new facility and this time around we’re not building a data center in it. The project kicks-off in December, and we are slowly migrating hosting out to third party, starting with the low hanging fruit – file services, those type of things – with the EHR at the end.

Campbell: Mission critical applications last.

Horner: Yes, we designed our Mesa Facility as our fail over location, so we do have redundancy there. We’ll continue to use that for fail over but for our primary, we want it in an external data center. And if anything is platform-as-a-service, software-as-a-service, we are always entertaining that. Anything that can accommodate a heterogeneous environment.

Anything that’s HTML5, a no SQL database back-end, that true software-as-a-service environment, that’s what I keep my eye on. Any vendor that’s moving that route, has a product there, is large enough to actually interface with others. I never used to be an agile project management style person, but over time I’ve changed and I see the same thing with software. Gone are the large monolithic products, where they do everything. Stick with your core competencies. If you’re doing something well, partner with someone who’s doing the other part well. Make one conglomerate product. That’s where I’m hoping to see things go.

Campbell: I did some research and saw that there was an initiative, back in May, where you went out for bid with some other organizations for application development

Horner: Yes, that is on the connected health end. That was the Phoenix Chamber of Commerce’s Reverse Pitch for Healthcare. Speaking of connected health, in the beginning of 2014, I went in to see my doctor, who happens to be an Adelante Healthcare provider. My heart was one minute going 160 beats, next minute going 70, just off and on. It was a nuisance to me and it had been doing that for about 4 weeks, during December, during the holidays. She hooked me up to some diagnostics and after about 20 minutes of checking readings, she immediately looked at my wife and said, ‘if he drove, he’s not, you’re driving him straight to the hospital; he’s to be admitted to the ED.’

For the next 48 hours’ things were looking bleak. I was on my last leg. I was feeling fine until that Monday evening when I was in the hospital. My heart was failing – down to 15% capacity, and my family was told I had maybe 48 hours, and to start making preparations. I had a team of twelve different specialists all trying to figure out what was going on, and finally it was a cardiologist who figured it out. It was my adrenal gland. One of them was causing this and he came up with a cocktail that actually worked, stabilized my heart rate and threw me on the road to recovery.

I was in the ICU for 10 days, and when I got out I had 5 months to recover before I could go back to work. During those 5 months I went through the ringer as far as what a patient experiences, and I was taking notes. Mental notes and physical notes as to what I was seeing, how things were being treated, keeping a focus on technology. When I got back, I wrote a 5-year plan for Adelante and I infused into it what is now called “Connected Health”.

I was given a great care plan, things that I had to do at home, and I didn’t have an at home nurse, so that responsibility was given to my wife. She would make sure I was taking my blood pressure every 4 hours, and taking these pills in the morning, these pills in the afternoon, I was walking around for x amount of time, and ensuring I was eating these low salt foods. Two weeks later she was tired of it, she was angry with me, and I was tired of it too. I was then slacking back into a mode where I wasn’t doing everything and my specialists and my PCP weren’t seeing me every other day to monitor. I was on a schedule to come back and they would evaluate me and see what my progress was. I was like “there’s got to be something to keep me motivated and also keep that care team informed early, in case something goes wrong.”

A lot of times providers experiment. You’re on one medication and then they’ll check-in maybe three months later to see if that worked, and if not, it is changed. Now take this medication. Well it didn’t work in the first 72 hours, it’s not going to work for the remaining 90 days. Connected health solves this by having those monitoring and diagnostic devices in the home. It’s nothing new for the hospital world, in fact it’s been around for a while. You get discharged and you take a package home, that’s got a blood pressure cuff, a thermometer, a scale, or whatever, all connected via an app to your phone, to the internet. For me though, knowing how tired and wiped I was from the hospital experience, I cannot see how somebody who wasn’t a CIO would go through the process of connecting all of these devices, having to always spark up a tablet or a phone in order to see readings and do things to communicate. I wanted it to be as simple as possible. For example, with my scale in the bathroom, I could replace it with a connected device whereby, I just set this scale down, I don’t have to program it, do anything to it, I just have to step on it. Everything should be done already. The reading should be able to go back to my provider seamlessly. Same thing with the blood pressure cuff, I just want to press the button and that’s it. Nothing else.

I went to HIMSS Connected Health Conferences, which was really a bunch of developers trying to figure out what’s going to play into this world, with not very many established products yet. I desired a product that was just dirt-simple. For our population, 50% of our patients are on state Medicaid, which means they’re in financial distress. I want our devices to be as [affordable] as possible. It just needs to be what it is. That was my ask. Create this…and there was a company that actually did. Carematix collaborated with Verizon to develop a solution. So now you’ve got your carrier service, and you’ve got your product. The transmission doesn’t go directly to the cloud from the scale. The scale actually communicates to this little hub device that is plugged into the wall or any outlet, hidden away. The patient plugs into the power, steps on the scale, anywhere in the household. They don’t need to program anything, don’t need to worry about it, don’t ever have to remember that they have the little box plugged into the outlet ever again. Everything works and it’s affordable. That was the other piece. Carematix has priced their product at a dollar – a dollar a day per patient. That’s $30 a month for two devices. The cloud based management system, the whole shebang, no carrier fees, nothing – that is everything. So for us, we’re looking at $360 per patient per year. That is sweet. Problem solved.

But I had to wait 2 years for something like that to appear, and none of this is new technology. We’re going to do a pilot for two years now too. We have a control group – same chronic conditions, same age, everything very similar to its pair experimental group. The experimental group gets the devices while tthe control group receives traditional care. Over time we’re going to see if we can improve that patient’s health by early warning, being able to follow up immediately when we see something, and being able to contact that patient to see if we can change something. Improve that health much faster than the traditional way. If so, money well spent. To circle back around to your original question, that’s what that initiative back in May was about.

Campbell: It’s seems you’re well in tune to startups. What learnings did you have with interacting with some of those startups and what advice would you have for folks in those areas that would give them a leg-up or make them more efficient?

Horner: Well for me, I’m getting really jaded. I’m tired of hearing “I have an app for that.” I’m experiencing app overload. I’m kind of reversing thoughts, back to making it simple.

When it comes to solutions, if you can shift the time and complexity away from the end user, make it as simple as possible and most importantly, know and understand your customer. I can’t believe the complexity of some of these devices in connected health that they’re sending home with elderly patients. Really? You’ve got to be kidding me. Keep it simple and affordable.

Forget about trying to capture the whole supply chain. Find your place on the supply chain and just focus on it. Do the best you can there. Play nice with your competitors because the consumer is going to piece-meal their solution together. Apple has done this, but they’ve kept to their own ecosystem, so kind of do like Apple but in an open way. I’m a big open source advocate.

Campbell: Well that’s the topics that I had looked to cover. I appreciate you taking out the time. That personal story you told was so compelling. To me it’s stories like that, where you, the information technology leader for the organization that’s trying to improve that care, has the first hand perspective – a perspective that a majority of the time is lacking

Horner: That was my silver lining. That was my experience and I appreciate having gone through that. Because that was everything, from imaging to lab work up the wazoo, blood work every other day, the diet and dealing with the nutritionist. These providers, they want you to get better and they come up with their plan for you. These people come up with their plan for you, and it’s so much you’re overwhelmed. You were sick and recovering to begin with and then to be burdened with so much stuff to have to do. It’s almost like that’s the formula for you to fail anyway, even with those great intentions behind it. Somethings got to be there, that’s in my house, with me by my side—and it’s not my wife—that will keep me moving along but not somethings that’s going to overwhelm me. It’s got to be simple and easy. Part of my routine in the morning, is getting up, stepping on the scale. I do that already. It represents a great opportunity to capture that data because that’s got clinical implications. For others, there would be other things that they do, maybe someone gets on a StairMaster every day. Well do you hold onto it? Is it capturing your heartrate? Data. Capture it. Use it. Internet-of-Things, where we’ve got devices communicating to devices communicating to devices, intelligently. That’s going to do things. “Oh your heartrate is going up quite a bit, let’s lower the temperature in that room” I didn’t have to do anything. My smart watch already communicated to my smart thermostat and did that for me.

This interview has been edited and condensed.

Boston Google Glass Challenge

Google glass is a ground breaking technology that will revolutionize the way that physicians practice medicine. Last Wednesday April 23rd I was present for the Google Glass Challenge “Final Smack down” at Google in Cambridge, MA. I gained a new appreciation for Google Glass after viewing innovative demos of the new technology and hearing first account experiences of the technology from physicians.

The first speaker, Nayan Jain, Presidential Innovation Fellow told an amusing story that demonstrates how new the technology is and how it is not widespread yet. He spoke about being in a foreign country and how the government officials of that country thought he was a terrorist because he was wearing Google Glass. He said was hoping to show the officials how glass can be utilized for homeland security, but they were unimpressed. In other words, he said “he was lucky to get out with his life and his Google Glass intact”.

Rafael Grossman, a pioneer in medicine, the first physician to use Google Glass during surgery presented next. He started by presenting the shocking figures that 440,000 deaths occur every year from preventable medical errors and 40 times a week wrong side surgery occurs. Google Glass would rectify these hazards by notifying the physician when they were about to perform a medical error. Google Glass would also engineer new medical training techniques as med students would be able to see exactly what the professor was seeing from anywhere in the world instead of the dated method of students watching through a viewing window. Currently, we utilize EHR’s in the same way we did with paper records, clinicians manually put data into the EHR and take it out. Google Glass would allow information to be sent and received from the EHR automatically.

Chris Coburn, VP of Partners Healthcare talked about the upcoming disruption in the field of healthcare. Currently there are 6,000 hospitals but in the coming years there could be 60 or 60,000 hospitals as the delivery of care changes. He said that while healthcare venture is down as is the funding for lab science, a wider range of companies including hospitals are becoming involved in ventures. Hospitals are starting to back technology and having their own investments.

Dr. Karandeep Singh of Brigham and Women’s Hospital explained that, historically providers would query the patient for information about how the patient was doing. However, the invention of EHR’s has changed this interaction. The science of medicine has been preserved, but the art of medicine has been lost as providers now spend most of their time with the patient entering information into the EHR. Google Glass would allow a provider to stay at the patient’s bedside while reviewing information from the EHR and bring back the lost art of medicine. Amazingly, the technology is able to tell where the provider is in the hospital and automatically pull up the patient’s info based on which room the provider is in. Dr. Singh did an exciting demo where he used phrases like “show me the lab results”, “show me the trend for sodium”, “show me the medications”, and “show me the chest x-ray”. All of the commands swiftly provided the information that Dr. Singh had asked for.

Steven Horng from Beth Israel Deaconess Medical Center described how the hospital has employed Google Glass in their workflows. He compared the implementation of Google Glass to the implementation of iPads at BIDC. BIDC went live with iPads immediately after they released which allowed physicians to spend 30 minutes less at their workstations. BIDC went live with Google Glass three weeks after they received Glass and it is expected to decrease time at the workstation even more. Their V1 one of the deployment permitted information retrieval, which included lists of patients, vital signs triage notes, provider information with pictures, comments on what is happening with the patient, medication reconciliation, problem lists and allergies. The purpose of their V2 is to integrate Google Glass with the entire enterprise. This will use machine learning to use all the available data about the patient and determine how sick a person is based on mortality rates.

Google Glass is a very exciting technology that will transform the way doctors practice medicine and utilize their Electronic Health Records. It will allow providers to focus more of their time and attention on the patient which will allow the art of medicine to be reawakened.