PHM

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

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

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

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

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Campbell: Yes, Outlook.

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

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

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

About Sue Schade

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

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

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

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

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

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

About Justin Campbell

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

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

Rich-Pollack-CIO

Rich Pollack, VP & CIO at VCU Health System

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

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Is Salesforce Ripe for Partnership with Health Cloud as a Patient Relationship Operating System?

Its human nature to draw analogies from past disruptors and apply to parallels in other industries. After all, we take experiences and lessons from the past to derive inspiration for future innovation. It’s in this regard that pundits have pointed to ATMs as a model to solve for healthcare’s interoperability woes, or present MINT.com and Kayak as a model for the healthcare’s move to retail and consumerization. It’s also in this regard that Salesforce is used as an example for patient engagement for healthcare. However, unlike the other industry-specific disruptors, Salesforce’s model fits healthcare as well. But just because it fits on-paper, that doesn’t mean that Salesforce is ripe to disrupt healthcare. There is certainly a lot of inertia to overcome in healthcare information technology, as Chilmark Research was quick to point out after Salesforce Health Cloud was announced

After several years of circling the healthcare market, Salesforce finally announced its intent to formally enter the market this week with the announcement of Salesforce Health Cloud. Unlike other enterprise vendors who have jumped into this market, with Blue Ribbon advisory panels (Google Health), or series of acquisitions (IBM Watson Health, Intuit) or a mixture of both (Microsoft), this announcement by Salesforce had little in the way of any of these attributes to bolster its announcement.

Salesforce is taking a much more tentative and low risk approach to entering the healthcare market and will look to its expansive ecosystem of partners who will leverage Salesforce’s existing tools to create healthcare specific solutions and services.

-Salesforce Enters the Fray: Will They Succeed Where Others Have Failed? CHILMARK BIGHT, September 2015, Brian Murphy and John Moore

Salesforce touts Health Cloud as a vehicle to acquire and manage patient data from multiple sources, from electronic health records, to patient generated data through wearable fitness trackers. Salesforce has also positioned the application as a communications platform for patient engagement and care coordination, as well as a dashboard for outcomes management and population health. Sound like every other vendor touting themselves as a PHM solution? Chilmark takes a deeper look into strengths and weaknesses:

Salesforce won’t compete with established transactional systems, but rather be a front end, as it’s not interested in being an electronic medical record provider like EPIC. As Salesforce CMO Dr. Joshua Newman told MedCity News, he sees competition from three places: electronic medical records vendors, startups and analytics firms.

EMR vendors may be entrenched, Newman said, but “they’re never going to be Internet-focused and multi-tenant.” A multi-tenant approach typical of a cloud service like Salesforce helps manage patients seen by physicians with privileges at multiple hospitals, according to Newman.

HISTalk also offered an optimistic assessment of Salesforce, declaring Health Cloud “the most interesting product I saw at HIMSS.” Mr. H from HIStalk noted the following advantages Salesforce Health Cloud offers:

  • Existing EHRs and other healthcare software products are way behind the times in meeting new requirements for health systems to treat patients and doctors as customers and to build relationships with them, including patient engagement.
  • It lets health systems that are willing to change their relationships with patients and doctors to do so effectively, with strong analytics and communications.
  • It’s cloud-based and is purchased on a relatively inexpensive per-user, per-month price with no capital outlay.
  • It’s built on the standard Salesforce CRM that has been battle-tested for years, with just those customizations needed to make it work for healthcare.
  • It integrates with the EHR and other patient and provider data sources.
  • The Salesforce open ecosystem allows using third-party apps when needed.
  • It Includes tools that allow users to build their own rules and apps.
  • Salesforce is a juggernaut that can force EHR vendors to open up their systems to obtain the data it needs.
  • Salesforce isn’t Oracle or Microsoft – they didn’t create a healthcare-specific product from scratch or acquire a questionable one, so they have no incentive to rebalance their product portfolio and walk away from healthcare and leave users hanging as big healthcare toe-dippers tend to do.

Given the optimistic outlook, what does this mean for healthcare startups and entrepreneurs Salesforce represents a good horse to attach your cart to. We’ve witnessed a plethora of companies go at patient engagement with their own custom solution. This approach lacks scale, established technology, and is crowded with competition. Not to mention, the path to monetization and profit is muddy at best. Further, Salesforce has built a rich ecosystem of extensibility via its app marketplace. Some could argue that this is exactly what healthcare needs.

The content presented in the Health Cloud Integration eBook suggests that Salesforce is still in the somewhat nascent stages, with limited adoption outside of pilots. Despite this, HCOs who have implemented the platform, such as Cancer Treatment Centers of American (CTCA) have demonstrated tangible benefits. CTCA now uses Salesforce to improve service in three different areas: physician referral intake; a 24/7 contact center; and, patient communities. The result is a 60% productivity boost for their technical team. One of the benefits to patients is their community platform, built on Salesforce Community Cloud, that empowers patients and families to support one another, join groups, participate in local events, find educational resources, and chat in real time. In turn, CTCA benefits from an enhanced referral process that improves customer loyalty and provides another way to communicate with patients.

There are clear gaps to fill. As the saying goes, “if the doctor doesn’t use it, it doesn’t matter.” Insights must reach the point of care and not be disruptive to existing workflows, but rather enhance it. It’s in this vein that partners are needed build the detailed workflows to support patient and care team communications. Salesforce represents a great candidate to partner instead of going at the crowded patient relationship management and patient engagement space alone.

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

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

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

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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