SDoH

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

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

Key Insights:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About Harun Rashid

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

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

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

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

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

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

Ahmad-Sharif, CMIO

Ahmad Sharif, MD, MPH, CMIO Fresenius Medical Care

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

Key Insights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About Dr. Ahmad Sharif

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

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