Q&A: Beware of train wrecks
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CMIO: What is Christus doing to get beyond point-to-point integration?
Conklin: The goals from an IT perspective are first, to have a manageable portfolio of applications, while realizing that a single vendor is not going to be able to deliver all of our service needs across [our acute care, nonacute/retail, and international] venues; and second, to have a varied vendor platform that will…integrate information so that a patiens information can be brought to any point of need, wherever that is.
In acute-care settings, we believe the science and technology and experience of healthcare delivery are going to be very different five years from now. As technology permits more and more stuff to migrate out of hospitals, and as more of the regulatory environment becomes focused around delivering treatment care and service in less intensive kinds of settings, hospitals steadily, we believe, are going to become the places you go [only] when you have an emergency, or some chronic exacerbation of a multiple co-morbidities disease structure that [is] really hard to treat, or high-tech [procedures] like transplant surgery.
We see those environments becoming drastically different than what they are today; very information--intensive because of the types of equipment and services, and types of patients with which we’ll be dealing in those settings.
From an interoperability perspective, our focus is around how do we quickly gather information and then process that information, then return decision support to the user of that information—whether it’s me as a clinician, me as a patient or me as a user of our retail website. [We want] to be able to apply that decision support in unique sorts of ways that will allow us to ensure the highest quality care is being given, and that we are uniquely positioned against our competitors and are the place where people want to go.
CMIO: Is your next step a universal EHR?
Conklin: Yes and no. One of the drivers of our managed portfolio of systems is the different kinds of business venues and the fact that there’s no vendor that has an integrated med record capability that would also let us to run a retail web site like Amazon.com. We are a big and growing system. We’re acquiring new institutions and going concerns [and] building new hospitals all the time. As we do that, we find it is not possible all the time to install our core set of information systems—[for] acute care it’s Meditech; for ambulatory it’s athenahealth, eClinicalWorks and Logician.
The way we’re going to bring all that information together is through our HIE effort. To manage that integration, we decided [in April] to go with Medicity and Novo Grid [agent-based] technology that underlies it to build the product that will provide that single view of information about [a patient], but also will allow us to interface with all the different HIEs that we’re beginning to see crop up in all of our different communities and states.
Medicity’s iNexx [secure collaboration] platform lets you build applications yourself, and we were probably the earliest user of the earliest form of that technology. The applications that we’ve developed are going to be one of the first things that Medicity will put in its app store. Other users will be able to acquire it [using a] point/credit structure that will let us go in and acquire apps.
CMIO: What made you decide to use this interoperability strategy?
Conklin: One of the virtues of the HIE decision that we just made was that we’ll be able to offer that architecture in our communities, in line with our community benefit mission—for other people to be able to utilize those technologies and gain value from them so this community health worker application could then be rolled out to some of these other communities and based upon the models for implementing them and the success we’ve shown, we hope that will take off in those other communities.
CMIO: What’s your opinion of the healthcare information exchange standardization efforts under way at the federal level?
Conklin: While we fully support the directions being taken by the ONC and what’s happening from a healthcare IT perspective, we also proceed very concerned about HIEs in general that have not gone through the same kind thought process that we have around establishing the standards for the information that’s out there. My big fear is that we’re going to create another major train wreck, because we’ll just be packing together a lot of information and throwing it in the face of the clinician.
If there’s no way of getting exactly the information that the clinician needs to him or her, they’re going to stop using these things before very long, so little or no value will be obtained from the billions that have been spent on health care IT. Or they will make very bad judgments because the data they’re looking at—because it’s on the computer—[is] going to have [an unwarranted] mantle of reliability and validity to it.
Without the thought being undertaken at a community level for what those standards are going to be and how the information’s going to be presented...you’re looking to create problems.
I plan to continue to hammer that message about the importance of our community getting together to try to come up with the standards that we need to be able to effectively manage the patients and to maximize the investment that’s going to be made in all these systems. And if we don’t do it, then train wrecks are going to start happening.
Interoperability for interoperability’s sake isn’t going to get us anywhere, and in fact may even take us steps backward. The first of the train wrecks that occur, people are going to say, ‘we put $20 billion into what?’