Charles Christian, CIO, St Francis Hospital: HIT Is Enabler, Not Population Health Panacea

After working in health IT (HIT) for 30-plus years, no one could accuse Charles Christian of being a Luddite. However, as a participant in a half dozen health information exchanges (HIEs) at his former post in Indiana—and even more transitions in federal health policy—Christian is not naïve about what HIT can and cannot do when it comes to managing population health.

The former chair of the board of directors of HIMSS left his post as CIO and health systems manager at Good Samaritan Hospital to accept the position of CIO at St Francis Hospital in Columbus, Georgia, where health information exchange infrastructure is in its infancy. Yet the hospitals in his region have the same responsibilities as those in even the most HIT-forward regions in the country to prevent readmissions and, for instance, monitor the hemoglobin A1c of diabetic patients.

For hospitals with both grand and basic HIT resources, Christian has the same advice: “At the end of the day, it’s about the patient, and making sure the technology does not get in the way of physicians getting the information they need in order to accurately treat the patient in a timely manner.”

To that end, cooperation, policy decisions, and allowing people to solve problems are as important as information technology in Christian’s experience.

Health Care Is Local

Christian’s current market is proof of the old adage that all health care (like politics) is local. Columbus is basically a two-hospital city: 376-bed St Francis Hospital, the only area hospital offering open-heart surgery, specializes in cardiac, orthopedic, and surgical services. The 413-bed Midtown Medical Center is an acute-care hospital with a strong pediatric component, including a neonatal intensive care unit and a pediatric intensive care unit.

Unlike Christian’s former hospital in Vincennes, Indiana, St Francis has more alignment with specialty physicians than with primary care, family practice, and internal medicine physicians, who he reports are more independent and less interested in alignment.

“I think that will change as the market pressures continue to increase, and as this generation of physicians go out of practice and the newer generation comes into practice,” Christian says. “They want to have a life, and they are not used to working—or willing to work—60 to 80 hours a week like the physicians of my generation have been doing. They also know that the industry is focusing more on the quality of care and that long-term connection with the patient.”

Data Exchange Requirements

St Francis’s immediate patient data exchange needs are also specific to its location in western Georgia. The mission-driven non-profit provides financial and operations support for a physician practice, MercyMed, that provides free or reduced-cost health care to the uninsured. It also supports a low-cost, no-cost prenatal care center, Trinity Center for Women.

“We have several OB physicians and midwives who provide services for those folks because we know that in order to have an impact on infant mortality rates, moms need to have good prenatal care,” Christian says. “We are providing that in the community as part of our mission and faith-based ministry.” Trinity Center is tied into the hospital’s physician practice management system.

The second factor is the hospital’s proximity to Fort Benning, where the Rangers are trained and sometimes need access to specialists, such as orthopedic spine surgeons and cardiac specialists at St Francis. Coordinating care between civilian and military facilities has its own challenges, Christian says, adding that he is working with Terry Newton, MD, to facilitate information exchange. “He has been a very valuable point of contact in moving that through, because he is working more from the physician standpoint of utilizing information and moving it back and forth,” Christian notes.

Third, as an open-heart cardiac hospital that draws referrals from a multiplicity of practices within a 60-mile radius, St Francis has occasional need to refer out to Emory University in Atlanta and across the state border to the University of Alabama at Birmingham. Christian implemented a cloud-based image sharing service that has been helpful on that front.

“That has been very valuable to us,” Christian says. “We created a hub here at St Francis where people can send studies in to us and we can send studies out to them.”

Keeping It Simple

Finally, St Francis shares some physician resources with cross-town neighbor Midtown Medical Center, including a GYN-oncologist. While Georgia has embarked on a plan to develop a series of HIEs that will communicate with each other under the leadership of Kelly Gonzalez, Georgia’s State Health IT Coordinator, currently the only secure IT infrastructure that enables communication among disparate health care entities is the Direct Service provided at the state level.

With offices in both St Francis and Columbus Regional and no ability to access information from the other entity while physically located on one campus, frustration levels were running high for the GYN oncologist and his staff. A palliative fix in the form of a workstation connected to each of the other facility’s EMR meant getting up from one workstation and logging into another to access patient records from the other facility, a drag on workflow and throughput.

The solution provides a case study in Christian’s unwillingness to let technology get it in the way of data exchange. When he heard that there would be a meeting with the gynocologic oncologist and his staff, Christian picked up the phone and called his counterpart at Columbus Regional, CIO Doug Coburn, and said, “I’m going, why don’t you join me?”

Through a process of questions and answers—and a spirit of cooperation—a solution was devised that would give the oncologist and his staff patient-specific access to both health records regardless of where they were, with St Francis providing the hardware and connectivity required when the care team is on its campus, and Columbus Regional providing the same on its campus. Both organizations will open up their networks so that staff can access only those assets they need for a specified patient’s episode of care.

“None of the people in the room knew what we were trying to do from a regional health information exchange point of view, because it’s just not fully baked yet,” Christian explains. “But that didn’t have to get in our way of providing the information to the physician and his staff wherever they reside. From an administrative standpoint, what we did is give that staff an opportunity to be creative and innovative, and succeed.”

Although the solution was implemented just a week prior, Christian was optimistic that it was working. “I have not talked to the oncologist yet, but he has not been ringing my phone either,” he quips. “No news is good news.”

Protecting and Empowering the Patient

As providers are asked to take more responsibility for the health of a community, one step policy makers could take to ease the way is to provide some level of patient identification, such as a unique patient identifier. “We spend an inordinate amount of time, just within our own system, making sure that we have the right patients, and that they are the right Mary Smith or the right Marie Gonzalez,” Christian says.

He applauds the Office of the National Coordinator, which recently announced a new initiative related to patient matching, something he calls the first step. “The worst thing you can do is to have a patient mismatched for a medical record,” he says. “You don’t want to miss something or give a patient an allergy or a disease process they don’t truly have. This is one of the very simple things we could do.”

When it comes to population health management, Christian believes that something important is missing in our approach: the patient. “Patient management is not up to just the providers—hospitals and physicians. The patient has to play a role in this as well,” he says.

Questioning the wisdom of holding hospitals and physicians financially accountable for readmissions and care regimen compliance, he says, “When I was in Indiana, there were many patients who were diabetic, but they chose not to [take responsibility] and wound up in our emergency room when their diabetes got out of control, using the most costly health care you could possibly get. They were not held accountable for their own behavior. We have to roll personal accountability into the equation at some point in time.”

Nonetheless, Christian is optimistic about the future ability of IT to help patients assume accountability, and the primary reason is a device that is likely no further than your elbow: the mobile smart phone.

He notes that some of the existing technology we deploy in patient homes to help them with weight and medication is beneficial, but powerful new applications on smart phones that can be accessed on a cellular network will be instrumental in giving younger, tech-savvy patients the tools they need to manage their health. Christian cites an attachment for the iPhone that can produce a decent EKG and his 23-year-old daughter, who can’t remember a time when computing technology wasn’t at arm’s length.

“The smart phones that each and every one of them carry has far more computing power than the first computer I had that ran a CT scanner back in the ’80s,” he says. “It actually has far more computing power than all of the computers put together that they used to put a man on the moon back in 1969.”

Yet he insists that technology can only get us part of the way there. “You can’t make it part of your limbic brain so therefore you no longer have to think,” he says. “Even though we may have some great technology, it is still up to us to make sure that we are using it appropriately and that it’s not getting in the way.”

Cheryl Proval is editor of HealthCXO.