eHealth Innovation: CIOs discuss IT initiatives, future needs

CAMBRIDGE, Mass.—A panel of CIOs from various Northeastern provider settings discussed their organizations’ IT initiatives and their future IT needs during the inaugural eHealth Innovation Conference March 15.

Reliant Medical Group (formerly Fallon Clinic) in Worcester, Mass., went live with SAFEHealth.org, its homegrown health information exchange in 2009, explained Larry Garber, MD, medical director for informatics. The organization also uses a registry to track its patients between visits, producing reports on total actionable deficiencies. By tracking these deficiencies, such as screenings, Reliant has been able to reduce its costs. For example, Garber said the facility’s costs per diabetes patient are lower than 96 percent of other U.S. providers.

Garber said Reliant’s current needs include better natural language processing, cheaper applications for telemonitoring and better clinical decision support tools with built-in artificial intelligence.

David Briden, CIO of Exeter Hospital in Exeter, N.H., said the hospital has four different, fully-installed EMRs—one each for its physician practices, oncology clinic, visiting nurses association and the hospital. Briden said he has found that the more information users have, the more information they would like to have. He is working on figuring out how they can do a better job of caring for patients by making sure the right information is available in the right setting.

Exeter’s five organizations “sit on the same community, serving the same 100,000 residents,” said Briden, adding that he would like to do a better job of sharing information between the different EMR systems. When a patient comes to the emergency department, for example, he would like the treating clinicians to be able to quickly obtain a list of that patient’s current medications.

Exeter has had a continuity of care document (CCD) live for a short time, which covers 70 percent of its hospital patients. So, 70 percent of the time a patient comes to the emergency department, the most pertinent information on that patient is available to the clinician without that clinician having to go looking for it. Going forward, Briden said he wants to work on reducing readmissions since payment reform will eliminate reimbursement for the readmissions. That might mean working more closely with skilled nursing or long-term care facilities or improving care management in the home.

Richard Kubica, MS, MBA, CIO of Hartford Hospital in Hartford, Conn., said the facility has a long history of innovation. In fact, the current Allscripts Patient Flow product was originally written by Hartford’s biomedical department.

Hartford also recently went live with a CCD that passes from ambulatory to inpatient records. They have written their own HIE and are now working on a mobile phone application, Kubica said.

Deane Morrison, CIO of Concord Hospital in Concord, Mass., moved from the pharmacy to IT back in the 1990s. “I got into IT through innovation,” he said, working with a vendor when the hospital signed on to build a new pharmacy information system.

“I can’t think of a time when we need innovation in healthcare more than right now,” Morrison said. That’s partly because healthcare professionals basically went from doing what they want when they want to getting their marching orders in the form of meaningful use and other initiatives.

He pointed out that the second part of the accountable care act is intended to encourage a switch from reactive care to proactive, procedural care to cognitive and activity-based to outcome-based care. In fact, if those outcomes aren’t there, there’s no income.

“Most IT is not developed to work in the accountable care world,” Morrison said. “We need better tools to connect.” He cited the need for tools to analyze populations, perform predictive modeling and care coordination. “We need the tools to be innovative. We have to figure out how to value, deploy and make IT work for us. It’s scary as hell but it’s a wonderful time to make a difference.”

Patient engagement is the key to success, said Chuck Podesta, senior vice president and CIO of Fletcher Allen Health Care in Burlington, Vt., a Stage 6 meaningful use hospital. “If we can’t get diabetes patients to stop eating Paula Deen recipes, then all the IT in the world doesn’t matter.”

Fletcher Allen maintains a big focus on its patients, Podesta said. For example, every heart patient gets a follow-up call five days after discharge. They originally found that half of those patients were either taking the wrong medication or taking the right medication at the wrong time. The organization has taken steps to change that. “We really need to reach out to patients to be viable.” To that end, Fletcher Allen has rolled out social media, patient portal and interactive television in the hospital. For example, if a patient is in the hospital for a hip replacement but also has diabetes, he or she will get information on both conditions. The education feeds off of the soft problem list.

He called for providers and entrepreneurs to remember the patient privacy part of the Patient Protection and Accountable Care Act. “Vendors need to think about protected health information,” he said. “We’re starting to see data breaches that are vendor-caused.” Even when a breach is caused by a vendor, it’s the hospital that suffers damage to its credibility, he said. “The next time you ask patients to opt into an electronic system, they probably won’t.”

Podesta also said that since healthcare systems continue to consolidate, entrepreneurs must consider how they can help providers keep an EMR in place. Many EMRs have only been installed within the last two years so providers don’t want a merger to force them to go through another EMR installation. Plus, tools that link claims and clinical information are going to be “extremely important going forward.”

When asked about their biggest unmet IT need, the panel primarily said better mobile solutions. “Help us use iPhones and iPads safely,” said Morrison. “They’re not going away and it’s very challenging to prevent breaches.”

“The security component of mobility is huge,” said Podesta. “We need an umbrella solution from a security standpoint, not one tool for each different device.”