How Well Do You Sleep?
“IT plays an integral role in all of our strategies,” says Patrick Gandy, Jr., MBA, senior vice president and COO of Lafayette General Medical Center in Lafayette, La., which has earned numerous accolades for delivering high-quality healthcare. “IT touches every part of the organization,” and the organization could not have achieved its success without it.
Given the ubiquity of IT in healthcare, “the CIO is the chief strategy officer, the chief innovation and chief transformation officer,” says Fernando Martinez, of Beacon Partners, a healthcare management consulting firm in Weymouth, Mass. “We’re in a position where we know the technology and must learn the operation to be thought leaders in our organizations. It’s that convergence of strategy and technology.”
Aside from headline IT initiatives, such as Meaningful Use and implementation of ICD-10, Clinical Innovation + Technology talked with several hospital leaders about other IT issues that might prevent the occasional sound night of sleep.
1. Going electronic
Last January, Lafayette General went live with an electronic clinical documentation system and computerized provider order entry (CPOE), says Gandy. The effort was very demanding for the clinical staff, he says. The focus now is to optimize the system in place to help physicians achieve efficiency and get back some of the time they spent making the shift to the electronic world.
“One of our key objectives since going live is to make sure we’re responsive to requests for assistance with the new EMR. We’re building that infrastructure to make sure clinicians have the support and help they need going forward.”
2. Managing data
With the deluge of data available through all of these electronic systems, “we’re going from a garden hose that you can turn on in the morning to a continuous fire hose” of information, says E. Gregory Marchand, MD, director of informatics, department of emergency medicine at MedStar Washington Hospital Center in Washington, D.C. The challenge is getting important data out of that powerful stream in a meaningful way. The data already existed in disparate systems but “data-sharing efforts will transform the way we’re able to provide care.”
Keeping hospital 30-day readmission rates down is on the priority list of many organizations. The penalties for 30-day readmissions that are deemed unnecessary will drive competing healthcare systems to share data, Marchand says, and for using informatics to help identify the patients most at risk. “We’ve got people, including the CFO and CIO, coming to the informatics staff asking them to use the existing system to best identify these patients proactively to decrease the likelihood of readmission.” This collaboration helps improve the recognition of the mission of informatics services in healthcare delivery, Marchand adds.
In addition, the ability to look at data around the clock helps pinpoint bottlenecks to better manage the flow of patients in and out of the system safely. “That has been transformational,” Marchand says.
3. IT staffing
Big data are going to require enormous resources both inside and outside the IT department to take advantage of all that data, says Marty Miller, vice president and CIO of Children’s Hospital Los Angeles. Finding skilled IT workers is a challenge because almost all healthcare organizations are trying to accomplish the same thing.
Miller oversees a “very connected, mature group who understand just how big of a challenge this is both organizationally and for IT.” With Meaningful Use and the ongoing implementation of ICD-10, the hospital is using outside consulting resources. But, Miller is keenly aware that the internal teams will be charged with supporting these efforts in the long term. As a result, “we’ve become very focused on staff retention and development. We want to make sure we have a very satisfied and talented workforce.”
4. Mobile health
Children’s Hospital has long had a bring-your-own-device policy, says Miller. “We use tools that essentially protect data that belong to the hospital while leaving the rest of the device and its data (i.e., music, photos) intact.” Even as the number of mobile devices increases, Miller says he is very comfortable with Children’s Hospital’s privacy and security policies. “We’ve spent a lot of time and energy establishing the right security protocol to make sure we’re protecting the right thing. Being academic in nature pushes us. We are the perfect test bed for mobile technology.”
However, mobile health presents a paradox wherein “we have technology we want to use, and around which we want to build policies and usage models, yet we lack the technology to manage it or properly enforce those policies,” says Martinez. IT must work with end-users, because those clinicians generate a lot of business. “We have no choice but to accommodate them, but we don’t have the tools to manage or enforce a lot of the policies that we’re building. The technology is simply not there yet.”
He cites his experience watching a physician photograph a skin condition with his smartphone and send it to another physician as a text message. Martinez realized that the whole exchange would never make it to the medical record. “I watched it happen in front of me and it was a defining moment. I realized that we don’t have a choice. We don’t have a mechanism; the technology doesn’t even exist for us to manage this kind of thing.”
5. Usability
Without usability, everything else is inconsequential, says John Lee, MD, one of three lead medical informaticists at Edward Hospital & Health Services, a health system in Naperville, Ill. “If I were given a choice between interoperability and usability, I would choose usability every time, because I use the systems every day. However, a CIO or CFO might disagree.”
Lee also is concerned about information overload, which we’re already seeing with alert fatigue. The trick, he says, is getting information to the person who can act on it. A general surgeon may have no use for a lab value that may be of critical importance for a cardiologist or internist. However, the key is determining who needs what specific information at a specific time. There are so many variables that Lee said the best long-term plan is artificial intelligence techniques like machine learning to replicate expert users.
Challenges abound but the pace of change, innovation and improvement is lightning fast. We’re sure to see significant variations in this list come this time next year when we enter 2014.
Tips to Improve C-suite, IT CollaborationNot all IT departments enjoy the luxury of a healthy relationship with facility leadership. “My sense is that about 25 percent of hospitals have a very supportive C-suite,” says John Lee, MD, medical informaticist at Edward Hospital & Health Services, Naperville, Ill. Approximately half of hospitals are in the middle and the other 25 percent “are in a situation where the C-suite just doesn’t get it.” He cites a 200-bed hospital with an IT staff of three. “That’s kind of ridiculous.” Lee says his C-suite wasn’t always very supportive as they are now, which is probably the way most hospitals were until three or four years ago when the healthcare reform bill came into play and with the looming changes in payment structure. Leaders are starting to realize that “a good data infrastructure is required to survive into the next decade.” Edward’s leadership mandated a new system that the emergency physicians initially resisted, Lee says. But, the clinicians’ willingness to make the system work gained his department a lot of good will. Armed with a new, progressive-thinking CIO, everyone came to a good, cooperative relationship. Leadership now “appreciates the good work we’ve done in the past as well as the challenges going forward,” Lee says. The buildup of good will now means that the ED staff gets more leeway in IT projects and their opinions hold more weight, he adds. “We’ve proven ourselves to be worthy, but that goes both ways.” There has to be trust and faith that both sides will fulfill their promises. For example, the C-suite will purchase a more sophisticated system or hire more consultants, but the IT team will create work-arounds as needed, work hard and trust that the C-suite will recognize a good job. “In speaking with colleagues, that sort of trust is not there in a lot of institutions,” Lee says. |
More Tips for Strengthening RelationshipsA strong governance process really helps to link priorities and strategies to technologies, says Marty Miller, vice president and CIO of Children’s Hospital Los Angeles. Patrick Gandy, Jr., MBA, senior vice president and COO of Lafayette General Medical Center in Lafayette, La., agrees. Organizations need a formalized governance structure that gets together all IT decision makers. When Lafayette General began its electronic clinical documentation system effort, “we created a new governance structure for IT.” They created an executive steering team with representatives from the C-suite, IT leadership, physician leadership and more. “We use that group to prioritize IT projects and set the strategic direction for IT.” Gandy says the team was vital to the success of the implementation. IT leaders also can help others “recognize the importance of having the robust system and not just relying on what we’ve had in the past,” says E. Gregory Marchand, MD, director of informatics, department of emergency medicine at MedStar Washington Hospital Center in Washington, D.C. Finance professionals have long recognized the power of data, he says. Now, the challenge is for healthcare to learn how to best utilize data to improve care. Involve physicians early and often, says Gandy. “They’ve got to be your partners because they play a key role in your success.” Fortunately, Lafayette General had a strong physician leadership team that helped with the transition to the new documentation system. CIOs need to keep themselves educated, says Fernando Martinez, a consultant with Beacon Partners. “To come up with a bona fide IT strategy around evolving trends, you need to know about advanced revenue cycle management, clinical delivery processes, the analysis and management of the business data and tools and more. The CIO simply has to be much more skilled in the overall management of a healthcare organization than in just IT.” |
Editor
Editor Beth earned a bachelor’s degree in journalism and master’s in health communication. She has worked in hospital, academic and publishing settings over the past 20 years. Beth joined TriMed in 2005, as editor of CMIO and Clinical Innovation + Technology. When not covering all things related to health IT, she spends time with her husband and three children.