External Pressures Drive Internal Changes For IT Mandates

The pressure on healthcare organizations to improve care quality and patient outcomes, and reduce costs while also meeting Meaningful Use measures and other mandated IT efforts is driving big changes within organizations.

Standardize & centralize

Inova Health System is taking a standardized approach, says Marshall D. Ruffin, Jr., MD, MBA, MPH, chief technology officer of the nonprofit healthcare system in northern Virginia. That approach includes the creation of his position in which he oversees all technology and helps the organization go from “a lack of standards to standardization everywhere we can.” Ruffin was with Inova 20 years ago when its first, “primitive” EHR was implemented and he returned in 2011 to oversee the systemwide implementation of a new EHR.

Standardization applies to virtually all aspects of Inova, summed by its initiative—OneInova, a systemwide effort to establish a common enterprise architecture by 2015. “To adapt to all of these changes in the way we manage information in healthcare, you need to reorganize all technology disciplines. They’re all becoming digital and dependent on a common enterprise architecture. OneInova is the word we’re using to encapsulate the importance of standardization.”

OneInova is helping to improve operations, quality and manage costs, says Ruffin. Previously, different Inova hospitals would request various surgical instruments, pharmaceuticals or work-flows. Now, every element must be a technique or technology that can be used across the enterprise. That includes employing the same vendors and processes at all Inova facilities.

The technology assessment committee, which previously considered new clinical technologies only, now has much more power, Ruffin says. The committee is responsible for physician credentialing criteria and setting standards for clinical technologies, including replacement technologies. Centralized materials management and contracting also now align with OneInova.

“OneInova, as a concept, pervades much of what we do now,” Ruffin says. Without it, Inova cannot achieve a single information architecture, because “everyone will ask for exceptions. OneInova is now the rule. The phrase is intuitive—we do things the same way throughout the enterprise. The CEO, COO and the rest of our leadership would agree that OneInova is the most important thing we’ve done in the last two years.”

‘Infuse’ innovation

While innovation is part of Inova’s name and foundation, it must become a fundamental part of all healthcare organizations, says Mark Pasquale, MBA, vice president of information services and chief information officer for Piedmont Healthcare, based in Atlanta. Many healthcare systems are shifting their research and development to innovation and development, he says, but innovation impacts more than research.

Piedmont is formalizing its innovation efforts and creating a new leadership position. In addition to research, “a lot of folks are inserting innovation in strategic areas. Innovation needs to align with the business needs of the providers.”

Another transformation driven by healthcare reform, changing payment models and expanding IT initiatives is the replacement of the old buzz term “value management” with “operational excellence,” Pasquale says. Piedmont’s information services group very transparently demonstrates its performance to the rest of the organization to help ensure that service metrics are where they need to be. Reporting out performance is a core effort for every IT group, he says.

However, service performance is only part of the equation, he says. IT must not only be aligned with the rest of the business, IT should be “infused in the business. It’s not an easy process—it requires lots of good communication and the right leaders meeting regularly to assist information services with our strategic efforts.”

After four major ambulatory EHR go-lives and with four hospital EHR go-lives scheduled for 2013, Pasquale says good project management is only part of Piedmont’s success. Changes will be necessary going forward and anticipating those changes is crucial. He cites three levels of IT: reactive, proactive and intuitive. “It’s much easier to go from being reactive to proactive than from proactive to intuitive. Project management is a [necessary] component of that.”

At Piedmont, both proactive and intuitive IT groups would publish their project management portfolio on their organization’s intranet, so all staff can see where demands on IT lie, how much capacity IT has and how that is allocated and know what IT resources are available.

Gaining in governance

Ruffin’s first task as Inova’s CTO was conveying to the institution that enterprise architecture is crucial to the success of using digital systems. “We are reorganizing our governance in profound and fundamental ways.” Previously, Inova had project managers across the organization but no standardized approach to project management.  

The need for greater collaboration also is impacting hospital IT departments, says Pasquale. “IT needs to go to other executives in the organization and talk about how to leverage information technologies. There has to be a push, not just a pull.” The most successful IT departments, he says, will be intuitive—understanding and anticipating business needs before they receive requests—and have an active governance council. Regular meetings at Piedmont initially cover operational metrics but increasingly focus on strategic initiatives, he says.

A big challenge to meeting strategic goals is capacity. “There is not an unlimited supply of bandwidth and other IT resources and there certainly is more demand than supply. That’s something we regulate through our governance council.” Resources are aligned to strategic process, but Pasquale’s team also must execute effectively within project timeframes such as its current EHR implementation plans.

Federally mandated IT initiatives primarily are accelerating changes that needed to happen anyway, Pasquale says. Piedmont would have implemented a systemwide EHR regardless of Meaningful Use (MU) but the program “affected the timeline of implementation.” As Piedmont implements the new EHR platform at each of its facilities, those facilities are attesting for MU.

MU is helpful, says Ruffin, but only “gets to about 1 percent of the standardization needed.” MU includes a couple dozen indicators while Inova’s new EHR tracks 10,000 data elements. “We’re systematically trying to improve all of those. Meaningful Use is a very important but primitive start to get institutions to implement an EHR and begin to use it. It represents 1 percent of what this nation’s healthcare system needs to do and can do.” MU is priming the pump but that’s all, he says. Once that’s done, “you become creative and innovate.”