The nation's healthcare system is undergoing a huge transformation, and IT is at the center of much of the change.
Thousands of hospitals, medical practices, and other healthcare organizations are struggling with a digital transition that's being forced on them by the American Recovery and Reinvestment Act's HITECH programs, which are providing subsidies to encourage electronic health record adoption but eventually will make it costly for them not to use EHRs. But even for those not happy about the change, it's become increasingly hard to deny that the old paper-based approach is too costly.
Many healthcare IT leaders have already made enormous strides improving healthcare through innovative and early adoption of technology. These are the people profiled in InformationWeek Healthcare's Healthcare CIO 25. Stimulus funds or not, they've moved ahead with e-health initiatives and are leading healthcare to the next stage of the IT revolution.
Several of the Healthcare CIO 25 are stepping up to help others through the transformation to health IT. John Bosco, CIO of North Shore-Long Island Jewish Health System, is leading education forums as part of a $400 million program to get the 9,000 physicians the health system works with connected to an EHR.
EHRs aren't the only focus, however. Personalized medicine is another technology getting attention. Mayo Clinic CIO Abdul Bengali has his eye on getting a person's genome mapped in a day and fitting on a USB key by 2015. That process currently takes a week and $5,000.
Some leaders in the Healthcare CIO 25 are also physicians. Others have roots in technology, medical informatics, business, research, and public service. Some work at small hospitals or clinics, others at large research institutions. A couple don't run IT operations at all, but instead are in charge of government programs that affect many healthcare providers.
The common thread is their passion and dedication to leading their organizations to improve healthcare delivery. Their pioneering work and leadership is providing direction and hope for the transformation of the nation's healthcare system.
Mayo Clinic CIO Abdul Bengali paints a vivid picture of the difference between good and bad information sharing in healthcare.
"We have to get our arms around how to best capture and disseminate knowledge to providers so that it's a viral spread of knowledge versus one that looks more like molasses," Bengali says. Doing that comes down to advanced and predictive analytics, he says, as well as "generating, cataloging, and defusing knowledge to the providers."
Rochester, Minn.-based Mayo Clinic is the largest integrated, nonprofit medical and research institute in the world. It's a leader in the push for personalized medicine and is starting to apply analytics capabilities to predict what genome markers mean for cancer and other treatments.
Making progress mapping the human genome is key. "Today at the Mayo Clinic, we're able to map a human genome in seven days, at a cost of $5,000 -- it took 13 years to do this in the past, at a cost of $3 billion," he says. By 2015, he expects that mapping will take a day. "Imagine how many people will be carrying their entire genome around in their pocket on a USB key," he says.
Mayo Clinic is looking for opportunities to apply individualized medicine. The problem won't be technology--it will keep pace, Bengali predicts. The challenge will be in figuring out how much of the genome sequence is really relevant to a provider. "If we aren't careful, clinicians and caregivers are going to be bombarded with so much information, they'll quickly suffer cognitive exhaustion," he says. IT needs to help providers figure out what "subset of information is relevant, credible, and can be used in today's care sciences," he says.
Bengali, who oversees an IT staff of 1,500, has been at Mayo for 35 years, including a decade as CIO.
Institute For Family Health
There's a digital divide when it comes to the use of healthcare IT. The larger, integrated health delivery networks with close ties to academic medical centers tend to be the "haves," while healthcare providers in small towns, rural areas, and low-income parts of cities are the "have-nots."
The Institute for Family Health--which runs 17 community health centers and eight healthcare sites for the homeless in the Bronx, Manhattan, and New York's Hudson Valley--shatters that stereotype.
Not only has the institute been using a fully integrated practice management and electronic health record system for nearly a decade, it's been using the technology for research, particularly into the reasons people of a particular race, ethnicity, or income group have worse health outcomes than others.
"In 2002, I had the opportunity to see [an EHR] system in action and was instantly convinced that the time was ripe for the implementation of health IT in our community health center system," says Dr. Neil Calman, a practicing family physician for 30 years, and co-founder and CEO of the Institute for Family Health.
Since the Institute rolled out its EHR in 2002, it has tracked quality metrics for more than 40 primary care and behavioral health problems, implemented clinical decision-support software aimed at better patient safety, and reported on quality metrics based on race and ethnicity, to spot disparities.
The institute each night uploads anonymous data to the New York City Department of Health's syndromic surveillance system and receives alerts back of emerging trends, which the institute passes on to providers in real time.
The downside to being an early adopter: The institute rolled out its programs before federal incentive funds were avail- able to help pay for them. The institute paid for almost all its health IT out of the practice's cash flow. Calman says that shows the staff's goal of "utilizing our EHR to improve patient care, not just to computerize our medical records."
As health IT drives major changes in patients' access to providers and in providers' ability to communicate with patients about their conditions, Calman is watching that those benefits aren't limited to the privileged few.
"I remain totally committed to making sure that people of color benefit from this technology on an equal basis as all others--something that has not been achieved with other health technologies," he says.
Johns Hopkins Health System
Rare is the CIO who runs IT for a major health system and an entire university. But that's what Stephanie Reel does as vice provost for information services and CIO at Johns Hopkins University (since 1999) and VP for information services at Johns Hopkins Health System (since 1994).
The $5 billion health system includes one world-renowned medical school, five hospitals, a network of physician offices, three health insurance plans, and a massive research operation.
"We are one of the most decentralized organizations in the country," Reel says. "There's not a lot of mandating from the top."
Reel has been in charge of stitching together a tech infrastructure that includes an internally built electronic patient record (EPR) system, a clinical documentation system, and a hodgepodge of commercial systems.
Now, as healthcare, education, and research institutions face uncertain futures with healthcare reform and possible deep cuts in federal funding, Reel is leading a full review of Hopkins IT. Everything is on the table, she says, including the possibility of replacing the homegrown EPR system.
MD Anderson Cancer Center
Vogel doesn't shy away from such strong opinions. The Houston cancer center decided, shortly after Vogel joined nearly six years ago, to build its own electronic medical record system, largely because he couldn't find a suitable commercial oncology-specific product. Many of the leading EMR vendors had systems based on MUMPS or some other decades-old architecture and never updated the core code. MD Anderson built its system on a service-oriented architecture.
Another difference between MD Anderson--the largest cancer center in the world--and the typical hospital is at the nexus of medical care and research. Vogel believes genomic medicine will transform cancer care, and patient records must be able to support genomic data. MD Anderson has spent the past five years focused on incorporating research data into clinical processes.
"It used to be, a university would do the research. Five, six, seven, or eight years later, it would show up in some clinical practice," Vogel says. "We want to shorten that. When people have cancer, they don't want to wait four or five years." They would prefer to find out about new research right away so they can enroll in clinical trials.
Palo Alto Medical Foundation
Paul Tang, VP and chief medical information officer, Palo Alto Medical Foundation, always seems to push the envelope--and always keeps the patient in mind.
Under his leadership, the not-for-profit medical group with more than 900 physicians helped develop the MyChart patient portal that Epic Systems now sells. PAMF was the first to implement the portal, which gives patients access to their records and lets them view test results, communicate with physicians, refill prescriptions, schedule appointments, pay bills, and enter health data online.
"We're pushing for more patient-generated data," says Tang, who's been at PAMF 13 years and is also a physician. To get more such data, PAMF is testing wireless, home-based monitoring of patients with chronic diseases. It just finished a three-year study of home-based monitoring of diabetics. It's about to begin a study on people with hypertension. One of the goals is to develop a business case that will convince insurers to cover home monitoring, which many believe is less costly than hospitalization and assisted living.
Center For Medicare And Medicaid Innovation
The work at the Center for Medicare and Medicaid Innovation is much like launching a startup, says Julie Boughn, CMI's acting deputy director for operations. CMI is a federal agency that emerged out of last year's healthcare reform legislation. Its goal is to develop innovative payment and service delivery models that will cut Medicare and Medicaid expenditures, while enhancing care.
Medicare and Medicaid are approaching 20% of the federal budget and almost one-third of the U.S. population receives benefits from federal healthcare programs, she says. "There's a lot of motivation to address these issues."
Prior to moving to CMI, Boughn was CIO at the Centers for Medicare & Medicaid Services' Office of Information Services. She led the development of the Health STAT Dashboard, which is used to analyze trends in Medicare and Medicaid data, such as why certain types of claims are higher in one state than another. The Federal CIO Council recognized the dashboard last year for its use of IT to improve transparency and engagement with the public.
Good Samaritan Hospital
Charles "Chuck" Christian has been in healthcare for 40 years, 22 of them as CIO of Good Samaritan Hospital, a 232-bed community hospital in Vincennes, Ind., that has been a role model for other small, rural hospitals in adoption of health IT and the exchange of patient data.
Good Samaritan has been doing bedside bar-code scanning before administering medicine for 10 years, and keeping digital records of doctors' bedside notes for 12 years. Both practices are still uncommon at many small hospitals.
Good Samaritan has had an electronic health record system in place for three years and is rolling out a computerized physician order entry system. The CPOE system has been on Chris- tian's road map for several years, but he thought it critical to first integrate it with other clinical information systems and decision-support tools. So now, for example, doctors ordering medicine for a patient with kidney problems can more easily pinpoint antibiotics that are cleared through the liver instead of the kidneys.
"We take a long view to IT," he says. "We make sure that IT strategic planning is tied into the operation plans, not just rolling out widgets. We've been doing that for years."
Christian started his healthcare career about four decades ago as an X-ray technician, eventually working with medical practices, building systems to help doctors track down radiology information.
He's a hands-on builder: He does woodworking in his spare time, and he still loves the hands-on nature of IT. "When you write code, there's instant gratification," he says. Christian admits, though, that his staff gets nervous now when he expresses a desire to code. "There are other people who do that much better than I," he says.
Baylor Health Care System
A couple of years ago, radiologists at Baylor Health Care System in Dallas pushed huge pieces of X-ray equipment around the health system's 26 hospitals to run tests on patients. After each trip, they'd return to the radiology unit to be dispatched to the next patient. Now, instead of making a return trip, they consult a BlackBerry app to find out where they're needed next.
The app has eliminated two hours of work for every eight-hour shift, says senior VP and CIO David Muntz. It's an example of common technologies being used in an unusual way, he says.
Another example of that: When Super Bowl crowds came to Dallas in February, Baylor Health released a mobile application that let visitors find the fastest route to a Baylor facility.
Baylor also has done extensive work with backup and redundancy for its two data centers to minimize downtime, particularly of its electronic health record system. The IT team customized an existing clinical-data-viewing technology so it could be connected to backup databases and provide patient data during any EHR downtime.
North Shore-Long Island Jewish Health System
Healthcare often does a really poor job when it comes to the patient experience," says John Bosco, CIO of North Shore-Long Island Jewish Health System in Manhasset, N.Y. That blunt assessment explains why Bosco is so focused on using IT to get the hospital system working better for patients.
North Shore-LIJ last year launched its Health-e Customer Experience project to eliminate administrative hurdles patients encounter. The health system is the nation's third largest, with 16 hospitals, 13 long-term care facilities, a medical research institute, four trauma centers, five home health agencies, and dozens of outpatient centers.
Health-e includes a patient and physician scheduling system, improvements to the health system's Web site, and a new customer service center. It's designed to make it easier for customers to find facilities and physicians, as well as set up appointments.
One goal of the effort, Bosco says, is to gather as much information before the patient arrives, so people can check in quickly using kiosks and "get right to the reason they're here--for treatment."
North Shore-LIJ also last year launched a $400 million effort to get all its physicians connected to EHRs. It installed inpatient EHR systems in two of its hospital emergency departments, and another four are scheduled to go live this year. Six North Shore-LIJ hospitals also will install inpatient EHR systems this year. And the health system is offering to help affiliated physicians implement Allscripts EHRs by subsidizing up to 85% of the cost.
Bosco talks a lot with the physician community about why practitioners need to implement EHRs and also what happens after a system is installed--about what adoption really means for productivity in the near term and long term.
Phil Fasano joined Kaiser Permanente in 2007 as senior VP and CIO and was promoted last December to executive VP, in a move that spotlights the central role IT plays at the $40 billion, nonprofit, managed healthcare provider and health plan.
Under Fasano's leadership, KP last year completed the six-year rollout of the world's largest private electronic health record system. The Epic software-based system connects 8.6 million patients and thousands of doctors, nurses, pharmacists, and other clinicians in 431 medical offices and 36 hospitals in nine states and Washington, D.C.
KP also has deployed innovative IT outside its offices and hospitals. It recently launched Mobile Health Vehicles: 10-wheeled, 500-foot trucks medically equipped and wired so clinicians can go on the road to treat KP patients as well as uninsured people.
Fasano was a proponent of the decision last year to donate KP's internal medical terminology to the International Healthcare Terminology Standards Development Organisation. The move is aimed at making it easier for other healthcare providers to adopt EHRs.
Office Of The National Coordinator For Health IT
Although Dr. David Blumenthal will be stepping down in April as national coordinator for health IT, his impact will be long-lasting. The work Blumenthal led during his two years as President Obama's health IT chief set the foundation on which the nation's e-health programs will evolve for years to come.
Blumenthal worked with government and healthcare industry leaders to craft the American Recovery and Reinvestment Act's HITECH programs, which include $27 billion in financial incentives for clinicians and hospitals that demonstrate meaningful use of health IT.
Blumenthal also oversaw billions of dollars in grants to establish 17 Beacon Communities that are models for using health IT to improve care, 62 Regional Extension Centers that provide assistance to healthcare providers rolling out e-health systems, and dozens of other efforts supporting local and state health information exchanges.
Blumenthal is known for his deft touch in pulling together public and private organizations to get decisions made.
"Despite pressure from many sides, he has been able to pull resources from across the government and the nation, stick to an extremely aggressive schedule set by law, and begin putting the critical pieces into place to establish a safer and more efficient healthcare system in the U.S.," said Stephen Lieber, CEO of the Healthcare Information and Management Systems Society when Blumenthal said he was leaving the ONC post.
Before joining ONC in March 2009, Blumenthal served as a physician and director of the Institute for Health Policy at Massachusetts General Hospital, which is operated by Partners HealthCare System in Boston. Blumenthal was also a professor of medicine and healthcare policy at Harvard Medical School, a post he'll return to next month.
Inova Health System
Geoffrey Brown, senior VP and CIO at Inova Health System, has spent most of the past 33 years in healthcare IT management, including the rare experience of having held CIO posts in public, for-profit, and nonprofit healthcare organizations.
With more than 2,000 patient beds and 3,167 physicians in northern Virginia, Inova is the largest nonprofit healthcare system in the Washington, D.C., area.
All five of its hospital emergency departments and its three emergency care centers have integrated electronic health records and computerized physician order entry. About 35% of its admissions start in the ER.
The digitization of the emergency department has led to "improvement in throughput and operations, and the real gem is in the clinical improvements in care and satisfaction gains," Brown says.
One of the lowest-cost applications Inova has implemented lets people see ER waiting times online via an iPhone app. "The bottom line is, we are on a journey to make access to our services easier for the community that we serve," he says.
University Of Pittsburgh Medical Center
Dan Drawbaugh has been a healthcare CIO for more than two decades, first at Pittsburgh's Shadyside Hospital and then at the University of Pittsburgh Medical Center, which acquired Shadyside in 1996. Since then, Drawbaugh has helped propel UPMC to be one of the nation's health IT leaders.
Drawbaugh, who was named InformationWeek's chief of the year in 2006, has led UPMC's extensive internal IT deployments. He's also helped steer the medical center into entrepreneurial and collaborative projects that are driving other healthcare providers to adopt innovative technology.
Under Drawbaugh's tenure, the medical center, which includes 20 hospitals, 400 doctor offices, multiple labs, and several long-term care facilities, has partnered with IBM, GE Healthcare, and other vendors, in relationships that have led to the creation of several startup ventures. Those include SmartRoom with IBM, which provides location-based technology that automatically recognizes hospital staff when they enter a patient's room and uses that data to prioritize clinician's tasks. Omnyx, a joint venture with GE, provides digitized pathology technology systems.
UPMC also has teamed with IBM, Verizon, and Alcatel-Lucent to create the Center for Connected Medicine, which demos new technology innovations in simulated hospital environments, and the UPMC Technology Development Center, which analyzes new and existing technology investment opportunities.
Drawbaugh has led UPMC's investment of more than $1 billion in IT over the past five years, including its development and deployment of an electronic health record system used in all UPMC care settings. The medical center is now looking to expand data exchange beyond its own facilities.
Poudre Valley Health System
Russell Branzell wears many hats at Poudre Valley Health System, a not-for-profit healthcare provider with two hospitals and dozens of medical centers across 50,000 square miles in northern Colorado.
He's CIO and VP of information services, overseeing an IT staff of 225, as well as CEO of Innovation Enterprises, a for-profit group that provides IT and consulting services to medical practices and other healthcare groups. He's also CEO of the Poudre Valley Medical Group, a medical practice with more than 100 physicians that PVHS owns.
During his more than seven years at PVHS, Branzell has expanded technology use among staff and independent physicians.
Getting physicians using electronic health records has been a focus of PVHS. "We were working on this even before meaningful use was being discussed," Branzell says. Innovation Enterprises, in particular, is trying to help physicians with technology issues so they can stay focused on patient care. "They didn't go into medicine to be business professionals," he notes.
Most providers of post-acute care healthcare, such as nursing homes and rehabilitation facilities, are not eligible to participate in the $27 billion federal meaningful use incentive program.
But Rick Chapman, executive VP, CIO, and chief administrative officer at Kindred Healthcare, is giving voice to the concerns of these institutions. Two years ago, he was appointed one of 20 members to the federal Health IT Policy Committee, which advises the U.S. Department of Health and Human Services' Office of the National Coordinator for Health IT on meaningful use and other HITECH programs. Congress has asked HHS to recommend ways for long-term care providers to take part in HITECH incentives. Chapman says "it will take a while," but he's confident it will happen.
Even without subsidies, Kindred has focused on using IT to improve care, productivity, and processes to support growth at the company's several hundred facilities in 46 states. Since 1997, Chapman has been leading Kindred in the adoption and use of e-health records and other clinical information systems, as well as its financial and business applications from SAP. His philosophy is "strong governance processes that promote alignment with business priorities," with an emphasis on scalable infrastructure that can be leveraged for growth.
The Louisville, Ky.-based provider is clearly focused on growth. In February, it announced it's acquiring its largest competitor, RehabCare Group, making Kindred the nation's largest for-profit provider of post-acute services, with combined revenue of $6 billion.
Chapman has a long career in health IT management. Prior to Kindred, he was CIO at Columbia/ HCA Healthcare and Galen Healthcare, and VP of information systems for Humana.
Huntington Memorial Hospital
For 30 years, Rebecca Armato has been developing and leading teams that implement process and technology innovations that improve medical outcomes, operational efficiencies, financial performance, and physician satisfaction.
For the past year, she's been doing that as executive director of physicians and interoperability at Huntington Memorial Hospital in Pasadena, Calif., running outreach programs to get the 1,000 area doctors to adopt more health IT. So far, 130 physician practices have taken up Huntington's offer of free Allscripts e-prescription service.
Huntington recently expanded its Allscripts partnership, teaming with dbMotion as well, to give area physicians Web-based access to patient data from a variety of sources, including EHRs and service providers such as radiology centers and labs.
Armato worries that, with federal incentives, people will take too narrow a view, adopting technology that meets federal requirements for the meaningful use of EHRs, but stops short of making bigger, longer-lasting changes necessary to improve healthcare and the health of the country.
Sharp HealthCare in San Diego has won numerous awards for its consumer-friendly IT. For that, the integrated regional healthcare delivery system can thank senior VP and CIO William Spooner, who saw the business value of the Web as a way to engage consumers way back in 1997.
"We thought it really offered us a marketing advantage," Spooner says.
Back in the days of ubiquitous AOL software mailings, Sharp was promoting the provider's site in Sunday newspapers by inserting a CD with a link to the health system's home page. "It took the town by storm," Spooner recalls.
Spooner joined Sharp in 1981 and has been CIO since 1997. He has added features to the Web site over the years, including the mySharp portal that lets patients view their medical records, request appointments, and communicate with doctors. Spooner insisted on adding the mySharp portal after he had some health issues while on a trip to the Middle East. and wanted to communicate with his doctor, but couldn't.
The electronic health records and other infrastructure behind the portal were the result of a bold move five years ago. After years of building its IT infrastructure piecemeal, Sharp, under Spooner's direction, decided to scrap the "best-of-breed" approach in favor of an integrated inpatient system from Cerner and outpatient technology from Allscripts for the 2,400 mostly private-practice physicians that make up the Sharp Community Medical Group.
Sharp has installed the Cerner technology in five of its seven hospitals. Spooner reports that at least 85% of practitioner orders get entered electronically at those hospitals, far above the national average in this key metric for patient safety.
Indiana Health Information Exchange
Dr. Marc Overhage, has spent his career creating, including co-developing the nation's largest and longest running and health information exchange.
In the 1970s, Overhage co-developed the Regenstrief Medical Record System for the Regenstrief Institute, an informatics and healthcare research organization where he has been director of medical informatics.
In the 1990s, he helped create the Indiana Network for Patient Care, a secure repository of healthcare data that expanded the Regenstrief EMR system to Indianapolis-area healthcare providers and later to other parts of the state.
In 2004, he co-founded the Indiana Health Information Exchange, which lets 19,000 physicians, 70 hospitals and 100 clinics, and surgical facilities share patient information.
Later this month, Overhage will leave the HIE to become the chief medical informatics officer at Siemens Health Services. Overhage is a member of the Health IT Standards Committee that advises the National Coordinator for Health IT, and he's also been the Indiana University School of medicine's Regenstrief Professor of Medicine.
Beth Israel Deaconess Medical Center
Think your CIO is busy? How about holding two CIO jobs while also leading multiple industry and federal advisory groups, and being a practicing emergency medicine physician and prolific blogger. Meet Dr. John Halamka, CIO at Beth Israel Deaconess Medical Center and Harvard Medical School.
At the Boston medical center, Halamka has led IT for more than a decade, including its early deployment of electronic health records, patient portals, and clinical decision support tools. BIDMC began offering subsidized, hosted EHRs to its 300 affiliated doctors more than a year before the American Recovery and Reinvestment Act's HITECH provision provided financial incentives.
In January, the medical center became the first U.S. hospital to have its own internally developed EHR software certified as meeting federal criteria for the meaningful use of an EHR system.
At Harvard Medical School, Halamka oversees one of the largest supercomputers in the world, recently expanding the school's high-performance computing facility from 1,000 to 2,000 cores, with a goal of growing it to 6,000 by March.
Halamka also chairs the New England Healthcare Exchange Network, a regional HIE, as well as the U.S. Healthcare Information Technology Standards Panel. He co-chairs the Health IT Standards Committee, which advises the Office of the National Coordinator for Health IT on its meaningful use programs.
Since 2007, Halamka has been writing "Life as A Healthcare CIO," a popular blog where he shares details of his work supporting 3,000 doctors, 3 million patients, and 1,000 faculty. He also muses about life in general, from his family to his hobbies, including rock climbing and playing the shakuhachi, a traditional Japanese flute.
Memorial Sloan-Kettering Cancer Center
As CIO at Memorial Sloan-Kettering Cancer Center in New York City, Patricia Skarulis heads development of one of the country's largest data warehouses for patient care and clinical research at a single organization. The Web-based system contains more than 1.2 million cancer patient records that feed into the center's electronic health record system, giving clinicians a unified view of patients' medical history and treatments.
Skarulis, who has been at Sloan-Kettering for nine years, led the implementation of a wireless network that enables instant communication among clinicians using walkie-talkie technology both inside and outside the hospital. She has also led work with IBM in the development of a pathology analysis systems to help forecast how individual patients will respond to specific cancer treatments.
She's also worked with multidisciplinary team to develop a chemotherapy order entry system that does the complex calculations needed to ensure that patients get the proper chemo dosages.
C. Martin Harris
When U.S. policy makers want a leader to help navigate the future of health IT, they often turn to Dr. C. Martin Harris, CIO and chair of the IT division of Cleveland Clinic in Cleveland, Ohio.
In addition to his work at Cleveland Clinic, Harris is a member of the Health IT Standards Committee that advises the Office of the National Coordinator for Health IT and an adviser to the director of the National Institute of Health's Advisory Committee. While President George W. Bush was in office, Harris was appointed to the President's Commission on Care for America's Returning Wounded Warriors and the Congressional Commission on Systemic Interoperability, which studied the development of a national health information network.
National policy and industry leaders are eager to tap Harris' expertise because of Cleveland Clinic's solid success and pioneering innovations in health IT, including an integrated, enterprise electronic medical record system that was rolled out in 2000 to thousands of Cleveland Clinic physicians, nurses, and other clinicians. The system, based on Epic's EMR system and containing data for nearly 6 million patients, also lets patients collaborate in their healthcare via a portal.
The EMR is used at the clinic's main campus in Cleveland, as well as nine of its hospitals and 14 regional family health centers in northeast Ohio. It's also used at other locations in the U.S. and Canada, and, soon, at a hospital in Abu Dhabi where Cleveland Clinic has a partnership.
In addition to its early adoption of e-health records, under Harris' leadership, Cleveland Clinic is also known for its innovative work using IT in personalized medicine, clinical analytics, disease management, and other emerging areas.
Children's Hospital Boston
During the decade that Dr. Daniel Nigrin has been CIO at Children's Hospital Boston, the hospital has transformed from paper-bound to paperless.
Last year, HIMSS Analytics designated Children's Hospital Boston at Stage 7 on its EMR Adoption Score--the highest level on the scale that measures digital patient chart adoption. Only 55 of the nation's 5,000 hospitals have achieved this level.
The Stage 7 designation shows that Children's is making optimal use of technology, says Nigrin, who's a practicing pediatric endocrinologist. "I've always been against technology for technology's sake, so this makes me very proud," he says.
Innovation at Children's Hospital Boston caught the attention of Dossia, the consortium that Intel, Wal-Mart, Pitney Bowes, BP, and a few other large employers launched five years ago to provide secure, Web-based personal health records to their employees. Not long after Dossia launched, the consortium replaced its original tech services provider's platform with key components of Indivo, the electronic health record system developed by a team at Children's.
Veterans Health Administration
Craig Luigart, CIO of the Veterans Health Administration, the healthcare arm of the Department of Veterans Affairs, is all about making things easier--in more ways than one.
A former naval aviator, Luigart contracted a rare neurological disorder while serving in Pakistan in 1990. He's had to use a wheelchair and has had a severe speech impediment ever since.
Luigart chairs the Federal CIO Council's steering committee that deals with making IT accessible to people with disabilities. "It's been a self-serving passion for me," he says. And in some ways, his primary mission as CIO of providing better healthcare data sharing also has become a self-serving passion.
When he left the Navy in 1996 and transferred his medical care from the Department of Defense to the VA, a military hospital gave Luigart a 4-and-a-half-inch-thick folder containing his medical rec- ords to carry to a VA facility. "I thought, Why am I doing this?'" he recalls. Even then, both the DOD and the VA had electronic records, but the systems didn't talk to each other. Today, recently discharged service members don't have to tote their records to the VA; instead, they're transferred electronically. "All of this is at the point of care," Luigart says.
Luigart got his master's in information systems from the Naval Postgraduate School. He's held CIO positions in the Navy and at the Department of Education prior to moving to the VA in 2003.
At the VA, Luigart has led the data-sharing effort. And now, he has grander plans. With more than 40% of VA patients also receiving care from the private sector, the VA and DOD want to exchange data with major healthcare providers. Trials are under way to prove the viability of a set of interoperability standards that could become a national connectivity model, he says.
When Marc Probst arrived at Intermountain Healthcare seven years ago, the health system had long been using a disparate set of mostly homegrown clinical systems. Since taking over as CIO, Probst has led a transformation to integrate and unify the clinical systems at Intermountain's 23 hospitals and 150 clinics in Utah and Idaho.
Intermountain has teamed with GE Healthcare on a multiyear, $200 million-plus project to co-develop electronic health records. Intermountain has invested $75 million in the effort to develop the vendor's latest generation of enterprise EHR and clinical decision support tools--for Intermountain to use and GE to take commercial.
In February, Intermountain opened its Homer Warner Center for Informatics Research, a research group focusing on clinical decision support and natural language processing technology.
President Obama has cited Intermountain for being among the nation's highest-performing health providers that use "common sense best practices" to offer high-quality care at costs below average.
Geisinger Health System
When the national discussion turns to quality care, best practices, and early health IT adopters, Geisinger Health System's name comes up frequently. The health system in rural central and northeastern Pennsylvania has been a leader in the use of technology to improve care and efficiency, starting with the rollout of its electronic health record systems in 1996. Today, it's out front in using analytic tools to study care gaps and patient outcomes.
Leading the team of 400 IT pros responsible for this technology is Frank Richards, who joined Geisinger in 1977. Richards has helped implement many of Geisinger's systems and technologies, becoming VP of IT in 1997 and CIO in 2000. Geisinger, which serves 2.6 million patients in 42 counties, operates 70 sites, including several hospitals and community care centers.
In 2005, the health system brought together local hospitals and physician practices to form Keystone Health Information Exchange (KeyHIE), which now has 13 members sharing information that includes lab results, discharge summaries, and radiology reports.