25 CIOs Transforming Healthcare
<em>InformationWeek Healthcare</em>'s second annual list of IT executives highlights the exceptional thinkers and doers who are moving patient care forward.
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What makes a health IT executive stand out from the crowd? A quick scan of the CIOs and CMIOs profiled in our second annual CIO 25 honor roll will make the distinctions clear. Common threads: passion, and dedication to improving patient care.
Take Drexel DeFord, senior VP and CIO of Seattle Children's Hospital and chair of the College of Healthcare Information Management Executives. One of the driving forces behind his work was the death of a patient as a result of medical errors. The investigation after that tragedy revealed clinicians' pervasive frustration with slow computer login times and eventually led to major changes in Seattle Children's IT infrastructure.
Likewise, there's no doubt that Dr. Peter Greene's work in creating smarter computerized physician order entry order sets and clinical alerts as Johns Hopkins' CMIO was driven by his experiences working with patients as a cardiothoracic surgeon.
Similarly, CIO Mike Restuccia and his team at Penn Medicine are inspired by genuine concern for patients' welfare. Under his stewardship, the healthcare system has made innovative use of its electronic health records to recruit patients for clinical research trials. Penn's program gives patients access to potentially lifesaving treatments they would likely never know about otherwise.
In a similar vein, Mark Hulse, CIO at Moffitt Cancer Center and Research Institute, recently launched the organization's Health and Research Informatics platform, based on Oracle data warehouse and analytics software. Part of Moffitt's Total Cancer Care program--a longitudinal study that involves 17 community hospitals in 10 states--the platform helps doctors collect and analyze patient clinical, genomic, and molecular tumor data to determine therapies based on cancer types and stages, previous treatments, age, medical history, genetic markers, and other characteristics. As a result, clinicians can quickly identify patients suitable for clinical trials and research projects. In the past, finding patients who fit the criteria "could take weeks or months," said Hulse.
Mike LeRoy, CIO at Detroit Medical Center, also has his sights set on saving lives. Last year, the medical center opened a "smart unit," a 30-bed acute care telemetry unit that links medical devices with clinical and workflow software to improve the safety, quality, and efficiency of patient care. Clinicians get vital signs and other patient data from bedside devices in real time, and information flows right to the patient's EHR.
George Brenckle, senior VP and CIO at UMass Memorial Health Care, is making his contribution to better patient care by harnessing the power of big data. With the help of Informatica, a data integration vendor, UMass has aggregated and cleaned up the healthcare system's enterprise master patient index, giving users easy access to the data contained in more than 5 million patient records. That sets the stage for the kind of data analytics that can improve clinical outcomes and lower costs.
UMass also has built an ICU "bunker," a central command center that's patched into the 10 intensive care units in the hospital system. Specialists in the bunker have video and audio access to the ICUs and receive real-time data on patients. The command center has been responsible for a 20% drop in mortality at UMass's ICUs since it was put in place, said Brenckle.
The list of life-saving changes that passionate health IT leaders are making goes on and on, which is why we hope you'll take a closer look at the exceptional doers and thinkers profiled here. (Wondering who made our first list? Read The InformationWeek Healthcare CIO 25.)
UC San Diego Health System recently received a Stage 7 award from HIMSS Analytics, signifying that it had reached the most advanced level of EHR development based on the association's criteria. Much of the credit for that achievement belongs to Edward Babakanian, CIO of UC San Diego Health Sciences, which includes the health system and its medical school and research arm.
Babakanian led the effort to create the advanced EHR. First, members of his team improved the performance of the legacy system they inherited, replacing green screens with graphical user interfaces and installing file caches that cut data retrieval time. Then they introduced computerized physician order entry and persuaded most doctors to use it. After that came an electronic medication administration record and a successful effort to get drug suppliers to bar code most of their units.
Over the past several years, UC San Diego also has converted both its inpatient departments and its ambulatory care clinics to the Epic HER system. UC San Diego Medical Center already has attested to Stage 1 Meaningful Use, and the health system's 300 ambulatory care physicians were almost ready to attest early this year. "I'm pretty sure that we're ready for any Stage 2 requirement," Babakanian said. "We're at 100% CPOE, and Stage 2 requires only 60%."
Another reason he believes UC San Diego could easily meet the Stage 2 criteria is that it has made significant progress toward interoperability with local healthcare organizations. Using a grant from the Office of the National Coordinator of Health IT, it's developing a health information exchange with Sharp HealthCare, Rady Children's Hospital San Diego, Scripps Health, and Kaiser Permanente.
Data integration is a buzz phrase in medical informatics. At Ochsner Health System, southeast Louisiana's largest healthcare provider, it's far more than a catchphrase--it's a key part of Ochsner's strategic plan, VP and CIO Chris Belmont said.
Under Belmont's lead, Ochsner has replaced legacy IT systems with Epic's EHR system and integrated a long list of applications into a data warehouse. In the past, doctors, administrators, and in some situations even patients had to scavenge through multiple systems to find the information they needed, Belmont said. That meant that figuring out something as simple as how many hospital visits a patient had in the last 12 months became a major headache, he said.
Belmont needed a way to take all the rich data the healthcare system had collected in the last 15 years--including clinical and operational data--and combine it all in one place so users would have easy access. Using Informatica's data integration software, Ochsner spent the past year moving data from 22 different IT systems into a data warehouse, giving employees access to a huge store of financial, clinical, administrative, and operational information.
Access to detailed work schedules, for instance, lets Ochsner's managers better adjust the labor pool to the ebb and flow of business. It also lets them manage productivity among their 850 physicians, eight hospitals, and 35 clinics. "The data analytics we can do now lets us track clinicians' patient loads and make sure each physician's schedule is full," Belmont said.
Bottom line? Data integration has improved the clinician's user experience, and that lets Ochsner run more efficiently and provide better care.
Carol Bickford is a trailblazer in nursing informatics. Her career in healthcare started 40 years ago in the Navy Nurse Corps, and she's still an outspoken advocate of patient-centric health IT. Bickford describes herself as "a canary in the mine." Health IT must address the full spectrum of patients in all care settings, she said.
Bickford is a registered nurse and nursing Ph.D. who's held medical-surgical, ambulatory care, administrative, and informatics positions. She's now a senior policy fellow in nursing practice and policy at the American Nurses Association, providing input to government initiatives, including the National Committee for Vital and Health Statistics and the Office of the National Coordinator for Health IT.
She also tells policymakers that even though nurses aren't eligible for Meaningful Use incentives, they are important to health IT. The emerging role of chief nursing informatics officer is a step in the right direction, she said, because the job makes sure health IT addresses all levels of patient care.
One of the challenges of running the IT department of a five-hospital organization that also includes two academic medical centers, two affiliated medical schools, and two physician groups, according to Aurelia Boyer, senior VP and CIO of New York-Presbyterian Healthcare System, is synchronization.
For example, a major priority for the hospitals at one point might be to improve connectivity with physician offices. But the practices might be busy getting 500 physicians to prescribe electronically. "It's not that everyone doesn't agree on what we want to do, but the timing of those things can get difficult," she said.
In some ways, complying with the federal Meaningful Use requirements has been less daunting. All New York-Presbyterian Healthcare System hospitals are using the Allscripts' Sunrise electronic health record system, and all are using computerized physician order entry for 100% of their orders, Boyer said. Nursing notes all are electronic and so are most physician notes, she said.
Resident physicians at the New York-Presbyterian's academic medical centers led the way in getting doctors to adopt the inpatient EHR system, Boyer said. Then, at some point, faculty physicians and other staff members began to realize that having a record-keeping system that was half electronic and half paper was inefficient and unsafe. "The physicians themselves said this is not a good practice, we have to go all one way." So with leadership from some department chairs, Boyer said, everybody got on board.
Like many other top-flight healthcare systems, UMass Memorial Health Care sees the value of "big" data. Senior VP and CIO George Brenckle worked with Informatica, a data integration vendor, to aggregate and clean up the healthcare system's enterprise master patient index, giving users easy access to the data contained in more than 5 million patient records.
The system also lets UMass address some crucial questions that its transactional applications haven't been able to deal with. Among them: How many patients have been seen at UMass, and which of them are being seen at a primary care site in a specific time frame.
Under Brenckle's stewardship, UMass also has built an ICU "bunker," a central command center that's patched into the 10 ICUs in the hospital system and three external ICUs at community hospitals.
Specialists in the bunker have video and audio access to the ICUs and get real-time data on patients. The command center has been responsible for a 20% drop in mortality at UMass's ICUs since it was put in place, Brenckle said.
The smallest state in the U.S. has some of the loftiest health IT endeavors under way, and leading the charge is Gary Christensen, CIO and COO of the Rhode Island Quality Institute (RIQI).
The nonprofit is the only organization in the country to receive federal funding for three of the HITECH Act's biggest programs. It serves as a regional extension center, runs the state's health information exchange, and leads Rhode Island's efforts as one of 17 national Beacon Community Programs.
RIQI last year helped Cumberland Primary Care, a member of RIQI's regional extension center, become the first practice in the country to send e-health record data to a state HIE using the direct messaging and interoperability protocols. If Rhode Island can scale the technologies' use statewide, it can serve as a model for larger states, and RIQI will have a national impact on health IT. "Rhode Island is an excellent petri dish," said Christensen.
Dr. Steven Davidson, chief medical information officer and former chair of emergency medicine at Maimonides Medical Center, has had many successes in medicine and health IT, but one project got stopped in its tracks.
The emergency department at Maimonides, a century-old, 705-bed academic medical center in Brooklyn, N.Y., with a history of technological innovation, turned on its electronic health record as planned, at 7:30 a.m. on a Tuesday. On Sept. 11, 2001. In New York.
"Of course, we turned it off at 9:10," Davidson recalled. He and his charges finally brought the system up for good in April 2002 after patient volumes returned to normal. It included a full EMR with computerized physician order entry, results reporting, and an electronic medication administration record.
"My history is as an innovator," Davidson said. That's clear from the foresight he had to ask Allscripts, Maimonides' EHR vendor, for a second site license so he could replicate the HealthMatics ED EHR to create a data warehouse that's being used for business intelligence and analytics reporting.
Drexel DeFord, senior VP and CIO of Seattle Children's Hospital and chair of the College of Healthcare Information Management Executives, is on a mission to improve care for the children treated in his institution.
In 2010, a patient died as a result of medical errors at the hospital, DeFord recalls. Hospital leaders analyzed the facility's processes to figure out how to prevent a repeat. One of the things they heard from clinicians was that as they moved around the hospital it took too long to log in to computers and pull up records.
DeFord and his team decided the best solution was to move to a virtual desktop infrastructure (VDI). Now it takes clinicians 25 seconds to boot up, rather than several minutes, he said. "We've taken 45 minutes out of a typical clinician's day just in logon and boot-up times," he said.
VDI also provides a mobility option that clinicians didn't have before: Anywhere they log in, they get the same PC image with the same applications, exactly as they left it during their last login. In addition, IT security has improved with VDI because all software patches are applied centrally. Also, the IT staff is accomplishing more because it no longer has to do desktop maintenance, DeFord said. This improvement is a perfect example of Seattle Children's "lean" philosophy: becoming more efficient to free up resources for more important work.
ICD-10 On Front Burner
Seattle Children's has devoted substantial efforts to preparing for ICD-10, DeFord said, and won't slow down even now that the government has postponed the ICD-10 deadline.
DeFord views ICD-10 as more important than Meaningful Use. "If you want to file claims and get paid, you have to do ICD-10. Meaningful Use is your bonus check," he said. "If you do Meaningful Use, you'll get some additional dollars. But if you don't do ICD-10, you won't be in business."
Seattle Children's is also at the forefront of computerized physician order entry. Instead of using canned order sets, it has developed specialty order sets--and generously provides them to other pediatric institutions heading down the CPOE path.
The challenge with order sets is that they must constantly be reviewed and updated, DeFord said. The same, he said, is true of EHRs: Implementation is only the beginning of the long process of maintaining and improving these systems.
CentraState Health System maintains a "very tight relationship" with community physicians and offers a lot of support services, said Neal Ganguly, VP and CIO of the not-for-profit health organization, which includes the CentraState Medical Center, an acute-care facility in Freehold, N.J.; three senior living communities; and a family medicine center.
CentraState has been helping local physicians in various ways, including providing advice on how to select, adopt, and implement electronic health record systems. Because the local doctors' practices have installed a variety of EHR systems, CentraState also has built a private health information exchange to connect with physician offices. The organization decided that this was a more efficient approach than building expensive, point-to-point interfaces with each EHR.
To connect with providers outside its own exchange, CentraState has joined a regional health information exchange, Jersey Health Connect, that includes 17 other hospitals, Ganguly said.
Baptist Health in Jacksonville, Fla., made a strategic decision nearly 10 years ago to open its Baptist Medical Center South facility, then under construction, as a paperless facility. When the first patients entered in 2005, a full EHR was in place, making it the first all-digital hospital in northeast Florida and among the first in the country.
"That began our journey to deploying electronic medical records at not only our hospitals but at our ambulatory clinics, too," senior VP and CIO Roland Garcia said. All five Baptist Health hospitals now use Cerner EHRs for inpatient care, and the health system recently completed rolling out an Allscripts system at its network of more than 40 primary care clinics.
IT has "given us a competitive edge in our local market," Garcia said. Baptist Health led quality and patient satisfaction rankings in National Research's 2009-2010 survey of the Jacksonville area, including for personalized care, latest technology and equipment, and the widest range of services. Baptist also made the 2011 InformationWeek 500 for its innovative use of IT.
Debe Gash, VP and CIO of Saint Luke's Health System, spearheaded a pioneering connectivity project that improved care and laid the groundwork for the interoperability of systems that will be a key part of Meaningful Use Stage 2.
Five years ago, the Kansas City, Mo., health system, which includes 11 acute-care hospitals and employs about 300 physicians, introduced a secure messaging system, partly to get doctors more involved in improving the quality of care. The Web-based system lets hospitals deliver results and transcribed reports to physicians, who also use it to communicate with each other and with patients.
In addition to the communication system, Saint Luke's is driving the implementation of a regional imaging exchange. In the last year, it has connected the majority of hospitals in the area, letting them use the exchange to distribute images, Gash said. "When a patient is transferred from a rural facility to one of our metropolitan hospitals, we can do the image exchange and don't have to wait for the CD to arrive," she said.
Dr. Peter Greene, the CMIO at Johns Hopkins Medicine, spends a lot of time thinking about ways to improve the health system's clinical decision support system (CDSS). "Alert fatigue is a massive problem in hospitals, so we are trying to create smarter alerts and 'choreographed' alerts to make it easier to manage patient care and reduce the number of unnecessary alerts," he said.
For instance, Greene and his colleagues at Johns Hopkins--which encompasses the university's medical school and integrated health system--have devised a smarter way to order postoperative insulin regimes for diabetic patients. Several hundred different insulin regimens are available for these patients. Instead of making the physician slog through countless screens and alerts in the CPOE, behind-the-scenes programming inserts key pieces of information from the patient's e-chart to help find the right regimen. The ordering physician only needs to answer a few questions before the CDSS makes a specific recommendation.
Greene's team also has tackled the complexities of managing indwelling urinary--a.k.a. Foley--catheters in hospitalized patients. The standard of care for surgical patients calls for removal of the Foley by the end of the second post-op day. On a busy surgical unit, that task is easily overlooked, risking needless complications. Using a team-based decision support approach, Greene said, so-called choreographed alerts are sent to members of the nursing and medical staff at various points in a patient's care. The alerts ask the appropriate clinician to document the presence of the catheter and explain why it's still needed.
Greene's efforts have gone a long way toward easing one of the main reasons so many docs in the trenches hate EHRs--alert noise.
At Moffitt Cancer Center and Research Institute, IT is playing a critical role in providing more personalized treatments, whether it's tailoring specialized care or identifying the right patients for clinical trials.
Leading the way is Mark Hulse, a one-time practicing RN who joined the Tampa, Fla., nonprofit as CIO three years ago after serving for six years as CIO at North Shore Medical Center near Boston.
One key project is the center's new Health and Research Informatics platform. Based on Oracle data warehouse and analytics software, the platform is foundational to Moffitt's Total Cancer Care program, a longitudinal study that involves 17 community hospitals in 10 states. The program collects and analyzes patient clinical, genomic, and molecular tumor data to determine therapies based on cancer types and stages, previous treatments, age, medical history, genetic markers, and other characteristics.
That data eventually will be applied at patient bedsides for clinical decision support. Already, it's helping Moffitt identify patients suitable for clinical trials and research projects. In the past, finding patients who fit the criteria "could take weeks or months," Hulse said.
Among the other IT initiatives he's exploring: embedding multipurpose medical devices into the walls of patient rooms, expanding clinicians' use of mobile devices, and using speech recognition and natural language processing to capture doctor-patient conversations and then analyze some of that data.
Hulse's experience as an RN gives him a broad perspective. "Doctors are more episodic," he said, "but nurses are always there, for everything from care to food services to lab work." If "clinical transformation" is to become more than a buzz term, Hulse said, even IT pros must understand all facets of care, including quality, safety, and costs.
EHRs aren't built for medical research. "The workflows are so far away from what researchers want to do," said Warren Kibbe, director of cancer informatics for the Robert H. Lurie Comprehensive Cancer Center at Northwestern University's Feinberg School of Medicine, and director of bioinformatics for the university's Center for Genetic Medicine.
Kibbe's team does a lot of custom application development because there aren't suitable commercial products to manage the kind of research and analytics projects that the cancer center does. The cancer center's data warehouse is enhancing its research efforts. "We've come a long way in understanding how research and patient care go hand in hand," Kibbe said. Anatomically defined cancer, such as breast cancer, can arise from many different causes, he said. "We don't fully understand this yet, but we're getting there very rapidly."
Analyzing the data in the warehouse should help researchers better understand diseases and enable clinicians to make more informed treatment decisions.
Mike LeRoy, CIO at Detroit Medical Center, has an affinity for technologies that improve not only patient care and safety, but also clinician workflows.
DMC, which includes nine hospitals with a total of 1,800 beds, was innovating with IT for patient care years before the feds waved incentive dollars at healthcare providers. DMC, acquired by Tennessee-based Vanguard Health Systems in late 2010, embarked on deploying Cerner e-medical record systems in 2006.
DMC last year opened a "smart" unit, a 30-bed adult acute-care telemetry unit that links medical devices and clinical and workflow software to improve the safety, quality, and efficiency of patient care. In patient "smart rooms," vital signs and other data collected from bedside devices is presented to clinicians in real time and flows right to the patient's EMR, eliminating repetitive manual work.
DMC also is introducing "smart beds," which feature sensors that monitor patient movements and mattress pressure. Smart-infusion pumps wirelessly connect patient IVs with hospital pharmacy drug formularies. DMC also is equipping nurses and select doctors with VoIP smartphones that send telemetry alerts, such as when a patient is experiencing ventricular fibrillation. "Response time is seconds, down from minutes," LeRoy said.
With more data feeding into EMRs, information overload was a concern, so DMC rolled out dashboards that provide graphics-intensive clinical summaries.
DMC also is looking at how these smart technologies can improve nurses' workflows. "If a nurse has 10 patients, how does the nurse know what order to see patients, other than bed to bed?" LeRoy said. Dashboard icons and alerts direct care to patients who need it immediately.
Harry Lukens has a cultlike following among the 315 people he oversees as senior VP and CIO at Lehigh Valley Health Network, which runs two hospitals as well as community health centers and clinics in eastern Pennsylvania.
Not your typical manager, Lukens every few weeks convenes what he calls his "Wild Ideas Team" where he has one rule: "no snickering." Every idea, no matter how off the wall, gets considered. Medication bar coding, which Lehigh has had in place since 2006, came from that group.
Lukens also hosts what his secretary has dubbed "Harry Hours," taking employees to lunch or happy hour to get feedback and answer questions.
Lukens' tech group has a low turnover rate. It was 30% when he arrived 18 years ago and went negative last year when two people returned to the fold. "We make sure people get the education they need, on our dime," he said.
Lukens is serious about the work he does. His mantra: "Technology in healthcare has no value unless it's supporting patient care in some way."
Dr. Farzad Mostashari took over as the national coordinator for health IT a year ago, picking up where Dr. David Blumenthal left off after serving in that role for two years. Mostashari was well positioned to take on the top federal health IT job, having been deputy national coordinator for programs and policy since July 2009.
Mostashari has spent the last year overseeing the execution of Meaningful Use Stage 1 and other HITECH Act programs. He also oversees the drafting of the next two stages of the Meaningful Use program.
Prior to coming to ONC, Mostashari led the New York City Department of Health and Mental Hygiene Primary Care Information Project, which worked to get more than 1,500 healthcare providers to use technology to improve preventive care in underserved neighborhoods. Working so closely with healthcare providers, Mostashari said, helped him understand the challenges they face in deploying health IT. The most important thing he learned in New York is that it was "going to be a continued process, with providers getting better and better and better," he said. He's now applying that approach on the national stage.
As of February 2012, 211,500 providers had registered to participate in the Meaningful Use program, with a total of $3.8 billion in incentive money already paid to Medicare and Medicaid providers. The progress so far has been "nothing short of breathtaking," he said.
Now the challenge is to get clinicians to use the systems. Providers face daily struggles in using IT efficiently and in meaningful ways, Mostashari said. The market will help, he adds. In the next few years, we should see vendors making health IT systems easier and more intuitive and efficient.
Partners Healthcare is one of 32 Pioneer accountable care organizations selected by the Centers for Medicare and Medicaid Services (CMS) to test a new payment model that requires these ACOs to take on more financial responsibility for patient care than the other participants in CMS' Shared Savings Program.
The Boston health system needs to do more work to prepare for this complex undertaking, said James Noga, VP and CIO at Partners, which includes seven acute care hospitals, 20 community health centers, rehabilitation facilities, and a network of more than 5,000 physicians.
To succeed in the ACO program, Noga said, Partners must gear up for a new approach to care delivery that emphasizes population health management, a model that focuses on keeping patients healthy and managing their care between encounters with the health system. Building on an earlier demonstration project in which Partners participated, the organization is increasing its emphasis on the use of electronic patient registries and event-driven alerts to help primary care doctors manage their patients, he said.
Partners is taking a proactive approach in other areas. It began planning for ICD-10 two and one-half years ago, putting a program management structure in place across the enterprise. Despite CMS's recent decision to delay the ICD-10 deadline, Noga said, "we have not slowed down." In fact, Partners is training its affiliated private practice physicians on ICD-10 documentation.
Since 2008, Partners has required its physicians to use either the health system's homegrown electronic health record system or GE Healthcare Centricity if they want to keep working with Partners. As a result, all of its doctors now have EHRs, and Noga expects them to attest to Meaningful Use this year.
As VP and CIO of Atlantic Health System, a three-hospital group in New Jersey, Linda Reed does more than maintain information systems. She's also president of Jersey Health Connect, a regional health information exchange that connects 18 hospitals, two independent physician groups, and a long-term-care facility.
Reed's other big project is developing an infrastructure for Atlantic's new accountable care organization, which includes its own hospitals; Valley Hospital in Ridgewood, N.J.; and more than 1,200 physicians.
In other areas, Atlantic has added electronic nursing documentation, electronic medication administration, and computerized physician order entry in the last five years. Partly because nurses were empowered to use CPOE early on, all inpatient orders are now entered electronically, Reed said.
Physician use of the system "goes up and down," she admits. "You have to remind them to keep doing it." Eventually, she said, Atlantic will simply eliminate paper order forms.
Mike Restuccia and his team at Penn Medicine have taken their EHR system a step beyond the ordinary, marrying it to clinical research trials. When recruiting patients for trials, medical researchers typically use billboards, newspaper ads, and sometimes social media to get the word out. But those methods often don't attract enough of the right patients.
Penn Medicine, which consists of the University of Pennsylvania's Raymond and Ruth Perelman School of Medicine and health system, uses the trove of data in its EHRs to find clinical trial candidates and then alert their doctors. Penn uses a feature of the EpicCare EMR called Research Trial Advisory to do this.
Doctors working from offices and clinics outside the hospital provide 85% to 95% of patient care, Restuccia said, and as a result, they have an ongoing, trusted relationship with patients and are better positioned to recruit them for clinical trials. Once researchers identify the candidate criteria for a trial--which includes diagnosis, gender, age, lab results, and medication--an alert is embedded in the ambulatory EHR of patients that match the criteria. Doctors of those patients get a message on their EHR screens encouraging them to discuss the trial with the candidate.
Penn Medicine has eight studies now using the Penn Research Trial Advisory. And the fact that researchers have come forward to request that their clinical trial recruitment characteristics be embedded within the EMR suggests the tool is having an impact.
The clinical trial tool wouldn't have been possible without Penn having deployed an Epic ambulatory EHR system for the more than 1,800 physicians employed in the healthcare system. That's no small feat when you consider that many major health organizations have yet to get all their docs on one common system.
Penn's ambulatory system is integrated with its inpatient Allscripts Sunrise Clinical Manager, letting clinicians seamlessly share patient data, and its IT and clinical leaders introduce common processes, workflow adjustments, and best practices across the healthcare system with relative ease.
Rick Schooler, CIO and VP of Orlando Health in Florida, sounds more like a chief medical officer than a tech pro. A "new level of decision support," driven by business intelligence, is moving health IT closer to what Schooler calls the endgame of disease management, clinical analytics, and population health.
Schooler believes that the success of transforming the nation's health system rests on how well organizations input and mine their data, both in real time at the point of care and in post-care review.
"This is real for healthcare and it's not going away," he said. "If you don't believe that, you probably need to get out of healthcare."
The seven-hospital Orlando Health organization made the 2011 InformationWeek 500 list largely because Schooler has been successful in tying together myriad, disparate information systems. These systems contain such data as patient demographics, laboratory results, medical images, clinical documentation, patient history, problem lists, medication lists, allergies, and discharge summaries.
"A health system like ours literally has hundreds of clinical information systems," Schooler said. Different vendors provide systems for registration, scheduling, billing, and ancillary departments. "There are all these technologies that need to be integrated."
With that in mind, Schooler and his team have implemented an enterprise data warehouse and advanced analytics tool sets, and they recently established a corporate enterprise analytics team.
The technology might have evolved, but the strategy for integrating systems is the same as it's always been. "It all stems from getting effective workflows into place," Schooler said.
After four years as senior VP and CIO for St. Joseph Health System, a $4.3 billion California-based healthcare system, Larry Stofko is taking on a new challenge as executive VP of the health system's Innovation Institute. The institute, which has internal and outside funding, is designed to introduce health IT products, services, investments, and partnerships. Stofko's 25 years of experience in healthcare IT made him the obvious choice to be part of the institute's executive leadership team.
As CIO at St. Joseph, Stofko has spearheaded several progressive initiatives, including the deployment of wireless smart IV pumps, remote ICU monitoring, medication bar codes, RFID, and a physicians' portal.
Since moving to the Innovation Institute, Stofko has launched its Innovations Lab, which is tasked with "mining and harvesting ideas from employees and physicians," he said. As administrative and IT staff, and physicians and other clinicians detect problems and come up with potential solutions, the lab will bring these to technology partners to prototype, pilot, and commercialize them.
Projects on the drawing board focus on breakthroughs in the areas of mobile health, personalized medicine, consumer technologies, and gamification. One project, for instance, uses IT tools to coordinate and standardize pre-op and post-op care based on personal health records and evidence-based medicine.
These new tools and platforms will be built to scale rapidly across healthcare organizations nationally, and, in some cases, internationally.
The rationale for the Innovation Institute was pretty straightforward, said Stofko: Traditional third-party reimbursement of medical services is shrinking and the institute is an important way for St. Joseph to innovate and explore growth opportunities.
Micky Tripathi was in the trenches of an e-health revolution long before most people were convinced a national, digitized, connected health information transformation would happen.
Back in 2003, Tripathi helped found the Indiana Health Information Exchange, what is now one of the country's largest and most successful regional health information exchanges. That was long before federal subsidies for electronic records, and even before President George W. Bush's 2004 goal for most Americans to have e-health records by 2014.
Tripathi worked first as a consultant and later as CEO and president of the Indiana Health Information Exchange, which partnered with the Regenstrief Institute to create a statewide health information infrastructure.
In 2004, the exchange brought in a local executive, Dr. Marc Overhage, and Tripathi moved on to become CEO of the Massachusetts eHealth Collaborative.
MAeHC is a nonprofit organization--with a for-profit consulting arm--that in 2004 led a $50 million initiative funded by Blue Cross Blue Shield of Massachusetts to roll out connected e-health records to providers in three communities in the state.
MAeHC is involved with HIE efforts in California, Massachusetts, Missouri, New Hampshire, and New York. Tripathi's 30-person organization also runs the regional extension center in New Hampshire.
Tripathi taps his consulting background to help organizations map where they broadly want to be in five years and what concrete goals they want to implement in the next two years. Said Tripathi, "If we pretend to know what health IT will look like in five years, we're kidding ourselves."
Will Weider, CIO of Ministry Health Care, a Catholic health system with 15 hospitals, 47 clinics, a health plan, and a hospice in northern and eastern Wisconsin, tries to keep his priorities straight.
Two of the hospitals, Ministry Saint Clare's Hospital and Ministry Saint Joseph's Hospital, have already attested to Stage 1 Meaningful Use and received their bonus payments.
Now, Ministry is working on a much larger IT project: Creating a single, standardized information system across all its hospitals, based on the implementation of a GE Healthcare Centricity Enterprise EHR and management system at Saint Clare's. That hospital opened as an all-digital facility in 2005, the first in the state to fully implement a computerized physician order entry system that met the definition of the Leapfrog Group, an association of employers and other healthcare buyers focused on improving standards of care and safety.
"That's our model. We've kind of been using that as our laboratory," Weider said. "We're very proud of that hospital."
This is an important time for the University of Chicago Medical Center. The academic healthcare organization is almost done with its implementation of an Epic Systems electronic health record and is getting ready next year to open a 1.2 million-square-foot pavilion that will add 240 patient rooms to the main hospital, which contains 532 beds. Eric Yablonka, VP and CIO of the medical center, expects to be ready to attest to Stage 1 Meaningful Use by the fall.
Yablonka, who won the 2006 John E. Gall Jr. CIO of the Year Award from the College of Healthcare Information Management Executives, said that in the next few years, he will look for cost savings and efficiency gains while also helping to improve clinical outcomes through IT.
He also will beef up analytics for research, clinical, and business purposes to support clinical collaboration and care coordination. For example, the university's Institute for Translational Medicine seeks to speed research breakthroughs into clinical practice. "We want to go from bench to bedside," Yablonka said.
This is an important time for the University of Chicago Medical Center. The academic healthcare organization is almost done with its implementation of an Epic Systems electronic health record and is getting ready next year to open a 1.2 million-square-foot pavilion that will add 240 patient rooms to the main hospital, which contains 532 beds. Eric Yablonka, VP and CIO of the medical center, expects to be ready to attest to Stage 1 Meaningful Use by the fall.
Yablonka, who won the 2006 John E. Gall Jr. CIO of the Year Award from the College of Healthcare Information Management Executives, said that in the next few years, he will look for cost savings and efficiency gains while also helping to improve clinical outcomes through IT.
He also will beef up analytics for research, clinical, and business purposes to support clinical collaboration and care coordination. For example, the university's Institute for Translational Medicine seeks to speed research breakthroughs into clinical practice. "We want to go from bench to bedside," Yablonka said.
What makes a health IT executive stand out from the crowd? A quick scan of the CIOs and CMIOs profiled in our second annual CIO 25 honor roll will make the distinctions clear. Common threads: passion, and dedication to improving patient care.
Take Drexel DeFord, senior VP and CIO of Seattle Children's Hospital and chair of the College of Healthcare Information Management Executives. One of the driving forces behind his work was the death of a patient as a result of medical errors. The investigation after that tragedy revealed clinicians' pervasive frustration with slow computer login times and eventually led to major changes in Seattle Children's IT infrastructure.
Likewise, there's no doubt that Dr. Peter Greene's work in creating smarter computerized physician order entry order sets and clinical alerts as Johns Hopkins' CMIO was driven by his experiences working with patients as a cardiothoracic surgeon.
Similarly, CIO Mike Restuccia and his team at Penn Medicine are inspired by genuine concern for patients' welfare. Under his stewardship, the healthcare system has made innovative use of its electronic health records to recruit patients for clinical research trials. Penn's program gives patients access to potentially lifesaving treatments they would likely never know about otherwise.
In a similar vein, Mark Hulse, CIO at Moffitt Cancer Center and Research Institute, recently launched the organization's Health and Research Informatics platform, based on Oracle data warehouse and analytics software. Part of Moffitt's Total Cancer Care program--a longitudinal study that involves 17 community hospitals in 10 states--the platform helps doctors collect and analyze patient clinical, genomic, and molecular tumor data to determine therapies based on cancer types and stages, previous treatments, age, medical history, genetic markers, and other characteristics. As a result, clinicians can quickly identify patients suitable for clinical trials and research projects. In the past, finding patients who fit the criteria "could take weeks or months," said Hulse.
Mike LeRoy, CIO at Detroit Medical Center, also has his sights set on saving lives. Last year, the medical center opened a "smart unit," a 30-bed acute care telemetry unit that links medical devices with clinical and workflow software to improve the safety, quality, and efficiency of patient care. Clinicians get vital signs and other patient data from bedside devices in real time, and information flows right to the patient's EHR.
George Brenckle, senior VP and CIO at UMass Memorial Health Care, is making his contribution to better patient care by harnessing the power of big data. With the help of Informatica, a data integration vendor, UMass has aggregated and cleaned up the healthcare system's enterprise master patient index, giving users easy access to the data contained in more than 5 million patient records. That sets the stage for the kind of data analytics that can improve clinical outcomes and lower costs.
UMass also has built an ICU "bunker," a central command center that's patched into the 10 intensive care units in the hospital system. Specialists in the bunker have video and audio access to the ICUs and receive real-time data on patients. The command center has been responsible for a 20% drop in mortality at UMass's ICUs since it was put in place, said Brenckle.
The list of life-saving changes that passionate health IT leaders are making goes on and on, which is why we hope you'll take a closer look at the exceptional doers and thinkers profiled here. (Wondering who made our first list? Read The InformationWeek Healthcare CIO 25.)
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