Where Does IT Hurt?

CIOs from four major health systems list their biggest pain points and outline their strategies to overcome these challenges.

It’s not easy being a healthcare CIO, particularly in today’s volatile landscape. Ever since the HITECH (Health Information Technology for Economic and Clinical Health) Act was passed in 2009, the demands placed on healthcare CIOs have increased exponentially, and stress levels have elevated in turn. Modern-day CIOs face a plethora of unprecedented IT and organizational challenges. In many ways, they are learning as they go, striving to develop successful strategies and systems to improve patient and business outcomes in the brave new world of healthcare. I recently interviewed the CIOs from four leading health systems — Georgia Regents Health System, Inspira Health Network, Memorial Hospital, and Southern Illinois Healthcare (SIH) — to gain insight into the challenges that keep them up at night and the strategies they’re deploying to address these issues.

Top CIO Pain Points
Too many projects, too few resources — According to the CIOs I interviewed, the sheer act of managing the vast amount of work currently on their plates is a huge challenge. “There is a ton of high priority IT projects I’m currently working on and the health system is trying to reduce expenses at the same time, which leads to budget and staff cuts,” says Tom Pacek, VP and CIO of Inspira Health Network. “Trying to meet project demands with fewer resources is a balancing act that’s a constant struggle.”

Furthermore, IT has less control over how these shrinking resources are applied than they may have had in the past. Government mandates and incentives are driving many health IT initiatives today and provider executives are pouring resources into these efforts.

“Getting our systems in line with Meaningful Use and HIPAA requirements is currently consuming most of our financial and human resources at an IT level,” says Charles Enicks, VP and CIO of Georgia Regents Health System. “With so much focus being dedicated to these government-driven initiatives, we have little left to allocate to other important projects such as improving ambulatory workflow, streamlining discharge processes, enhancing rules and alerts for CPOE (computerized physician order entry), and launching the specialty department applications that are necessary for a complete and integrated clinical record.”

Healthcare reform — The ACA (Affordable Care Act) will fundamentally change the reimbursement structure for healthcare providers — shifting from a fee-for-service to a value-based reimbursement model that rewards optimal patient outcomes. With value-based reimbursement, the health provider takes on more risk when it comes to being compensated for patient care — a development that is hard for many CIOs to swallow. “With healthcare reform, health IT vendors, consultants, pharmaceutical manufacturers, and insurance companies continue to make healthy margins, but the health provider’s reimbursement is under tremendous scrutiny,” says Gene Thomas, VP and CIO of Memorial Hospital. “Providers are under extreme pressure to improve performance and patient outcomes with declining reimbursement, yet they aren’t expected to pay others in the care continuum any less to support them in these efforts.”

Value-based reimbursement will not only hold health providers accountable, it also aims to reduce hospital visits, length of stay, and readmissions. This will shift the organizational priorities for many health systems. Health providers throughout the U.S. are trying to figure out what the “new normal” will be when this new reimbursement model becomes the norm. CIOs are at the center of this transformation as they aim to provide the best information technology to support this transition.

“A value-based model will require us to move some, but not all, of our patient volumes to a less costly ambulatory setting to maximize reimbursement,” says Pacek. “This is challenging because you need information technology in each of these settings to support clinical decision making and positive patient outcomes. Until recently, most of these efforts have been focused on hospital settings. Ambulatory is becoming a bigger part of the equation, but it’s a painstaking transition.”

User adoption — Not surprisingly, driving clinical adoption and use of IT systems (especially EHRs) is a painstaking ordeal for many healthcare CIOs. “We need the end users to take ownership of clinical IT systems and to engage with us during implementation to help us tweak these solutions to ensure they are effective,” says Dave Holland, CIO of SIH. “Unfortunately, this is easier said than done. Most clinicians don’t view the EHR as being part of their clinical process — at least not initially. Our IT staff needs to spend a great deal of time and energy working with doctors and nurses to get them to understand the value of EHRs and modify their workflows to incorporate the technology in a productive manner.”

Data exchange — Data is the fuel that feeds most effective health IT solutions. However, gaining access to the data necessary to move an IT initiative forward can cause headaches for CIOs. This is becoming a bigger issue as ambulatory settings begin to play a larger role in the care continuum.

“We have a wealth of data on the acute care side of the health system, so we have the information we need to understand the patient population that’s inside the hospital,” says Pacek. “However, we now need to access data from ambulatory facilities to coordinate care. This is difficult because oftentimes we don’t own this data. Instead, it belongs to local physicians’ practices, long-term care facilities, or behavioral health facilities we work with, but don’t own. Getting patient data from these facilities is a challenge because it’s in a variety of different formats. Sometimes, the data isn’t even discrete electronic data, but scanned document images.”

Pacek goes on to say that it isn’t always the partnering providers that make data exchange such a difficult proposition. Oftentimes, these entities are willing to share their data with Inspira, but the various EHR vendors in use at these facilities make getting access to patient data in required formats a struggle.

Patient engagement — Finally, many CIOs seem to be struggling with the Stage 2 Meaningful Use requirements surrounding patient engagement — largely because they feel patient behavior is something they can’t control. “How at an IT level can we get a patient to engage?” asks Thomas. “How can we guarantee that a patient will be compliant and do the things he or she needs to do to stay well? We can’t. All we can do is provide the tools that encourage patient/clinician interaction and allow our staff to provide the best possible care at every encounter.”

Dealing With The Pain
Implement enterprise IT infrastructure — For most of the CIOs I interviewed, the essential building block necessary to deal with most of these pain points is implementing a unified and integrated IT infrastructure throughout the enterprise. “Getting the entire enterprise on the same clinical and financial system with the same reporting capabilities is crucial when it comes to addressing new health IT demands,” says Pacek. “Proper care coordination and measurement require uniformity from both a data and procedural standpoint. An enterprise infrastructure provides much of the core integration necessary to provide a solid foundation that future initiatives can be built upon.”

Get good data — Ensuring IT systems are full of good data is another way to effectively address the new breed of challenges facing healthcare CIOs. This data needs to be accurate, normalized, and come from all points of the care continuum. With it, healthcare providers can gain solid insight into their clinical performance, the condition of their patient populations, and their financial projections (even with value-based reimbursement considerations). In response, they can put processes in place to intervene with clinicians and patients, model contracts, and ultimately improve outcomes.

The importance of clean data to the healthcare equation these days makes data integrity and governance a top priority for CIOs. “We need to make sure our enterprise data warehouse is a source of truth for our health system,” says Thomas. “Otherwise, hospital personnel could make decisions based on inaccurate data. In response, we’ve dedicated several analysts to ensure the integrity of the data going into and coming out of our IT systems. We then layer analytics on top of this data to provide the evidence we can act upon.”

Even with clean and accurate data, it’s important not to fall victim to data overload. As Holland points out, this tendency is often counterproductive.

“With new technology, IT has a propensity to throw a ton of data at clinicians,” he says. “Our mind-set is often ‘the more, the better.’ However, this only serves to muddy the waters by providing clinicians with masses of data they don’t need. Typically, there are just a few pieces of critical information that clinicians need to be able to locate quickly in order to make the best decisions for their patients. Over the years, most physicians have become astute at quickly locating this data in a paper chart. EHRs and Big Data can easily lead to data overload. IT needs to ensure that technology systems not only deliver, but highlight, the electronic data that’s of highest value to clinicians.”

Clinical collaboration — CIOs realize that the key to not only effective data presentation and exchange but also overall system adoption and utilization is through increased collaboration with clinical personnel. For example, SIH has combined its clinical process improvement teams with IT. These teams are currently working hand-in-hand with nursing to integrate process improvements with evidence-based data and clinical guidelines. This practice ensures that nurses are provided with the best data and that their workflows are optimized to make the best use of this information. Furthermore, SIH mandates that each member of its IT department complete one set of rounds with a doctor or nurse each month.

“Our IT staff has learned a lot by simply observing the processes and habits of clinicians,” says Holland. “Our clinical observations have led to several IT system tweaks. In some instances, we realized that technology was actually creating barriers to the way clinicians work. Through regular observation we were able to better align the technology with these workflows.”

Similarly, Georgia Regents, Inspira Health, and Memorial Hospital have all hired clinical informaticists to work with clinicians on workflow optimization. These efforts have gone a long way toward encouraging IT system adoption and use. Inspira has even focused the efforts of some informaticists and other IT staff on working collaboratively with physicians’ offices outside of the enterprise to share patient data.

IT collaboration doesn’t end with clinical departments. As Thomas sees it, his role as CIO requires him to interact with almost every department enterprisewide. “My role as CIO has changed over the years,” he says. “It used to be all about bits and bytes, but today the CIO is a member of the administrative staff. The CIO is an umbrella that covers every department in the health system. This includes clinical departments, finance, and even mail services and the cashiers in the food court. To be effective at my job, I need to engage and collaborate with people at all levels of the organization to provide them with the IT tools they need and that are in line with the mission of our health system.”

Effective prioritization — Finally, with all of the IT initiatives CIOs are forced to juggle today, effective project prioritization is a must. The health systems I interviewed each employ different methodologies for prioritizing IT implementations. For example, SIH weighs each potential project based on the likelihood it will improve the quality of patient care, enhance patient safety, increase patient satisfaction, and reduce operational expenses. The more of these criteria the project meets, the higher on the priority list it goes. Georgia Regents’ prioritization methodology, on the other hand, is a bit more straightforward. According to Enicks, clinicians and the CFO have a lot of influence over which IT projects are given top priority.

“Our clinicians drive many of the IT initiatives that fall outside of the realm of regulatory mandates based on the impact they will have on improving patient care,” he says. “ROI is also an important project prioritization consideration. If an IT initiative has a demonstrable ROI for the health system, then the CFO will green-light it, even if it doesn’t satisfy Meaningful Use or other regulatory requirements.”

A Little Help, Please
While the CIOs featured in this article have implemented several homegrown strategies to address their biggest pain points, they admit that some changes at government and industry levels could help make their jobs a lot easier. For example, the Meaningful Use (MU) program came up again and again as a source of pain and frustration for CIOs. By and large, the CIOs I interviewed are supporters of the MU program. They believe the incentives were necessary to spur adoption and use of EHR technology throughout the healthcare ecosystem. However, as they become more and more entrenched in Stage 2 MU initiatives, these CIOs have begun to realize that the priorities of the MU program don’t necessarily line up with the IT needs of their organizations. These CIOs now wish that they could be given more flexibility to meet the ultimate goals of MU in a way that makes the most sense for their individual health systems.

“I think the government should declare victory on the MU program and accelerate the implementation of pay-for-performance reimbursement,” says Enicks. “The MU program has achieved what it set out to do. It has motivated the healthcare industry to adopt EHR technology. However, the program has become too complex. There are provisions continually added to the program that make it increasingly difficult to determine attestation and penalty requirements and time frames. In my opinion, it would be easier [and more effective] to simply begin rewarding or penalizing providers based on outcomes. Let us be responsible for determining the systems and applications necessary to best do things like reduce length of stay and readmissions or improve chronic disease management.”

The need for a more universal set of healthcare data standards was also a rallying cry from the CIOs I interviewed. “The poor interoperability we see in healthcare isn’t a technology issue — it’s more an issue of standards, politics, and money,” says Thomas. “Sure, we have HL7 and CCD [continuity of care document] standards for interfacing health data, but there are several variations of these standards, and it is messy. Health providers and the government are spending a ton of money to integrate all of the data contained in these different silos. If we had a universal standard that required all IT systems to collect the same data elements in the same format, you wouldn’t need to worry about any of that.”