Allina’s Pioneering Move Forward on Population Health Risk Stratification and Management

Tomes: I think the patient story is so intuitive in this tool, that the way that it was designed has meant that it takes very little training to use. It actually takes more training just to make a few clicks to get to the tool—and once you open it up, it is so intuitive in terms of accessing data on the patient. The other great benefit is that this crosses the entire continuum of care. And we started new relationships, quite honestly, using this tool. We still have opportunities to build on that concept. Formerly, it had been relatively hard to find information in the record; now, the entire care team across the continuum can easily find that information.

Heichert: And I would add, from an organizational perspective, I think it’s important that, as we’re putting in our electronic record, that’s not going to be the be-all and end-all for everything. You try to use the functionality and work with the vendor and all that, and that’s great. But at some point now, we’re starting to have to go faster and faster and faster. But it’s been kind of a revelation that we can kind of figure out some of this ourselves. And if you can get these fantastic people together with the clinicians, they can figure things out, and operationalize things. We’re learning that we need to be a little bit open-minded about what tools to use and how to use them, and we need to be willing to fail a bit in order to learn. So we have to allow ourselves to be a little bit more adventurous in that.

What kinds of lessons learned could you share with fellow CIOs?

Heichert: Well, it does help that I have a clinical background. But it’s been Karen and Mike who’ve been doing the work. And they come to me and say, here are some tools and technologies that we can work with, and what do you think? Certainly, we say, you have to make the business case for what we’re doing. And we don’t want to harm the infrastructure with this. And Mike pushes the envelope a bit, but these are the challenges we need to take on, or we can’t change the way we do things.

What do non-clinician CIOs need to do?

Heichert: Well, it’s not earth-shattering, it’s something we’ve known for a long time: that CIOs need to know the business that their organization is in. And CIOs need to knock on people’s doors and follow them around, and learn.

Wheeler: I want to underscore something that Susan said, and something that Mike and Karen said. And that is that they got very deeply involved with the clinicians from the outset, and that’s very important. Another element is that all this clinical IT infrastructure should report up through the clinical reporting structure in the organization. That keeps it aligned to what Susan said is our core business. And make sure that the people using the tools are co-designing those tools. And a big lesson learned, too, is, meet the clinicians where their passion lies. So if you have a group of clinicians ready to run on, say, reducing heart failure readmissions, then dig in deep with them.

Tomes: And I would add that a CIO should bring clinicians in and shoot for the sun; give them that permission to dream. Sometimes, they’ve been working in an environment where they’ve been adapting to the current environment. So allow them to dream.

What has been most challenging for you so far in all this?

Heichert: Actually, what’s most challenging is the frustration with having all of this data and not having great tools in the past; I’m thinking maybe five years ago. We didn’t have those tools. And it would be great if things were a lot more intuitive. And we do have some limitations in that regard. And frankly, things are very expensive; it does require an investment on the part of the organization. We’ve got a lot of clinicians around here, and if you think about the ability to put all this information and all these tools in every clinician’s hands, it does require an investment. And ultimately, we want to put these tools even into the hands of patients. So it does require a very large investment, and not every health system has as much capital to invest as we do.

Doyle: And we couldn’t have done the work we’ve done without Susan and Penny setting up the culture to innovate towards success. Let me give you an example: a lot of this started because we had a data feed that went to the EDW, on a shared drive, a couple of times a day. And we realized that with a little more effort, we could get that feed going every hour, but we had to work more closely with IT. And once we got that developed, we were on the path.

Another possible lesson here is that one’s organization has to be willing to invest in the technology, too, correct?

Doyle: Yes, and these really are great multi-purpose tools. A great carpenter has to invest in a great table saw, and a great set of wrenches, for example. In a similar way, Allina made the choice to invest in a great BI technology; it’s not a healthcare-specific BI technology. But our organization’s leaders also were willing to invest in general tools at a time when we couldn’t find the healthcare-specific tools we were looking for at that time, so we re-purposed broader tools.

How hard is this, on a scale of one to 10?

Doyle: If you had no EHR, it would be a 10; if you had no enterprise data warehouse, it would be a 9. But given the fact that we have both means that it’s not technically difficult; it’s something like a 2 or 3, if you have people trained on the tools like QlikView, Cognos, or BusinessObjects. And you get down to that 2 or 3 because of the investment you’ve made in the culture, the EHR, and the data warehouse.