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Geisinger Leaders on Interoperability and “Inter-App-Erability”

August 17, 2014
by Mark Hagland
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At the Danville, Pa.-based Geisinger Health System, leaders have been involved in a panoply of clinical transformation and IT innovation projects

At the Danville, Pa.-based Geisinger Health System, leaders have been involved in almost continuous clinical transformation efforts for the past decade and more. Geisinger, which encompasses eight hospital campuses, two research centers, a 1,100-member multispecialty physician group practice, more than 21,000 employees, two research centers, and a 467,000-member health plan, serves more than 2.6 million residents across 44 counties in central and northeast Pennsylvania.

Geisinger is justly famous for the development of innovative care models such as ProvenCare® and ProvenHealth Navigator®, which have helped to transform the concept of value in care delivery and payment. Earlier this summer, HCI Editor-in-Chief Mark Hagland spoke with John Kravitz, the health system’s vice president, information technology, and associate CIO, and Alistair Erskine, M.D., its chief clinical informatics officer, to find out some of the latest developments there. This is part two of a two-part interview series.

In part one of the interview, Mr. Kravitz and Dr. Erskine discussed the extensive efforts of Geisinger leaders to develop advanced analytics capabilities, to innovate new care management strategies, and to create a culture of innovation at the integrated health system. Below are excerpts from the second part of the interview with the two executives.

Is all this work creating a culture of collaboration and innovation among clinician leaders, clinical informaticists, and IT leaders in the organization?

Alistair Erskine, M.D.: With regard to the physicians who become leaders in the organization, one thing that Geisinger does on purpose is to take a clinician leader and match them up with an administrator. So I have a vice president of clinical informatics that works directly with me, and we work daily together. She will tend to be more in charge of the change transformation aspects and some of the administrative aspects of the budget and even HR things; but she’s just as much a part of the equation. She has more of the business savvy, and I have more of the clinical leadership savvy, and that’s typical. Second, much like the typical integrated health system, our structure is very matrixed and flat. Formally, I may have one boss, but I actually have many bosses, and that ensures collaboration. And my remuneration is at risk, based on performance. In addition, it’s strongly encouraged that people have shared goals across departments and divisions, to make sure people are aiming at the same things.

Two more things: We have the Institute for Advanced Applications, which was created to do three things—healthcare reengineering; emergent technology (gadgets, Google Glass, portable ultrasounds, etc.); and a third thing, which is clinical innovation, around key areas that have been ongoing problems in healthcare. They’re the ones that came up with the care gap program. They’re also coming up with a new way of doing online documentation for physicians. So that’s IAA, the Institute for Advanced Applications. And it’s funded at Geisinger, to be able to form those functions. Another group, one I lead, is the Division of Applied Research and Clinical Informatics, or DARCI. Some people refer to that as the clinical informatics group or clinical transformation group or CMIO group; it has lots of names internally. One is your standard clinical transformation around optimizing work through the EHR, including making sure that the literature out there in JAMIA [the Journal of the American Medical Informatics Association] and Healthcare Informatics and elsewhere, is being absorbed and used.

Alistair Erskine, M.D.

When did the Institute for Advanced Applications begin?

Erskine: It began in concept when I arrived ten months ago; it had existed at Geisinger, but not under one roof; it was scattered previously. We just gave it a name. It’s got 70 people in it, and it’s a combination of people who are part of the Epic team, of the care gap team, of the eHealth and mobility team, and the analytics team. One department is clinical transformation; the second is Geisinger in Motion; and the third department is Data Science. Geisinger in Motion is all the things we’re doing with provider mobility, with patient mobility (remote access, etc.), all the things we’re doing relative to telehealth, and to HIE, which is what John talked about at AMDIS.

What are the biggest, broadest learnings so far in all this work?

One key element has to do with clinical transformation, via EHR optimization. We use Epic [the core EHR solution from the Verona, Wis.-based Epic Systems Corporation]. And we’ve customized Epic, because we’ve had Epic for 17 years, and Epic has been moving more slowly than we’ve wanted. So we’re working to take the customization, and we’re de-customizing in a very specific way. We don’t want to just put in “vanilla Epic”; we want to get closer to Epic and to create apps that work for us. We are finding that we want to be able to take some of our intelligence and feed it back into Epic. That customization is something that gets re-integrated into Epic. We’ve been talking about interoperability for years; but what will come is inter-app operability. Basically, what we’ve realized is that the apps need to be more “inter-app-erable.”