The lead medical informaticists in hospitals, medical groups, and health systems are juggling an unprecedented number of "menu" items on their to-do lists these days. Which are the most strategically important? And do the CMIOs in those positions have what it takes to deliver the goods? Healthcare Informatics asked a virtual roundtable of industry-leading CMIOs for their perspectives.
CMIOs in hospitals, medical groups, and health systems are facing a complex stew of challenges right now, from fulfilling the requirements for meaningful use under the Health Information Technology for Economic and Clinical Health (HITECH) Act, to helping their organizations lay the foundations for accountable care, value-based purchasing, and readmissions reduction under the Affordable Care Act (ACA).
What are the top items on their strategic “to-do lists” right now? To find out, Healthcare Informatics’ Editor-in-Chief Mark Hagland spoke recently with five industry-leading CMIOs, and wove their responses together into a virtual roundtable. These five industry leaders offered quite varied responses, and diverse perspectives, on the challenges ahead. But all are absolutely agreed on the centrality of the role of the CMIO as someone whom his or her organization will need to turn to in order to help lead forward change.
Ferdinand Velasco, M.D.
Chief Health Information Officer
Texas Health Resources
G. Daniel Martich, M.D.
CMIO, University of Pittsburgh Medical Center (UPMC) Health System
Christopher Longhurst, M.D.
CMIO, Lucile Packard Children's Hospital, Stanford University
Palo Alto, California
Brian Patty, M.D.
CMIO, HealthEast Health System
St. Paul, Minnesota
Colin Banas, M.D.
CMIO, VCU Health System
Below are excerpts from his discussions with these visionary leaders.
WHAT ARE THE MOST PRESSING CHALLENGES?
Healthcare Informatics: Gentlemen, when you look at the huge to-do list facing CMIOs across the U.S. these days—a to-do list driven very strongly by policy and regulatory mandates and initiatives right now—what do you see as the top few strategic challenges on your lists?
Colin Banas, M.D., CMIO, VCU Health System: On my end, the two biggest issues right now are interoperability and the exchange of data and information with the right person, at the right time, and in the right format. Creating true interoperability and data exchange are probably the single-biggest impact we could have, and that matters to me more than anything else. The problem is that this gets all balled up with ICD-10 and meaningful use Stage 2, and now the former PQRS [Physician Quality Reporting System] program, the outcomes measures. It’s no longer going to be good enough to construct spreadsheets on this; you’re going to have to totally automate the process. Now, obviously, that’s important, and we all want to get there, but in the sea of computing priorities, that isn’t nearly as important as interoperability, both on its own and as part of Stage 2.
G. Daniel Martich, M.D., CMIO, University of Pittsburgh Medical Center (UPMC) Health System: The first issue for me is around clinical documentation. You know very well the copy-paste dialogue that’s going on among CMIOs now; and at the grassroots level, it’s painful at times. So we’re stuck in this land of, how do we capture what we need for billing purposes and for the ICD-10 transition so that we can continue to code appropriately; and code medical-legally appropriately; and yet make the process easy for clinicians? The second for me is around leveraging the power of analytics. At UPMC, we’re starting down the path on this, and we continue to live the dream of our organization’s $100 million investment in data analytics, but under the dream layer, the real work is a few layers below that, in terms of NLP [natural language processing] and applying that to quality outcomes research and other important purposes.
Chris Longhurst wrote that article in the [Nov. 2, 2011] NEJM [New England Journal of Medicine] about mining the data. The reality is, every one of us would like to be able to go in there and say, gosh, I’ve got this 14-year-old girl with lupus and nephritis and blood clots, and I’d like to scan the EHR to support my diagnostics in her case; but it’s much harder in practice, so the entire set of issues around deriving information from the record would be number two on my list. Number three has to do with how you derive information from the EHR and clinical information systems to support academic research, and to support the emergence of personalized medicine.