Annamalai Ramanathan is one of those healthcare executives who can truly say that he’s seen things from both the healthcare IT side and from the non-IT side, as both a healthcare IT executive and now as a non-IT executive in medical administration. For a few years, he had worked at the Medical College of Georgia, in Augusta, Ga., as senior transformation leader, tasked to help evaluate the next generation of innovation in technology around care management, and to bring that innovation back to the Medical College of Georgia. Then he transitioned to a position as director of clinical transformation, in charge of process change for clinical transformation.
Then, in mid-January of this year, Ramanathan was asked to transition again. Now, he is director of administration in the Department of Family Medicine at the Medical College of Georgia. He spoke recently with HCI Editor-in-Chief Mark Hagland on the varying perspectives of IT and non-IT leaders in healthcare administration, and what he’s learned from working on both sides of the divide. Below are excerpts from that recent interview.
When you think about how different things look from how they looked when you were on the IT side of care delivery administration, what strikes you most?
I live in a world in which there’s an interesting intersection between volume and value. We’re still very volume-driven, but we have our eyes on value. In my day-to-day operations, I have targets to meet with regard to quality, volume, and work RVUs in terms of physicians’ production. Now, increasingly, I’m being asked to look at value, meaning quality in relation to volume. So I’m looking at what the potential upside and downside of the transition value will be. So the IT tools are essential, and some of these population health tools are becoming more important.
What kinds of population health tools are you looking for?
We’re in the early stages of understanding what’s out there. There are various tools in the marketplace, and I’m always open to new things. Now, the natural lead-in is to tools embedded in core EHR [electronic health record] products. But there’s a gap in those tools with regard to predictive modeling, as offered by vendors like SAS. So I’m looking at companies like Jbion, which does care learning using machine language processing. We haven’t signed any deals yet; we’re in the early part of the journey around these tools, and are keeping our view wide.
But the off-the-shelf embedded tools don’t seem so great, correct?
What do you and your colleagues to do in the next year or so, as an organization, in this context?
We need to create a governance team with both clinical and operational leadership, so they understand how these practical requests are funneled and prioritized, and so that there’s a clear accountability in the use of these tools. So we are staging it by creating a foundational governance structure.
And where you in that process?
We’re starting to have conversations. We’re looking at Carolinas Health, Memorial Hermann, and a health system in Florida, talking to them, and trying to learn what we can learn about an IT governance structure. The challenge is not to create the rigor, but rather to ensure that there is real clinician participation. I’m seeing the same stakeholders involved in multiple meetings and engagements. And what happens is that there’s a level of fatigue when you go to them for prioritization.
How do you convince the physician leaders in your organization, or any organization, to be willing to invest their time and effort and mindshare into this?
That’s a great question. You need to bring in your physician champions to own it. I’m also seeing CMIOs becoming exhausted. The CMIOs are stretched; certainly, my CMIO is stretched. So CMIOs cannot be expected to be the main leaders. At the same time, CMIOs are great with statistics and numbers. And also, you need to give people quick wins, and say, this is how your department is performing, and in order to get to the next level, here are the several key steps you need to take to get there.
In other words, you need to break it down into clear process steps?
Exactly. And we in healthcare tend to fall into a conversational interaction about this. I always think that it’s because healthcare comes from a non-profit culture. Meanwhile, in technology, where I was before healthcare, things were much more action-oriented. So if you can make it more action-oriented, with clear points of accountability, you can make it more successful. And so my hope for the population health governance committee meeting, is for us to make it more action-oriented.
There are population health pioneer organizations right now breaking new ground, but there is no established template for this right now. How do you get around that?
Learn from other industries, is a strategy I often follow, and one I think we’ll need to pursue in healthcare. Because population health management is about risk assessment and risk management. So what can we learn from other industries? I would look at the payers, like AIG and similar companies. What do they do, based on understanding risk? So, I run a primary care-based organization. And we’ve just started documenting who our payers are and who are patient panels are, in a concrete way; historically, we knew this in a tribal way, but now it’s becoming more concrete. So we’re looking at HEDIS measures, and taking small steps based on known publications and known protocols, and then evaluating what works and what does not.