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Pushing Ahead at Legacy Health in Oregon: Focusing on the Triple Aim

January 10, 2014
by Mark Hagland
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John Jay Kenagy, Ph.D., Legacy Health System’s CIO, is focusing on Triple Aim-driven system change

John Jay Kenagy, Ph.D. is senior vice president and CIO, as well as CISO (chief information security officer), at Legacy Health System in Portland, Oregon, and has been serving in that role since March 2012. There, he is responsible forstrategic management and operational oversight for Legacy’s information systems and services functions, supporting a six-hospital, 50-plus-clinic, community owned, integrated health system.

Dr. Kenagy, who leads a team of 275 IT professionals at Legacy Health, will be participating in a panel entitled, “Health Care 2020: The Hurdles and Opportunities Ahead,” which will examine the key challenges and opportunities ahead for hospitals, medical groups, health plans, and employers, to leverage health IT to improve healthcare, at the upcoming Health IT Summit to be held January 21-22 in San Diego, sponsored by the Institute for Health Technology Transformation (iHT2). The Institute became a part of Vendome Group, LLC, Healthcare Informatics’ parent company, in December 2013. Kenagy spoke recently with HCI Editor-in-Chief Mark Hagland about the initiatives he and his colleagues have been leading at Legacy Health. Below are excerpts from that interview.

What are the top goals for your health system these days?

Boiling it down to its simplest parameters, it’s the Triple Aim: better-quality healthcare, with better access, at lower cost. [The Triple Aim is a concept that has been developed and promoted by the Cambridge, Mass.-based Institute for Healthcare Improvement.] And people have been talking about that for decades; but this is an opportunity for us to, truly informed by data, provide better care coordination, better management of those with chronic illnesses, provide better management of ED utilization; bring people into primary care via the ACA [Affordable Care Act]; and manage disease better. And Oregon has been on the map for really wanting to change our Medicaid program, and bring dental, behavioral, and physical health together. And that’s provided us with the opportunity to try to integrate those, for a population that has high levels of co-morbidity. So payment reform and collaboration among previously competitive health systems, has helped us get there.

John Jay Kenagy, Ph.D.

There is a clearer policy landscape and set of imperatives for CIOs and for patient care organizations now, would you agree?

Yes, I would agree. And with meaningful use, which is a shorthand for an incredible amount of work—but with physicians and hospitals on electronic systems and with electronic systems needing to operate in a standards-based way, things are beginning to move forward. And, consider this: if I can money out of an ATM in Greece, why can’t I get the fourth- and fifth-floor ICUs in my hospital to communicate? So with so many more electronically driven interactions, the onus on CIOs and CMIOs is to help facilitate better decision-making from the point of care to across the entire ecosystem. And it’s not like we have a better situation than any of our competitors or a worse one. But in an academic medical center, the faculty is driving the decision-making; and at Kaiser, the Permanente Group is doing so; and at Providence, increasingly, they’re using physician employment to drive decision-making. But for us, it’s all about collaboration. We are a mixed model, with some employed physicians, but out of 2,000 members of our medical staff, about 400 are employed. So we don’t have a strategy that disenfranchises independent physicians. We’ll host Epic if you want it, or integrate through our private HIE, if you want to go that route. And anything around care transformation is really better coordination of care, and better surveillance of care. If you’re a diabetic, and have not been seen recently, there should be a trigger for us to check in on you.

So what are your biggest challenges right now as a CIO?

That’s a great question. There are a number of them. I think with business intelligence and HIE, I would say that we’re struggling with the infancy of the industry as we know it. The tools are really blunt, we’re really in the Stone Age right now, the Paleolithic period of tools in healthcare. KLAS recently did a monograph on the stage of the art of business intelligence, and it was really a perception study; it was fascinating. You’ve got Cognos, IBM, Oracle, Microsoft, the big players outside healthcare that want to get into healthcare, but the tools don’t really fit super-well  in healthcare yet; so the tools are somewhat immature. And managing expectations with insurers; some of them are pushing us along, but they don’t know what they don’t know.

In the past, I’ve said that when we go out to talk business intelligence with our clinicians, it’s like asking a caveman before fire has been discovered, whether he’d like his stake medium well done or rare! So we’ve seen a vision—kind of hazy—the tools are really mediocre—but we’ve conceptualized what this will mean to people. When I’m treating the patient, I want to know what other drugs the patient is taking that might interact. But the population: not just John the diabetic being treated in clinic today—but all the diabetics, how are you treating them? And now that you have the data, you can look at the anomalies.

And the reality is that the tools have been very focused on reimbursement processes until recently.