During the CHIME/HIMSS CIO Forum, being held March 3 at the Hilton Riverside New Orleans Hotel, George T. “Buddy” Hickman, executive vice president and CIO at Albany (N.Y.) Medical Center and chairman of the board of the Ann Arbor, Mich.-based College of Healthcare Management Executives (CHIME), spoke exclusively with HCI Editor-in-Chief Mark Hagland regarding the strategic challenges facing healthcare CIOs right now and the recent selection of Russell P. Branzell as the incoming CEO of CHIME.

On a day when over 550 CIOs and other healthcare leaders were gathered in New Orleans for the Forum (co-sponsored by CHIME and by the Chicago-based Healthcare Information and Management Systems Society), one day before the main educational sessions opened at the HIMSS Conference, Hickman sat down with Hagland to talk about the strategic healthcare IT landscape, as he and the CHIME leadership see it. Below are excerpts from that interview.

With regard to the presentations and discussions taking place today at the Forum, what do you see as the most important issues facing healthcare CIOs right now?

I believe the themes of what we are working on as an organization are consistent with the things people are thinking about. If you think about our mission, professional development is one of the things people are very interested in right now. And in my view, the networking aspect of what goes on here on this particular day when we have the Spring Forum, is incredibly important. The programming is in some cases meant to be about professional development, as with Stephen M.R. Covey speaking this morning about trust as a component in healthcare organizational success, or Judy Murphy [Judy Murphy, R.N., deputy national coordinator for programs and policy at the Office of the National Coordinator for Health IT] speaking about the progress of meaningful use, also this morning.

As to themes, the agenda for the week [both at the Forum and at the HIMSS Conference] speaks to it, doesn’t it? There’s no doubt that a lot of energy is happening around public policy. At the same time, our public policymakers have positioned themselves carefully and appropriately with HIMSS and CHIME and some other associations, to have this big interactive and listening approach to what goes on this week. There are a number of listening sessions going on this week, as you know [at the HIMSS Conference], in which ONC and other federal officials are coming together in discussions with healthcare IT leaders.\

George T. "Buddy" Hickman

Do you think Dr. Mostashari [Farzad Mostashari, M.D., national coordinator for health IT] and his people at ONC are listening appropriately to the industry?

I believe they’re listening, and listening harder than ever before. I hold David [Blumenthal, M.D., former national coordinator of health IT] in high regard; he pioneered the vision, and frankly, that vision is being implemented. And Bob Kolodner [Robert Kolodner, M.D., who preceded as national coordinator for health IT] listened, too, and now Farzad is. And if you think of the top leadership at ONC, they came up through the provider side, people like David Muntz [principal deputy coordinator] and Judy Murphy, and Jacob Reider [Jacob Reider, M.D., chief medical officer], and indeed, Farzad himself—you’ve got people who are incredibly empathic, who know how hard this is to do. I spoke recently with David Muntz—and I know I can have a conversation where he knows what it’s like. He understands, for example, that I’ve got a vendor who’s trying to catch up to the additional requirements of meaningful use, because they’ve got to catch up quickly and get [upgrades] out the door. And this stuff is continuously coming at the vendors, as it’s coming at us. And the ONC is very empathetic.

Do you think the vendors are being responsible enough?

I think the vendors are doing the best job they can. I was talking to Claudia Williams [senior advisor, health IT, at the White House Office of Technology Policy] recently, and I described an example of an intimate group of CIOs meeting to talk about the meaningful use transition of care requirements, and was sharing with her some of our concerns at CHIME with some of the unintended consequences of some of the meaningful use requirements. Let’s take for example the need for a good medication reconciliation process. Med rec is supposed to occur with every transition of care, so that if you came into the hospital through trauma into surgery, there should be a reconciliation going into surgery, and then later another one when you change floors post-surgery, and another one at the point of discharge.

What’s necessary is for your vendor to automatically send the update to the med rec information to your electronic health record [EHR]. We may also ping the Surescripts database with the software enabled in an EHR, in a new upgraded version, by the way—and the physician is writing orders at that same time. And that same process should also occur at discharge, so that that database is pinged to make sure we know what you’re walking out the door with. Well, that was a new requirement in the EHR under meaningful use. And for some reason, the ambulatory EHR community got around that issue a while ago, and most of their solutions already incorporated that medication reconciliation “ping” with Surescripts into their solutions, so no upgrade was required. But now, on the inpatient side, we now have a new per-transaction fee that’s built into the process that we must pay.

I shared that with Claudia as an example of some of the issues we have to deal with, where not only will an MU requirement create a new mandate that will impose a new transaction fee on us for a process change, it will also require investment in upgraded software. So while the meaningful use measures are about the right kinds of things, and the benefits case for them is right, we don’t always understand the cost-side consequences of putting those measures into place.

Another clear example is around quality reporting [of outcomes and process measures]. You build a database with certain reporting metrics in it; well, to accommodate the database, you have to extend out your reporting model. So it’s the same kind of thing: all the vendors had a new development cost associated with the new reporting requirements around quality metrics, and so we’ve all had upgrade costs.

And you do think ONC understands that?

What I find is that when you sit and explain those things to ONC, that they understand.

From your standpoint, is the pace of required changes under MU about right? Or is it too demanding?

I remember a scene from the movie “City Slickers,” in which Billy Crystal’s character is all totally frazzled by all the things he has to deal with, and the guy who ran the dude ranch says, ‘You’ve got to remember the one thing.’ But there isn’t a ‘one thing’ for us in healthcare IT; instead, we’re trying to cope with Stage 2 of MU; trying to predict what will happen with Stage 3; and we’ve got a whole bunch of things coming out of healthcare reform at us, probably in 2014. And we’re struggling with bundled payments and ACOs; and all that requires good data; and we’ve got to get through the ICD-10 challenge. And many of us also have individual things coming at us back home, including ways to fund and support our research organizations. So the challenge is obviously one of keeping all the plates spinning. So that’s what I’m challenged about. The pace isn’t about just meaningful use—if it were only that, it would be fine. I do see some sensitivity with regard to the pace of that. And I understand politically the need to keep things moving forward at ONC.

And in terms of the demographics-driven changes to healthcare costs, I can’t imagine that the policy- and reimbursement-related pressure will slacken, correct?

I can’t imagine it either. Think about the biomedical device tax that was embedded into the ACA [a provision that imposes a 2.3-percent excise tax on the sale of medical devices under the Affordable Care Act]. It’s that sort of stuff that adds the additional pressure on us. It’s a pressure that you can’t anticipate—you just know that it will be one more thing that you’re going to have to manage on the margin.

Let’s talk about the process that led up to CHIME’s selecting Russ Branzell as its incoming CEO.

The conversation about upping the ante for CHIME’s leadership has been open for at least a few years now. The understanding has been that CHIME is continuing to grow, and the question that the board needed to work through and give itself some time to do, was, what did we need to do to allow the organization to continue to grow? And it might be in ways beyond what we know the organization to be like today. I said to my fellow board members, we need to diversify our portfolio—we needed to move down many paths to support our missions. And Rich [Rich Correll, who has been CHIME’s CEO and who is moving to the COO position on April 5 when Branzell comes into the CEO position] has been incredible in helping us to build this organization and move it along and really produce good results for over 20 years now. And when I introduced Jim Turnbull this morning to acknowledge his John E. Gall CIO of the Year Award, Jim mentioned having a conversation 27 years ago who introduced the term CIO to him and described what that role might be. And he said that conversation made all the difference to him; and that individual was Rich Correll. So I’m delighted that Rich will stick around and continue to run things, while we also bring a new face of leadership to the industry, and it’s someone who knows all the leaders in the industry, while we continue to run the operations of the organization. So Rich will continue to do that while Russ brings back new case studies to help us think of new possibilities.

Russ is one of those CIOs whose name and face are both quickly associated with CHIME. He has personally invested in numerous ways in the success of CHIME over his 15 years of membership, most notably as a faculty member in the CHIME CIO Boot Camp, and in his leadership of the StateNet function, in terms of corralling all 50 states and the District of Columbia to help advocate in terms of more local public policy; he’s been a sparkplug for that. And a past chair, he’s been very close to our Foundation. So when we interviewed him as a search committee, he was very clear that because of his proximity to the organization, combined with his passion for what CHIME does, that he had a number of ideas ready to go that he would bring into CHIME. And the enthusiasm he brought into the conversations, such that one search committee said to me, ‘He’s knocking the ball out of the park.’ So I’m very excited that we’ve gotten someone of CIO and CEO competencies to step into this CHIME CIO role.