This past September, eight CIOs from some of the nation’s leading healthcare organizations convened at the annual Scottsdale Institute Fall CIO Summit in Arizona to discuss the most important IT-related challenges their health systems are facing and the strategies to position their organizations for success over the next year.
The Summit was hosted by the Scottsdale Institute, a Minn.-based not-for-profit membership organization of health systems advanced in IT, and sponsored by Impact Advisors, a Naperville, Ill.-based provider of healthcare IT consulting services. The conversations and key findings from the Summit are outlined in the report, “The New World of the Health System CIO: Consumers, Consolidation and Crooks.” The group identified five challenges that are consuming a majority of their time and creating the most angst. Those challenges include new payment models; optimization; mergers and acquisitions; security and competing for and retaining patients and consumers. The CIOs also identified key focus areas and strategies to help address those challenges, concluding that leadership skills, taking risks and innovation will be crucial to the success of their health systems over the coming years and beyond.
Following the Summit, HCI Managing Editor Rajiv Leventhal spoke with one of the CIOs who was in attendance—David Bensema, M.D., Louisville-based Baptist Health Kentucky—as well as Tonya Edwards, M.D., physician executive at Impact Advisors. In Part 1 of this story, Leventhal looked to get a “war room” inside look at the most pressing issues CIOs are currently grappling with specifically around changing payment models and electronic health record (EHR) optimization. Below are excerpts of those discussions with Drs. Bensema and Edwards.
What was the general mood of the CIOs who convened at the Summit? Can you give me an “insider” feel?
Bensema: The general sense is that we’re all overwhelmed with a number of opportunities in IT right now, and our main challenges include helping our executive leadership to maintain focus so they don’t go chase every single thing that’s out there. I get the sense that everyone is invigorated. I don’t know any CIO who doesn’t feel stimulated, and that room at the Summit was filled with engaged and stimulated people. I am just a 20 months into my CIO experience, so listening to the experienced voices in the room showed me how much enthusiasm they have sustained for this role.
David Bensema, M.D.
Edwards: This group was full of engaged and bright people who are key for the leadership of their healthcare systems that understand that going forward, it’s not the same environment we were in just five years ago. The pace is much faster, and they have to be very responsive to that. There is a broad leadership role that’s needed now, beyond IT.
I’d like to go through the main challenges that were identified in Scottsdale. The first one up is new payment models. What are CIOs saying about this?
Bensema: This challenge is truly the biggest on people’s minds right now. Security has been elevated in our minds and in our boards’ minds, and while we may not have our ducks in a row completely, people feel like we do have that identified and do have people’s attention. With the new payment models, with the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), with the merging of the reporting requirements, and with how meaningful use Stage 3 is currently proposed, IT leaders and CIOs are scrambling to integrate information. Where can you best aggregate the information so you know that you’re able to report for all of these different regulatory and quality outcomes, and reimbursement reporting needs? Also, how can we know and provide insight for our C-suite and board to help them understand if our systems are ready to take on risk?
As the risk contracts increase, there is the need to understand how you are spending money and where your opportunities are to reduce spend and increase quality, and that’s coming from the data. That’s a huge pressure. What an awesome responsibility for a CIO it is to be able to provide insight into the data. We may not be the analytics folks, but we have to have the data available for the data folks to crunch. If you get it right, it’s a big opportunity, but if not, your systems are at risk. That’s frightening.
What do you mean by “not getting it right?”
Bensema: By miss, I mean if you don’t provide insight into the full breadth of data, and you miss being able to give your leadership access in aggregating key data elements, they will be seeing costs and trends that may not truly represent the experience of the system. They might take on a population or contract, but then realize they don’t have the ability to meet the requirements of it. So you have to give them the right access to the full suite of data needed.
Also, in that room, I think that the feeling was that meaningful use had accomplished one of its goals: to get the majority of the physician practices and hospitals onto EHRs. However, they felt that it missed its greatest opportunity which was true interoperability and the adoption of standards. Meaningful use did not create any incentives for the vendors or the systems to utilize the standard languages and standard reporting formats. They spent billions and missed.
To this end, another challenge identified was EHR optimization. Are CIOs finally past the software implementation stage?
Bensema: Not in my system yet unfortunately, but for those organizations that were in the room, the majority are at the point where they have implemented the product that they view as their long-term answer. Medium-sized hospitals are making some decisions, but the large ones in the room, other than us installing Epic and just going live with that, are on the product they will be on, and are looking to enhance their use of it. Most of the major hospitals will be on a top two or three product, as those products are robust. Everyone is looking to find opportunities to help our operation teams to utilize the resources that are there. We also recognize our budgetary constraints, so no matter the vendor, if they can do it, we will figure out how to do it well. No one can afford to do best-of-breed anymore, it’s just too costly.
We also had a voice in the room who felt that no one was offering them the best options for their system, so they are sort of becoming a software developing shop, or at least developing some aspects of products. I thought that was a unique view at times where most of us are away form being coding shops, but one of the members in the room was operating more along those lines. But you still have to optimize what you have and do it in a cost-effective manner.
Edwards: We did spend a lot of time on EHR optimization, and the challenge there is that organizations have spent millions of dollars implementing EHRs, but the data doesn’t support that most organizations are seeing the value of them yet. Significant challenges are associated with this, with one of biggest being adoption and training. Also, governance for optimization activities continues to be one of the biggest challenges organizations are facing. CIOs do have the underlying project management structure, but they agree that the work is much more successful when clinicians and operations lead the optimization efforts, and IT is there to support it.