The Danville, Pa.-based Geisinger Health System is an integrated health system that serves more than 3 million residents across 45 counties in central, south-central and northeast Pennsylvania, and a part of southern New Jersey (with its acquisition in October 2015 of the Atlantic City, N.J.-based AtlantiCare health system). In the fiscal year ending June 30, 2015, Geisinger documented an operating profit of $160 million on $4.56 billion in revenues, while AtlantiCare’s operating profit in calendar year 2014 was $43.7 million on revenues of $805.3 million.
The physician-led system is comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 12 hospital campuses, two research centers and a 510,000-member health plan, all of which leverage an estimated $8.9 billion positive impact on the Pennsylvania economy. Geisinger has repeatedly garnered national accolades for integration, quality and service.
Geisinger continues forward in numerous areas as a pioneer, including in the leveraging of data analytics and the ongoing expansion of population health work. Nick Marko, M.D., a practicing neurosurgical oncologist and the health system’s chief data officer, spoke last month with HCI Editor-in-Chief Mark Hagland about the data infrastructure that the health system is architecting in order to support continuous clinical performance improvement.
Meanwhile, also last month, John M. Kravitz, senior vice president and CIO at Geisinger, spoke at the Health IT Summit in Cleveland regarding the health system’s transition from the use of an enterprise data warehouse to creating big-data platforms. Recently, Kravitz, who became CIO nearly four months ago (he had been an associate CIO previously, and has been at the health system for six-and-a-half years), spoke individually with Hagland about that transition and about the broader context of Geisinger’s current initiatives. Below are excerpts from that interview.
Geisinger continues to be a real pioneer in the industry. Given that, you’ve got a lot on your plate, as CIO. How do you see your role right now, and what are your priorities?
We’ve got a number of new initiatives—some of the things you’ve seen with regard to our big data platforms, with the goal of moving decision-making to real-time. A lot of our work with the enterprise data warehouse has been around same-day availability of data, to look for gaps in care and respective issues we want to help resolve. But going forward, we want to do it in real-time, as I said at the conference. We want our patients using iOS-type devices like iPads, in waiting rooms, and we want them to enter questions based on their condition, so that ultimately, we can take that data and churn it very quickly within a matter of seconds, and provide them with data for analysis and decision-making.
John M. Kravitz
Could you provide an example of this?
Let’s take a patient has diabetes, for example. With diabetes, you typically have a couple of key performance indicators (KPIs)—one is your hemoglobin a1c, which is a bloodwork-based exam; others can include a foot exam, an eye exam, etc. In the old world, we’d have our enterprise data warehouse, which would churn the data and look to see if a patient hadn’t had an a1c test or foot or eye exam recently, for example, so an order would run the next time they are seen again, by a PCP, an endocrinologist, or in the ED. The order would be programmatically, automatically done, via a care gaps analysis.
Now, going forward, what we’re planning by September or October of this year, is to be able to use a tool called DatStat—it’s a very user-friendly tool that actually resides on an iOS device on an iPad. We would give the patient an iPad in the waiting room, in this case, for diabetes. How are you feeling? Have energy? Tired or listless? Etc. And the key thing is that we have data from our Epic system, or lab system, or documented results from prior visits. So when they’re answering the survey and hitting the button, it would update Epic with that day’s episode of care. And with the big-data, Hadoop platform, we’ll be able to churn that data in seconds, automatically. The only manual intervention involved would be handing the patient the iPad. So that’s one of the initiatives we have going. We call it CareGaps. This is one of the ways in which we’re trying to close out those gaps in care.
And we have them for a number of conditions—CHF [congestive heart failure], COPD [chronic obstructive pulmonary disease], CAD [coronary artery disease], and asthma; and we also have them for rheumatoid arthritis and a lot of other chronic illnesses. And the concept is, collect the data in the waiting room.
And perhaps you could share another example of a high-priority focus for you and your organization?
Another one that’s a pretty high priority is this: with regard to electronic health records, there seems to be so much data being collected in the EHR, that it’s hard to navigate and find. So from the inception of care in the PCP’s office or a lab draw in the community, or a radiology diagnostic exam, that’s all in the EHR. Any outpatient care will be in the EHR, as will an inpatient stay. So we’ve been working on an initiative called SuperNote. The idea is that SuperNote will correlate the data down to discrete data you need to see, based on SNOMED codes, CPT codes, problem identification codes, etc., that provides physicians with summated data.
What is involved in that process?
It is an algorithm that’s been developed; it’s almost a cubed approach, using a three-dimensional data model, to take data and put it into the physician’s view. These are physicians and nurses who are working on that initiative.
What is the timeline around that initiative?
We’ve had some turnover in our leadership in that area, so that’s kind of pushed that off a bit. But we have an Institute of Advanced Application, led by Dr. Greg Moore, who’s the lead for the IAA, and this is on their priority list. We’ve prototyped it with our own physicians, but it’s continually being refined over time.
How is your strategic thinking as a CIO animated, as you move further into the role?
Since taking over about three months ago, I’ve had a different philosophy. I’ve wanted to take the silos out of IT and have the teams work seamlessly together. We have about 800 employees in IT, between our health system and health plan. It is a large group, but we’re at $6.67 billion a year in revenues. We’ve got about 30,000 employees, 12 hospitals, and about 1,200 physicians, and hundreds of care locations.
What is the secret of leading a team that big in a pioneering organization with so many priorities?
Number one is structuring. We’re establishing a service management structure for the organization. I’m sure you’ve heard of ITIL [Information Technology Infrastructure Library] as a service management strategy. We’re following ITIL practices.
Do you see ITIL as a form of project management?
It’s more of a service delivery model. We would like to have a service catalog of all the services we provide to the organization. We would also include in that incident management, such as helpdesk support for any changes to the infrastructure, such as for voice-over-IT phones, network management, escalation processes. These are all components of what we want to establish as a service management entity in an integrated organization.
What have been the biggest challenges and opportunities for you so far as the new-ish CIO of the organization?
As a whole, cybersecurity is a very pressing challenge right now. It’s not only hitting healthcare, but many industries. But for us, protecting our reputation is very important. We are very serious about this. We have a person who is a security director; not yet officially named as a CISO, but may be on the horizon. They know the industry and security well.
What would your advice be for other CIOs, based on your experiences so far?
To put this into context, of course, I was not new to the organization. I spent six-and-a-half years here as associate CIO in the last two-and-a-half years, and in that role, I had responsibility for all the infrastructure, as well as mergers and acquisitions. But, per priorities… if it’s someone who’s new to the organization and came in as CIO, you want to understand, as you just put it, where the bodies are buried; the culture of the organization, and the willingness of the organization to move forward, the strategic direction of the organization. IT is not there for any reason but to support the business objectives of the organization, and at the lowest cost. The first 100 days when you’re new to an organization are absolutely critical. Gartner has a white paper around that. In my case, I was already here and was promoted into the CIO role, because I already knew what the burning platform and needs were. So my first 100 days were more about restructuring, and about compliance, to make sure we retained a very high level of ethics and compliance across the organization. We’ve ballooned so much over the years because of having a lot of applications, to install a governance process to manage all of this.
What do you see as CIOs’ biggest challenges overall, nationwide, right now?
Interoperability is one; cybersecurity will continue to be a thorn in our flesh. I worry about that all the time. But I think interoperability, because we’ve really continued to work to be a population health organization. And I think with Obamacare going forward, or even if it gets repealed, I still think population health will win, and caring for that patient end to end, will win. And that’s what’s best for patients, and that’s why we do it. In healthcare, we’re here not just to treat people for an episode, but to make sure that they are OK, long-term. So that interoperability between the acute-care world and the post-acute care world, which is pretty large, and where I served for years before I came to Geisinger.
How do you feel overall, looking forward? Optimistic? Pessimistic? Somewhere in between the two?
I have a distinct advantage working here: so many people have helped to build foundations here. That doesn’t mean it’s an easy job, because it’s not. But I heard comments after my presentation [at the Health IT Summit in Cleveland], per big data platforms—we use our own and one developed by Cerner. And people said, yeah, John’s up there shining his rocket while we’re here on our tricycles. And I feel lucky, because a lot of people have sacrificed a lot, and I’ll sacrifice for the next generation. We’ve been fortunate, we’ve gotten some good notice or publicity over the years, and that’s great, because we want to make our patients’ lives better. And with Dr. Feinberg on now, with his focus, it’s very clear that its’s about meeting or exceeding patients’ expectations of us.
Is there anything you’d like to add?
I think the challenges that CIOs have throughout the country are pretty difficult, pretty challenging. Think about what they’ve gone through with meaningful use. CIOs may or may not have had an electronic health record, so they’ve had to implement one or replace one, and go through a certified EHR, that’s no easy task. And now they’re being asked to do new things with data analytics that they hadn’t been asked to do before. And then they’re hit with cybersecurity issues that keep them awake at night. But over the next three years, there are a lot of new demands that will be put on a CIOs. They’re being tasked to catch up; the healthcare industry’s been a laggard in many ways, which is not a surprise. While standards are being developed in healthcare, healthcare is still behind financial services, as with ATMs. And even though we have a lot of automation already, there’s still a lot that’s unknown.
So we’re trying to create innovative tools to support the emerging healthcare system. And we’re committed to not fall backwards. We’re committed to a population health-based approach. And the other factor here is transparency. I think healthcare is becoming more transparent. When more than 17 percent of your GDP is being spent on healthcare, it’s way too high now, and it’s projected to go over 20 percent; that’s ridiculously high. I was on a call this morning on the way to work with a gentleman. And my comment is that healthcare’s been given a lot of liberty in how it’s been paid. Now it’s time that we be held accountable for our actions and become more efficient, in order to bring this cost curve down. That’s a big part of every CIO’s job and of my job. I’m looking to obtain a 5-percent reduction in expenses, that’s my personal goal.
That would be amazing, considering what you and your colleagues are accomplishing already.
Yes, but we could still become more efficient, and my team of IT executives agree with me. So improving that cost curve and getting better at this process, will be very important going forward.