Bob Sarnecki hasn’t been in his role—CIO at Birmingham-based Children’s of Alabama—for long, but that hasn’t stopped the veteran health IT professional from getting an early feel about what the biggest healthcare needs are for the region’s population.
Indeed, Sarnecki, who previously served as CIO at Phoenix Children’s Hospital and Kingman Regional Medical Center, both in Arizona, started his role at Children’s of Alabama about a year ago as a consultant before becoming full-time CIO last summer. Early on, he says his main goals will be to “re-energize the IT department,” getting it more aligned with the hospital’s business needs, and get it prepared for the “next century of healthcare challenges within the region.”
Sarnecki continues, “We are still doing some EHR [electronic health record] deployment—last year when I first got here, none of the ambulatory clinics were up on the EHR. But our team has gotten quite a few of them up in October, some more in January, and now we have just one clinic left. We are also about to cut over from an older surgery system to [a new vendor’s] surgery module that is compatible with our EHR. So we are getting a fresh coat of paint, and getting up-to-speed with [upgrading to new versions] of the technology we already have in place,” he says.
Making Progress with a Struggling HIE
Sarnecki notes that Alabama’s statewide HIE (health information exchange), One Health Record, has – like most HIE’s – had its fair share of struggles, but “sometimes it takes a couple of iterations before an HIE catches on in a state. I have seen that from my consulting background,” he offers. But nonetheless, he says that One Health Record is expanding participation, both in terms of physician practice and hospital participation (The HIE’s website states that there are 13 connected hospitals and 87 connected facilities in all).
That being said, a core goal for Sarnecki in 2018 is to get Children’s of Alabama onto the HIE, noting that with children’s hospitals, “You are always cognizant of the fact that for kids with chronic conditions, you have 18 years of healthcare history that provide value insight to physicians. That carries value as they grow into the adult side of healthcare. So we are actively trying to get physicians to participate in the HIE by providing the data Children’s is uniquely positioned to contribute.”
One of the key problems with One Health Record, as is the case with many other HIEs across the U.S., Sarnecki points out, is lack of money and participation. He explains that the basic HIE is often funded by Medicaid for the state, with additional funding at the federal level. But a state HIE has to be self-sustained after a few years, or risk losing funds. At the same time, participants are wary about investing in a technology that may “fold.” The problems are very real, and participation by provider-based CIOs (as in Alabama) is one way of building governance, participation and funding.
Sarnecki and other provider CIOs in Alabama have formed a governing body to work with One Health Record to begin to get the HIE more in line with where the hospitals are going, and to assist one another in adopting the HIE as a key to their future delivery strategy. The idea, he says, is “that we can all attach to it [so there will be] value for the hospitals, which will help make us make a case to senior leadership to fund the HIE for the state,” he says. “I am very proud to be working with a motivated and insightful group of CIOs, focused on improving care throughout Alabama. The value this will provide to rural patients cannot be measured just in dollars and cents”.
Navigating the Rural Healthcare Landscape
According to 2016 U.S. Census data, about one-quarter of Alabama residents live in rural areas. Of course, this presents its own unique set of challenges for healthcare leaders in the state—issues that do not arise in metropolitan regions.
But rather than run away from the burdens that rural healthcare can put on a state, Sarnecki says that the environment is actually one of the things that attracted him to Alabama. “The challenges are very real in Alabama, but so is the opportunity to directly improve patient care and outcomes through solid technology”, he says. “The sense that ‘we are all in this together’ is palpable, and I have a deep appreciation for the spirit of cooperation between healthcare CIOs in the state”.
Indeed, Sarnecki recalls when he was working in that area of Arizona, he and his colleagues did a population health study that involved an Indian tribe, the county, and a regional hospital. What they found was that there was a higher incidence of lung cancer in a very small age group that was studied; in fact, it was the exact age group that was living in this area during the time nuclear testing for weapons was taking place in Nevada in the 1950s. “So the prevailing idea was that winds took these [dust clouds] all over the region, creating a higher incident of lung cancer compared to the rest of the state,” he says. “When the pieces come together, it is amazing to see population health management become real and significant in improving patient outcomes”.
Could these lessons learned be applied to Alabama and other states? Sarnecki notes that the metro areas in Alabama tend to be smaller and the rural areas tend to be vast. And while there are small community hospitals dotted all over the place, generally speaking, integrated delivery networks in the state are not widescale. “So getting people access to care is a real challenge,” he admits. “Alabama is the true test for rural healthcare. Being able to get into a place where rural healthcare delivery has to be a focus since there isn’t a lot of metropolitan area around you is something that appealed to me.”
To this end, Sarnecki predicts that Children’s of Alabama will look to participate with others in the state pursuing population health management, leveraging telemedicine, etc., to help bridge some of these barriers. He admits that Alabama is “just beginning to dip its toes in the [telemedicine] water” as a state, but Children’s and other hospitals have been aggressive in its hospital spend, so he believes that telemedicine and other new technologies is something that will “grow exponentially and fast here.”
Of course, the core focus for Sarnecki and his Children’s of Alabama colleagues is taking care of kids in these rural areas. He notes that where Birmingham is located geographically, which is in the middle of the state, getting to Mobile (near the bottom of the state on the Gulf Coast), is a four-hour drive through some of the absolute most rural areas. “The landscape is different, but so much of Alabama reminds me of Arizona”, he says. “There’s not much in the way of large, integrated healthcare networks, even off of major highways,” he says. “So how do we reach into those areas and make them part of the population we support? How do we provide services to meet those needs in the rural areas?”
These are the key questions that Sarnecki will face, and must answer, as he continues to evolve into his new role.