In his first HIMSS conference as executive vice president and CIO of Kaiser Permanente, Dick Daniels sat down with Healthcare Informatics contributing editor David Raths to talk about some of his priorities for 2015 and beyond.
HCI: Have you had time to do an assessment of some of the things you want to focus on as CIO?
Daniels: I have. I had six months as interim CIO, of course, and that helped. We are looking at how we can meet the evolving needs of our members, because those needs are changing. Increasing consumerization comes in the form of more convenience, ease of use and the notion of “care anywhere.” People want ubiquitous access to us, which translates into digitizing the experience members have with us, including telehealth. That leads to another point: innovation. We have been big on innovation and we need to continue to be. That includes leveraging new technologies like telehealth and making video available for clinician-to-clinician visits so that care teams can communicate. We are looking at remote patient monitoring opportunities as well.
HCI: When you talk about innovation, are there organizational things you can do to encourage innovation at the clinician level?
Daniels: Absolutely. We have a few formal programs, one of which is an innovation fund. Anybody in the organization can submit an innovation fund request. A project may require seed funding to get started. We limit the amount to $200,000. In fact, it was through the innovation fund that we did some of the initial work on telehealth. We did a lot of pilots about where it might be effective, what operational changes were required and which vendors we should use.
HCI: You worked in IT in financial services before moving over to Kaiser several years ago. Could you talk about how your experience has been different in the two industries?
Daniels: Working in financial services, technology was extremely important. My responsibilities before I left JP Morgan Chase were in the area of securities processing. We processed roughly $200 billion a day, so it was incredibly important to make sure we got that right. I thought that was really important until I got to Kaiser Permanente. Now we are involved with systems that are involved in patient care, so the definition I would put on it is “life-critical” systems. While the money was very important, now we are talking about the lives of people, especially since we have moved away from paper records and are solely dependent on the electronic medical records that caregivers need. If those systems aren’t available, that could be a real problem.
HCI: What about the cultural of the IT organizations between healthcare and financial services? Do they seem similar or different?
Daniels: Different. The profession is the same. But I noticed at Kaiser Permanente, the people in IT are very mission-driven. They really get that we are involved in patient care.
HCI: You have geographically dispersed operations. Is there a balance you have to strike between standardizing and harmonization vs. allowing regional groups freedom to use applications or processes that they prefer?
Daniels: Yes. We are looking at which systems we want to have centralized, vs. which ones are decentralized. Some of our administrative systems such as finance or H.R. are centralized systems that provide services to the entire organization. The closer we get to patient care, we start to have differences in practices and things done locally, although we recently installed a single pharmacy system that serves the entire organization. We can now transfer prescriptions across the regions easily.
HCI: What about imaging?
Daniels: Imaging we are using the same software, but we have multiple instances of it installed across the organization. In terms of data warehouses, we are working to bring all the data together, but we do have different warehouses. We are pulling together a single membership warehouse in our health plan, and a single claims data warehouse where we will have all the claims. We need to do that to meet external reporting requirements.
HCI: At this HIMSS conference I heard an executive of Intermountain Healthcare say that knowing what they know now they probably would have not bothered with the meaningful use incentive program because it had so many negative unintended consequences for the organization. Like Intermountain, Kaiser has a reputation as having a sophisticated IT infrastructure. Has meaningful use been helpful to Kaiser or not worth the hassle?
Daniels: Well, first of all, I think there were some great things in meaningful use. It basically propelled the use of EHRs across the country. That was a good thing. Even for us, it brought some greater discipline to a few things, such as reducing medication errors, increasing the amount of coordination between care providers and increasing the engagement with members about their health. Even though we had a good base already, I think we got more traction and went further as a result of meeting the meaningful use guidelines.
HCI: Has it helped Kaiser exchange data with other organizations?
Daniels: Yes. However, there is still more work to do around interoperability. We utilize Epic and use some of the Epic tools so we can exchange information with other Epic customers. But there is more work we need to do to communicate with safety net and ambulatory providers and other systems not using Epic. We were inaugural members in the Care Connectivity Consortium along with Mayo, Intermountain, Geisinger and Group Health. We saw the need to have interoperability standards.
HCI: Anything else you are excited about that I haven’t asked about?
Daniels: I am excited about being here at HIMSS. We look at all the technologies on display and figure out which ones we want to bring in to Kaiser Permanente, so they can help us accomplish our mission. There is a ton of innovation taking place in this industry. I am excited about picking and choosing.
HCI: Do you have to make build vs. buy decisions?
Daniels: Speed is pretty important to us. So in some cases we are definitely going to be buying technology to integrate it vs. building it ourselves.