Later this month, October 14-16, leaders at the Cleveland Clinic, the large integrated health system based in Cleveland that encompasses 10 owned hospitals and one affiliate hospital, with 4,450 beds, plus more than 75 outpatient locations in northern Ohio, as well as more than 3,000 physicians and scientists, and serves 5.1 million patients a year, will be presenting their annual Cleveland Clinic Medical Innovation Summit, under the theme, “Finding Balance through Innovation: Obesity, Diabetes, & the Metabolic Crisis.”
Last month, HCI Editor-in-Chief Mark Hagland interviewed Gary Fingerhut, acting executive director and general manager of HIT commercialization at Cleveland Clinic, regarding the organization’s goals for the Innovation Summit, and his perspectives on IT development. This month, Hagland interviewed C. Martin Harris, M.D., the organizations CIO and chairman of its Information Technology Division, to learn his perspectives on the bold innovations taking place at Cleveland Clinic, on the eve of the organization’s innovation summit. Below are excerpts from that interview.
Overall, as CIO, what is your vision of the overall IT strategy that you’re helping to facilitate at Cleveland Clinic, at what many are regarding as both an exciting, and a challenging, time in healthcare?
You’re absolutely right, it’s both an exciting and a challenging time; but from my point of view, it’s absolutely the right time to be in healthcare and healthcare IT. So as I think about strategy, I really think about only one strategy, and that’s the strategy of the organization, of the actual healthcare delivery organization, the Cleveland Clinic. The basic challenge all healthcare delivery organizations face right now is this: how we maximize the quality of care we deliver, that we provide a great patient experience, and that we be as cost-effective as possible. And healthcare IT is really critical to achieving that strategy; and it really is focused on redesigning that care delivery model, giving us opportunities to interact with patients at different points in time, and in different ways, that will meet all those objectives I’ve talked about. So the simple example I’ll share here is around orthopedic care—patients who are going to be getting knee and hip replacements. Historically, someone would develop a problem, see a primary care physician, eventually get a consultation with an orthopedist, and eventually, come around to the decision to get a replacement.
We start with the idea that someone will see an orthopedist, and we have the ability to send them over the web a survey that assesses their functional status, and a general sense of their activities of daily living. Related to your hip and knee, how much can you do? And if you’re going to have an outcomes-driven process that really drives quality, the patient is really going to be a big part of that success. So now we collect that information over the web; and let’s say a patient needs a hip replacement. They’re now put into that care path, which is a series of tools inside the electronic medical record designed to maximize the clinical outcome and minimize the variation in getting to that. And if we do that, we will optimize the outcome and minimize the expense.
C. Martin Harris, M.D.
That’s exactly where things are headed in healthcare.
Do you think that most physicians affiliated with Cleveland Clinic understand your strategy?
That’s a journey. I think most physicians understand the need to manage care in a different way. They’re getting that input through report cards coming out of Medicare and out of independent organizations. There is this sense that you’re going to be measured by objective data, and every physician is aware of that now. The greater challenge is working as an interdisciplinary team, and we have to get everyone in that team to practice at the top of their license.
And as we move towards that new model, the old turf wars around the old "guild" system of clinical prerogatives are beginning to disappear, right?
Yes, absolutely; in order to hit that value target in the new value-based healthcare, you have to think about maximizing teamwork.
Meanwhile, even those physicians in practice who are on board with the new healthcare—the emerging accountable care, care-managed, system—say that the clinical IT tools they’re being given aren’t helping them to do their jobs better.
So, just as getting to value-based healthcare is a journey, providing optimal IT tools for physicians is a journey. And it’s highly unlikely that a computer company will be able to build a tool that is ready to cover the gamut of healthcare. That’s why this is a really exciting time, particularly at the Cleveland Clinic—we are completing the journey of getting the needed tools to everyone—physicians, nurses, pharmacists, allied health professionals—and that’s why I could give you that example of the orthopedic knee and hip replacement situation. The IT can cover all the transitions of care; and what’s constant is the management of the person and a shared sense of teamwork, based on having all the information, and that the information is organized in a way so that you see what you need to do. And yes, an EMR does not come delivered like that today. Somewhere in the next five to ten years, you’re likely to see that.
What are your biggest strategic IT challenges right now at Cleveland Clinic?