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?
The challenge element is partly being driven by the complexity of the challenges in this value-driven world. So all the care providers belonging to this collaborative probably will not belong to the same organization. So the biggest challenge to my mind right now is the effectiveness of interoperability. We talk about it a lot, but the effectiveness and sophistication are going to have to improve considerably.
We’re still doing a lot of interfacing now, to be honest, right?
Yes, point to point—and that’s even worse.
Can you articulate your philosophy and strategy around co-development, per your Innovation Alliance Program?
Absolutely. I would come back to that example of orthopedics. And it’s really important to recognize it as a process. And a lot of people think that engaging the physician means getting them to look at a screen and tell you how to organize an EHR, for example. That’s just one piece. And in the orthopedic situation, it started out with the clinicians sitting down and writing what we here call a care guide—a pathway. So everyone—physicians, nurses, etc.—was involved in creating that care guide. And medicine is still an art, not a science, still. And there are still a lot of areas where you need that interpretation, and it’s good for that interpretation to share information together. So that’s a first step; then you get to analysis, a paradigm change, and then the transformation of the process.
The analysis says, if we are going to be caring for patients across the continuum, what’s the most efficient way to do those things? What could I do at home? What could I do in the physician’s office? And that causes you to rethink where you locate resources. And only after you’ve done all that, then you’re ready to go think about how you e-enable that in the computer. That is the process that you need to go through, to get to that e-enabling piece. And if you skip over that and just get to the optimization of the screen, that will do nothing in terms of absolutely transforming the care delivery process.
Do you use performance improvement metholdogies as part of that?
Yes, we have a continuous improvement, or CI team, and they’re there all through the process, working with the clinicians and others on every aspect of any care transformation process.
On a spectrum of optimism to pessimism over what needs to be done, and the challenges, in healthcare, in the next several years, where do you fall?
I am optimistic, and I will tell you why. I believe that we have the opportunity, through this transformation process, to take the precious financial resources we have, and reapply them, and actually get a better outcome for patients and for society, than we do today. So I’m incredibly optimistic. I’m not naïve; it’s extremely hard work ahead of us. But I believe we’ll get there.