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CEO and CIO Priorities for Tech-Enabled Healthcare

June 21, 2018
by Jason Fortin, Impact Advisors
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Key takeaways from a Scottsdale Institute roundtable discussion of CIOs

Executive Summary

During the recent 2018 Scottsdale Institute Annual Conference, a group of 22 CIOs from leading health-delivery organizations across the country gathered to discuss their CEOs’ top IT-related priorities. Although a wide range of issues were featured, five key themes emerged. At the top of the list was “digital health and the patient experience,” cited by 17 of the 22 CIOs as a top priority, followed by IT “cost containment and IT value realization” (cited by 13 CIOs), “innovation” (12 CIOs), “support for growth” (12 CIOs), and “cybersecurity” (11 CIOs). Although the top priorities discussed by the panel are not necessarily representative of every provider nationwide, the session provided great insight and important perspective into how a group of leading CIOs from advanced organizations are responding to the rapidly evolving health-delivery landscape.

Participants

Mary Alice Annecharico, R.N., senior vice president and CIO (retired), Henry Ford Health System; Bobbie Byrne, M.D., senior vice president and CIO, Advocate Aurora Health; George Conklin, senior vice president and CIO, CHRISTUS Health; Darby Dennis, R.N., vice president, clinical information technology, Houston Methodist; Darren Dworkin, senior vice president, enterprise information services and CIO, Cedars-Sinai Medical Center; Gene Fernandez, vice president and CTO, Methodist Le Bonheur Healthcare; Jason Joseph, senior vice president, information services, Spectrum Health; Eric Leader, chief technology and information officer, Verity Health System; Ken Lee, senior vice president and CIO, Centura Health; Brennan Lehman, CIO, Mosaic Life Care; Heather Nelson, vice president and CIO, University of Chicago Medicine; Patrick O’Hare, vice president, facilities and CIO, Spectrum Health; Mark Pasquale, CIO, INTEGRIS Health System; Michael Pfeffer, M.D., CIO, UCLA Health; Andrew Rosenberg, M.D., CIO, Michigan Medicine; Jon Russell, senior vice president  and CIO, John Muir Health; Chuck Scully, senior vice president and CIO, HonorHealth; Marcus Shipley, senior vice president and CIO, Trinity Health; Brent Snyder, CIO,  Adventist Health System; Subra Sripada, executive vice president and CIO, Beaumont Health; Tim Thompson, senior vice president and CIO, BayCare Health System; Jim Veline, vice president and CIO, Avera Health

Moderator: Ralph Wakerly, president, C-Suite Resources

Written by Jason Fortin, Impact Advisors

Introduction

The topic for the Scottsdale Institute’s 2018 Annual Conference was “Pushing Past the Payment Barrier: From Innovation to Transformation of Healthcare.” During the conference, a CIO roundtable discussion among 22 CIOs from leading health-delivery organizations across the country focused on the issues keeping them up at night. Specifically, each CIO was asked to share their CEO’s top strategic priorities. Some CIOs focused on the top one or two priorities, while others mentioned as many as five or six.

Key Themes

Although a wide range of priorities was discussed by the CIOs, five key themes emerged. In many ways, these five themes reflect not only the rapidly evolving health-delivery landscape, but also key competitive differentiators for provider organizations in the coming years.

Digital Health and the Patient Experience. The most frequently mentioned priority—by far—pertained to patient engagement, cited by more than 80 percent of CIOs. That there is so much attention on digital health and the patient experience right now is telling on a number of fronts. First, it underscores a growing recognition—especially among industry leaders—about the critical need to be able to compete on convenience, access to care and value (as defined by patients). Technology can obviously play a critical role in transforming the consumer experience in healthcare, just as it has in other service industries. “Digital health” tools cited by the CIOs ranged from patient-facing engagement solutions (e.g., wearables, mobile apps, self-service tools) to a number of provider-facing solutions that can help streamline transitions of care and overall patient flow. However, as CIOs on the panel repeatedly pointed out, digital-health technologies—regardless of how promising—cannot succeed without the right level of leadership, governance, clinician engagement and overall organizational commitment.

Examples Of “Digital Health” Solutions

 

Virtual care apps & tools (mobile-based virtual visits, e-triage, patient-provider communication tools, secure messaging, etc.)

The focus by participating CIOs on digital health, virtual care and the overall patient experience is also notable because health-delivery organizations are no longer just competing with other hospitals, health systems and physician practices. New, non-traditional players have also emerged, such as retail clinics from major pharmacy chains and onsite workplace clinics increasingly being offered by large employers.

IT Cost Containment and IT Value Realization. More than 60 percent of CIOs cited either containing IT costs or improving IT value as a top priority, reflecting how perspectives about IT spending are evolving among leading healthcare organizations. As recently as even five years ago, many hospitals and health systems nationwide were investing significant amounts of money to implement a new enterprise EHR—or upgrade an existing one—to maximize meaningful use incentive payments. In some cases, implementations were rushed or narrowly focused on the capabilities needed for meaningful use. Fast forward to 2018, and financial challenges are forcing CIOs to stretch the technology dollar more than ever. At the same time though, there is also now significant pressure internally to demonstrate tangible value from existing IT investments—particularly the enterprise EHR. Containing IT costs will continue to be important moving forward, but there is also an increasing premium on the ability to actually define value and quantify ROI.

Innovation. Interestingly, almost 60 percent of CIOs cited innovation as a top priority. “Innovation” can obviously take on many shapes and forms. Some CIOs mentioned targeted pilots focused on machine learning and AI, others cited strategic partnerships with large employers or influential tech firms, while some even discussed plans to establish a dedicated “innovation center” at their organization. Although approaches to innovation range widely, one consistent theme in the discussion was the importance of putting more structure and governance behind innovation to ensure efforts are better aligned with the organization’s overall strategic goals. Interestingly, there was little mention of emerging technologies such as blockchain or FHIR (i.e., “Fast Healthcare Interoperability Resources,” a draft standard from HL7)—both of which have been surrounded by considerable “buzz” of late in healthcare.


 

Support for Growth. Not surprisingly, almost 60 percent of CIOs mentioned support for growth as a top priority, underscoring the continued efforts by health-delivery organizations to achieve scale. As competition increases in many regions, hospitals and health systems are trying to grow organically (e.g., expanding existing service lines or building out new ones) as well as through acquisitions and strategic partnerships with a variety of different stakeholders. The CIOs noted the importance of being able to ensure that IT is positioned to be able to support all of that growth.

Cybersecurity. The need to proactively protect against evolving cyber threats was also a key theme, with more than half of CIOs citing cybersecurity as a top priority. Not only are cyber-attacks becoming more sophisticated, there are also now more vulnerabilities to exploit—with connected medical devices representing one of the most pressing concerns. It was clear from the Roundtable discussion that participating CIOs felt strongly about the importance of being proactive; beyond the steep financial consequences of a breach, there can also be irreparable damage to an organization’s reputation and brand. It was telling that multiple CIOs pointed out that cybersecurity—just as with many of the other top priorities mentioned above—is as much about policies, processes, governance and culture as it is about technology.

The Bottom Line

Although the priorities highlighted by CIOs in the roundtable discussion may not be representative of every provider organization nationwide, the discussion underscored how the health-delivery landscape is rapidly evolving—and how many leading hospitals and health systems are preparing for the future. In particular, participating CIOs felt strongly that efforts focused on digital health and transforming the patient experience are likely to be among the biggest competitive differentiators for many providers moving forward.

The Scottsdale Institute (SI) is a not-for-profit membership organization of prominent healthcare systems whose goal is to support our members as they strive to achieve clinical integration and transformation through information technology.

Impact Advisors is a healthcare consulting firm aiming to solve some of the toughest challenges in the industry by delivering strategic advisory, technology implementation and performance improvement services.

 


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New Report Examines Healthcare in the “Amazon Era”

October 5, 2018
by Rajiv Leventhal, Managing Editor
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Hospital business leaders are open, and even optimistic, about the benefits of innovation from non-traditional healthcare players, such as Amazon and Apple, according to a new report from Captains of Industry, a marketing consultancy.

The research, which included interviews with hospital leaders across 11 hospitals in the Boston area, identified a gap between where hospital executives expect Amazon to debut in the marketplace and the areas where the market truly desires innovation. Principally, while hospital executives anticipate Amazon entering healthcare through supply chain and retail initiatives, the majority of respondents pointed to consumer-facing healthcare IT as the area most in need of transformation.

Indeed, hospital executives are keenly watching Amazon given its strategic edge. While Apple and Microsoft have the most traceable digital footprint inside hospitals today, healthcare leaders ranked Amazon as the #1 company most capable of bringing transformative change to healthcare in the next three years, the study found

As Healthcare Informatics reported in January, Amazon, Berkshire Hathaway, and JPMorgan Chase & Co announced they were teaming up on an initiative to improve satisfaction and reduce costs for their companies’ employees. Although not many details are known about this collaboration, the organizations named Atul Gawande, M.D., as CEO of the initiative, back in June.

Meanwhile, in August, Amazon said it would be part of another endeavor related to healthcare—to remove interoperability barriers and to make progress on adoption of health data standards. For this, Amazon will be teaming up with Microsoft, Google, IBM, and others to jointly commit to support healthcare interoperability by advancing healthcare standards such as HL7 (Health Level Seven International), FHIR (Fast Healthcare Interoperability Resources), and the Argonaut Project.

Indeed, over the past year, industry observers have had their eye on non-traditional healthcare players such as Amazon and what they can bring to the table from an innovation and cost-cutting perspective. One recent survey of 100 healthcare organization leaders found that most C-suite executives do have their eyes on Amazon to shake up healthcare.

This latest report, “Healthcare in the Amazon Era,” researchers explore the transition to Amazon era healthcare. It seeks to define the strategic questions that organizations, hospitals and leaders on the edge of medicine and technology must address to deliver care and conduct business in the Amazon era of healthcare.

“The ability to distribute healthcare broadly, reliably and timely—when the patient wants it—is exciting, but business leaders and clinicians who participated in this study call for a future where healthcare in the Amazon era is also safe, equitable and sustainable for all involved,” Lauren Prentiss, strategy director for Captains of Industry and head of Captains Research, said in a statement accompanying the report. “Delivering against those parameters is incredibly difficult. But the more we do it, the more rewarding it will be. Not only for those shaping the Amazon era of healthcare, but for our society as a whole.”

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CDC IT Leader Details Progress on Developing an EHR Blockchain

October 1, 2018
by Heather Landi, Associate Editor
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Blockchain is an innovative technology that has garnered a significant amount of interest across many industries, and, within the U.S. healthcare industry, thought leaders and innovators continue to weigh in on the potential opportunities, and the countless complexities, around the adoption of blockchain technologies.

Many healthcare organizations are pushing forward with pilot projects and proof of concept initiatives to explore the development of blockchain and distributed ledger technologies, yet this is a technology that is still very much in its nascent stages. Potential use cases for blockchain in healthcare will be topic of discussion by a panel of experts during the Healthcare Informatics Beverly Hills Health IT Summit, scheduled for November 8-9 at the Sofitel Los Angeles at Beverly Hills.

As noted in a Fast Company article, companies like IBM and Microsoft are exploring how the technology can be used in traditional industries to sync up data like logs and transaction records between business associates, like health providers and the Centers for Disease Control and Prevention (CDC). IBM and the CDC’s National Center for Health Statistics are collaborating to build a proof of concept for an electronic health record (EHR) blockchain, and there is the potential for the technology to be used as a data system that could track public health issues.

The CDC’s National Center for Health Statistics collects a large amount of health data from surveys. The blockchain project is focused on the National Ambulatory Medical Care Survey (NAMCS), which is a national survey designed to provide information about the provision of medical care services in office-based physician practices in the U.S. NAMCS is designed to meet the need for objective, reliable information about the provision and use of ambulatory medical care services in the United States. Findings are based on a sample of visits to non-federally employed office-based physicians who are primarily engaged in direct patient care and, starting in 2006, a separate sample of visits to community health centers, according to the CDC’s website.

Askari Rizvi, chief of the technical services branch of the CDC’s Division of Health Care Statistics, says the CDC looks for innovative solutions to resolve business problems and is developing a blockchain use case to potentially see what types of current and future EHR data collection challenges can be addressed. Rizvi recently spoke with Healthcare Informatics Associate Editor Heather Landi about this proof of concept project, what project leaders have learned so far about blockchain’s potential and what they hope to accomplish with the project. Below are excerpts of that interview.

What is the CDC-IBM blockchain collaboration focused on and what is the aim of the project?

The collaboration started about a year and a half ago. The CDC has an official collaborative agreement with IBM. The CDC is a large organization, and we have a lot of different centers and I’m part of the National Center for Health Statistics. The CDC’s Innovations Committee reached out to several centers to see if anyone had a project to utilize blockchain for, and I made a case for the EHR proof of concept on a blockchain project, and it was well received within the CDC community along with IBM as well. I picked one of our services, called the National Ambulatory Medical Care Survey, or NAMCS, and we based the proof of concept on the NAMCS to get us started. Currently, it’s quite a process to capture that data [for the NAMCS], so the idea is to capture EHR data, so that we can bypass a lot of that and so we can get the data in real-time.

Askari Rizvi

We have created a proof of concept, but we do have a small application where we can demo the project. I’ve spoken at a number of conferences and events where we have demoed the project. The entire project is hosted at IBM and it is a research and development project. It does not have any real data. I want to be very clear because we take privacy and security extremely seriously here at NAMCS; all the data that in this proof of concept is completely synthetic data. And, because it is an R&D project, and there’s no real data involved, we could put it offshore. There’s a lot of legislation and regulations we would normally follow in a traditional federal application, which you don’t have to do when you’re doing a research and development project. But as we move toward a production solution, which would be a long-term strategy, then we would need to get the appropriate approvals and the authority to operate.

Based on what you have seen so far, what are the benefits of using blockchain?

Essentially, we’ve created a promising EHR blockchain proof of concept based off our NAMCS. Thus far, the primary benefits that seem quite promising are consent management, sharing of data, enhanced privacy and security controls and embedded audit trails. The long-term vision is to be able to collect large sets of data, which should provide researchers and organizations the ability to develop deeper insights and trends. We are at a stage with our proof of concept where we are recruiting for partners, specifically EHR vendors. The vision is to partner up with EHR vendors to build capability in our solution where the sharing of the data becomes simple for the providers, and, at that point, all we would need is consent from the providers.

What drew your interest to exploring blockchain technology? Are there particular challenges that blockchain might help to solve?

I have a hefty background in IT; I’ve been doing it for a few decades. Anytime I see a new technology, I’m interested in finding out what it has to offer, so essentially, that is what piqued my interest. By no means am I a blockchain expert. It was more so as an R&D project, to see what it is and how can it possibly help us manage our national healthcare surveys. As we’ve been through a series of meetings and working sessions, we began to realize that it will enhance the privacy and security of our service, which is always a key aspect, along with better sharing of the data, consent management, and the audit trails.

But, besides that, there was another primary goal. The survey response rates have been declining throughout the industry, so we wanted to think out of the box in order to compensate for that. The idea was if we can build a solution with EHR vendors or these larger systems that host a lot of the data that we need for research, then it would become a lot easier. We would have larger data sets, and we would have them in real-time; there wouldn’t be any issues with the frequency of the data that we are receiving. Some people describe blockchain as a decentralized database, and it really depends on the model that we create going forward. We’re flexible; we have capped the proof of concept at a very high level in terms of flexibility, because depending on the partners that we select, we want to make things as easy as possible for them. I think for the next steps, once we have a number of partners, then we would ask for them to send data from their EHR system and then we would move forward.

What are the next steps with this project, and what is the long-term goal?

What we’ve built so far, it is promising. I see that it does offer several benefits, in terms of privacy and security and audit trails. For the next steps, when we’re able to get a number of providers and if we’re able to build a bridge, or let’s say [the providers] are a node on our blockchain, then it becomes easier to share data from that EHR system for any of the providers, because we would build that bridge between our application and the different EHR vendors. All the providers would need to do is to give us consent, and then we would have that data, from that EHR system. It’s a very long-term strategy. It’s not going to be done any time in the next few months. It is a holy grail of where we are headed, and then we can tap into the data, and depending on the different data sets, we can even enhance the data collection that we currently do. There are many data elements that we collect, and EHR systems have a lot more data elements, so we’re increasing our ability to capture additional data sets, and then providing the flexibility for researchers to be able to run their analysis, look at deeper insights, and come up with trends.

I just want to, again, that all the data for this blockchain prototype is completely synthetic; there is no real data that we’re using here. And, I want to be clear on our current state versus our “to-be” state. So, current state is, we have developed this proof of concept, it’s off-site, no data, and, on top of that, we’re simulating providers. The “to-be” state would be to get providers, partner up with them, start collecting synthetic data from them and then moving toward production state.

What does the status of this proof of concept signify to you about the potential for blockchain adoption in healthcare? Do you see other potential use cases?

There are a number of different centers in CDC that are focused on solving different business problems for CDC, and their mission and goals are very different. I think blockchain could be used for a number of those business units. The idea over here is to get this R&D project off the ground, get it working, have providers on board and move forward towards a production stage. I think that will open things up where others can see that this product looks promising and that it could resolve certain issues. People use blockchain for supply chain management, so another use case could be where the CDC could see the different areas when you are tracking down let’s say, some sort of bacteria in a product. If you have a system that’s developed on a blockchain, you can see where that product originated from. Essentially, you could work your way backwards, go all the way to the origins of where that product came from, and you could identify the source. That would be another use case.

Moving forward, what are some of the potential challenges with this project?

We’re at a juncture where we need to partner up with the EHR vendors or different providers or systems. I think that would be the current challenge, or the biggest challenge for us to face. We want to make sure we’re able to pick the right partners, so we can get something going and continue to make progress.

 


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ONC Announces Recipients of Two Health IT Awards

September 28, 2018
by Rajiv Leventhal, Managing Editor
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The Office of the National Coordinator for Health Information Technology (ONC) has announced awards to two awardees under the Leading Edge Acceleration Projects (LEAP) in Health IT opportunity.

The LEAP in Health IT awardees, totaling nearly $2 million in funding over two years, will aim to address fast emerging and future challenges to advance the development and use of interoperable health IT. The funding opportunity solicited applications focused in one of two areas of interest: (1) expanding the scope, scale, and utility of population-level data-focused application programming interfaces (APIs); or (2) advancing clinical knowledge at the point of care. An API is technology that allows one software application to seamlessly access the services another software application.

The awardees are Children’s Hospital Corporation, based in Boston, and MedStar Health Research Institute, in Hyattsville, Md.

  • Children’s Hospital will aim to expand the scope, scale, and utility of population-level APIs including enhancing the use of flat data files and creating a new population health analytics app allowing payors to access permitted data and metrics on covered populations through the use of those files.
  • MedStar will advance clinical knowledge at the point of care by transforming isolated risk calculators into open standards-based applications that seamlessly and securely run across health IT platforms and provider organizations to optimize clinical workflow, improve care coordination, and support patient engagement. 

“We expect these two awardees to demonstrate where healthcare interoperability can go next,” said Don Rucker, M.D. national coordinator for health information technology. “Their efforts should inform a new generation of health IT development.”

The LEAP in Health IT funding opportunity has a three-year open application period and ONC may issue future awards to eligible applicants for new priority areas of interest. This will be contingent on the availability of funds and ONC priorities, the agency stated.

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