Earlier this spring, while participating in the World Health Care Congress in Washington, DC, HCI Editor-in-Chief Mark Hagland sat down with Judy Murphy, R.N., to get her perspectives on some of the current developments taking place in the healthcare policy, business, and IT arenas.
In October 2014, Judy Murphy became chief nursing officer and director, Global Business Services, at IBM Healthcare (the company’s Health Care Global Business Services is based in Washington, D.C., where Murphy is based). Prior to that, she had been chief nursing officer and director of the Office of Clinical Quality and Safety in the Office of the National Coordinator for Health IT, from June through October 2014; while from December 2011 through June 2014, she had been deputy national coordinator for programs and policy, at ONC. Prior to her positions at ONC, Murphy had been vice president-EHR applications, at Aurora Health Care, a Milwaukee-based integrated health system, for nearly seven years, between January 2005 and November 2011. She has been a board member of AMIA (the American Medical Informatics Association, January 2004-December 2009) and HIMSS (the Healthcare Information and Management Systems Society, June 2010-November 2011), and is also currently co-chair of the Alliance of Nursing Informatics (January 2011-present).
Judy Murphy, R.N.
At the time when Hagland sat down with Murphy for a conversation back in March, the news had not yet broken that IBM was acquiring the Dallas-based Phytel and the Cleveland-based Explorys—that news was to be revealed on April 12, as the HIMSS Conference was being held at the McCormick Place Convention Center in Chicago.
Below are excerpts from the March conversation with Judy Murphy.
What does the world look like to you right now?
To be clear, my personal interest is coloring the way it looks. I had done electronic health record implementation; and infrastructure components are extremely important. But I was ready to more tings on top of all of that. So for me, moving to IBM was the icing on the cake, in terms of being able to be involved in exciting things at this point. The analytics, the decision support, wrapping things with mobility, getting to stuff that leverages health IT and gets us to the next level, all of those things are exciting to be involved with. And a tipping point has been reached in the industry, with electronic health record implementation. So now, the question is, how do we get to the next level? And that’s what I personally was looking to do, at IBM.
How might analytics help us get to population health, which is so necessary?
We’ll be doing a HIMSS webinar on this topic next Wednesday. And Sean Hogan, one of our partners, Michael Wiener, a physician, and I, will be doing it. And one of the things that I think of—you started with population health, a somewhat nebulous idea, and then brought in analytics. And analytics is how we get to population health, right? My premise is that analytics gets us to population health, but also helps us analyze individual encounters. How do you take your evidence base of ideal care and hardwire that into care processes, to make sure you’re consistently delivering good care? Once, you’ve done that, you can analyze that. And so we build our evidence base. That has been called continuous quality improvement in healthcare, right? So I want to tie those concepts together.
That’s also the virtuous cycle, as those involved in clinical performance improvement have reported.
Yes, and it’s also the learning health system. And it’s a circle, and you learn more information, and you iterate that back into you evidence. And traditionally, we did that in research. And historically, we had nurses digging down into stacks of records, through chart review. Now, with electronics, we can do it in months, not years.
Are clinicians now really accepting the reality of where healthcare is going?
Of course, there’s a range of understanding among different people, but most people in the middle realize that we can’t stay on this trajectory. And what I liked on the panel just now [the panel discussion in which she had just participated at the World Health Care Congress] was the discussion of how important both care coordination and the engagement of patients are. And sometimes, in talking about accountable care, we lose track of the fact that it’s not just a payment model, not just how we pay, but also how we deliver care. And the things that are really important become more obvious; care coordination is a good idea, clinically. But we don’t always think about how important all that is.
Part of care management is the whole panoply of processes around the patient, right?
Yes, Karen DeSalvo talks about that a lot. It’s not just healthcare. It’s everything around the person.
And where are organizations being smart?
The leaders in organizations that are doing care management right realize that it’s not just about the doctor—the solution involves the nurse, the OT person, the home dietician, etc. Meanwhile, with regard to nurses specifically, nurses so often aren’t practicing at the top of their licenses. Even nurse practitioners who can prescribe, aren’t always doing that. So you have to move clinicians to the top of their licenses.
What kinds of things need to happen with regard to analytics solutions?
Two things are going to happen: the Cerners and Epics will start offering their own solutions in this space. On the other hand, you’ll be seeing folks who are really smart about analytics, and you’ll see that services and software becoming more product-ized. What happens today is you call me in, and I tailor-make a product for you, and I go to Susie and I tailor-make it for her, too. But you would both benefit from it becoming more productized. The analogy I would draw is… you probably remember the time where with the core EHR vendors, you really customized everything from the beginning. But they created model content or start content, and they idea was that they looked back at their clients and have done some level of pre-configuration. So I see the same thing happening in analytics, where it’s not starting from scratch every time, so that instead, there’s a base of something a number of people can use. And there’s a broad spectrum, from foundational reporting, to predictive and prescriptive analytics, and the Watson-type of computing. And it was clear even in the panel that there was a difference in the ability to extract and understand the information.
What’s going to happen at IBM in the coming months?
Analytics is huge. And we’re bringing so much in from other industries. Our experience in retail is very important, in that regard. And we’re going to do that in healthcare. It’s a huge focus, not just because we have the expertise, but because healthcare needs it.
What would your advice be for CIOs and other healthcare leaders, on analytics?
The simple answer is just to get started. And understand what you’re doing well on cost-effectiveness and quality effectiveness. And hardwire it through continuous improvement, use your analytics for continuous improvement, and continuously make it easy to the right thing.