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Chief Quality Officers Seek to Create a ‘Healthy Tension’ in Their Organizations

January 26, 2018
by David Raths
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Focus on value-based care requires CQOs to pivot to population health
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As healthcare systems transition to value-based care and population health, and an increased focus on patient and worker safety, the relatively new role of chief quality officer is often charged with overseeing a cultural transformation. But it is a challenging role to fill, with no clear job definition across the industry. In a Jan. 25 webinar put on by the Institute for Healthcare Improvement (IHI), two CQOs spoke of creating a “healthy tension” within their organizations to spark progress.

In the webinar, David Williams, Ph.D., IHI’s executive director for improvement capability, interviewed Petrina McGrath, R.N., M.N., Ph.D., executive transition lead: people, practice and quality for the Saskatchewan Health Authority, and James Moses, M.D., chief quality officer and vice president of quality and safety for the Boston Medical Center, about how they are redefining their positions.

Williams started out by noting that the CQO role is relatively new, and their responsibilities sometimes reside in another position such as chief medical officer. IHI has interviewed two-dozen CQOs in the U.S., Canada and Europe. It found that people were establishing this role in their organization, but there was not a unified theory of what that the role was or what they worked on.

Besides engaging other stakeholders, including the C-suite, interviewees often mentioned the idea of creating a culture around scientific improvement and the desire to fail forward.

Among the key priorities CQOs address are reducing infections and medical errors. But in the larger picture, this role needs to be able to link with stakeholders throughout the organization, including front-line leaders, Williams said. “They have to be able to activate a system of people working on improvement. They recognize that there is a significant need to develop a culture that supports people to work in favor of quality,” he said. “That requires a number of different skills that may not be traditional in some of the folks who get into that role — soft skills around relationship building and building will, and harder skills around change management.”


Integrating Data Sources for Successful Care Delivery

The advances in and availability of data from disparate sources create new opportunities and frontiers in care coordination for complex patients. These can range from mobile health/Internet of...

McGrath said that Saskatchewan had been focused for a few years on tools and events to do quality improvement but noticed that they were struggling to sustain some of the progress. “We shifted to a focus on how to build quality improvement and safety literacy into daily work at all levels of the organization,” she said.

“I find it important to test and model what I am asking others to do and expect the same of my team,” she said. “We are trying to create and embrace a healthy tension, because learning is uncomfortable.”

She has found observing behaviors important as a clue to employees’ depth of understanding and can guide her in terms of where to focus her efforts. She wants to see if leaders are taking methodological approaches to the problems they are trying to solve or instead just jumping to the solution. “In units and clinical areas, are the managers coaching or telling? That can help me understand where we have to do more work. Those can be leading indicators of whether we are getting that culture in place.”

Boston Medical Center’s Moses has been in the CQO position less than a year, although BMC, the largest safety net institution in New England, has had the position since 2008. He is the third CQO there.

Boston Medical Center’s mission involves serving vulnerable populations. Moses said his job is determining how quality and safety fits into that mission and get the institution to embrace quality and safety as a core value of taking care of the poor. Other Boston-area health systems have more resources to invest in quality initiatives, he admits. “We need to make meaningful investments in quality and safety and reducing inefficiency and waste to maximize the care we are providing,” he said, echoing McGrath’s comment about creating a “healthy tension” in the organization to change the culture around quality.

Unlike his predecessors in the position, Moses reports to Boston Medical Center’s chief medical officer, which he thinks makes sense. “It leads to better alignment because the CMO is physician-in-chief for the institution,” he said. “You need providers at the table and you need a strong physician leader to facilitate culture change. My role is centered on quality as a strategy. This allows a specific focus.”

With the rise of accountable care organizations comes an increased focus on value, Moses said. The CQO role at BMC traditionally has been about inpatient and ambulatory outcomes, and largely hospital-based. But BMC is all in on Massachusetts’ Medicaid ACO. “My role in that effort was undefined, but clearly over the last several months, I have been having more doctors knock on my door asking me to help out. So that is on the horizon. As CQOs, value-based care is one of the key pivots in this role.”

In the Q&A portion of the webinar, the CQOs were asked about the growing number of quality programs tied to payment. There has been huge growth in the number of bonuses and penalties designed to get hospitals to focus on quality.  To some extent, this has led to managing the measures instead of focusing on quality of care, Moses said. “You can’t ignore those measures, because it is not just about finances; those measures impact the quality reputation of the organization as well,” he said. “We have to do well on those and have enough resources to do other work, such as asking patients what matters to them. You have to do both.”

McGrath said one challenge in Saskatchewan is how to get good data to help show the impact of improved quality in a financial way. Culture and continuous improvement is a multiyear effort. Some people assume that you would be showing dollar improvements in the first year, she said. “It takes many years to build capacity and get the depth of culture where you need to. It takes five to 10 years. We are able to show cost avoidance but it takes time.”

She added that Saskatchewan is reorganizing to create one health authority for the whole province. “We are removing boundaries and really looking at the health of our population, focusing on improved quality and safety. It is a time of change and an opportunity.  We have been building a quality mindset. Now we can accelerate to the next level.”

The IHI is launching a Chief Quality Officer Professional Development Program starting in June 2018. “We hope this can act as a starting point to help new and current CQOs,” Williams said.





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AMIA to Honor Informatics Leaders

October 17, 2018
by David Raths, Contributing Editor
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Cerner’s Overhage to Receive Lindberg Award for Innovation in Informatics

At its 2018 Annual Symposium in San Francisco next month, the American Medical Informatics Association (AMIA) will honor several informatics luminaries with its Signature and Leadership Awards.


AMIA Signature Awards

• Donald A.B. Lindberg Award for Innovation in Informatics
J. Marc Overhage, MD, PhD, Chief Medical Informatics Officer, Cerner Corp.
Overhage joined Cerner in 2015 with the Siemens Health Services acquisition. Prior to Cerner, he was the Director of Medical Informatics at the Regenstrief Institute and the Sam Regenstrief Professor of Medical Informatics at the Indiana University School of Medicine. He helped create the Indiana Network for Patient Care, which contains data from laboratories, pharmacies and hospitals in central Indiana.

• Don Eugene Detmer Award for Health Policy Contribution in Informatics
Julia Adler-Milstein, PhD, Associate Professor and Director, UCSF School of Medicine
Adler-Milstein is an Associate Professor and Director of the Center for Clinical Informatics and Improvement Research (CLIIR). She is an expert on policy and management issues related to the use of IT in healthcare delivery. Her research assesses the progress of health IT adoption; the impact of such adoption on healthcare costs and quality; and the relationships between market, organizational, and team structure and health IT use. A core focus of her work is on health information exchange and interoperability.

• William W. Stead Award for Thought Leadership in Informatics
George Hripcsak, MD, Professor and Chair, Department of Biomedical Informatics, Columbia University
Hripcsak’s current research focus is on the clinical information stored in electronic health records and on the development of next-generation health record systems. Using nonlinear time series analysis, machine learning, knowledge engineering, and natural language processing, he is developing the methods necessary to support clinical research and patient safety initiatives. He leads the Observational Health Data Sciences and Informatics (OHDSI) coordinating center; OHDSI is an international network with 180 researchers and 600 million patient records. 

• Virginia K. Saba Informatics Award
Bonnie Westra, PhD, RN, Associate Professor, University of Minnesota School of Nursing
Director of the University of Minnesota’s Center for Nursing Informatics, Westra’s research includes terminology development, application, and evaluation; knowledge discovery in databases; predictive analytics for outcomes; and evaluating and deriving new evidence based guidelines from EHR data. 

• New Investigator Award
Jeremy Warner, MD, Assistant Professor, Vanderbilt University
Warner directs the Vanderbilt Cancer Registry and Stem Cell Transplant Data Analysis Team. His primary research goal is to make sense of the structured and unstructured data present in EHRs and clinical knowledge bases to directly improve clinical care for patients, with a focus on oncology. 

AMIA also announced the following Leadership Award winners:

Sarah A. Collins, PhD, RN: For leadership in developing and championing AMIA’s applied informatics recognition program (FAMIA).

Jeffrey A. Nielson, MD, MS, FACEP: For leadership in developing and championing AMIA’s applied informatics recognition program (FAMIA).

Lucila Ohno-Machado, MBA, MD, PhD: For steadfast leadership of JAMIA as editor-in-chief (2011-2018) and decades of commitment and service to AMIA.




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Nemours Children’s Health’s New CEO: “The Most Exciting Time in Healthcare”

October 12, 2018
by Mark Hagland
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Nemours Children’s Health’s new CEO, R. Lawrence Moss, spoke with Healthcare Informatics about the opportunities and challenges facing children’s healthcare providers

On June 5, the Nemours Children’s Health System, based in Wilmington, Delaware, and with care locations in the Delaware Valley region and Florida, announced that R. Lawrence Moss, M.D., had been named the organization’s next president and CEO. An announcement posted to the organization’s website stated that “The Board of Directors of the Nemours Foundation today announced Dr. R. Lawrence Moss has been selected to succeed Dr. David Bailey as the President and CEO of Nemours Children’s Health System. Dr. Moss will begin his tenure October 1, 2018. Dr. Moss, a renowned pediatric surgeon, biomedical researcher, educator, and health system executive. He is internationally recognized for leadership in healthcare quality and safety, including service as a founding director for developing quality standards for pediatric surgery nationally. He is also known for with tremendous achievements in academic health centers, national hospital associations, and government organizations accountable to the public. He joins Nemours after serving seven years as Surgeon-in-Chief at Nationwide Children’s Hospital in Columbus, Ohio, and the E. Thomas Boles Jr., Professor of Surgery at The Ohio State University College of Medicine.”

The announcement went on to say that "Dr. Moss brings unique experiences as a physician leader in academic health centers, and he embodies the character of Nemours, a health system dedicated to continuous learning and improvement," said Brian Anderson, Chairman of the Board of Directors of the Nemours Foundation. "In addition to his clinical roles, he brings invaluable perspective and expertise in the development and execution of value-based care focused on the overall health of children through collaboration with payers and government agencies. The Board is pleased that Dr. Moss will continue fulfilling our mission to meet the needs of children, families, and the communities we serve."

R. Lawrence Moss, M.D.

"The President and CEO role at Nemours represents a wonderful opportunity to lead an institution that embodies the values I hold as most important to the future of American healthcare," Dr. Moss said in a statement included in the June 5 announcement. "With a focus on creating health over treating disease, efficient care delivery and an alignment of the success of the medical center with the health of the population it serves, I believe that Nemours is in an optimal stage of development to offer the next leader the opportunity to catalyze a quantum step forward."

As the organization’s website notes, “Nemours is an internationally recognized children's health system that owns and operates the two free-standing children’s hospitals: the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and Nemours Children's Hospital in Orlando, Fla., along with outpatient facilities in five states, delivering pediatric primary, specialty and urgent care. Nemours also powers the world’s most-visited website for information on the health of children and teens,, and offers on-demand, online video patient visits through Nemours CareConnect. Nemours is a program dedicated to preventing reading failure in young children, grounded in Nemours’ understanding that child health and learning are inextricably linked, and that reading level is a strong predictor of adult health.”


Integrating Data Sources for Successful Care Delivery

The advances in and availability of data from disparate sources create new opportunities and frontiers in care coordination for complex patients. These can range from mobile health/Internet of...

On October 1, Dr. Moss officially joined the organization, replacing David Bailey, M.D., who retired following 12 years as Nemours’ CEO. On October 11, during a break in a one-day conference presented by the Nemours organization entitled “Pediatric Moneyball: Technology, Consumerism & Population Health,” focused on the opportunities and challenges facing our healthcare system, our communities, and our society in caring for children and improving their health and wellness, Dr. Moss, along with Gina Altieri, senior vice president and chief of strategy integration at Nemours, sat down to speak with Healthcare Informatics Editor-in-Chief Mark Hagland regarding their perspectives on the landscape around children’s healthcare in the present moment. Below are excerpts from that interview.

Strategic planning has never involved higher stakes than it does these days at children’s hospitals operating in the United States. Can you speak to this moment in U.S. healthcare? How does it strike you right now?

R. Lawrence Moss, M.D.: I’ve been doing this for a long time, and I have to say that this is the most exciting time in healthcare at any time in my career. I think it’s fantastic, because we have the opportunity to address and fix the two biggest problems I’ve seen in my career. We have the opportunity to align the finances of the system with the health of the patient; it’s been totally backwards. When a child needs more treatment, the system benefits. But finally, we have society’s attention and focus on, how do we create a situation where the child stays healthy, the family wins, and the system wins? Dr. Bailey, my predecessor, said it so well this morning, that health is so much more than healthcare. And we can be more than we’ve been; and we aspire to do that.

Children’s hospitals are facing payment challenges as never before. What do you see as the keys to their survival in the current reimbursement environment?

Dr. Moss: First of all, as children’s hospitals, we need to do a better job of articulating our value to society. We bring enormous value to society, and a lot of folks don’t know that. And we’ve got to get better at telling that story; it’s the greatest story in the world. Secondly, we need to more effectively partner with our government partners, because 60 percent of the children whose healthcare is funded, it’s funded through the government. Third, we need to be able to use the massive advances in technology to bring HC to the patient, in the way that the patient and family needs.

Gina Altieri: I agree that technology can enable a lot of the collaboration—even as our last panel was talking about how we get to where the children are, and partner with others, and bring the provider to the family that might be in a rural area, and might not have easy access to care, for example.

Gina Altieri

We’ve been so health system-centric, rather than patient- or family-centric, until recently, as a U.S. healthcare system.

Altieri: Yes, we shifted from provider-centric to consumer-centric, in developing [ and the Nemours CareConnect]. We did that with design thinking, and we really did partner with families early on. We had our providers, families, and technical people early on, to understand their needs.

Moss: A really interesting thing I learned a really interesting thing at dinner last night, talking to a strategic consultant over dinner. He showed some data about the use of smartphones—that those are actually disproportionately used by the most disadvantaged parts of society.

Altieri: And it’s a misconception that disadvantaged people don’t use technology.

How do you look at technology, at the investment involved, and what can be achieved with it?

Moss: I look at it as a tool to achieve what we want to achieve. Innovation being the intersection between science and humanity, what Walter Isaacson said this morning [journalist, author, biographer and historian Walter Isaacson had delivered a presentation to the Pediatric Moneyball audience on Thursday morning]. It’s wonderful to have the technology, but unless we have the humanity to know how to use it, we won’t advance. What Nemours brings to the table, and the people in this organization bring to the table, is the ability to understand and care about what children really need.

Altieri: From a budget or investment perspective, we did recognize 20 or so years ago that this cost of investing in this technology was an investment in our future, and that we needed to look at this as a long-term investment. And we’re far beyond initial investment in an EMR, for example.

Moss: We’re cognizant of the investment, and it’s well worth it.

And you and your colleagues have achieved significant improvement in patient and family satisfaction, through the technology-facilitated advances you’ve made at Nemours.

Yes, we’re very proud of our patient and family satisfaction.

And how does the investment in and development of technology, for telehealth and other purposes, support the shift into value-based healthcare?

Altieri: Yes, and in addition to improving the experience for families, we recognized that we really did need to come up with alternatives that were less costly. We did surveying and found that 60 percent of families would have gone to the ED without the telehealth.

What do you see as your biggest challenges and opportunities in the next few years?

Moss: I prefer to talk about opportunities. The opportunities are to play a major leadership role in what children’s healthcare looks like tomorrow in this country. We are a multiple state organization; our patients come from the most disadvantaged and the most privileged backgrounds. We are a microcosm of the country, and when we get it right, it will be important.


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NLM’s Flatley Brennan to Receive AMIA’s Morris Collen Award

October 11, 2018
by David Raths, Contributing Editor
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She spearheaded efforts on including patient-generated data in EHRs

Patricia Flatley Brennan, R.N., Ph.D., director of the National Library of Medicine, will be awarded the 2018 Morris F. Collen Award of Excellence by the American College of Medical Informatics (ACMI).

The award is given each year at the AMIA Symposium in honor of Morris F. Collen, a pioneer in the field of medical informatics at Kaiser Permanente. It is presented to an individual whose personal commitment and dedication to medical informatics has made a lasting impression on the field. 

Brennan is widely recognized for her abilities to repurpose commercial technologies to improve the safety and effectiveness of health service delivery systems, according to AMIA.  She developed a first of its kind technology-based home care service for persons living with AIDS in the 1980s. She also worked to develop home care technologies to support elder caregivers, people recovering from cardiac surgery and patients with chronic heart disease. Her work had a profound impact on future development of technologies used for in-home chronic illness management.

She also spearheaded the biomedical informatics efforts that led to the federal requirement that electronic health records systems must safely and effectively include patient-generated and patient-sourced data. Patient access to information is now a core part of the CMS EHR incentive program.

Brennan has been elected to the American Academy of Nursing, the American College of Medical Informatics, the National Academy of Medicine, and the New York Academy of Medicine. She has also been honored with the AMIA Leadership Award and the AMIA Virginia K. Saba Award.



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