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Glancing at the Boston Healthcare Provider Market: Consolidation and Physicians

July 28, 2018
by Mark Hagland
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Barbara Spivak, M.D., CEO of MACIPA, an area independent practice association, shares her perspectives on the prospects and context of a proposed mega-merger of Boston-area hospitals

What’s going on in the metropolitan Boston healthcare market these days? A lot. Among other things, major consolidation continues to advance in that market. Indeed, one proposed merger involving 13 area hospitals, is causing considerable discussion—as well as some dissension—in that market.

To wit, the Associated Press published an article on July 19 that included this reporting: “A state watchdog group says a proposed merger between two major Massachusetts hospital systems could drive up health care costs in the state more than $250 million per year. The Health Policy Commission's report released Wednesday says a merger of Beth Israel Deaconess Medical Center and the Lahey Health System could mean $191 million more per year for inpatient, outpatient, and primary care services and almost $60 million more per year for specialty physician services,” the report added. “The higher costs would be passed on to insurers, employers, and consumers. The commission does not have the authority to prevent the merger, which would also include New England Baptist Hospital in Boston, Mount Auburn Hospital in Cambridge, and Newburyport's Anna Jaques Hospital.”

And just the day before, on July 18, The Boston Business Journal reported this: “The state's health care watchdog has strongly criticized a proposed mega-merger between Lahey Health, Beth Israel Deaconess Medical Center and three community hospitals, saying the deal would raise health care spending by $168 million to $251 million. At a Health Policy Commission hearing on Wednesday, commission staff said they had reviewed the proposed merger between Lahey, BI, New England Baptist Hospital, Anna Jaques Hospital and Mount Auburn Hospital, and found that the group would create a second mammoth health system in the state that could enact higher prices in negotiations with commercial insurers. The findings are detailed in a preliminary report the commission voted to release to the public Wednesday afternoon,” the Boston Business Journal’s Jessica Bartlett wrote. “The hospitals must now address the concerns before the commission issues a final report in 30 days.” And she quoted Stuart Altman, chairman of the commission, in saying that “There's a lot of good things in this merger, but our choice (between) letting it go forward (and) not trying to make this a win/win, I find unacceptable. I'd say to the parties: To the extent you can come forward with some help in reducing the likelihood of price increases, we would all be better served."

But the Boston Globe’s Priyanka Dayal McCluskey reported on March 7 that “Led by Beth Israel Deaconess Medical Center and Lahey Health, the hospitals say that by joining forces they can provide high-quality care to patients across Eastern Massachusetts at a lower cost than does Partners, the state's largest health care network. Beth Israel Deaconess and Lahey announced their merger plans in early 2017, after years of on-again, off-again talks,” McCluskey noted. “he deal grew to encompass New England Baptist Hospital in Boston, Mount Auburn Hospital in Cambridge, and Anna Jaques Hospital in Newburyport, and includes about 4,300 physicians. Partners owns Massachusetts General Hospital, Brigham and Women's Hospital, and nine other hospitals, and has about 6,000 doctors.” And she quoted Leemore S. Dafny, a health care economist at Harvard Business School, who told her, “This is a play to really change the dynamics of the market. It's a big play."

And in a June 12 article, McCluskey quoted Dr. Kevin Tabb, chief executive of Beth Israel Deaconess Medical Center, which evolved from [a] shaky start in 1996 to become a profitable and reputable Harvard-affiliated health care provider, as saying that "Cultural differences can be either the downfall of a merger— or, if you embrace them, can really be to the benefit of all.” McCluskey noted that “The proposed merger of Beth Israel Deaconess and Lahey is very different from the earlier deal,” which had created Beth Israel Deaconess Medical Center. This time, she noted, “The health systems are based about 20 miles apart — in Boston and Burlington, respectively — rather than across the street from each other. And, critically, their merger is not coming as a surprise. Executives negotiated on and off for years before unveiling their plans in January 2017. New England Baptist Hospital in Boston, Mount Auburn Hospital in Cambridge, and Anna Jaques Hospital in Newburyport also joined the merger last year.”


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...

McCluskey went on to note that “The deal received one key state approval in April, and other state and federal approvals are pending. Many aspects of the Beth Israel Deaconess-Lahey merger are unknown, including how much the systems will combine operations and how that will affect patients. Post-merger, there could be conflicts between the hospitals and their staffs that no one has foreseen. But the two hospital companies are taking steps now to bridge the differences in their corporate cultures and to reduce worry about the merger,” she added. “Executives and hundreds of other staff from the hospitals are holding frequent "integration planning" meetings. This includes doctors and nurses, as well as corporate employees in departments such as finance and legal.”

Also, she noted, “Beth Israel Deaconess and Lahey already have agreed to make Tabb the chief executive of their new company — to be called Beth Israel Lahey Health — avoiding a potential leadership fight. The two health systems will have equal numbers of seats on the board of the company. But over time, the board will try to eliminate those factions; board members will not be required to come from any particular hospital.”

In a recent interview with Healthcare Informatics Editor-in-Chief Mark Hagland, Barbara Spivak, M.D., President and CEO, Mt. Auburn Cambridge Independent Practice Association (MACIPA), offered her perspectives on elements of the merger, in the broader context of what’s happening across the New England region. The Brighton-based MACIPA, which encompasses 500 affiliated physicians, operates an accountable care organization (ACO) that is a participant organization in the Medicare Shared Savings Program (MSSP). Below are a few excerpts from that interview.

One of the things happening now in New England and across the U.S. healthcare system is a blurring of the lines between providers and health plans, correct? How does that also play into this situation in the Boston metro area?

I think there’s been a definite blurring of the lines, with Partners buying Neighborhood Health Plan, a Medicaid plan, and they got rid of the Medicaid element, and made it a commercial health plan. And then it became the insurance plan for their 100,000 employees. That’s a blurring of the lines. And on top of that, they’re trying to buy Harvard Pilgrim, and you have you presume that it’s they want the geographic distribution to help them to extend into Rhode Island, New Hampshire, and Maine, where Neighborhood isn’t licensed. You look at Blue Cross Blue Shield of Massachusetts, and it gives the organizations that take risk with it, a great deal of data. But the only ones that succeed are the ones that produce their own data as well.

We have our own data warehouse, and as 13 hospitals are looking to merge, one of the key pieces for success will be not just data analytics, but how will all the diverse electronic records connect, so that data can seamlessly go through. And how will they connect with home healthcare agencies, palliative care agencies, and what data will they produce?

How might the proposed merger activity affect you and your colleagues at MACIPA?

Our IPA is in a very interesting and unusual position, because our hospitals is one of the hospitals that’s merging. About half of our doctors are in fact employed by the hospital and half are in private practices. And so we are affiliating, not merging. We can’t merge, because we are an independent organization with our own board and bylaws. But we will clearly be an affiliate, because Mt. Auburn Hospital is, and it’s our hospital affiliate. But look online at the Globe, and there’s been a whole lot of coverage about the 13 hospitals that are trying to get permission to merge, from the state and the FTC. The Attorney General approve.

Do you think the merger will ultimately be approved?

I think so. They’ve put a lot of time and money into the effort to get it approved.

Would the approval be a good thing for your organization?

I would hope it would be good for us; I would hope they would be able to provide us with some things we can’t provide ourselves. We’re in Cambridge and Belmont, in this mixed suburban/urban area. Lexington is 10 miles away, but in rush hour, that could be a half-hour drive. And so care management and sophisticated data analytics, are very important for us. And a lot of our patients still go to the more expensive hospitals like the General and the Brigham, and if they do this right, the hope is that they’ll be more competitive.

How are physicians feeling about everything that’s going on right now in the Boston metro market?

Physicians are—there’s a whole lot of discussion about burnout and physicians being unhappy with the practice of medicine. And I think when you look at physicians in private practice or employed, in their day-to-day world, physicians are asking, how is this going to make my life better and make it easier to take care of patients? That’s a prominent feeling among both. Private practice docs feel like they have a little bit more control, because they can control their staff and work-life balance—but even they, because it’s so hard to keep their income up to expectations, and overhead is so high, are feeling challenged right now.

When did you join the MSSP?

We were one of the original Pioneers, in the Pioneer for three years, during 2012, 2013, and 2014. And then in the fourth year, they changed the methodology for determining the benchmark, and our benchmark dropped 10 percent. Of the 30-plus pioneers, most people did a little better or stayed where they were. We were the only group that plunged. We had saved 5.5 percent, and there was no way we could save 10 percent to get to zero, so we had to drop out. In 2017, we went back into the Shared Savings Program, where their benchmarking is a little better; we’re in track 3. We don’t actually know yet. And the interesting thing I’ve always talked about is that in our organization, because we had been a Medicare Advantage organization since 1994, and we’d always had commercial risk, the doctors here weren’t worried about whether they could manage the care of the patients; they were actually quite happy to be a Pioneer or MSSP, because they wanted the same services available to their Medicare Advantage patients, to other patients. They were just worried about the benchmarks; they didn’t want to lose their shirts. It wasn’t a matter of principle; there had already been a culture shift.



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The Evolving Healthcare CIO: Innovation Over Information

November 15, 2018
by Rajiv Leventhal, Managing Editor
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The pressure is on CIOs and others in the health IT C-suite to become organizational leaders, while delivering in ways different from ever before

The healthcare CIO is the correct initialism for “chief information officer,” but as the landscape continues to shift—with the focus now on digital and strategic optimization, transformation and innovation—some observers are now wondering if “information” is really the most appropriate word for all that encompasses the modern-day CIO.

For the past two decades, Chuck Podesta has been a healthcare CIO, spending the last four years at UC Irvine Health, the integrated health system at the University of California-Irvine in Orange County, California. Podesta recalls the days when the CIO had a more IT-based title and financially-related job in healthcare, since clinical IT wasn’t a strong focus at that time. But with the evolution of EHRs (electronic health records), says Podesta, “The focus became clinical and the job suddenly had a broader scope. It’s not just the day-to-day running of the systems anymore; the CIO is now needed from the standpoint of strategy development because he or she is affecting the entire organization.”

Some would refer to the early-day healthcare CIO as an IT engineer of sorts, someone very technology-focused whose core responsibilities centered around hardware and software implementations, and getting servers up-and-running within the organization. Then came the influx of EHR deployments across hospitals and health systems, and now that there is near-universal possession of EHRs in U.S. hospitals, the tide is once again shifting.

“In the past, the CIO had more of a technical role and the focus was more on the operational side of the house—things such as enterprise resource planning (ERP) and the billing cycle. But the widespread advent of EHRs changed so much of that,” says Dave Levin, M.D., a former chief medical information officer (CMIO) at Cleveland Clinic and current chief medical officer at health technology company Sansoro Health. “When you deployed the EHR, it tightly linked clinical operations to IT. And that’s obvious. But it also put IT in the middle of enabling all kinds of activities and strategies. So, this requires strong enterprise governance and strong IT governance, and it requires that they fit together. A lot of organizations are struggling with that, and that’s reflected in the role the CIO plays,” Levin says.


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...

Podesta notes that when the CIO title first came about, many directors of IT in healthcare organizations wanted the “chief” designation. But to Podesta, there was a key difference between IT directors and CIOs:  good directors of IT spend 80 percent of their time managing day-to-day operations and 20 percent of their time on strategy, but for “true” CIOs, it’s the opposite, he says. “There was a period where there was a ‘filtering out’ of individuals who tried to become CIOs, but were really IT directors and couldn’t make that leap into the strategy world. That led to a changing of the guard,” he says, adding that much of the new focus turned to developing EHRs and then becoming an equal player in the C-suite on the strategy teams. “You have to be able to work on IT strategy and develop it in conjunction with the business strategy,” Podesta attests.

Today’s CIO—One of the Scariest Jobs in Healthcare?

For the modern CIO, priorities are indeed changing and becoming more complex, and with that comes increased pressure. For instance, in addition to all of the technical aspects of the job, today’s healthcare CIO must also stay out in front of various up-and-coming health IT innovations, while maintaining a much-needed big-picture view of how digital transformation will affect business operations.

And then there is the cybersecurity factor; a 2016 survey of 100 healthcare CIOs from Spok and the College of Healthcare Information Management Executives (CHIME) revealed that 81 percent of CIOs said strengthening data security was their top business goal for the next 18 months. Put all together,

“The CIO role in healthcare is one of the scariest roles there is because of the high risk involved, and the fast pace of technology,” offers David Butler, M.D., founder of healthcare consulting firm Calyx Partners, and a former clinical IT executive at Sacramento-based Sutter Health. “The cost of healthcare IT has gone up tremendously. [The days of] just buying Epic’s EHR and having your job be safe are long [gone],” Butler adds.

Butler notes that an EHR go-live, and the optimization that follows, are typically the most transformational things that occur in a CIO’s life, and the audience for these deployments are what he calls the CIO’s "golden geese”—physicians and nurses. “So there is more pressure on the CIO than ever before,” Butler attests. He adds that in addition to all of the clinical and IT considerations, it’s unfair to expect CIOs to be privy to all of the regulatory requirements that come from CMS (the Centers for Medicare & Medicaid Services) as well. “There is just no way that CIOs can know all these things. I think expectations need to be reset,” Butler says.

New Considerations

As such, experts believe that the “new” healthcare CIO must have a broader understanding of healthcare. “Smart organizations are looking for a more strategic role for the CIO, and think that they should be in the C-suite and in the middle of strategy discussions,” says Levin. "CIOs need to understand both where the organization is going—so that they can think about the technology that can enable that [vision]—while also informing and expanding on the thinking of the folks that are considering strategy—things that might not have been considered without that [CIO] expertise in the room,” he adds.

A core part of a healthcare organization’s vision going forward will certainly involve strategies on transitioning to a value-based care environment. Indeed, the emphasis on accountable care has increased the need for hospitals and health systems to collect and analyze data to drive improvements in quality and efficiency—leading many hospitals to ask more of their CIOs.

To this end, Podesta notes that the industry has been operating in a fee-for-service world for so long now, and in most cases, IT is an enabler of the business strategy, so once the business strategy starts to move toward value-based care, IT needs to come into play from a strategy perspective. “If you don’t have that background or the ability to understand it, you will be left behind,” he attests.

Podesta adds that in some instances, he is seeing CIOs play in both the medical provider and payer world, since lots of healthcare systems also have their own insurance companies. “You will see more and more of that in the future, and as a CIO, you will need to understand what risk means and how to manage risk,” he advises. “It’s a completely different way of caring for patients, and being able to sift through all the technologies out there for your organization, without making huge mistakes and spending the money in the wrong place, will certainly be a challenge,” he adds.

What’s more, all the sources interviewed for this article were quick to point out yet another new business consideration for CIOs: the influx of non-traditional players looking to move into healthcare. Podesta brings up the new Apple Health Records feature that allows patients of hundreds of hospitals and clinics to access medical information from various institutions organized into one view on their iPhone. “Lots of organizations are signed up for [this], and we have actually started to create apps; five years ago, you wouldn’t have been thinking about that. But now you have to model your organization to make sure you have the people to utilize these technologies as they are coming out,” he says, adding that hiring the right people who can work in these environments will be crucial. “The time for the sequel programmers is coming to an end. You need data scientists now.”

And as Butler bluntly puts it, “Apple, Amazon, Google and Microsoft have been watching this $3 trillion [healthcare] prize for a long time, but have not touched it because of HIPAA and other over-regulated [barriers] that prevented them from innovating in this space. But then you had deductibles go from $1,000 to $7,000 before the insurance kicks in, so the patient turned into the customer. And these disruptors said to themselves, ‘We know customers, we don’t know patients. So now we will go for it.’”

The CIO-CMIO Partnership

As CIOs continue to take on more responsibilities, experts believe that another clinical IT role in the C-suite, chief medical information officers, or CMIOs, are also ready to take on an increased role, especially as IT becomes much more critical to support value-based care and other quality initiatives. Indeed, as CMIOs have become more engaged in healthcare organizations, the interaction between these key IT players is expanding and continuing to evolve.

Levin recalls that in the early days of EHR deployments, folks saw the CMIO as the person that should go deal with the “angry physicians.” But now, post-deployment, as the tide turns to thinking about getting the most out of these IT systems, the partnerships between CIOs and CMIOs are stronger and more equal, Levin says.

“You are even seeing CMIOs migrating into the CIO role, which was rare in the past, but becoming more common. You are also seeing CMIOs migrate into other C-suite-type roles such as chief health information officers, chief quality officers, chief transformation officers, and in some cases, chief medical officers. And that makes sense, since there is an increasing emphasis on the intersection of clinical and operational, and the role of IT in supporting all of that,” he says. Podesta agrees with Levin’s premise; quite a few  CMIOs are becoming CIOs, he notes. “A lot of them have gone back and gotten MBAs to understand the business side [of healthcare].”

Podesta is also seeing another trend: that some organizations, such as academic medical centers, are struggling with clinical IT, and are thus recruiting for CIOs who are physicians, to get a level of credibility with doctors to help them with issues around physician adoption and EHRs. “I get lots of calls from recruiters, and when I talk to them about different positions out there, many are looking for clinically-oriented people. I am seeing that more and more,” he says.

To some, the evolution of the CIO-CMIO relationship also paints a bigger picture of just how tightly linked everything has become—particularly the dependency that a healthcare organization has on IT for its success. “It’s never been greater,” says Levin, who believes that the CMIO “is a unique beast, and one of the few healthcare roles in which you sit at a crossroads and have a view of the world that is different from other C-suite leaders.” He adds, "And that view might not be better; it’s complimentary. The typical CMIO has practiced clinically, has been involved in IT, and many have had operational backgrounds as well, or a medical affairs background. They are kind of ‘unicorns’ in a way, and I think they match up nicely with the way the governance and strategic needs of the organization overlap,” he says.

What the Future Looks Like

In a myriad of different ways, it’s been quite the evolution for CIOs, CMIOs and others in the healthcare IT C-suite. With all of the challenges and increased pressure that experts believe have mounted in recent years, comes opportunity for certain individuals to thrive.

Levin says the qualified CIO going forward will need the necessary “soft skills,” leadership ability, and strategic knowhow. It will be less about the technical aspects of the role. “The ultimate challenge everyone is facing is the pursuit of the Triple Aim and doing it efficiently, so a lot of the [job] is about how you can do more with less,” he says.

These roles also have another kind of unique balancing act, in that so many of them try to maintain a clinical practice, which Levin notes “is admiral,” but because they have also taken on these important administrative and leadership roles, he has seen many of his colleagues struggle with the balancing act. “Too often, they think the clinical/administrative ratio is 50:50, but in reality, it’s 75:75 and they are working at 150 percent capacity,” he says.

Adds Podesta, “It’s not just understanding the IT world—the programming and the infrastructure—but you have to understand the business side as well. To be in that C-suite and in those meetings, you need to be able to add value to items that maybe aren’t under your control. But you need to be that thought leader within the C-suite—just like the chief operating officer, chief medical officer and others are.”

Podesta believes that the “information” part of the chief information officer title is simply no longer indicative of all the CIO must do now, and what will be required of the role moving forward. “People view the CIO role as ‘you must work in medical records’ or even that you are in marketing, so yes, I think we probably do need a better title,” he acknowledges. Podesta notes that titles such as chief digital officer are making the way into healthcare organizations, and given the digital landscape, it’s actually more appropriate. “The CIO might move to ‘chief innovation officer,’ and that makes a lot of sense,” he says.

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Vanderbilt Announces Health IT Leadership Transition

November 6, 2018
by David Raths, Contributing Editor
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Patel to succeed Johnson as leader of VUMC HealthIT

Vanderbilt University Medical Center HealthIT has announced a change of leadership. In January 2019 Neal Patel, M.D., M.P.H., who has been VUMC’s chief health information officer, will succeed Kevin Johnson, M.D., M.S., as HealthIT leader.

HealthIT’s responsibilities include informatics support for a broad scope of VUMC’s health system demands. Tools supplied and supported through HealthIT help enable VUMC to achieve its strategic objectives within the clinical, educational and research enterprises.

Johnson, Cornelius Vanderbilt Professor, will continue to serve as chair of the Department of Biomedical Informatics (DBMI). A professor of pediatrics, he joined the Vanderbilt faculty in 2002 and has been chair of the DBMI since 2012. He was named Senior Vice President for Health Information Technology in 2014.

During his tenure, Johnson served as leader for the multi-year, system-wide effort to replace its homegrown EHR with Epic, which went live in November 2017. Patel joined Johnson as co-lead during the Epic launch.

Through this leadership change, Patel will now report to John F. Manning Jr., PhD, MBA, Chief Operating Officer and Corporate Chief of Staff. “With Dr. Patel succeeding Dr. Johnson in this role, there is an assurance of continuity as we move forward. With our Medical Center and health system at an important inflection point, and in a period of significant growth, I want to express my appreciation to Neal for assuming these new responsibilities,” Manning said in a prepared statement.

Patel joined the faculty of the Department of Pediatrics in the Division of Pediatric Critical Care in 1997. He was named Chief Medical Informatics Officer in 2006. His responsibilities in this role included leading efforts for translating the Medical Center’s healthcare delivery, quality and patient safety goals into informatics strategies to optimize the delivery of patient care.



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CHIME’s Russ Branzell: A Tech Revolution is Coming to Healthcare

November 2, 2018
by Rajiv Leventhal, Managing Editor
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The president and CEO of CHIME said at the association’s Fall CIO Forum this week that collaboration and being a community will be key steps to succeeding in the new healthcare

Healthcare CIOs, CMIOs and other top IT leaders are under increased pressure these days for a variety of reasons, and staying out in front of emerging health IT innovations, while maintaining a big-picture view of how digital transformation will affect business operations, are right at the top of the list.

Russell Branzell, president and CEO of CHIME (the Ann Arbor, Mich.-based College of Healthcare Information Management Executives) for the last six years, leads an executive organization which has a membership of a few thousand CIOs, CMIOs and other senior healthcare IT leaders. And with so much happening these days around technology innovation, new entrants into the market—some of which could be seen as potential disruptors—in addition to policy considerations and cybersecurity challenges, associations like CHIME are relied on to drive clinical IT executives in the right direction.

At the CHIME 2018 Fall CIO Forum in San Diego this week, Branzell sat down with Healthcare Informatics Managing Editor Rajiv Leventhal to discuss the challenges and opportunities that lie ahead for CIOs, and what skills will be critical to success going forward. Below are excerpts from that interview.

I am sure you would agree that it’s both an exciting and anxious time in healthcare. What is top of mind right now for your members?

Yes, I think there is a duality to this that is exciting and scary at the same time. There are practical and technical challenges we are being faced with now, with one of the biggest being cybersecurity and the threats and pains in those areas. Organizations are changing to new models [of care], and there is also consumer engagement that is unique to this time period; it’s not the same old game we have always played.


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...

The most interesting thing coming at them, though, is this next wave of what we refer to as “fourth revolution technology” that’s on the way. So that means 5G [technology], robotics, biosensors, genetic manipulation, and neural networking. These are buzzwords, but the reality is that they are real. Things are coming at us, and we have not been able to deal with at this level of advanced technology before.

What we have done in the past is incrementally gain the existing technology that has been in play in healthcare for the last 30 years. So we are trying to keep the trains on time, advance the organization, help them get benefits realization, and move to a new care model of consumerism and value. But we also see this other thing coming down the track that will dramatically disrupt all this. While it’s a unique time, and a little bit scary, scary is another way to say “great opportunity.”

Is the traditional/current CIO ready for this revolution? 

We have always been able to keep up with the small, incremental learnings. We have had the CIO 2.0 model out for 15 years, and that brought people from the traditional technology environment to driving change in organizations. The difference now is, the new things coming at us will require us to learn at a pace we have never learned at before. There will be disrupters in the industry for us to adapt to and understand at a pace we have never understood before. Undoubtedly, the CIO 3.0, the health IT leader 3.0, and the digital leaders of the future will monumentally change their internal skillsets and how they work.

On the policy front, lots of relevant regulations are set to drop in the next few months. The administration has been aggressive thus far in its proposals for promoting interoperability, but some would argue that fundamental data sharing challenges need to be ironed out first. What is CHIME’s stance on this?

There is still a strong degree of gap between the reality of today and the things that need to be put in place to enable [interoperability]. Some of those things are relative to standards and the universal transport across the country from an information sharing perspective. The government is trying to say there shouldn’t be barriers to inhibiting things that we are being successful in.

San Diego offers a good example in that things are well put in place, health systems are willing to share, I would say that there is no ubiquitous information blocking here, and the organizations generally all want to do the right thing for the patient. So in this micro-environment, though a big city, they do a good job of sharing information and being interoperable with each other.

But now magnify that across California, and it’s a scale issue in which we don’t have in place the universal standards, identification, transport layer, agreements, and multi-state consent. So many things still need to be addressed, whether that’s through administrative rule, law, or presidential order, some things need to be addressed at a macro level to accelerate that last 10 percent. About 90 percent is being done in local environments. Most people don’t often leave their local environment to seek care. But for the 10 percent or so that do, these things are not quite in place yet.

I’ve been interested in reading CHIME’s comments on aligning 42 CFR Part 2 with HIPAA, though this provision was not passed in the recent opioids package. Could this be reconsidered down the road?   

We were disappointed that it wasn’t [included], but we also considered different areas of statute ownership, within the government, relative to this and we [knew] they had to get [the bill] out. We will still advocate for the alignment in these areas so that we could accelerate solutions and service the people who need the help. This was ubiquitous across all our membership, and this was something that could have been addressed, but what we heard was, and I understand this, that they needed to get this out [now], and then possibly the [alignment] piece could be bolted on later.

In this pressured current moment, what advice could you offer to CIOs?

Like never before there is a need for people to hone and advance their skills, and become educated in what’s coming down the tracks as far as advanced technologies, while also getting the solutions they already have in place to higher degrees of success. The answer to all of this will be about us being a community.

We have been successful here at CHIME for almost [three decades] in building this network, building the relationships, and building the trust environment that we need. We need to lean on each other. People do this in small pockets and big pockets, and to survive in the future, we will need to ubiquitously share with each other. You don’t want to have everyone invent and innovate locally; not that we shouldn’t in a micro sense, but in the macro sense, we have to share in ways that we never have before. 

I’ll use opioids as an example. If Anne Arundel [County in Maryland] and Geisinger Health System are the two best in the country [at fighting the opioid epidemic], why would the other 5,000 or so places go and start from square one. That makes no sense whatsoever, but that’s the way our industry has worked for a long time. They key to us solving problems is communication and collaboration.

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