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At the HIT Summit in Minneapolis, the Mayo Clinic’s CIO Shares His Perspectives on IT Leadership

June 13, 2018
by Mark Hagland
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Cris Ross, CIO of the Mayo Clinic, shared his perspectives on HIT leadership, at the Health IT Summit in Minneapolis

At the Health IT Summit in Minneapolis, sponsored by Healthcare Informatics, Cris Ross, CIO of the Rochester, Minnesota-based Mayo Clinic organization, shared his perspectives on CIO leadership and his organization’s IT journey, on Wednesday morning, at the Marriott Minneapolis City Center.

Complexity is built into the landscape at Mayo Clinic, Ross noted, with its 23 hospitals, 3,715 beds, 112 clinics, 1.3 million outpatient visits per year, 4,500 physicians, 2,400 residents and fellows, 57,1000 allied health staff, 67,000 employees overall, and $10 billion in annual revenues, spread out across several states. Furthermore, with its illustrious history of clinical and operational innovation, it is imperative that the healthcare IT leaders in the organization create and optimize systems worthy of the organization, Ross said.

Ross began his keynote address by providing his audience with some background on the history of Mayo Clinic, including on the innovative culture that emerged at the very beginning of the organization’s existence, 153 years ago, when the English-born William Worrall Mayo, who had served as an examining surgeon for the military draft board during the American Civil War, set up a medical practice in Rochester, Minnesota, with his sons William James Mayo and Charles Horace Mayo. After a devastating tornado struck Rochester in 1883, the Mayos collaborated with the Sisters of Saint Francis in establishing a hospital there, and from there, the Mayo story evolved forward.

Cris Ross

Among other innovations very early on were the creation of one of the very first true medical group practices, in the early 1890s, and the creation of the first shareable patient medical record, by Henry Plummer, M.D., one of the original group members at Mayo Clinic. “They hired Henry Plummer, an endocrinologist, who was also an engineer,” Ross noted. “He also invented the modern medical record. He and his colleague Maude Mellish [Wilson] came up with the concept of how to consolidate all the data about a patient in one place, which was an innovation, as data was scattered everywhere. The other was how to share a record, as the fuel to the operations of an integrated group practice. That was also a huge innovation. The last piece was, Maude’s insight was, if we could systematize the way data was collected, we could use it for research purposes, and derive insights from data. Quite an insight during the period 1908-1910. The work behind creating a single record was a huge element in creating a unified clinic at Mayo. And even the idea of outpatient consultations was more or less pioneered at Mayo Clinic.”


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...

It is in that context that he sees his responsibility as CIO, Ross told his audience. “This is a world-class institution that needs world-class IT,” he said. And that constant awareness sits at the core of his strategic planning as CIO, he noted.

Thus, his “lesson number one” among several: “know your place”—meaning that he feels it incumbent on himself and his team to provide the Mayo organization with a level of IT foundation and capabilities worthy of its culture of innovation.

And while the Mayo Clinic’s IT organization “consumer-centric, responsive, individualized, and best-of-breed”-focused several years ago, Ross, said, the best-of-breed focus had created a level of IT foundational weakness that was not sustainable. “To this day,” he said, “we have 2,000 named applications. The bad part was that our technology was siloed, proprietary, diversified, and imperfect. Here we were, arguably, the world’s best group practice, but our IT was far from perfect. So we created themes. For example, we had three EHRs [electronic health records]—one in Rochester, one shared between Arizona and Florida, one used in our community health systems in the Midwest. We were on a sustainability death march. We had multiple systems kluged together, we just couldn’t get there. So, sustainability was a theme” for the corporate IT team, moving forward into the future. “Innovation was another theme. Capability and execution were the third and fourth themes.”

Given some of the operational imperatives involved, Ross said, “We developed a plan for strategic workforce readiness, with five IT imperatives: maintain service while we change; secure the enterprise; implement shared enterprise systems; build platforms guided by architecture; transform the IT organization.”

Moving forward in terms of creating a single, unified, enterprise-wide EHR, Ross and his colleagues named that initiative “The Plummer Project. We wanted to honor Henry Plummer’s legacy,” Ross noted. And, within the context of the initiative, Ross and his colleagues have implemented a number of new systems, including the enterprise-wide EHR implementation. “One of the things we felt we needed to do was to put as much data into the EHR as we could,” he added, with regard to the idea of making the EHR as useful to Mayo clinicians as possible. The Rochester campus went live with the new EHR implementation on May 5, while the Arizona and Florida campuses are scheduled to go live in October. Meanwhile, a number of new systems, including a new dictation/transcription/speech recognition system, a new electronic fetal monitoring system, and a new real-time eligibility system.

“Lesson number two” in this journey, Ross said, “is that table stakes don’t win; and maintaining a stable enterprise core is table stakes.” In that regard, he said, “The absence of that enterprise core might break us, but its presence won’t ‘make’ us.”

The bottom line for CIOs? Creating and optimizing an exceptional information technology foundation; maintaining the highest level of service possible for clinicians and all end-users; and continuing to innovate forward, to support the clinical and operational innovations constantly evolving forward at a pioneering patient care organization. And, Ross said, providing a continuous level of information technology and IT service, to the high-performing clinicians and staff at a high-performing patient care organization, remains a continuous challenge, but with tremendous opportunity.


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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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