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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."


"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, KidsHealth.org, and offers on-demand, online video patient visits through Nemours CareConnect. Nemours ReadingBrightstart.org 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.”

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.

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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.


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 [KidsHealth.org 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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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.

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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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CHIME Hands Out Innovator, Transformational Leader Awards

October 31, 2018
by Rajiv Leventhal, Managing Editor
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At the College of Healthcare Information Management Executives (CHIME) 2018 Fall CIO Forum in San Diego, health IT executives were recognized today for their transformational and innovative leadership.

 

Omer Awan, senior vice president and CIO, Navicent Health in Macon, Ga., joined the patient care organization two years ago, but in just that short amount of time, he has changed the culture in his department and has elevated the profile of IT within the ranks of Navicent’s executive leadership, giving him a seat at the table as they carry out Navicent’s vision, according to CHIME officials who presented Awan with this year’s Transformational Leadership Award.

Awan said he institutionalized a framework that called for simultaneously strengthening their IT foundation, advancing the culture and innovating, always keeping in mind Navicent Health’s business needs. IT staff embedded themselves within other groups to better understand their programs and get more involved in problem solving and decision making. This process changed mindsets within the IT department and throughout the organization.

“IT has broken out of the shell of technology,” Awan said. “It is all over the place. It is in business; it is in the clinical areas. All of my IT managers and directors rewrote their job descriptions. They are not just managers and directors, they are solution partners. It was incumbent on them to know as much about their respective clinical and business areas.”

One of the organization’s specific IT-related successes has been the rollout of a real-time care coordination platform that serves as a one-stop shop for surgical staff and patients. The program, utilized for OrCarestra, Navicent Health’s surgical patients, has eliminated the use of faxes, phone calls and hand-written requests and added standardized processes. OrCarestra has shortened scheduling times, decreased scheduling errors, sped up financial clearances and allowed them to complete more cases faster, according to CHIME officials.

Also this morning at the Fall CIO Forum, CHIME presented Simon Lin, chief research information officer at Nationwide Children’s Hospital in Columbus, Ohio, with its Innovator of the Year Award, citing Lin’s innovative approach to help pediatric burn victims through their recovery.

The Ohio patient care organization collaborated with the Center for Pediatric Trauma Research and the Pediatric Burn Unit at Nationwide Children’s to develop and pilot test a virtual reality app that immerses young patients in a game while clinicians remove and replace dressings. Preliminary results showed a dramatic reduction in reported pain scores compared to controls—a reduction achieved without altering pain medication.

Burn patients already are in distress from the pain that can occur during dressing changes, Lin said. Watching the process may intensify children’s trauma. The game, which requires patients to wear a headset, distracts them while the headset shields their view of the clinical activities going on around them. Patients can passively watch the game or they can actively engage in it using breathing controls that substitute for hand consoles.

The app itself has been well received, based on study results: 96 percent of patients reported satisfaction with the game; 100 percent of parents were satisfied; and 83 percent of physicians reported that virtual reality is helpful. Lin and his group are now conducting a larger study that stratifies children into three groups: active participants, passive watchers and a control group that will receive standard care. The long-term goal is to be able to reduce or eliminate the use of pain medications such as opioids in this patient population by using innovation.

“Simon’s virtual reality app is a perfect example of patient-centered care,” said CHIME Board Chair Cletis Earle, senior vice president and CIO at Kaleida Health. “They developed a tool that children will respond to–a game– and worked with clinicians to make sure it fits within their work flow. The result is a better experience for the patient with no added burden for clinicians. This is a win for everybody.”

 

 

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