Among those attending HIMSS14, the annual conference of the Chicago-based Health Information and Management Systems Society, in Orlando, Florida, the last week in February, some have a broader historical perspective on the events and discussions than others. One who had a comprehensive historical perspective on all the happenings at HIMSS14 was Marion Ball, Ed.D., senior advisor and research industry specialist in healthcare informatics at IBM Research.
The Baltimore-based Ball has spent 40 years in healthcare and healthcare IT positions, including serving for years as a hospital CIO. She is a member of the Institute of Medicine, and serves on a variety of boards, including the Board of Regents of the National Library of Medicine, the International Medical Informatics Association (IMIA), and the American Medical Informatics Association (AMIA), and the American Health Information Management Association (AHIMA) foundation, and has co-chaired the HIMSS board. Also a member of the editorial advisory board of Healthcare Informatics, Dr. Ball spoke recently with HCI Editor-in-Chief Mark Hagland regarding her perspectives on where healthcare and healthcare IT have been, and where they’re going. Below are excerpts from that interview.
You recently received an award from HIMSS. Please tell me about that.
Every year, they recognize a few people who have attended HIMSS for the past 30 years. Four of us got this award, called the “Life Member Award 2013”: in 2013, I had been a member for 30 years. These are people who have made contributions. I was lucky three years ago, when HIMSS celebrated “50 in 50”—they celebrated the most influential people in healthcare, during HIMSS’ first half-century, and I was honored as one of the most influential IT contributors to the field in the past 50 years. What happened was that they picked ten people in five different decades, who had made contributions, and I was one of the ones picked for the 1990s. That in a way was a much more prestigious award than this one; but it’s just nice to be recognized. And I’ve been fortunate to have served twice on the HIMSS board—the first time, in the early 1990s, as we were transitioning from being a personal membership society in the American Hospital Association, and then again about five years ago.
Marion Ball, Ed.D.
What did you think about the issues discussed at this year’s HIMSS Conference?
Well, at the very beginning of HIMSS, it really was the management engineers who started this thing. And I was one of the ones saying, you’ve got to get the clinical people involved—I wanted to make sure the nurses, physicians, and other clinicians would be involved, not just the management engineers and the IT people. Cindy Spur, who’s a nurse, a senior person at Partners, came into the picture. She and I worked very diligently, and were able to get the board to approve the notion of HIMSS growing into the whole clinical world.
That’s so obvious now.
Yes, of course! But in the very early days, the management engineers initially were reticent, but we were able to make it possible for the clinicians to play a role in HIMSS. And over time, many things came about, for example, the whole TIGER [Technology Initiative Guiding Education Reform] Initiative. It is becoming clear that we need to infuse clinician education—for nurses, physicians, and pharmacists—with IT education and training. And at the very beginning, David Brailer didn’t see that we needed the nurses involved as foot soldiers in transforming healthcare. So that’s how TIGER was born. And we said, we’ve got to get these two worlds together, education and application.
And two-and-a-half years ago, with wonderful support from Steve [H. Stephen Lieber, HIMSS’ president and CEO], Carla Smith [executive vice president, HIMSS], and Joyce Sensemeier, [M.S., RN-BC, HIMSS’ vice president, informatics], TIGER was established as a 501c3 organization, under the umbrella of HIMSS agreed to support TIGER until it might become self-sustaining. And Sally Schlak until recently served as an excellent leader as the TIGER executive director. She has just been hired by Cerner. We will miss her! HIMSS is going to have to decide how to work together with TIGER now, and whether to continue to financially support TIGER or not.
For the future, the whole push in trying to transform healthcare is around clinical transformation, and it’s really all about what happens at the point of care. If the clinician and the consumer are not in sync with each other, that’s a problem. We are working on a research project on adherence, related to the point of care. The bottom line is that 40-60 percent of patients don’t understand exactly what their physicians have told them, and you wonder why people end up in EDs! And we’re working in a chronic disease clinic, mostly with diabetic patients. And we recorded and checked what the physician is actually saying to the patient. And is it being understood by the patient? And then we have the patient go to a little kiosk, and ask them five questions, for example, let us make an appointment with the eye doctor and the foot doctor; and the patient says, I didn’t hear that! But what he told them was, you need to see an ophthalmologist and a podiatrist.
The same thing is true with the medications: many patients fail to remember to take their pills four times a day as directed by their physicians, and instead, ending up taking four pills all at once. So how do we educate not only the patients, but also the clinicians? We’ve got cultural issues, language issues, meaningful use issues, etc. Our study is taking place in a medical home practice. In this culture, who’s going to be the co-captain of the team? It’s mostly going to be nurses. And we’re still not getting required IT courses into nursing. And even at Johns Hopkins, where I was in the School of Nursing, they’re not requiring IT training in master’s degree programs, and that in my opinion is a big mistake.
So those are the kinds of battles I’m fighting, while always keeping my eye on the ball. What can you do for the clinician at the point of care? That’s why I’ve written and edited so many books in the field of health informatics; and the only series on clinical informatics are in the Springer series; and among their most popular books is Nursing Informatics and Health Information Management Systems, and they’re working on the fourth edition of that book. It’s worth looking at the series, because that is the future, the diffusion of IT into the clinical world, to bring about the transformations I’ve been talking about.
So those have been some involvements, and I’ve been so fortunate. Having been president of the Society for Computer Medicine, which ultimately became AMIA [the American Medical Informatics Association], I’ve been fortunate to bridge both the applied and academic worlds, having been a professor. I was a full professor while a CIO for 13 years at the University of Maryland, and before that, at Temple University, I was director of information systems there for 18 years. I have to say that it has been an interesting journey, being able to bridge the world of academia and the world of applied informatics in hospital systems, as well as bring about CIO-type activities into academic medical centers. I think we’ll see a new breed of people; and the funny thing is, being a female, and having started this in the 1960s, everybody always thought I was a nurse. But my doctorate at Temple University was in medical education.
What would you like to see happen in the next five years?
That’s an awfully good question. First, we need to move much more into a multidisciplinary approach and look at healthcare IT as a team effort; that is starting now. I do fault the industry for not making the technology as simple and transparent as it should be. It needs to be much more user-friendly, and until it is, it won’t be fully embraced; so there do have to be major changes made in that regard. I do think we’ll see tools that will help with decision-making, to give physicians better diagnostic tools, because 30-40 percent of diagnoses are inaccurate from the get-go. So how can we enable the caregiver—the nurse, the physician, the pharmacist, the dentist—to get the information they need at the point of care? And also, we will absolutely have to transform the educational programs to bring about changes for the provider and consumer, to enable the whole area of prevention, with more of an apprenticeship approach—we do too much theory and not enough practice. So I think the internship opportunities need to be increased. And the field of knowledge has exploded; you can’t keep everything in your head anymore. So we need tools to help clinicians at that point of care; and that’s what we’re doing now.
So those are the things that I envision. I might add that I believe that legislative changes need to be made, such as changes that will allow for telemedicine practice across state borders! And I see completely new professional roles that don’t yet exist. I think we’ll see intermediate roles—the person who will work with the patient before they leave the doctor’s office to make sure they understood what was told to them and understood their medications; that doesn’t have to be a registered nurse. And at the top, too, look at the doctor of nursing practice (DNP) degree. This is an applied doctorate; and I think we’ll see degrees like that one in other areas as well.
And look at health information managers—they’re completely changing their profession. So it’s an exciting period for medicine; but if we don’t educate and train people, we’ll be in bad shape. And look at the roles now—the CIO today is nothing like the CIO of the past. When I was a CIO, I didn’t have to have a strong background in finance or change management; I did my thing and made sure my system was running. Directors of computing did not sit at the table with senior management, as CIOs do now.
And many roles are changing, including that of the CMIO.
Yes, and the CNIO [chief nursing informatics officer] role is changing, too. And we’re now seeing nurses who are now CIOs. Mary Alice Annecharico is an example; she’ll probably have one of the best Epic implementations, at Henry Ford in Detroit. And you know what? She knows how to work with the clinicians. And now you have all these new jobs, like the chief knowledge officer, chief information security officer, and so many others; so it’s exciting times.