Headquartered in Dallas, Christus Health is a Catholic, faith-based, not-for-profit health system comprised of about 350 services and facilities, including more than 50 hospitals and long-term facilities, 175 clinics and outpatients centers, and dozens of other health ministries and ventures. Christus serves patients in Texas, Arkansas, Louisiana, Missouri, Georgia and Utah as well as parts of Mexico, and is listed among the nation’s Top 100 Integrated Healthcare Networks. Conklin, who has held the CIO role at Christus since 1999 when Sister of Charity Health System (where he briefly served as CIO) and Incarnate Word Health combined to form a united system, is focused on providing patients with the guidance and support needed to make them accountable for their healthcare. He faces a significant challenge as Christus begins a long-term project of integrating information from across the organization as it seeks to continue to grow acute care while also building non-acute and retail areas as well as international operations.
KH: How long have you served as CIO at Christus Health?
GC: Since the creation of the organization in 1999. I was the CIO at the Sisters Charity organization for a very brief period of time before the formation of Christus.
KH: Was that your first CIO position?
GC: I was CIO at Integris Health in Oklahoma before that. I’ve been in this game for 30 years.
KH: As someone who’s been in the field for so long, I’m sure it’s interesting to you how healthcare is becoming so patient-care centric. What are your thoughts on this trend?
GC: I started out as a clinical psychologist many years ago. I practiced for a very long time, so my focus has always been around patients and what we can do for them to provide them better care. The current patient-centric focus, particularly as evidenced in PHRs and people taking more responsibility for their own healthcare, is something that I’ve been striving to do for 30 years.
That being said, there’s a complication to it. The metaphor I like to use is the lousy job I’m doing managing all of my financial programs — 401Ks, investments, things like that; how complicated the market has gotten is an analogy to how complicated our body is. So how can you expect an individual — particularly given the amount of detailed information available about the human body and how it functions — how can we expect just any person to be able to pick up and run with that information and be responsible and accountable for what occurs? I don’t think we can, so our focus here at Christus Health is not just how do we make people more accountable for your healthcare, but how do we provide them with the right support so that they can make the right healthcare decisions. It’s not just, ‘here you go, here’s your PHR. Lots of luck!’ It’s ‘now that you’ve got this tool, let’s work together to put together the best health program for you.’
KH: What do you think is the best way for clinicians to provide patients with the support that they need in maintaining their PHRs?
GC: We started a program here that we call Christus Healthy Living. There’s a website associated with it that patients can go on and enroll. It’s brand new; it’s only been up for about 2 months, but the whole idea behind it is that it’s going to evolve and grow along with the needs of people who become members of Christus Healthy Living. The plan will be guided by what our users want and will provide concierge services where the patient can see his or her EMR, the clinician has access to it on the concierge site, and they sit down and talk about what the issues are, what the problems are and what the services are that the patient needs. It fits right into a strategy we’ve developed (which our CEO, Dr. Tom Royer has talked about) within Christus, which is focused around the goals we want to achieve by 2016. Today we’re very heavily acute care-focused (big hospitals, etc), but by that time, one-third of our portfolio will remain in acute care hospitals, but a different kind hospital that is very much focused around the type of care we envision acute care institutions providing in the next 15-20 years.
The second would be a large, non-acute, retail initiative, and the third is our growing and developing international business, including a term we coined called medical travel, which is based out of our offices in Mexico.
As a concierge, we’ll have — not unlike the concierge has at a hotel — a list of all the different services as we explore what you need, what you want, stuff like that. We ought to be able to help you craft a healthcare plan based on all the information that we have available to us. A partnership gets established. It’s kind of like going to a hotel in a foreign city. What chance do you have picking out a good restaurant? You go to the concierge at a hotel, and you hope that they have relatively good taste, but at least it’s a start.
KH: This is for patients who already have an EHR within the hospital system, correct?
GC: Not necessarily; you could sign up yourself — you can just create a relationship with us through that. Obviously, if there’s a service that you need and you’re in one of our markets, we’re going to be more likely to direct you to one of our service entities than to a competitor. It’s like how Amazon.com wants you to buy books from them, not Barnes and Noble.
KH: It seems like this system is almost a necessity with a network the size of Christus that has so many facilities and services.
GC: Exactly, and we have our Mexican hospitals as well. You’re going to get a concierge who’s going to sit down with you and talk about what your needs are. Let’s say you want a physical and you live in New York or New Jersey. It’s not unlike what Continental Airlines or Amazon would do – if we don’t have it, we’ll direct you to a partner. If we have a partner up there in the northeast, we’ll direct you to, say, Nyack Hospital or Hackensack Medical Center for your service. But if we don’t, we might suggest that you hop on an airplane to Mexico because we can provide a very advanced physical down there, very likely, inclusive of the airfare and hotel stay at half to five-eighths of the price of what it would cost you to do it in New York or New Jersey. That’s what we’re finding with our costs in Mexico as compared to the United States.
Right now we have the only Joint Commission accredited hospital in Mexico. It’s called Christus Muguerza and it’s in Monterrey. So the concierge will help you organize and speak through what you need; it will help provide you with input on care and there will be an expert on hand. We’re developing a clutch of these people that we call community health workers, some of them will actually be on the ground in our community helping poor and uninsured people get better healthcare earlier so they don’t end up really sick in one of our emergency rooms. They will also be able to serve as concierges and act on the phone or on email with you with whatever is your chosen form of communication.
KH: That sounds like a great program, and I think it’s ahead of its time, kind of setting the bar for patient care. Do you think this type of philosophy will become more common?
GC: It already is, in some respects. You hear about programs like this on the west coast, but you don’t hear it in association with healthcare systems. You might hear it associated with a health plan, because these plans are trying to get control of patient costs and things like that, but they’re typically going to be much more focused around how they can get you the cheapest treatment for service. So they’re not necessarily aligned with you from a quality perspective.
KH: And of course, that’s part of the problem. So with Christus Healthy Living, if a patient does decide to follow the concierge’s recommendations, does all of this then go on the patient’s record? How is all of this tied in with the health system’s information system?
GC: Yes, this is something that’s in process — we’re not totally there yet. But the idea is that the information about you, to the extent that you want to make available, is available to other Christus entities to view. Let’s take a best-case and worst-case picture. Best case, there’s someone who comes in and says during an admission or intake or online interaction that this information should be made available to any other Christus person or system providing treatment or services to me. You may think that the worst case would be that you fill all that out and you say, ‘don’t make it available to anybody,’ and we’ll follow your desires at that point, but we’d also recommend back that that doesn’t necessarily put us in a position to be able to provide you with the best treatment and services.
Here’s a for instance with this: one of the things we’ve got online right now is an e-store where you can buy Christus-branded vitamins and have them sent to your house. But let’s just say that we know from either a prior hospital stay or a doctor’s visit or your PHR that you are allergic to gluten. What we want to be able to do — we’re not there yet, but we’re working in that direction — is if you’re going to go to the e-store to buy vitamins in which there is a constituent to which you’re allergic, we’d like to be able to pop a message up onto the screen that says, maybe you don’t want to buy this because it has gluten in it, and you’ve indicated an allergy to gluten.
KH: So you’d be using information from the patient’s record to steer them in the right direction and away from possible adverse events.