Arguably one of the busiest people in healthcare IT, John Halamka, M.D., is CIO at both Harvard Medical School (HMS) and Beth Israel Deaconess Medical Center, a 621-bed facility that is a teaching hospital of HMS. He is also Chairman of the New England Health Electronic Data Interchange Network, CEO of the Massachusetts Health Data Consortium (MA-SHARE), Chair of Healthcare Information Technology Standards Panel (HITSP), and a practicing emergency physician. Recently, Healthcare Informatics Associate Editor Kate Gamble caught up with Halamka to discuss the growing use of social media and the ramifications of the stimulus package.
KG: What are you up to now? I’m sure you’re traveling somewhere.
JH: I am. I’m on my way to meet with Eric Lander, who runs the Broad Institute. He’s co-chair of the President’s Council of Advisors on Science and Technology, and he asked for a briefing on what the stimulus is all about and where it is going.
KG: That’s such a huge topic right now.
JH: Right, so when President Obama’s science and technology committee said they needed a briefing, I just cancelled my morning and I’m going to give them a personal briefing.
Everyone’s talking about it; every other email is about stimulus this or stimulus that. So I figure every CIO in America is going to be asked by their board to present what the stimulus really means — what are all the details. So my blog this morning is a Power Point presentation which I have open-sourced for the entire world saying, ‘here’s a set of slides to describe everything the stimulus is. Use it as you wish. Hope it saves you time.’
It’s just a short slide deck that will hopefully save thousands of hours.
KG: I’ve noticed that a lot of the conferences — especially HIMSS — are revolving a lot of their educational content around the stimulus package, which I think is a great idea.
JH: I’m actually giving the HIMSS keynote on that topic. They asked me to do a complete, comprehensive overview of the stimulus, the future of CCHIT, HITSP, NAHIT, governance policies. I said, ‘sure, as long as I can get my slides in seven minutes before my presentation.’
KG: How on earth do you summarize all of that into one presentation?
JH: Exactly. The problem is that every day when we wake up, the landscape changes. The keynote I’m doing in on April 7, and we have no idea what’s going to be happening between now and then.
KG: That’s the beauty of blogs — the information is fresh. Now I know that in addition to your blog, you also use Twitter and other types of social media. I know that some people see tools like Twitter and blogs as just more activities that take up time, while others say that they can help manage time better. I’m guessing you’re in that second camp.
JH: What’s really interesting is that my blog has actually become the way I organize my life, as opposed to a distraction from it. As an example, this morning at 7 a.m., I’m getting emails about what’s going on at the National Committee for Vital and Health Statistics at CGHS (CareGroup Health System) and I think about that and say, there’s a whole lot of profound policy issues going on here. What I’m going to do is write over the next day a summary of where I think the country should go, based on all the input I had this morning.
And I’m going to post that, and it’s going to generate dialogue and it’s going to be useful guidance for people inside my organization and people in my region. So it’s really interesting that this has become my communication modality and… some people say I’m a thought leader, and it’s because I do this blog.
KG: So then you can use the Twitter site to drive more people to the blog, right?
JH: What I do with Twitter is not only do I auto-post all my blog entries, but I’ll use it when there are events happening very quickly and I have my Blackberry and I instant message Twitter and say, ‘I am now sitting in the Senate and here’s what’s happening.’
KG: And it’s set up so that you can’t say a lot, but you can reach a large number of people with one post.
JH: Yeah, I have about 700 people who follow me on Twitter, and I don’t really know who these people are. But it seems like one aspect of social media, for me, is guiding the next generation of health informatics folks; they like to see what I’m thinking and what I’m doing, because it helps them in their careers. So there’s actually kind of a social responsibility aspect to all of this.
I have about 5,000 readers to my blog every week, and some of these people are CIOs and they are grappling with the same problems. But a lot of them are students, and people who are maybe in clinical professions but not yet in informatics, they want to learn a bit about it. It’s been a way of really, in a sense, making me available as a private consultant to thousands of people on an instantaneous basis.
KG: Do you communicate with other hospital executives through sites like Twitter?
JH: I do, and here’s my problem. Here’s the problem — I get 800 emails a day, and if someone asks me a real pithy question, like, ‘here’s what’s going on in Washington, what do you think?’ Either I can spend a half-hour writing a single email to one person, or I can say, that’s a really good question, and now make it available to thousands. So what it actually does is it reduces the time I spend on email, and it leverages the time that I spend thinking about responses to challenging questions.
KG: That’s amazing. Now there are a few major ways in which social media can really impact healthcare IT, and one of the ways is by making large organizations seem a little smaller and by making the big wigs a little more accessible. What are your thoughts on this?
JH: I think there are two major effects. The first is that it has democratized the organization, because now (Beth Israel) CEO Paul Levy, blogs every day. So between Paul and I, we’re really connected to every single employee in the entire organization, and people feel no separation; there’s no hierarchal boundaries. Social networking is a simple way to really bring internal communication, at no cost — zero cost — to a whole new level.
The second thing it does is it’s forced us to rethink the way we use the Web, because people no longer want to read bulk emails. Everyone thinks that’s just spam. So what you use is, in your Internet and your extranet, you now focus on social media, chat, forum, blogs, wiki — these kinds of things. And people really seem to prefer that kind of pull communication as opposed to a push communication. They may use an RSS feed as a way to achieve a push, meaning that I’ll write all this blog stuff and give it to as many consumers as they want every day, rather than sending to 18,000 people in an email, most of which won’t want to read it.
From a corporate communications-internal communications perspective, it’s been very effective. And from an infrastructure perspective, we use social media throughout the organization — not only for communication, but also things like quality improvement. So all of our quality improvement activities focus around a series of blogs, wikis and forums we’ve created that any person in the entire organization can contribute to, in real time. And then we use it as kind of a swarm, and say, ‘here’s a problem, let’s all come together to solve it.’
KG: So where do you see this going in the future? I know that when we first exchanged emails about this you mentioned research recruiting.
JH: One of the things we have done, and you’ll find this at catalyst.harvard.edu, is we’ve created websites to bring together the 18,000 faculty of Harvard. So yeah, it’s unbelievable but true that Harvard has 18,000 faculty members, set across 17 hospitals. Suppose I’m really interested in finding the guy who knows more about genomics and cancer than anybody else. I don’t know which of the 18,000 I should talk to, but if you create a social networking site as we have, that takes every single publication that every single faculty member has ever written, and breaks it down into the medical subject heading, and then makes it social network, so you can say, ‘I need a medical informatics guy and a genomics guy and a person who’s willing to collaborate and teach,’ and then the sight just puts your team together for you. That’s pretty powerful.
KG: That seems like a really effective use for social media.
JH: And you’ll see that the site is not password protected, and that idea was sort of controversial at the time, that we’re putting all of our people and all their profiles and all their intellectual property out there to the public, but the whole idea with social networking is you are being inclusive. Anyone — students, faculty or staff — can get at anything. You can go look up my profile and see the 144 areas of expertise I have, and connect to me. All of that was done using natural language processing, publicly available databases, and systems of record at Harvard.
KG: So you’re taking this information and making it very transparent. I’m sure that makes some people nervous. But would you say that the advantages of doing that outweigh the benefits?
JH: I certainly think so. I can be a very transparent person. I mean, my cume is on the Web. And I’m sure there are risks, and obviously I know that privacy is personal and everybody has a different view on it. But thus far, I have found transparency — this willingness to connect — has so many benefits that it outweighs the risks.
KG: I agree. Do you think that what you’re doing with social media is the future for CIOs? Are we going to see more CIOs on sites like Twitter?
JH: Absolutely; I look at the role of the CIO as, what is the strategy of the organization, how do you create budgets, processes, structures and staffing, and all of that requires incredible communication. Whenever I see a CIO who just huddles in their office and does email, I think, that’s not going to work.
Being a CIO these days is a whole new level. I mean, you have to have technical expertise, absolutely. But you have to be able to interact with people and you have to have a level of communication that just didn’t exist 10 years ago. Embracing social media, for me, has really facilitated that.