Most agree that behind every successful CIO stands a supportive CEO, one who sees IT not as a cost center, but a strategic enabler. James Mongan, M.D., president and CEO of Partners HealthCare (founded in 1994 by Brigham and Women's Hospital and Massachusetts General Hospital) seems to personify this concept. Mongan was recently one of the individuals presented with a “CEO IT Achievement Award” by Modern Healthcare and HIMSS. Recently, HCI Editor-in-Chief Anthony Guerra talked with Mongan about his approach to information technology.
AG: Why do you think you won the award? What is it about your style, your approach towards technology that you think got you recognized?
JM: Modestly, I would say I really think it’s probably a tribute to the work of the organization rather than a tribute to me personally. I think that Partners has been noted both because of John Glaser and his team’s great work on the IT side, and the fact that we’ve got some very involved and interested clinicians. I think we’ve been viewed as an organization that has had a leadership role in this area and I certainly try to encourage and facilitate that.
AG: You just used the words “encouraged” and “facilitate.” Can you expand on that? Obviously you’ve created a climate where these people that you mentioned can flourish, and they at least have the leeway and the budgets to do what they want to do. So tell me more about that climate you’ve created.
JM: Well I would say that there’s probably two insights, if you will, that our leadership team (and it has been a team effort) has had over recent years. I’ve been here about five years now, and I think Partners is about 13 years old, and I think we’ve been struggling during that period of time with really trying to get a clear vision of what a healthcare system is, as opposed to individual hospitals. Now I think that the first insight we had as a leadership team was that, in a way, the major physiological element of a healthcare system is its IT linkages and its common electronic records. I have told people it’s the same thing as how 50 years ago, what defined a medical group practice was that doctors had their office in the same building. Now I think what defines a healthcare system is that we’re all linked on the electronic medical record. I would say that that insight led indirectly to saying, ‘Well, the way we will develop and build ourselves as a healthcare system is to build out this robust electronic record that links all of our practitioners and components.’
And then I would say the second insight that went parallel to that was that it was never just about IT; it was about having clinicians and practitioners use the information technology to advance clinical medicine. So we spent a lot of time shaping what we called our high-performance medicine initiatives, which were five or six ways that we directly tried to demonstrate the linkage of the electronic records and clinical care. For example, one of those ways was to demonstrate how we could monitor quality better across the system by having the electronic records and the ability to draw the data. So we did a lot of quality tracking that we’d not been able to do before. We were able to move disease management forward by being able to identify our most chronically ill patients and plug them into the programs. We were able to work on cost and efficiency issues by trying to devise algorithms and prompts that would move people towards generic drugs or more efficient imaging procedures. And then looking towards the future, we were also saying, ‘How can we link this electronic record to the developments in genomics that are going on in our research centers to begin to really move us towards personalized medicine where the electronic record would have the genomic data encompassed also.’
The fact is that IT is the definitional element of the healthcare system and, secondly, that it’s not IT for IT’s sake, but to demonstrate to everybody in our system how we can and should harness that to change clinical medicine.
AG: Do you think some organizations that are putting together health systems through acquisitions fail to understand just how much it takes to integrate different hospitals?
JM: I would say that it’s difficult. And I’ve also looked at this issue, not just from my viewpoint here at Partners, but I’m chairing this commission Commonwealth Foundation has on high performance medical systems. We’re trying to look around the country at how various organizations are dealing with these issues, and I’d say that there’s two problems. In general, the first is that these systems are very costly and consequently very difficult for smaller hospitals or independent practice groups to do. To do this well, you almost have to be aggregated into larger groups.
I would say the second issue is as you try to aggregate into larger groups, you’re often pulling together a couple of different legacy systems and that leads to a bunch of difficulties and decisions about what do you pull out of the old systems or which ones do you pull out? How do you integrate them and those sorts of things that are not easy undertakings?
AG: I’d like to talk a little bit about the CEO/CIO relationship and some best practices that you’ve identified in that relationship. Tell me a little bit about the dynamic you have with John Glaser, your CIO. Is it often that you’re talking about direction and then tells you what is or is not possible based on the technology side?