HEALTHSYSTEM MINNESOTA WAS formed in 1993 from the merger of two Minneapolis-based organizations: Park Nicollet Clinic, a 400-physician group practice serving 45 specialties, and 426-bed Methodist Hospital. The organization also includes an 11-clinic primary care physician network, a home healthcare organization, 12 pharmacies, a foundation and the Institute for Research and Education.
David Wessner joined HealthSystem Minnesota in 1994, after 17 years of administrative experience at Geisinger Health System, Danville, Pa., and the Geisinger Clinic and Medical Center. He was an executive vice president and then COO briefly before becoming president and CEO on July 8. Professionally, Wessner has been involved with information systems projects for several years, but personally, his interest goes back much further: "I have a natural interest in organizing work. It may go back to my degree in philosophy."
As COO Wessner says he spent about 20-30 percent of his time working on IT issues. Over the years, he has witnessed the evolution of senior management: "It’s increasingly information systems that are mechanisms to manage processes within healthcare. There’s such a high level of information transformation going on--from capturing the initial symptoms and problems of patients to documenting solutions and claims. Information technology is a big part of the job today."
While most healthcare organizations are scrambling toward systems integration and vendor solutions, Minneapolis-based HealthSystem Minnesota has taken an active role in influencing the direction of its IT development partners. By developing a standard information architecture that vendors must subscribe to, HealthSystem Minnesota has created an innovative infrastructure that is flexible enough to move with the organization.
In 1995 HealthSystem Minnesota embarked on an ambitious IT infrastructure overhaul to help the new organization integrate a highly-disparate mix of systems and procedures--48 different master patient indexes, 25 different ways to code physicians and payors, a patchwork of internally-developed and commercial software products. Since then, the organization has defined an object-oriented, Web-based standard architecture and is busy creating a new care delivery system called Care 2000--focusing on the reengineering of two core processes through technology.
Newly-instated president and CEO David Wessner is an active proponent of the organization’s use of information technology; he also plays a central role in helping to shape a process and rules-based approach to IT. Wessner’s career in healthcare has focused on the evaluation and transformation of clinical and business processes--critical skills he is putting to test in developing a fully-integrated, patient-centric healthcare delivery system.
How are you achieving information integration?
We look at our information as an asset that spans all the organizational boundaries. We have an organized approach to data as an organization, not just as an information technology department. We have defined what data is important to us, and defined its attributes.
Then we establish an owner of the data who provides guidance and leadership for the organization, to make sure that whenever we deal with that type of data we’re dealing with it in a consistent fashion and we’re using the same definitions and tables--whether we’re working in the clinic or in human resources. That’s building an infrastructure so we have real power in using that information in the future.
Another key dimension is we have an understanding of the process level of the organization. Are we in touch with our work processes? Can we identify them? Do we know who are the owners of the processes and what is the state of their performance?
Do you think in healthcare we have placed more emphasis on buying software products than on internal processes?
Usually we have a problem--a business need in an area that needs to perform better--so we realize there’s a software solution out there that would help. The problem with that is if it isn’t preceded by a clear understanding of what the processes are, it’s very difficult to realize improvements in performance.
Then all of the pressure falls to the vendor. Quite often there is too much emphasis on a particular vendor relationship as being the answer to supplying information technology inside healthcare organizations. Instead, if you are better in touch with your data and your processes, you can better evaluate what a vendor can do--and realize that no vendor can provide a total solution.
Does a process approach to IT require a particular management style?
It requires that the leadership of the organization be interested and in touch with processes as much as they are with the organization. Because processes tend to go across organizational functions, they are usually the first thing to go when the pressure comes on. People sort of retreat to their own boundaries, rather than concern themselves with what’s happening on the outside.
We have set up guidance teams to support organizational processes, focused on patient access and the management of the encounter. On these teams we have a combination of senior management and clinician representatives who are involved in those processes.
How are these process teams tied to implementing information systems?
We also have two physicians working with us full time on access and encounter management. They are working with (CIO) Mike Minear and the IT professionals to create these new systems.
We have a multidisciplinary group that I meet with weekly to learn and to provide guidance.
Everyone would like to get to the point where the way we implement processes is through information technology--where a certain predictability of the process comes with the use of the technology. We’re still building that.
Tell me about the standard architecture you have built to support these integrated processes.
Our information architecture is called CHITA--Common Healthcare Information Technology Architecture. Any vendor we do business with will subscribe to these standards and therefore we have the ability to use different vendors to communicate. By having that architecture we’re developing a larger interactive system than any one vendor can provide.
We have a concept here called "stone soup." By creating our CHITA architecture, we are putting our soup kettle in the middle of the square. We’re heating the water, but our vendors are bringing a lot of the meats and vegetables to it. We learn a tremendous amount but it’s mutually beneficial. By being integrated as a system we provide a great place to experiment and to develop products.
The organization spent more than $19 million of your capital budget on IT in 1997. Was that a tough budget to sell?
Yes it was. One of the things that has been most pressing is year 2000. That has probably upped the percentage of the budget going to information technology. We’re spending over half of our budget on Y2K. On the one hand, it’s a lot of money to spend and how do you demonstrate return? On the other hand, it has a lot of acceptance as something we have to do.
Do you think Y2K is significantly slowing down progress on IT initiatives in healthcare?
It’s probably increasing our capability and productivity to implement systems by several-fold. We’re improving our management of projects significantly…and daily meetings are now becoming standard. I think it will accelerate IT implementation.
What is your long-term vision for how IT can transform healthcare?
Fundamentally I believe the core process of work in healthcare is not inside the organization but in the individual or patient we serve. We are finding that increasingly people are taking charge of their own health. From that, I see an information technology structure that strongly supports the individual. The vision I have is to help the organization understand the learning process of the patient. I think IT will be key in doing that.
Polly Schneider is senior editor at Healthcare Informatics.