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Favorite Health IT Quotes of 2017: A Baker’s Dozen

December 19, 2017
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Machine learning, population health, FHIR and Open Notes were focal points in 2017
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Each year I like to look back through my interviews at some of the quotes from industry leaders that intrigued me the most to see if they help elucidate any patterns that I might miss in my day-to-day reporting on informatics trends. Often the ones that stand out to me are from people who reject the accepted wisdom or offer some controversial or blunt comments about the state of our healthcare system and the role technology is playing in it. I may not always agree with them, but I appreciate the fact that they are challenging established notions and making us rethink our assumptions. From the following quotes, presented in no particular order, it is clear there is plenty of change afoot, matched by a healthy dose of skepticism and frustration.

1. “Given how much we spend and how much technology we apply, I was struck by how much manual processing is going on. On the issue of measurement burden, that is an area for significant improvement. I wince when I see how much physician time is devoted to data entry. I think we can all agree that makes no sense in 2017 and we can do better.”
-- Lewis Sandy, M.D., UnitedHealth’s executive vice president for clinical advancement

2. “One of the reasons it takes so long for a drug to get to market, or any finding to lead to a change in clinical care is because of this lengthy cycle we go through of hording our data and hiding our algorithms in order to publish a paper so we can be first and get tenure and promotion. The patients deserve better than that. If we can address the attribution and contribution problem, you can be first just by posting it on GitHub or the web.”
-- Melissa Haendel, Ph.D., an associate professor in the Department of Medical Informatics and Clinical Epidemiology at Oregon Health & Science University, and one of the leaders of the new National Center for Data to Health (CD2H)

3. “The idea that machine learning is about to be launched in our healthcare system is tremendously exciting. It could really turn the system on its head. Ever since healthcare was something humans did, the patient has had to hold up his hand and the system would respond. The idea here is that if you have rich enough data you can instead predict who may need help and do outreach and move care upstream. That is a goal for healthcare in general, whether it is dealing with cancer or a person heading toward self-harm. I am excited and thrilled to see how clinicians will use it.”
-- Don Mordecai, M.D., Kaiser Permanente National Leader for Mental Health and Wellness

4. “For my doctor to use my data with me on an individual level advances the quality of care in and of itself, but when you can aggregate data within an institutions and across institutions, there become increasing opportunities to conduct comparative effectiveness research and outcomes research.”
-- Claire Snyder, M.H.S., Ph.D., a professor at the Johns Hopkins University School of Medicine and Bloomberg School of Public Health and co-author of a “Users’ Guide for Integrating Patient-Reported Outcomes in Electronic Health Records: Design and Implementation Considerations”

5. “Every American needs to have the totality of the medical information available to every physician and hospital at every point of contact. It can be done. It's called ATMs. But it won't get done.  Why is that? Because the people who manufacture and sell the electronic health records are not going to open up what's called APIs, the application processing software that's necessary for third-party developers to come in, because they know it will break the stranglehold they have on those who have purchased the systems already.”
-- Robert Pearl, M.D., former CEO of the nation's largest medical group, The Permanente Medical Group

6. “We spend more time shoveling coal than steering the ship. We want to shift our energy to looking at the data and navigating where we are going.”
-- Robert Kagarise, director of population health informatics and IT for the Delaware Valley Accountable Care Organization

7. “You need big data to drive you to the right place. Once you know who is at risk, that is where little data comes in. You need the boots on the ground. Large data sets are good, but it comes down to messaging the provider or patient. Then you can use care management to drive provider behavior.”
-- Terri Steinberg, M.D., chief health information officer and vice president of population health informatics, Christiana Care Health in Delaware

8. “At Mount Sinai, we are a big academic medical center, but like most of America, we have an Epic system that is not necessarily easy to get data out of en masse. If you need data out of Epic, you take a ticket and get in line.”
-- Mike Berger, vice president of population health informatics and data science at Mount Sinai Health System

9. “Three numbers tell the story on healthcare systems’ efforts on social determinants of health: 80, 72 and 40. Eighty percent of the people we surveyed said, yes, social needs are a core part of our mission. Seventy-two percent said they don’t have sustainable funding to do it. That is in many ways a heartbreaking mismatch. They are saying ‘we know this should be part of our mission, but we really don’t know how we can pay for it.’ Forty percent felt they were doing something in this regard, but had no way of measuring whether it was working or not.”
-- Josh Lee, principal in Deloitte’s Healthcare Provider Strategy Practice

10. “This is the largest government study ever on its own people. When the government does science on its own people, participant welfare and trust are essential and we may not get second chances.”
-- Nancy Kass, Sc.D., a professor of bioethics and public health at the Johns Hopkins Bloomberg School of Public Health in Baltimore. She was talking about the Precision Medicine Initiative, now called the All of Us Research Program. Kass chairs the institutional review board (IRB) for the project, which aims to create a million-person cohort.

11. “We [Open Notes] are facing pushback to the cultural change we represent. Doctors aren’t used to sharing notes with other people. We think this should be the standard of care. Clinicians will be saved and helped by their patients. They need to get together in a transparent interchange of information.”
-- Tom Delbanco, M.D., professor of general medicine and primary care at Harvard Medical School

12. “You could have some systems with a robust payload of data in their CCD [continuity of care document], and you have others that have really nothing at all. That was a real shock for me. It was my assumption that Meaningful Use was going to help us solve this problem. That is why you are starting to see the rise of FHIR now because it is a vendor-driven initiative, whereas CCDs were the government pushing it down.”
-- Bill Gillis, CIO of the Beth Israel Deaconess Care Organization (BIDCO) in Boston

13. “We have a wonderful hospital across the street, but this is not a healthy community. In the future, a proportion of every hospital’s revenue — and one day it could be a very significant portion — will be held accountable for what is happening in this community, and that will turn things on their head.”
-- Jonathan Weiner, DrPH, director of the Johns Hopkins University Center for Population Health Information Technology in Baltimore

 

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The Modern Healthcare CIO, CMO, and CTO

December 10, 2018
by Lori Williams, Industry Voice, vice president of fulfillment, Gigster
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Disruption in the healthcare space comes primarily from the expansion of data’s role in the industry, and the healthcare C-suite’s familiarity with that expansion will help drive company and industry success

For the healthcare C-suite executive, the industry has never been more complex—nor has it ever contained so much potential. Emerging technologies mixed with political uncertainty has created an environment where incredible amounts of healthcare data are revolutionizing how patient care is handled, but patients remain uncertain about the future of their own health. With better data and the means to draw insights from it, healthcare CIOs, CMOs and CTOs are in a position to help address patients’ uncertainties and make hospitals and clinics more accessible and effective than ever before.

Here’s a look at how the role of the modern healthcare CIO, CMO and CTO is changing:

The Modern Healthcare CIO
The modern healthcare CIO’s role has evolved to become more innovative. No longer a title reserved strictly for engineers and IT professionals, today’s healthcare CIOs are focused on information science instead of simply setting up network infrastructure or providing back-end support. The trend towards a more data-centric role began as hospitals rolled out electronic health records, equipping individuals with better access to healthcare provider data. Through enterprise data warehousing, CIOs are becoming masters of data management, governance and predictive analytics, and passing along the many benefits of those knowledge bases to patients.

The Modern Healthcare CMO
The confusing healthcare landscape makes the role of a healthcare CMO more necessary than ever before. Thanks to ongoing regulatory changes, uncertainty surrounding the Affordable Care Act, and shifting consumer expectations for on-demand services, healthcare CMOs are responsible for helping patients navigate their way through a complex and opaque industry. As patients continue to assume the role of consumers, carrying out comparison shopping as they would for any other industry, CMOs must be adept in crafting a healthcare provider’s brand and messaging.

At the same time, CMOs must also ensure that healthcare providers offer a modern online experience, ensuring websites are mobile-optimized and social media accounts are generating engagement. This also means CMOs need to help move marketing efforts into the 21st century, transitioning away from direct mail or billboards towards digital marketing and CRM tools. Because if they don’t, there are plenty of med tech startups that will promptly eat into their market share.

The Modern Healthcare CTO
Unlike healthcare CTOs of the past who remained siloed off from the rest of the organization, today’s modern healthcare CTO is fully engaged with healthcare providers and their technology stacks, utilizing new software and hardware to improve daily workflows. The CTO is enabling the transition to patient-oriented self-service operations, enabling patients to carry out administrative tasks like scheduling appointments or refilling prescriptions over the internet. Because medical data is often stored in a variety of different sources, it’s critical for the CTO to be able to keep these systems interoperable with one another. For hospitals riddled with legacy software, CTOs should expect to continue employing middleware solutions to bridge the gap between old and new.

Members of the healthcare industry C-suite have the power to transform lives, and the CIO, CMO and CTO have roles that directly affect a provider’s ability to carry out positive change. With better data from the CTO’s tech stack, the CIO can use better analytics to help providers determine the best solutions for their patients, marketed to consumers by the CMO through modern platforms in clear, easy-to-understand language.

Lori Williams currently serves as Gigster’s vice president of fulfillment. Prior to joining Gigster, Lori was the general manager for Appririo.


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What Does Your Magnum Opus Look Like? A Few Operatic Thoughts

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I was given the privilege and pleasure recently of presenting, for the second year in a row, a lecture on Richard Wagner’s “Ring” cycle, as the leading opera company in my city, a world-class opera house, has been putting on, in yearly succession, the four operas of the “Ring of the Nibelung” cycle by German composer Richard Wagner (1813-1883). Last year, the second opera in the tetratology, “Die Walküre,” was performed; this year, the third opera, “Siegfried.” After the concluding opera, “Götterdämmerung,” is performed, the entire cycle will be presented in festival format, always a major cultural event. I spoke on “Siegfried.”

I’ve been fortunate to have seen six complete “Ring” cycles in live opera houses in different cities, and I can tell you, it’s a life-changing experience, as this four-opera work (16 hours of music altogether), sits at the absolute summit of western art. Richard Wagner was a hideous human being himself, but spent numerous years working on something that changed the course of classical music and redefined opera.

What’s more, from the summer of 1848, when Wagner wrote a first sketch of the libretti, or texts, of the operas, until their true compositional completion in 1871, more than 23 years were to pass; and it would be another five years before the tetralogy was fully presented, in a purpose-built new opera house in the Bavarian town of Bayreuth. It was a herculean feat to create the entire text of these four long operas, and compose 16 hours of music that would completely redefine the concept of opera. Indeed, when the crowned heads of Europe, the great living composers, and the 19th-century European intelligentsia and glitterati, gathered at the new Festspielhaus in Bayreuth in 1876, many were so overwhelmed by what they saw and heard, that they were rendered speechless. Even now, 142 years later, first time Ring-goers are overwhelmed by the breadth and sweep, the musical and dramatic audacity, and uniqueness of the “Ring” operas, with their story of gods, giants, dwarves, flying Valkyries, Rhinemaidens, one huge dragon, humans, gold mined from a river, magic swords and spears, and of course, a gold ring whose possessor can control the world and its fate.

Even just looking at the third opera, “Siegfried,” Wagner struggled mightily. For one thing, being essentially a grifter and a cad, Wagner borrowed/took money from everyone who would lend/give it, and often had affairs with the wives of the patrons bankrolling his compositional work, leaving his life in constant chaos, as he fled from one city to the next. One such wife, Mathilde Wesendonck, inspired the opera “Tristan und Isolde,” groundbreaking operas that Wagner wrote during a 12-year hiatus in his composition of “Siegfried.” And “Tristan” itself changed the entirety of classical music, its tonality-challenging chromaticism.

Well, no one is expecting anyone to match the unique creativity of Wagner’s “Ring” cycle. But the leaders of U.S. patient care organizations are doing a lot of important things these days, including using formal continuous improvement methodologies to rework core patient care delivery processes in order to transition into value-based healthcare. What’s more, as our Special Report on Leadership outlines, the entire role of the CIO is being rethought now, as the demands for leadership and strategic capabilities are catapulting that role forward; and patient care organizations are beginning to make real headway in advancing equality for women and people of color among the ranks of healthcare IT leaders and managers.

So while no one is expecting anyone to create an operatic tetralogy that will change the face of music, there are plenty of heroic endeavors open to anyone willing to envision the healthcare system of the future. The opportunities are as limitless as the imagination.

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Using Performance Management to Scale

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Performance management is so much more than just a year-end performance review
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Performance management and goal setting have always been part of my DNA. It’s like a compass that tells us we are steering the ship in the right direction or gives us a chance to course correct if we wander off track. It’s hard for any organization to determine how they are doing unless there are clear measurable objectives. CIOs and their leaders need monthly, quarterly and annual goals to measure how you and your team are doing against the plan. I also firmly believe they should be S.M.A.R.T. goals: Specific, Measurable, Achievable, Relevant and Time-based.

Once the goals have been established, you need a written plan. I like three-year rolling plans so you can look into the future and describe your vision of what your organization will look like 36 months out. Then you can work back to the second year, and eventually the first year, to give you the framework for what you need to accomplish in the next 12 months. I suggest you do it with your managers. It makes them accountable to the organization since they are involved in the formation of the plan.

Your plan must be a living document to be used frequently during team meetings throughout the year to see how you are performing as a team and individually. This is not a process you invest in to review at year-end to see how you performed. By then it’s too late. It must be reviewed on a consistent basis to make sure everyone is on track. Performance management is so much more than just a year-end performance review. If there are individuals who are not performing against the plan, you can use the plan as a tool to performance manage them to re-engage as an important member of the team. 

I just returned from the Scale-up Conference in Denver and learned so much about taking goal setting and performance management to a whole new level by adopting the "Rockefeller Habits," as written by Verne Harnish. After reading the book, everything changed for me in the way we will be doing our planning, goal setting and performance management forever. It’s so brilliant and easy to understand. Here they are:

Rockefeller Habit #1: The executive team is healthy and aligned

Rockefeller Habit #2: Everyone is aligned with the #1 thing that needs to be accomplished this quarter to move the organization forward

Rockefeller Habit #3: Communication rhythm is established and information moves through the organization accurately and quickly

Rockefeller Habit #4: Every facet of the organization has a person assigned with accountability for ensuring goals are met

Rockefeller Habit #5: Ongoing employee input is collected to identify obstacles and opportunities

Rockefeller Habit #6: Reporting and analysis of customer feedback data is as frequent and accurate as financial data

Rockefeller Habit #7: Core values and purpose are “alive” in the organization

Rockefeller Habit #8: Employees can articulate the key components of the company’s strategy accurately

Rockefeller Habit #9: All employees can answer quantitatively whether they had a good day or week

Rockefeller Habit #10: The company’s plans and performance are visible to everyone

Accountability is no longer hard to measure since the entire plan is visible to everyone throughout the organization. Each part of your team should have key people accountable for every functional part of your organization. No more guessing is required. I’ve read countless books about leadership, performance management and goal setting, as I’ve been an avid student on the subject for decades.

These ten habits, once adopted and measured regularly, can change any organization that wants to grow and scale, and keep everyone accountable along the way.

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