At the tail end of 2017 National Health IT Week, which ran Monday, October 2 through today, a webinar focused on the industry leaders who are driving change, both by championing health IT initiatives at their own organizations or by advocating for policy change at the local, state and federal level, offered interesting insights on leadership and policy development.
The webinar, sponsored by HIMSS (the Chicago-based Health Information Management Systems Society), featured women health IT and informatics leaders, including Liz Johnson, R.N., chief information officer, acute care hospitals and applied clinical informatics at Dallas-based Tenet Healthcare, a 77-hospital health system; Teri Takai, now senior advisor at the Folsom, Calif.-based Center for Digital Government (a national research and advisory institute) and formerly CIO of the State of California; and Lisa Gallagher, managing director at London-based PwC (PricewaterhouseCoopers) health industries advisory practice for cybersecurity and privacy.
The speakers come from different areas of healthcare IT—Johnson comes from a clinical background in nursing and nursing informatics and now hospital CIO; Takai, as former CIO of the State of California, advised the state’s governor on the direction of information technology during the state’s modernization project; and Gallagher has an engineering background and is now focused on healthcare data security. Yet, what struck me is how similar their stories were as it relates to championing health IT initiatives, with change management as a central issue.
Takai said, “One of the things about health IT is that it’s really important that you have senior level engagement at the organization that’s going to use the system and use the data. One challenge over the years in getting health IT to happen is it’s a change management issue; it’s about people.” Takai, who also served as the CIO of the Department of Defense as well as CIO of Meridian Health Plan, noted the importance of building partnerships and collaborations. To get that change management to happen, she said, “It was important, at a state level, to engage the large payers and large providers in the state to make sure they were a participant and bring everyone in to get their input. We conducted some town halls to make sure that people that wanted to have input could be engaged in giving input. Number one, it’s make sure you’re engaging the right people, and, second, that you are defining what you’re overarching goals are for that collaboration and allowing a venue for everybody to have an opportunity to have their voice heard.”
Johnson also noted the importance of effective collaboration to move forward on enterprise-wide IT initiatives. “You need to recognize that, within that group, there are competing efforts and agendas, and you have to clearly articulate your vision, where you want to end up at the end of the effort, and stick to that focus,” she said, adding. “Health IT is about our patients, but you have to acknowledge that we are also a business, so you need to balance those two things.”
The speakers also addressed the importance of health IT leaders advocating for policy advancements at the national, state and local level and the challenges of policy development.
“When we talk about advocacy, some of our biggest challenges are working with federal, state and local people who don’t understand healthcare or health IT, any more than we understand how to run the FDA. We have a huge job in front of us to help educate them,” Johnson said. Johnson has been involved in advocacy work for many years and served on the Health Information Technology (HIT) Standards Committee of the Office of the National Coordinator (ONC) after the passage of the HITECH Act. Her advice for advocating for policy changes with policymakers and agency leaders: “Start with getting on the same page with them, then go with a clear ask. What is very effective is to take a specific ask and make sure they know why you are asking for it, and how they can help.”
As the challenges of healthcare IT are unique, and can impact the delivery of care to patients, it’s crucial to convene those challenges and implications to state and federal legislators and government agencies as they develop new healthcare regulations, laws or guidance, Gallagher said. “We need to explain, ‘If you are writing policy or regulatory guidance a certain way, what would be the true impact on healthcare organizations and on the patient, especially in terms of patient safety?’ You have to speak to them on their terms, and explain the implications. We need to talk about the impact in terms of the clinical workflow and patient safety. With us being at the table and with those dialogues, we can say, ‘This might work, but we might consider writing the guidance this way, so there is less impact on the patient.’”
The speakers were then asked to highlight what changes they are focused on advocating right now. Gallagher, with PwC, said she continues to advocate, as she has for the past 10 to 15 years, for getting the healthcare industry to converge on a common framework of security principles and practices. “That will enable us to measure [security] maturity against the framework. It’s a good way to all go down the same path together and speak the same language, and it speaks to all different sizes of organizations. We can measure and compare ourselves to the framework and to each other," And, Gallagher noted, "It seems to be taking hold now.”
What's more, Gallagher added, “When it comes to health IT policy, we should talk about what we want the end state to be. Keep that end state in mind and that helps us communicate in terms of policy.”
Takai said the work she is doing with the Center for Digital Government focuses on helping states work on data analytics. “One example that has been in the news a lot is using data analytics to address the opioid crisis. My work is around looking for those organizations that are doing best practices and then share those best practices across other organizations.”
Johnson noted that she is currently advocating on behalf of healthcare provider organizations for more harmonization among the various agencies within HHS—ONC, the Centers for Medicare & Medicaid Services, the FDA and the Office for Civil Rights. “I’m working with them diligently so they understand that what they do impacts us every day and we need to make sure they don’t have conflicting guidance.”
Johnson also said that she learned the importance of advocating for change years ago when she served as a nursing leader and recognized, along with other informatics leaders, the need to have up-to-date patient data at the bedside, which helped to drive efforts to digitize healthcare information. Her advice for other healthcare IT leaders: “Use your voice, be loud, be strong, nothing changes unless you call attention to it. Put your voice to your passion and your commitment to solve a problem.”
Takai and Gallagher also advised patience and persistence in pushing health IT initiatives and policy development. As the healthcare industry continues to undergo transformative change and as the pressures on healthcare leaders continue to mount, strong leadership in health IT will be needed, so it may well be worth it for HIT professionals to heed all of this practical advice.