from cmio to chio: information, integration and...
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From CMIO to CHIO: Information, Integration and Innovation
Wednesday, April 15, 2014
Luke Webster, MD, VP & CMIO
CHRISTUS Health
Pam Arlotto, FHIMSS, President & CEO
Maestro Strategies
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
Conflict of Interest Luke Webster, MD
@LukeWebsterATL
Pam Arlotto, MBA @PArlotto
Has no real or apparent conflicts of interest to report.
© HIMSS 2015 2
Luke Webster, MD Vice President & CMIO CHRISTUS Health
Over 20 years of clinical and health informatics experience specializing in health informatics and physician leadership including service as the senior physician with The Southeast Permanente Medical Group in Atlanta
First CMIO for CHRISTUS Health in Dallas, led the creation and staffing of a Health Informatics department for a complex Integrated Delivery Network with both US and International operations
Under his leadership, CHRISTUS Health has rapidly progressed to a successfully implemented Electronic Health Record with high physician adoption and Meaningful Use attestation
Brought evidence-based medicine programs, tele-medicine and remote patient monitoring capacity to CHRISTUS as well as the foundation of what will become an advanced clinical intelligence/health analytics platform
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35 year track record as a healthcare industry consultant, thought leader and entrepreneur
Fellow and Past National President of HIMSS, HIMSS 50-in-50 top HIT thought leaders
Frequent speaker and author, HIMSS all time best selling series on HIT ROI and winner Book of the Year
Service as Board Member:
– The Georgia Tech Foundation and Alumni Association
– The Wallace H. Coulter Department of Biomedical Engineering at GA Tech & Emory University School of Medicine
– The Scheller College of Business at Georgia Tech
– Advisory Boards of several privately held healthcare companies
Faculty of UAB Health Informatics Masters program
Member ACHE, HFMA and AMDIS Foundation
Pam Arlotto, MBA, FHIMSS President & CEO Maestro Strategies
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Benefits Realized & Value of HIT
http://www.himss.org/ValueSuite
What have we learned:
The Value STEPS must be managed into reality
The CMIO/CHIO should be the strategic leader of the
organization’s HIT value realization process
Health systems will have to build new competencies
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Learning Objectives Define the role of the Chief Health Informatics Officer (CHIO) and
contrast the CHIO responsibilities to the activities of Chief Medical
Informatics Officer (CMIO) at key stages of Health IT maturity
Shift the focus of physician informatics leaders from adoption and
implementation, to strategic leadership of value creation and realization
Explain the changing relationship between the CIO, CMO and the CHIO
Discuss specific competencies needed to succeed in the CHIO role
Demonstrate how at CHRISTUS Health, the research is applied to create a
new focus on information, integration and innovation
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“The secret of change is to focus all of your energy,
not on fighting the old, but on building the new”
Socrates
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CHRISTUS Health
Luke do you have introductory slides for
CHRISTUS – size of mission,
organization et al
International Catholic, not-for-profit health system that began a ministry of healing almost 150 years ago
Over 60 hospital and long-term care facilities in seven U.S. states, Mexico and Chile
9,500 affiliated physicians
30,000 employees
Headquartered in Dallas
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Starting Point c. 2010
No implementation plan in place
No content developed
No standard Informatics structure
Docs completely on paper processes
No System CMO. Regional CMOs variable
Medical staff culture variable across multiple geographies and generally highly resistant to change
The Challenge….
Desired Future State
Implement CPOE within 18 months: In time for earliest MU attestation in all 24 hospitals
Full EBM program
Standardized order sets
(What do you mean “give up MY order sets”?)
Health Informatics at CHRISTUS Health
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Today’s Challenges & Opportunities
Changing healthcare landscape market by market
Organizational uncertainty regarding the role, value and
purpose of informatics
Budgetary constraints
Expansion of informatics impact beyond acute care and
meaningful use across the care continuum to analytics, quality
and population health management
Explosion of technologies, such as mhealth, information
exchange, and the cloud, with significant potential to engage
the patient and impact access, quality and cost of care
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Informatics:
Making the Pivot
What got us here won’t get us
“there”
Shifting from “mandate” to strategy
Convincing executive leadership of
our strategic role
Need for benchmarks
Crafting the long term vision
NEED FOR SPEED
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Health Informatics & Analytics Research
Conducted qualitative interviews with over 60 CEOs, CMOs, CIOs, CMIOs and CNIOs at leading Integrated Delivery Networks
Asked key questions such as:
What are the enterprise strategic priorities given the transformation from volume to value?
How are the information and technology leadership roles changing?
Describe the responsibilities of:
• Information Technology
• Health Informatics
• Analytics
• Quality
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Landmark HBR Article – “The Work of Leadership”
Adaptive Change – People and organizations are forced to adapt to radically altered environments, much like what is happening in healthcare today
Strong leaders have the capacity to move from the field of play to the press box
By understanding the game from a broader perspective, they see how offense and defense are working together, who is missing the block, who is open for a pass – they are able to execute strategy by considering a larger field of play
Source: Heifetz and Laurie, “The Work of Leadership”, Harvard Business Review, Dec 2001
Many CMIOs fall prey to the “fix it now” problem solving approaches
that served them so well in clinical practice
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Some say this timeline “is too fast” other say it is “too slow”
2010 2015 2020
Fee for service reimbursement
Hospital Consolidation
Practice Aquisition
Enterprise Maturity Transformation Stages
Clinical Integration
Patient Engagement
Cross Venue Process Redesign
Performance Measurement
Early Stage Population Stratification
Risk Management
Population Health Management
Retail Care
Virtual Care
Consumer Behavior Management
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Typical 1.0 Informatics Attributes
CMIO is often known as the “doctor” in IT and reports to CIO
Focuses on adoption of acute care EHR and meaningful use
Assumes role of cheerleader or “doctor police”
Informatics resources are distributed across the health
system
Reactive, focused on responding to requests
CMIO has limited budgetary authority
C-Suite often is unclear of role or assumes it will “go away
once we are done with Computerized Physician Order Entry”
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Key
Take-
Away
The CMIO is focused the
tactics of MU and EHR
adoption at the entity level
Emerging 2.0 Informatics & Analytics Attributes
CMIO is aligned with Clinical leadership – Chief Medical Officer,
Chief Clinical Officer, Chief Transformation Officer or Chief
Integration Officer
CMIO must “pivot” focus from EHR adoption to people, process,
information and change – value realization
Expands responsibility beyond acute care to the “system of care”
or enterprise, analytics and innovation
Dyads, triads, matrix and “dotted line” leadership
Creates governance, demand management and value
management processes
Aggregates fragmented resources and defines standard
practices
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Key
Take-
Away
The CMIO needs a game
plan to formalize Health
Informatics
Transition
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From 1.0 to 2.0: Game Plan for Formalizing Health Informatics & Analytics
Clear Vision for Health Informatics & Analytics
Defined Strategy for Health Informatics & Analytics
Defined Organization Structure and Operating Model
Specific Roles & Responsibilities for core activities such as data definition and analysis, workflow design, content development, education, value management, etc.
Metrics or KPIs defined based on financial, quality or process metrics
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1.0: Decentralized Operating Model
Limited alignment or standardization of people, process, data integrity and
use, technology, information policies, etc
2.0: Hub and Spoke Operating Models
Hub - Corporate Standards, Centers of Excellence and Governance
Spoke – “Localization” v “Customization”
Daisy – Multi-Entity and Complex Organizations
From 1.0 to 2.0: Health Informatics & Analytics Operating Models
Key
Take-
Away
HI & Analytics Operating
Models must align with
Clinical Integration Strategies
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Emerging 3.0 Informatics & Analytics Attributes
CHIO has responsibility for information strategy and leadership
of Health Informatics & Analytics
Collaborative leadership across the C-Suite, less focus on dotted
lines and who reports to who
Digital capabilties are woven into the fabric of new business,
care delivery & reimbursement models
Focus on getting the right information to the right person at the
right time to make the right decision to care to create value
New capabilities in predictive and prescriptive management of
populations, personalized medicine, virtual care, retail care and
consumer behavior management
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Key
Take-
Away
CHIO partners to achieve
convergence of quality,
informatics & analytics
Digital Health &
Healthcare
3
“Local MIOs support service lines,
entities, regions, etc.”
2010 2015 2020
Health Informatics & Analytics Transformation Stages
Implement EHR systems
and align lean with
traditional quality
functions
Build new informatics,
analytics, transformation
and innovation capabilities
Rethink IT and Quality
operating models
Weave digital capabilties
into the fabric of new
business, care delivery &
reimbursement models
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Rethinking IT & Quality Roles
Information Technology
Centralizes operations to build economies of scale
Standardizes, and reduces complexity
Ensures security while expanding interoperability
Deploys ACO enabling technologies
Transitions operations from hospital IT department to multi-entity shared services provider
Integrates targeted SaaS & Cloud based technology, mhealth, social media and other digital innovations
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Quality and Performance Improvement
Uses registries for population health management
Applies analytics tools to stratify problems
Deploys lean and performance improvement skills to the frontline
Engages consumers and patients to improve processes
Shifts from retrospective analysis to enablement of real time, point of care decision making
Challenges business models through use of predictive and prescriptive analyses
Rethinking IT & Quality Roles
CIO Quotes from the Research
“We see the convergence of quality and informatics, and need strong physician leadership within the senior executive ranks”
Patrick O’Hare, Senior Vice President and CIO, Spectrum Health, Grand Rapids, MI
“The future is about information, integration and innovation”
Praveen Chopra, EVP & CIO, Thomas Jefferson University and TJU Hospital System
“Its no longer a hero’s game. Effective decisions require multiple perspectives. The information literate team is essential for the future”
Tim Zoph, Senior VP and former CIO, Northwestern Medicine
“Many of my peers are struggling, they want to remain in charge, collaboration is the future”
Bill Montgomery, Retired CIO, Hospital Sisters Health System
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CHIO Required Competencies
Thinking systematically about the health system as a
whole instead of its components
Leading change through people, process and the use
of information in addition to technology adoption
Leveraging the health system’s investment in clinical,
financial, care management, analytics and patient
engagement systems to drive value creation and
realization
Improving and reinventing care delivery across the
continuum
Convening multidisciplinary teams to improve care
practices and processes
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CHIO Required Competencies
Collaborating with other members of the C-Suite to lead
the convergence of quality, informatics and analytics, and
aligning with the overall IT strategy and direction
Leading teams of informaticists, process engineers, data
analysts, content management specialists, change
management experts and curriculum designs to
standardize care processes
Enabling patient and consumer engagement through
mhealth, social media and stratified health information to
improve wellness, prevention and management of
chronic disease
Thinking about emerging trends and enabling innovation
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HI’s Role in Redesigning the
Care Delivery Model
Access
Management
Mobile
Health
Telehealth Patient
Portal/PHR
Practice
Management
Electronic
Health Record
Data Exchange
Business
Intelligence
Patient Identity
Orders/
Referral
Management
Home
Monitoring
Information &
Workflow
Integration
prevents rework
& billing errors
Pressure on CGCAHPS
penalties (2-4%), is driving
larger group practices to
go out of network if in
network providers can not
see patients in a timely
manner.
Reducing no-shows and
improving access by creating
multi-channel contact centers
that aggregate disparate hot-
lines (i.e., find a doc, Ask a
nurse, scheduling, etc.) and
moves a portion of call volume
to online tools.
Stratified routine
visits become e-
visits which
enables PCPs to
meet same day
appointment
regulations for
PCMH
Reducing
treatments and
improving
recoveries by
monitoring data
collected via
wearable devices.
Increases provider
interactions to alter care
plans, improve patient
compliance, and avoid
readmissions penalties.
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“Health Informatics is as much
about computers as cardiology is
about the stethoscope” (Coiera,
1995)
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The Strategic View of the CHIO
Transition from meaningful use compliance enabled authority
to:
Strategic alignment with Clinical Excellence & Clinical
Integration Strategy
Partnerships and collaboration with Chief Clinical Officer,
Chief Medical Officer, Chief Nursing Officer, Chief Quality
Officer and others
Focus on people, process, information and change
Clarity regarding Information Technology and Health
Informatics roles and responsibilities
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Where are We Now?
CPOM live in all hospitals. 72% adoption
Successful MU attestation first 3 years. MU2 ready
Physician documentation in process
Health Informatics Department created, centralized
“Connected Care” Division
Clinical Intelligence Division
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Mission: To extend the healing ministry of Jesus Christ
Source of Funds Use of Funds
Clinical Integration Strategic Concept Map
Physicians Patients, Families & Communities Governmental & Private Payors
Human Capital Organizational Capital Information/Technology Capital
Growth & Innovation Relationship Management Clinical & Operational Excellence External Impact
Talent and
Technology
Strategic
Actions
Customers
Finance
Improve
Financial Sustainability
Grow Health Plan
Products
Assume Risk in Select Markets
Develop Capitation
Models
Reduce Healthcare Disparities
Enhance Clinical
Management
Enable Me
to Deliver Clinical
Excellence
Improve My Overall
Wellness and Quality of
Life
Be Good Steward of Health Care
Spending
Create Market Relevance with
Adequate Access Points and Integrated
Network
Improve Access to
Care Through Health Plans
Partner With Physicians in a
Meaningful Way
Create a Patient Centric
Network
Partner with Payers, Employers and Other Relevant
Stakeholders
Create Competent
Leaders,
Clinicians and Associates
Create a Culture of Engagement
and Alignment
Develop Seamless
Technology Platform
Provide
Exceptional Quality of Care
Optimize
Efficiencies
and Reduce
Unnecessary Spend
Enhance Our Impact in
the Communities We Serve
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The Strategic View of the CHIO
Creation of a Health Informatics Vision with Guiding Principles to guide our work across the entire health system
Development of a clear strategy that spells out Health Informatics’ strategic imperatives and critical success factors
A clear, multi year operating model that explains:
The relationship of the CMIO/CHIO with other C-Suite Executives such as the CIO, Chief Clinical Officer, Chief Quality Officer, etc.
The role of HI in convening and consulting with others
A resource plan that identifies skills, capabilities and gaps in competencies
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Meaningful Use
Connected Care
Clinical Decision Support
Clinical Intelligence
Clinical Documentation
Population Health
Management
Micro Macro
Highly Effective Clinically Integrated Risk Management
Clinical Operations Care Delivery & Accountable Care
Clinical/Medical Informatics Health Informatics
Valu
e
CHRISTUS Health Informatics Strategy S
trate
gic
Imp
era
tives
35
The Strategic View of the CHIO
Expand our focus on Value Realization
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“It does you no good to get swept up in the field of play.
Leaders must be able see a context for change or
create one…..” Heifetz and Laurie, The Work of Leadership, Harvard Business Review, 2001
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Questions Luke Webster, MD luke.webster@christushealth.org @LukeWebsterATL Pam Arlotto parlotto@maestrostrategies.com @PArlotto
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