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

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“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

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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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