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October 27- 30, 2009 | Indian Wells, California
The CHIME09 Fall CIO Forum is the most-cost effective method for CIOs to obtain focused professional education unique to the CIO. This is the event where you gain information, while establishing and maintaining relationships with other organizations and colleagues that are vital to long-term success. Follow blogs from H&HN Senior Editor Matthew Weinstock and Associate Publisher and Executive Editor Alden Solovy for daily insights from the meeting. All comments are welcome and may be posted to the blog. Comments may be edited for clarity or length. Click here to return to the H&HN blog homepage. |
Don't sell cold, dead fish
by Matthew Weinstock @ 11:30AM
Here’s something for all of the CIOs and technology firms out there to ponder: Are you creating value or are you just selling a product?
That’s the question futurist Thornton May, executive director and dean of the IT Leadership Academy, put to attendees at this morning’s keynote. You can guess what he thinks CIOs ought to be doing. Too often, he said, we get hung up on the product. If technology firms were put in charge of selling sushi in America, he suggested, “they’d call it cold, dead fish.” While technically accurate, it doesn’t do much to stir the soul or add a value proposition.
May, who is also on the faculty at Arizona State University, the Ohio State University, UC Berkeley and UCLA, delivered his lively and humorous presentation at a near-frenetic pace. Still, his overarching message wasn’t lost, and it’s a critical one for health care leaders, particularly CIOs, at this important juncture: The focus shouldn’t be the technology you buy, but rather how you apply it.
“We are using the wrong bait,” he said, referring to the typical approach of selling products and services to other executives. “The reason we live as C-level executives is to create value.”Submit a Comment | Back to Top
Vendor neutral
by Alden Solovy @ 10:10AM
One topic that has been nearly absent from presentations, questions and comments during the meeting: the role of the vendor in achieving meaningful use. That was the observation of Jim Veline, senior vice president and CIO, Avera Health, Sioux Falls, S.D.
Assume that every vendor has to make at least some modest change in its computer code and that the change needs to be rolled out to every customer. “That’s a pretty stiff timeframe on a scale that’s unprecedented,” Veline noted.
Perhaps the vendor role feels less critical because hospitals are focused on their own work. “Meaningful use falls on us to carry out,” said Mike Smith, CIO, Lee Memorial Health System, Fort Myers, Fla. “We’re going to have to translate this into our purchase decision. It put the onus on us to be better consumers.”
The criteria, Smith said, are straightforward. Are products intuitive, driven by workflow and producing a high-quality user experience?
Veline put it this way: “We’re looking to the vendor community to deliver here, and they are going to be hard-pressed.”
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Homework from Blumenthal
by Alden Solovy @ 9:35AM
On Wednesday after his keynote, David Blumenthal, M.D., National Coordinator for Health Information Technology, met privately with a group of 12 CIOs. The group reflected the diversity of America’s hospitals, from east to west, from academic medical centers to small and rural hospitals.
“We provided targeted feedback,” said Chuck Christian, CIO, Good Samaritan Hospital, Vincennes, Ind. Christian said that he had a specific message for Blumenthal: “I’m worried about critical access hospitals and onesie-twosie physician practices having the wherewithal to achieve meaningful use.”
Bill Spooner, senior vice president and CIO, Sharp HealthCare, San Diego, said he had a potentially unpopular message for the National Coordinator about meaningful use criteria. “There are some of us who feel that the bar is too low,” he said, noting that the stimulus funds will not be allocated fairly “if a neighboring hospital did half the work but gets the same check.”
Spooner said Blumenthal is “telling us everything he can. He’s giving us some direction,” adding that hospitals need to work on interoperability, CPOE and quality indicators.
The dialogue is just beginning, said Pam McNutt, senior vice president and CIO, Methodist Health System, Dallas. “We were given some homework,” she said. “He wants feedback from the field. What works? What’s not working? Are there unintended consequences?”
McNutt said that CHIME’s advocacy group will reach out to members, as needed, to gather feedback from the field. “The lines of communication are open,” she said. “That’s exactly what I hoped for.”
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'This is not trivial stuff'
by Matthew Weinstock @ 9:00PM
Bill Spooner, senior vice president and CIO at Sharp HealthCare, San Diego, gave us a little history lesson this afternoon, recalling that five years ago David Brailer, M.D., the nation’s first IT czar, spoke at CHIME and told the CIOs to get ready to join a RHIO. Remember those?
Today, Brailer is a venture capitalist and no longer stumping for health IT. There have been fits and starts in data sharing—mainly fits, especially in California. Oh, and we no longer refer to it as a RHIO. It’s a health information exchange, or HIE.
But perhaps the most significant change from five years ago is that the federal government is now mandating health information exchange as part of HITECH.
Spooner joined CIOs from three other health systems who are participating in successful HIEs. They all talked about the challenges:
- Physician and patient comfort with and acceptance of the technology
- Getting a variety of groups involved—providers big and small, employers, payers, patient advocates and vendors
- Making the business case for why hospitals need to get involved
- The technical architecture
- Governance models
Sustainability has long been the biggest trouble spot for HIEs. In Tennessee, CareSpark (http://www.carespark.com/) relies on transaction fees from providers and contributions from employers. The non-profit entity is also hopeful that Tennessee and Virginia state governments will help eliminate a $9 million debt, mainly the result of capital expenditures. The Nebraska Health Information Initiative (http://www.nehii.org/) charges membership and licensing fees.
But all of the CIOs also noted that HITECH and stimulus funds will drive information exchange. “This is not trivial stuff,” said Frank Richards, CIO, Geisinger Health System, Danville, Pa.
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Incentive or penalty, that is the question
by Matthew Weinstock @ 1:50PM
It’s become a reoccurring theme here in the California desert: should you charge full-bore with an IT implementation in hopes of chasing those highly-touted stimulus dollars, or take a more a patient and deliberate approach and avoid severe penalties down the road?
Linda Reed, vp of information systems and CIO at Atlantic Health, during a session this morning on ARRA readiness said each institution needs to do a full assessment—not just an IT assessment, but an organizational assessment—to answer that question.
There are a lot of things to consider, she said:
- What are the priorities in your current IT strategic plan? Would you have to shuffle the deck and put some things on hold?
- What’s your capability to archive, retrieve and report quality indicators?
- What’s your level of compliance with privacy and security protocols?
- What is your level of physician adoption? You can install CPOE, for instance, but how many docs are using it?
Reed said an assessment will highlight your gaps and how long it may take to catch up. “You have to think about what year you are aiming for,” she said. Which is more costly, rushing an implementation, or taking a couple of years of penalties? How ready are your vendors to supply a certified product?
After doing its assessment, Atlantic has decided to go for stimulus dollars. Reed thinks they’ll be able to deploy a certified system—recognizing that no one knows what that means at the moment—by 2012.
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Are information exchanges sustainable?
by Matthew Weinstock @ 12:40PM
Jamie Welch, CIO of the Louisiana Rural Health Coalition would tell you that the answer to that question is no. Well, it’s a qualified no. Health exchange by itself is not a financially sustainable model. That won’t come as a surprise to those of you who have seen RHIOs and other similar ideas come and go.
Instead, Welch’s group has built a telemedicine network between 44 rural hospitals and the LSU health system. That network, which went live in March 2008, turned its first profit last week, Welch said this morning during her presentation on rural health information exchange. The coalition charges the rural hospitals 3 percent of the revenue for an inpatient stay for a tele-consult with LSU. It’s actually a plus for the hospitals because they get to keep the patients in their facility, rather than shipping them to a large tertiary center.
The coalition built an information exchange on top of the network. It’s a federated model—so the patient’s main hospital keeps the record, but other providers (once a relationship with the patient is verified) can view it.
“We started with telehealth first because we thought access was more important,” she said.
She also had a word of caution for rural hospitals viewing stimulus funds as the Holy Grail: don’t. That reinforced comments made yesterday by Partners Health Care’s John Glaser. He said to be more concerned about the penalties that kick in for not complying with meaningful use. The stimulus funds, Welch said, will barely cover the initial outlay of building an information system.
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UK and US: High tech lessons for HITECH
by Alden Solovy @ 12:00PM
Broadly speaking, the EHR journey in England has the same goals of the EHR journey in the U.S. Change the way health care is practiced and delivered by implementing information technology. According to Archie Galbraith, chief technology information officer at UCLA Medical Sciences, both nations are ‘priming the pump’ of progress.
Galbraith was a consultant with Accenture in the U.K. when its national HIT plan began in the early half of the decade. To date, with roughly 400 hospitals, England has spent a bit more than $410 per person to implement its strategy. The HITECH breaks down to about $62.50 per capita. He’s concerned that the amount of money needed to keep the wheels of change in motion is staggering.
“We tried to buy our way into the future and it didn’t work,” Galbraith, asserting that “there isn’t a single [hospital] EMR installed and in use.”
There have been some successes in England, such as a 90 percent adoption of ambulatory EMRs, but Galbraith said the effort to push vendors to create functionality that didn’t yet exist failed miserably. He used the analogy of hospital construction: “It takes time to conceive it, it takes time to design it, it takes time to finance it and it takes time to build it.”
Take home lesson from across the pond: this will take time and money to accomplish…and mistakes will be made along the way.
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Big bang your way to an EMR
by Alden Solovy @ 10:30AM
“The heck with the small stuff,” Daniel Barchi told his team at Carilion Clinic as they pressed forward with a ‘big bang’ EMR rollout. “Don’t worry about it. As long as we’re not harming patients or violating privacy, we’re pressing on.” That, he said, is how you get things done.
Carilion, bucking common wisdom, started with largest, and therefore most complex, hospital, rolling out most applications. The organization then continued to press forward with the other seven hospitals, as well as one physician practice per week.
Barchi, senior vice president and CIO, listed five benefits of the big bang roll out:
- Reduces debate
- Demands intense collaboration
- Delivers results more quickly
- Demands more participation from clinical team
- Accomplishes the most difficult work early in the project
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Certifiable CIO
by Alden Solovy @ 8:30AM
So you want to be a hospital CIO? Get ready to climb up the learning curve. There are eight areas of knowledge that map into 13 skill sets that breakdown into 75 core competencies. Whew. And, of course, you’ve gotta know how to actually apply those core competencies in real world situations. Demonstrating that knowledge to your peers is the goal behind CHIME’s new designation: Certified Healthcare CIO, or ‘CHCiO.’
At a sunrise session, CIOs who helped design the 125-question exam told a full-house of professionals that the certification is designed to evaluate, recognize and distinguish CIOs in health care. On Tuesday, 45 CIOs sat for the exam. They hope to join 23 others who’ve already passed the test.
Whether or not the certification catches on and has real meaning in the market depends on whether or not CIOs participate and on the test itself keeping up with changing times. But there also appears to be a unique opportunity, a serendipitous consequence of all the work that went into developing the exam. There’s finally a coherent way to communicate to other senior managers in hospitals the depth, breadth and complexity of the CIO’s role.
My take: CHIME has created the means to educate the entire hospital senior management team about what it takes to be a CIO.
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Anxiety abounds
by Matthew Weinstock @ 8:30PM
It’s clear from Day 1 at the CHIME Fall Forum that hospital CIOs are anxious, some even nervous, about compliance with the HITECH Act and the pending definition of meaningful use.
Throughout the day, there were concerns about looming workforce shortages for IT professionals and the short timeframe—2011—for initial compliance with meaningful use, especially since a rule won’t be finalized until spring 2010. There were questions about a new certification process, which the feds also have yet to finalize.
CIOs are certainly grateful for the billions of dollars made available through the ARRA, but, as John Glaser noted during a town hall meeting, a stimulus law demands that monies be spent in relative haste, thus the expediency with which the law’s requirements kick in.
“This is a challenge,” Glaser said.
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Don't do anything dumb
by Matthew Weinstock @ 7:00PM
John Glaser put it in the simplest of terms: Don’t let the pursuit of money blind you. While you might end up getting federal health IT dollars, you could also end up damaging your organization and health system.
Glaser delivered that sage advice during a town hall meeting this afternoon focused on the HITECH Act. Glaser, who is pulling double duty these days as CIO at Massachusetts’ Partners Healthcare and senior adviser to the Office of the National Coordinator, urged the room full of hospital CIOs to be deliberate in their efforts to build electronic record systems. Sure, there are lots of federal dollars at stake, but he said hospitals should “not do anything dumb.” He suggested that hospitals look to recommendations from ONC’s policy committee as a good map.
Smaller providers, Glaser said, can turn for help to regional technology centers, which should be up and running starting next year. He also expects to see private-sector firms cropping up to provide guidance. Tony Rogers, director of the Arizona Medicaid/SCHIP programs, who appeared with Glaser, said hospitals can also play a role. More advanced hospitals can work with state governments to provide guidance.
Rogers said that there’s a possibility some states will try to tack onto the federal definition of meaningful use. The law allows for states with a special interest—say in population health—to ask HHS for permission to add on requirements. “Most states will default to the federal definition,” he said.
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The role of the patient
by Alden Solovy @ 6:45PM
When it comes to implementing a national HIT strategy, David Blumenthal, M.D., National Coordinator for Health Information Technology, said that “our guide will always be: where’s the patient in this? That attitude permeates my office.”
From a practical perspective, the role of the patient comes into the discussion to varying degrees depending on the issue, said John Glaser, vice president and CIO at Partners Health Care System and a senior advisor to the Office of the National Coordinator.
For example, the patient doesn’t get mentioned during discussions of certification. But Glaser said that the patient is front and center in discussions of meaningful use, privacy and health information exchange.
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Meaningful measurement
by Alden Solovy @ 6:20PM
The process of measuring and reporting that a hospital meets the meaningful use criteria—once those criteria are adopted—will evolve over time, said David Blumenthal, M.D., National Coordinator for Health Information Technology, during his morning keynote. “We’re going to be experimenting with the way that will happen,” he said.
That answer did not satisfy at least one CIO, who asked for an elaboration from John Glaser during an afternoon HITECH Town Hall event entitled “Meaningful Use and Beyond.” Glaser is vice president and CIO at Partners Health Care System and a senior advisor to the Office of the National Coordinator.
Glaser said that the simplest form of reporting will be for hospitals to certify to CMS that they meet the criteria. Remember, CMS will monitor compliance since it involves Medicare and Medicaid dollars. “To the degree that you make it up, you wander into fraud,” he said, adding that CIOs may want to give that approach second thoughts, noting the potential for the creation of a RAC-audit style process to check up on that assertion.
Both Blumenthal and Glaser say that measuring and reporting meaningful use will likely change over time. “There’ll be an evolution in sophistication,” Glaser said, adding that verifying meaningful use will “evolve into something more electronic and less burdensome.”
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Got more CHIME?
by Alden Solovy @ 4:00PM
So okay, we’re not the only one’s blogging from the CHIME Fall Forum. The CHIME staff is also posting updates from the event. Want more CHIME? Then check out the schedule, photos and more stories at http://www.cio-chime.blogspot.com/.
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Selling people their dreams
by Matthew Weinstock @ 3:30PM
Lowell Catlett, regent’s professor at New Mexico State University, certainly sent us off to lunch (well those attendees who went to lunch and didn’t go back to their rooms to file blog reports) with a lot to think about and smiles on our faces.
It’s the first time I’ve ever heard Catlett talk and I’m glad I did. He knows how to keep an audience’s attention, by effectively weaving together humor, hard facts and poignant commentary.
He started out talking about the recession, GDP, the affordable housing index—none of which was the true focus of his speech. He was really there to talk about Maslow’s hierarchy of needs, or more specifically, what health care leaders can learn from the hierarchy. People like his parents, who lived through the Great Depression, focused on elements that form the foundation of the hierarchy, such as food and water. Successive generations have climbed the ladder and now we find ourselves at the top, which is self-actualization. As each generation ascended, they didn’t want to go back down. Whereas coffee was a luxury for people who lived through the Great Depression, people today “whine because they can’t go to Starbucks 17 times a week.”
How does this relate to health care and health IT? Well, health care leaders have a dual role: they have to build the foundation (the IT systems), but also need to realize that today’s patients have very personalized needs and won’t accept a delivery system that can’t address them.
“Don’t sell people products and services,” he said. “Sell them their dreams.”
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Least wired reporter
by Alden Solovy @ 2:00PM
It was back to the future for me at CHIME, with pen and reporter's notepad doing the classic "person on the street" interviews after a keynote by David Blumenthal, M.D. It's kind of fun, simply asking folks for reactions.
My buddy Russ Branzell slyly noted that I was not using a digital recorder. I said that there was one up in my room, in my briefcase.
"This is how I was raised as a reporter," I told him. "I'm not always comfortable with the recorder."
As soon as I said it, I regretted it. And Russ got his classic grin on, suggesting I might fess up in the blog. So here I am, confessing: I'm an old school reporter, perhaps a Least Wired reporter.
Thank goodness there're no federal standards for meaningful use of IT in journalism.
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Revolution, not evolution
by Alden Solovy @ 1:45PM
CIOs agree: There was no new ground broken as David Blumenthal, M.D., national coordinator for health information technology, addressed the crowd. Yet, Russ Branzell said that "if you listen between the lines," CIOs got all the direction they needed.
Branzell, the CIO at Poudre Valley Medical Center, Fort Collins, Colo., said the gist of Blumenthal's message is all the direction a hospital needs to understand the upcoming proposed rule defining "meaningful use" is already publicly available.
"Take the last matrix and go for it," said Joanne Sunquist, referring to the materials released by the committees advising the Office of the National Coordinator on meaningful use. Sunquist is the chair of CHIME and CIO at Hennepin County Medical Center, Minneapolis. "People really want the specifics," she said, adding that "what's out there is 80 to 90 percent of what it's going to be like."
Even with the lack of specifics, CIOs said they appreciated the effort by Blumenthal to connect. "He did a great job of putting this in context and explaining some of the history and process we're in now," said Mary Ann Leach, vice president and CIO, The Children's Hospital, Denver. Her advice, like that of Sunquist and Branzell: Keep pressing ahead.
Branzell said the most important comment Blumenthal made is that the core goals for both ARRA and the HITECH Act are about technology as a means, not an end. In his comments, Blumenthal said the true mandate is to change the way medicine is practiced. Branzell interprets that to mean that health care "needs to focus on revolutionary change, not evolutionary change."
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Blumenthal speaks
by Matthew Weinstock @ 1:30PM
You can say this about Dr. David Blumenthal: He is certainly passionate about his work and his belief that information technology can transform health care.
Delivering the keynote this morning, Blumenthal didn't really break new ground. Those who expected him to hand out advanced copies of the definition of meaningful use—well, they were disappointed. In fact, he let it be known early on during his address that no such notice would be forthcoming today. We'll just have to wait like the rest of the world for a proposed rule to show up in the Federal Register, hopefully before year's end.
That's not to say that he didn't provide some tea leaves for people to read. Blumenthal emphasized that the rulemaking is focused on three areas, as required by law: e-prescribing, information exchange and quality reporting. He also referred several times to the importance privacy and security will play. In terms of other applications, such as personal health records or CPOE, he suggested that people take a look at the matrix from the Health IT Policy committee, which advises his office.
Another central idea, he said, is that meaningful use will get more stringent over time. So, the requirements in year 4 will be more demanding than in year 1. Interestingly, Blumenthal said he's been talking with credentialing boards and medical societies about how they measure core competency for physicians. Eventually, he believes IT know-how will be factored in.
Blumenthal worried, like many in the room, that a workforce shortage could hamper IT adoption. Some estimates, he said, suggest a shortage of 40,000 to 100,000 IT workers. His office puts it somewhere in the middle, maybe around 50,000. What's needed are not just technicians, he said, but a new breed of IT worker. They need to have interpersonal skills to communicate with docs who are reticent to try the new tools, they need to help in workflow redesign, and more.
That, in fact, was a key theme in his remarks: This isn't about technology. It's about using the technology to fundamentally change the way health care is delivered. It's about putting the patient first.
A couple of other thoughts on his speech:
- Just this week, he asked the policy committee to look at a growing privacy issue: Patients wanting to put access restrictions on their records, or parts of their records. How does that mesh with the needs of clinicians and administrators to get valuable information they need to make information exchange successful?
- The law only focuses on hospitals and physicians; there's no money for or mention of post-acute settings—yet everyone involved knows that they need to be part of the process. He hopes Congress will eventually address that, or that the market will bring these providers along.
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Meaningful use: All wet?
by Matthew Weinstock @ 1:00PM
The CHIME 09 Fall Forum started with a splash—literally. Three people took unexpected and accidental dips last night at the poolside opening reception. No one was seriously hurt. Thankfully, they fell into a small wading pool.
I didn't actually witness the slips and trips, but as people were retelling the story to me at breakfast this morning, I couldn't help but wonder if there was some parallel with the focal points of this three-day conference: HITECH, ARRA and, of course, those two glorious words "meaningful" and "use."
In a very informal survey at last night's reception and this morning at breakfast, a handful of CIOs I talked to were eager to hear what Dr. David Blumenthal would say during his keynote address. After all, it is one of the few speeches Dr. Blumenthal has given since becoming national coordinator for health IT some six months ago. And this is one of his target audiences—nearly 500 CIOs from hospitals nationwide, not to mention the EMR vendors present.
While no one really expected Blumenthal to reveal government secrets, like what meaningful use means, the CIOs I chatted with were skeptical. One said there isn't enough transparency from D.C. on the rulemaking; another worried that there would be too much stick and not enough carrot to spur IT adoption; and yet another wondered if we are moving too quickly, considering that the majority of providers—both docs and hospitals—are still feeling their way through the early stages of IT adoption.
They wouldn't go so far as to say that the rulemaking process is all wet, but they were certainly leery of the feds tripping and slipping along the way.
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Meaningful use and beyond
by Matthew Weinstock @ 1:00PM
There they are, those two little words: Meaningful. Use. Did you ever think that combining them into a single phrase could set off such a firestorm? Billions of dollars in funding hang in the balance as the feds do their best impression of Noah Webster and try to define "meaningful use" of an EMR. There certainly won't be a shortage of ideas—and concerns and questions—when hospital CIOs gather this week in Indian Wells, Calif., for the CHIME Fall Forum. And they'll be able to deliver their messages directly to the man in charge: David Blumenthal, M.D., national coordinator for health IT, is slated to give the keynote address Wednesday morning. He's sure to draw a packed room.
H&HN Executive Editor Alden Solovy and I will be there too, blogging all week. To get ready, we asked a few CIOs what they want to hear from Blumenthal. Here's what they told us:
- Pamela McNutt, senior vp, CIO, Methodist Health System: I think the No. 1 question on every CIO's mind is, "When will the definition of meaningful use and the required quality metrics be finalized?" The other big question many of us very active in advocacy have is, "What further opportunities do we have to provide input to the final requirements?"
- David Muntz, senior vp, CIO, Baylor Health Care System: I'd be curious to know how Dr. Blumenthal will measure success for the HITECH initiatives and on what basis will the public receive reports on the anticipated efficacy and efficiency of the related activities. What percent of compliance is anticipated for each of the major elements of the plan and at what intervals?
- Stephan D. O'Neill, VP of information services at Hartford Hospital: I'm concerned that the meaningful use criteria are setting the bar too high for hospitals and physicians who have not fully deployed an EHR.
Whatever Blumenthal says, you'll be able to read it here. And that's not all. Believe it or not, the three-day meeting will hit on topics other than the HITECH Act, meaningful use and stimulus money. For instance, there's the session "Back to the Future: Strategies for Success After the Economic Downturn," in which five CIOs will talk about their plans to survive in the "new economy." Another session that should be useful will consider how rural hospitals can start sharing clinical information.
Thankfully, I booked a late flight on Friday. I wouldn't want to miss the closing keynote: "Renowned symphony conductor Boris Brott interacts with 'Professor Siegfried' on screen, and together they will take the audience through the steps necessary to concoct anything from E=MC2 to an enlightened business plan... After each step, Boris conducts the audience playing their own musical tone bars, and concludes this inspiring presentation with a roaring rendition of the music from 'Star Wars.'"
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