CIOs target population health, patient engagement in 2016

For systems like Mount Sinai, Meridian, Beebe and others, the demands of delivering better technology-enabled care continue to evolve.
By Mike Miliard
10:05 AM

Whether they work at small rural hospitals or sprawling, multi-state health systems, staffers at the 21 winning Healthcare IT News' 2015 Best Hospital IT Departments are very busy folks.

They were busy in 2015, and they'll be busy in 2016 as the demands of delivering better technology-enabled care -- all under the watchful eye of an increasingly demanding federal government, wanting bigger bang for its reimbursement bucks -- continue to evolve.

We polled the chief information officers of the winning IT departments and asked them about the projects they'll be pursuing in 2016 as well as their predictions for healthcare or health IT in the coming year.

Here's what some of them have to say.

Kumar Chatani, CIO: Mount Sinai Health System (New York)

The first order of business for 2016 is "ensuring that all of our IT systems can support our providers as they comply with New York State's new regulations requiring electronic prescribing of controlled substances," said Chatani. Beyond that, he offers a substantial to-do list for the 3,500-bed health system:

As digital medicine moves beyond the disruption phase, led by innovation, consumer interest and efforts to democratize access through applications and services, we will continue implementation of our digital medicine strategy across the enterprise.

[See also: The bold art of build-your-own IT.]

We will be focusing our population health management initiatives first around the tactical, such as supporting New York State's Delivery System Reform Incentive Payment (DSRIP) program in which Mount Sinai is one of the larger performing provider systems. We will also take a strategic view of such initiatives given that they will be core to our ongoing transition to value-based care and payments.

We will be concentrating on providing our researchers with tools to expedite pre-drug discovery efforts (e.g., analytics, integration with EMR data).

For our Icahn School of Medicine, we will be strengthening our Content Management and Collaboration management capabilities for our students and faculty.

As more millennials enter our IT workforce, we further enhance our tools and capabilities that they appreciate (e.g., Enterprise Social, Digital Workspace) in order to attract and retain talent.

As for his predictions for health IT in general this coming year, Chatani sees the following:

  • An accelerated migration to cloud services as part of efforts to reduce operational costs and complexity.
  • In response to an increasingly complex and active threat-scape, healthcare will focus considerable effort on IT security and "cyber hygiene" through the deployment of more sophisticated and defensive IT security infrastructure tools.
  • Vendors will need to better understand the financial realities of nonprofits and academic medical centers and come to the table to negotiate cost reductions.
  • Big data tools will harness the power of genomics for clinical decision-making at the point of care.
  • Risk management tools used by the insurance industry will start to be used in the provider environment in order to better manage care and costs.
  • Consumer-focused, patient-centric health IT will become further defined and lead to new innovations.

Judy Comitto, CIO: Trinitas Regional Medical Center (Elizabeth, N.J.)

For her part, Comitto, said 2016 "looks like a year of continuing security enhancements, updating security policies and educating the employees of Trinitas of all the perils that are out in the wild and woolly Internet.  An increased focus on analytics will also be on the front burner, she said: "We are on a quest of educating our consumers -- staff members -- of all the data stored and how we can help them mine that information."

[See also: Trinitas answers the big questions.]

As for larger industry trends, "I believe that 2016 will continue to rock and roll!" Comitto tells Healthcare IT News. "We will be learning more about the social issues of insurance reform and how successful -- if at all -- the Affordable Care Act will be."  Meanwhile, offering a sentiment that would be music to many hospitals' ears, Comitto suspects that "population health will grow as meaningful use becomes background noise."

Nancy Birschbach, CIO: Agnesian HealthCare (Fond du Lac, Wis.)

"We are headed into 2016 at full speed, and our slate of projects are as extensive as ever," said Birschbach of her 102-person IT team. "Our strategic projects include working with our ACO to select a clinical integration and analytics tool, expanding telehealth tools (and) implementing customer relationship management." Standing up Cerner's HealtheIntent population health analytics platform and expanding Agnesian's home monitoring program are also on the agenda.

On the tactical side, "projects are too numerous to fully cover," she said. But the short list includes implementation of an array of Cerner tools (maternity, anesthesia documentation, acuity based scheduling, etc.) and installing a replacement lab system.

As for industry happenings she expects to see this year, Birschbach said she's "hopeful that 2016 will be the breakthrough year for telehealth. As an industry we are lagging behind the rest of the world in the use of virtual technology, and collectively we need to advocate for improved reimbursement for these services.

"I am also hoping to see the foundation for interoperability really take hold as we move forward into Stage 3 meaningful use and beyond," she said. "We owe interoperability to our patients, and that means data standards for all!"

Rebecca Weber, CIO Meridian Health (Neptune, N.J.)

Weber's email to Healthcare IT News wasn't long, but she didn't need to say a lot to communicate just how much work is on the docket for 1800-bed Meridian this coming year: "Epic enterprise system implementation and two health system mergers."

She did have time for a few predictions, however. "More emphasis in mainstream health systems regarding population health and big data," Weber wrote. Mergers will continue at "a fast pace," she added, "one IT system projects" would continue apace and "biomedical/EMR integration" would see continued momentum in 2016.

Becky Magee, CIO: Washington Regional Medical Center (Fayetteville, Ark.)

A major women's health center expansion tops WRMC's to-do list for 2016, along with "new tower, expanded Ob-Gyn clinic, Level III NICU expansion, education center, helipad and network infrastructure implementation."

Some other strategic goals, she said, will include population health management ("expanded automation to support patient care continuum, health management and revenue capture with regional and statewide focus") and a more integrated EMR strategy ("as a health system IS has developed a multitude of EMR interfaces; do we move to single EMR vendor, or perhaps two?").

As for the industry at large, Magee predicts, not unreasonably, that "healthcare IT will continue to be mortar that supports the clinical and business workflows of our industry. The challenge is moving automation to an integrated platform versus the interfaced approach.

"The way reimbursement is changing in how healthcare gets paid will require both clinical and revenue cycle evolutions," she adds. "How can we move to episodic care (EMRs and billing systems) and automate the reality of our new world when perhaps our vendor partners are fragmented and not all our vendors understand the requirement NOW for a new approach?"

On the plus side, Magee predicts that 2016 is the year interoperability will become "not only a word we can pronounce and spell, but will be seamlessly delivered by our vendor partners because they also know it can be done -- and should be done, for the communities we all support."

Wade Jyrkas, Director of CIS: Lake Region Healthcare (Fergus Falls, Minn.)

This 108-bed hospital just opened a new clinic on its campus in December. "As a small IT department, we are hitting this with an 'all hands on deck' approach," said Jyrkas of his 15-person team. "My tech team is focused on getting the new equipment in place and tested while my applications and clinical teams are working with the clinical leaders to develop new workflows for the updated space."

[See also: At Lake Region, nurses carry the meaningful use message.]

Another big focus in 2016 will be security, he said. "While it has always been an emphasis for us, we have recently built a relationship with a new security partner and will be working with them on an updated, long-term security plan."

As Jyrkas bolsters the computer information systems at Lake Region, he expects that the rest of healthcare should "see a lot of EHR shopping" in 2016.  "It's quite clear that EHR vendors are not meeting the needs of physicians across the country," he tells Healthcare IT News. "I don't know that there will be any dramatic shift, or a mass exodus of any one vendor, but I expect everyone to shop around (even more than in the past) and see what's out there.

"Vendors, meanwhile, will be asked to demo and price their solutions quickly and without the lengthy RFP process they are accustomed to," Jyrkas predicts. "Hospitals and health systems have become experienced in how to use an EHR. We know more specifics in terms of what we need, what we want and what actually matters. This time around, healthcare entities have the advantage of having lived with an EHR for several years, and we know more specifically what we want out of our systems.

"When you couple this with the recent changes to meaningful use, which allow for an extended stay on Stage 2, I think the EHR market could see a lot of shopping over the next year or two," he adds.

By the same token, "I expect the EHR vendors to start releasing some more meaningful updates to their systems," said Jyrkas. "The focus has been on coding meaningful use changes and meeting the certification requirements. A lot of the MU modifications have created silo functionality that just doesn't flow with the rest of the system. I anticipate the vendors cleaning this up over the next year."

Finally, Jyrkas hopes to see some "additional clarity on the long-term status" of meaningful use in 2016. "The Stage 3 proposed rule has some pretty lofty measures. A big concern for us is that we will have to focus so much time and energy on meeting regulatory measures when we need to be focusing on optimizing how we use our EHRs to better care for our patients."

Bernie Clement, CIO Thibodaux Regional Medical Center (Thibodaux, La.)

"Our hospital is opening a medically-integrated wellness center next year," Clement tells Healthcare IT News. "Much of our current efforts are focused upon solutions to support the education, communication and integration aspects of that center and the wellness initiative as a whole."

In other to-do items, he said, "we have big process improvement projects focusing upon improving the admission and discharge process for our physicians and their patients. Finally, we want to leverage our investment in Health Catalyst (data analytics tools) to aggressively impact the Triple Aim."

Across healthcare, Clement said he thinks "physicians will finally begin to see value in their IT investments," in 2016. "It's been a few years now, since many of them have gone electronic -- with few reporting productivity improvements from it."

This year, he hopes that, "with everyone's interoperability efforts, improvements in clinical analytics, clinical EMR maturity levels and growing population health management expectations, physicians may begin to feel genuine benefit from their investment."

LaBebe A. Nickell, Senior Director of IT: Fort HealthCare (Fort Atkinson, Wis.)

Asked to lay out Fort HealthCare's strategic narrative for the coming year, Nickell offers a list of specific plans for some big-picture goals we're all familiar with:

Population health. "We are implementing Cerner's HealtheIntent. The solution allows an end user to analyze data on individual patients to better understand their conditions or gives them visibility to risk factors and disease processes for their populations at large."

Interoperability. "We are also implementing CommonWell as a first step in our interoperability journey. Our goal is to be as connected to other EMR data as possible providing the necessary patient information to our providers."

Patient engagement. "OpenNotes is something we plan to turn on Jan. 1, 2016, for our patients. We believe providing patients access to their data through their patient portal will help them stay engaged in their health plan."

Security. "We have rolled out secure texting at our hospital and plan to do the same at all the clinics beginning in 2016. The goal is to provide a HIPAA compliant solution to clinicians allowing them to text PHI, images and videos to their peers."

Asked for wider predictions, Nickell confesses a bit of uncertainty: "I wish I had a crystal ball to determine where healthcare is headed, but I suspect the future of healthcare will experience more change over the next few years than it has the last 30," she said.

"While meaningful use was disruptive to the industry (some good, some bad), we were all in it together and it provided set rules/regulations. Population health is 100 times bigger and the road isn't yet paved; it isn't just about the data or the tools used by clinicians, it is really about changing the way healthcare organizations think about practicing medicine.

"Care models must change to support the needs, which is a dynamic shift in the way we think today," she adds. "How will we support the added work that population health will bring about? It's all unknown, and it's up to healthcare leaders to figure it out. A very exciting time to be in healthcare technology."

Michael J. Maksymow, CIO: Beebe Healthcare (Lewes, Del.)

"For the last few years we've been building, implementing or changing out EMRs and (managing) the on-again, off-again deadlines for ICD-10," writes Maksymow in a long and detailed response to Healthcare IT News' 2016 for 2016 predictions.

"Now, with these distractions behind us, we can focus on taking the EMR to a higher, more meaningful level to allow us to truly transform healthcare."

"As I'm sure is the case with my other colleagues, my list is too numerous to mention in one article," he said. "We are continuing down the path of legacy system replacement and consolidation with our Cerner EMR, as well as continuous enhancements and functionality to improve its use. Some examples of significant projects that recently kicked off include surgical, anesthesia, GI, capacity management, secure texting and communications for providers and clinicians and blood/breast milk management." Most will go live early- to mid-2016, he said.

"We have several dozen projects already in flight in various stages, and we will be looking at digging deeper into analytics, population health and care coordination technologies," he adds. "We're also looking to do some more cool development\alpha\beta activities with our vendor partners."

Industry-wide, Maksymow said he thinks 2016 will be very exciting for health IT. He offers the following predictions, grouped by category:

Security. "Listed first purposely, security must be paramount to everything we do in HIT and beyond. Rather than a check-the-box security risk assessment, I think organizations are getting a real wake-up call with the number of breaches hitting the headlines. This will include increased C-Suite and Board awareness and interest, significant increase and improvement in user education, implementation of technologies such as Security Information Management systems (SIM), the planning and implementation of BioMedical device security management programs and outsourcing security management to various degrees. However, I think the biggest security development coming in 2016 will be in networking and information sharing. Instead of each healthcare organization combating cyberthreats alone, we need to collaborate, learn from each other and share real-time information. I think we'll see a significant increase in security association memberships information sharing networks, such as NH-ISAC and AEHIS (a CHIME Association for senior security leaders)."

Interoperability. "Most organizations have been using EMR's for some time now for documentation, ordering, alerting and notifications, clinical decision support rules and even some sharing of documents and data with other providers, patients and Health Information Exchanges. It's time to take interoperability to a national level. In our service area, many of our patients flee to warmer climates this time of year (we affectionately call them "snow birds"). The ability to provide meaningful clinical data to their out-of-state primary care physician or emergency physician (and vice versa) should be seamless. Frankly, there should be seamless access to patient's data regardless of geographical distance."

"Beebe Healthcare is fortunate to participate in a mature and progressive state HIE, the Delaware Health Information Network, to share data with the other Delaware hospitals and over 98 percent of our providers in the state of Delaware; however, the information is contained within the state (with the exception of sharing ADT information with the state of Maryland's HIE). Beebe Healthcare has disparate ambulatory and acute care EMRs and we are collaborating with one of our competing hospitals (Nanticoke Health Services, Seaford, DE), Athena Health and Cerner in the development, implementation and participation in CommonWell Health Alliance to share our clinical data with other participating CommonWell members for the benefit of excellent patient care."

Collaboration. "On a local level, small community hospitals just do not have access to the same capital and human resources that many of our larger systems and metropolitan healthcare organizations have; yet we have the same needs. Instead of two neighboring and competing hospitals separately pursuing a similar technology, they both can benefit by leveraging each other's strengths. At this level, there is no sharing the recipe to the 'secret sauce,' we're simply discussing bits and bytes, lessons learned, etc. Beebe Healthcare and our competitor/collaborator Nanticoke Health System have enjoyed many benefits of such a collaborative approach and our teams continue to meet or talk every week or two."

"On a macro level, the healthcare industry lags many other industries in setting industry-recognized standards to share data. In a presentation at the 2015 Cerner Health Conference, John Glaser, Cerner Executive VP spoke on this very topic and cited examples of how retail, finance, manufacturing and other industries have agreed upon standards (i.e., UPC codes, ATMs) to drive their costs down and facilitate efficient operations. Not only were they able to reduce cost and gain efficiencies, as a result of these collaborations, the consumer gains in the form of electronic banking, payment cards, EZ Pass, automotive safety, etc."

Open Source. "SMART/FHIR will catch fire! What EMR has done for healthcare, SMART apps on FHIR will do to EMR. To have the ability to take data from EMRs and present as meaningful information is a great thing for our clinicians, but to do so using a simplistic, secure and open technologies to do it yourself right NOW is awesome! Currently, driving desired software enhancements through a software vendor partner can take months to years to develop. Can you imagine browsing through an 'app store' to find a clinical application that enhances your clinicians' workflow and download the plug-and-play application to work with your EMR? Furthermore, FHIR is positioned well to ignite interoperability and provide for exchange of deeper clinical data among FHIR compliant EMRs."

Twitter: @mikemiliardHITN