IT and informatics play well together

'If you have the clinical leadership, and you're willing to make those cultural changes, Epic is going to work, Cerner is going to work.'
By Mike Miliard
11:11 AM

When CHRISTUS Health decided to spin out two separate IT and healthcare informatics departments, there were plenty of challenges to grapple with. But so far the decision has been well worth it, with both clinical and financial ROI.

[See also: Clinical informatics critical to reform]

A balanced, well-defined and cooperative relationship between the two sides – with each focused on the tasks it does best – is key, says Bill Morgan, senior regional director of information management at Corpus Christi, Texas-based CHRISTUS Spohn Health System, which comprises six hospitals and six family health centers along the Gulf Coast.

"As CHRISTUS Health made the decision to stand-up a formal informatics department and separate it out from information management as a pure IT function, we came to realize there were a lot of little things IT was doing," says Morgan. "There was a lot of regionalization of the informatics effort. And in order to get a full-on informatics capability, CHRISTUS decided to break it out separately."

[See also: CEO resigns amid troubled EHR rollout]

In many ways, making that decision was the easy part. The real hurdles came when it was time to decide how to implement it.

"The challenge our organization has faced is, 'OK, we're going to have a separate informatics capability, what does that mean? What does that look like? Who does what for whom?'" says Morgan.

That meant developing and implementing strong governance requirements for both the IT and informatics teams, thinking hard about the right skill sets for both staffs and being agile enough to evolve workflow processes under this new way of doing things.

Marc Stearman, director of health informatics at CHRISTUS Spohn is also a physician's assistant by training, and says that on the clinical side, "We're wired a lot differently than the tech people are."

So having "an acute sensitivity to clinical workflows and the end-user is really what is, in my opinion, the real value in having a dedicated informatics group," says Stearman. "From my experience, the key to informatics maturing as its own discipline is really emphasizing the 'health' in health IT initiatives."

At CHRISTUS, "not unlike at a lot of other large healthcare organizations, there were a number of technology implementations and rollouts that weren't, how should I say, overly embraced by our clinical end-users," says Stearman.

With this new set up, he says, when "thinking in terms of implementations and technologies and the way forward, we now have clinical representation at the table that advocates for insuring a clear understanding about how the technology might be disruptive to clinical workflow and how we can mitigate against that."

CHRISTUS hired a dedicated chief medical informatics officer about three years ago.

"That was the first seed planted, if you will, in formalizing and centralizing our informatics program," said Stearman. "He reached out and pulled some of the regional informatics assets together, and we began to have a discussion about how we could centralize all these assets and bring them under one umbrella."

But there were complex personnel issues related to "culture and turf" to untangle along the way.

For instance, "informatics personnel at the time, in all the different regions were really reporting up through nursing structures," he said. "We had some of our lab folks – though not formally considered lab informatics people – answering up through the labs, the pharmacists answering up through the pharmacies. We had a lot of different individual silos. The real challenge was then pulling the resources out from their individual chains of command and bringing them all up under one umbrella."

It was disruptive at first, says Morgan, but big changes in healthcare – from technology to delivery methods to payment models – meant that most people recognized it as the right way forward.

"No one likes change," says Morgan. "From a junior analyst all the way up to the executive suite, no one embraces change naturally. It's something you really have to lead. But healthcare is changing all around us. You may hear physicians talk about standardized order sets as 'cookie-cutter practice,' or computerized provider order entry as 'cookbook medicine.' But we understand that we have to embrace the change in order to be successful. We're not there yet. It's still very much a journey."

Naturally, folks with different areas of expertise have different perspectives on how departments should be set up, he says.

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