Q&A: Kumar Chatani, CIO of Mount Sinai Health System
The Mount Sinai Health System is an ambitious, acquisitive and quickly-growing leader in the New York market, with revenue of $2 billion. The system consists of a medical school, several research institutes, seven hospitals and a large ambulatory network, and it is standing up a new health insurance company.
Kumar Chatani, the system's executive vice president and chief information officer, manages a budget of roughly $240 million and 800 full-time staff members. Under his leadership, the Mount Sinai Health System won the HIMSS Enterprise Davies Award in 2012. Chatani recently offered his thoughts on a variety of topics to Healthcare IT News.
On using technolgy to empower value-based care:
IT systems are integral in facilitating the shift from the traditional fee-for-service model to value-based care. We have elements of this in place to support our accountable care organization, but we need to do more. We will move from an environment that is focused on having systems available everywhere to one in which data is available everywhere in a system-agnostic manner. To support patient engagement, we will increase our use of e-health and telehealth to provide all of our stakeholders, providers and patients alike with tools that enable greater involvement in care, and support expanding our focus from treating conditions to one that also addresses health, wellness and prevention. We will leverage the "Internet of Things" to provide context-based and location-aware solutions.
On how collaboration, not control, drives innovation:
There is extensive collaboration and coordination between our central information technology department and the specialized technology functions created in certain departments. Researchers in areas like genetics and genomic sciences are in the business of discovery, and that often includes enhancing and developing new technology to support their discovery mission. We do not want to limit their agility through excessive constraints. The information technology department works and supports these researchers, working closely with the researchers to develop new policies on data governance and use as research moves into new territory in genetics and personalized medicine.
[See also: Mount Sinai drills down on care]
On how an enterprise master person index bridges legacy systems prior to Epic rollouts:
The EMR is a key enabler behind the Mount Sinai accountable care organization, and it has a profound impact on safety, quality and efficiency and provides a data and research platform for the National Institutes of Health and other grants.
Our long-term plan is to migrate all our sites to the Epic EMR. In the meanwhile, we have several legacy EMRs that are connected through the internal and external health information exchanges. We are creating the enterprise master person index to provide a unique patient identifier across the health system.
On cinical decision support and external reporting driven from the EMR:
Epic's decision support capabilities, such as duplicate test alerts, potential drug-drug interaction warnings, and allergy or contraindication information, allow for safer patient care. Prior to Epic, clinicians manually assessed patients for signs of sepsis, requiring them to be experts in this area. The "Triage Screening Sepsis" best practice alert uses an algorithm that evaluates eight criteria of sepsis infection based on standards by the Greater New York Hospital Association. BPA alerts clinicians the patient has screened positive for a possible sepsis infection. When the BPA fires, it prompts nurses and providers to place orders to initiate early, aggressive sepsis care.
[See also: Mount Sinai links EMR with DNA]
Prior to the Epic go-live, monitoring patient vaccinations was especially problematic because immunizations were occurring in both outpatient and inpatient settings. Clinicians were often forced to rely on the patient's memory for immunization history. Vaccination compliance is now monitored and tracked in the EMR and ensures nurses on both the inpatient and outpatient units access and view a patient's vaccination history. The system reminds nursing every 24 hours to administer the vaccination until it is completed. In the event a vaccination is not administered, the discharge process cannot be completed. This EMR workflow has resulted in close to 100 percent vaccination compliance for patients who receive care in Mount Sinai Hospital and Mount Sinai Queens.
Clinicians quickly generate lists of patients meeting particular criteria. The health system used this feature to group, track and treat patients during an MTA subway derailment and a gas main explosion that left many injured. Case managers have also used this tool to identify and coordinate patients in need of nursing home placement. The platform is useful for bio-surveillance and reporting to the New York State Department of Health. Real-time data is now sent directly to the New York City immunization registry.
On how innovation in the ED empowers transitions to acute care:
The ED continues to use various platforms that have transformed the way care is delivered. The informatics team has built numerous "track board" icons and signals to inform staff how patients are being treated and where they are located throughout the hospital. The platform opens the lines of communication. For example, a track board allows providers to see whether a colleague left a note after a consultation or whether their patient was recently discharged. The ED used this tool to specifically track patients with pending radiology studies. In the geriatric ED, nurse practitioners use this technology to monitor patients at risk of falling or becoming delirious.
On best practices for EMR rollouts:
Implementing an electronic medical record is a complex process that involves technical acuity and an appreciation for the human element involved in the rollout. The team learned early on this is not a technical implementation, but an overall clinical transformation. Challenges arise in ensuring staff is aware of their changing workflows and are adequately prepared to seamlessly transition to an electronic platform. Our most valuable lesson learned along the way has been to implement an intricate, formal change management program, assign project managers to oversee the plan and appropriately fund the project. This allows clinical champions, front-line nurses, trainers, superusers and other resources to fulfill duties as members of the implementation team during the course of the project.