From CMIO to CHIO: Information, Integration and Innovation

Transcription

1 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.

2 Conflict of Interest Luke Webster, Pam Arlotto, Has no real or apparent conflicts of interest to report. 2 HIMSS 2015

3 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 3

4 Pam Arlotto, MBA, FHIMSS President & CEO Maestro Strategies 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 4

5 Benefits Realized & Value of HIT 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 5

6 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 6

7 7 The secret of change is to focus all of your energy, not on fighting the old, but on building the new Socrates

8 CHRISTUS Health Luke do you have introductory slides for CHRISTUS size of mission, organization et al International Catholic, not-forprofit 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 8

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10 The Challenge. Starting Point c 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

11 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?)

12 12 Health Informatics at CHRISTUS Health

13 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 13

14 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 14

15 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 15

16 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 16

17 Enterprise Maturity Transformation Stages Fee for service reimbursement Hospital Consolidation Practice Aquisition 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 Some say this timeline is too fast other say it is too slow 17

18 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 Key Take- Away The CMIO is focused the tactics of MU and EHR adoption at the entity level 18

19 Emerging 2.0 Informatics & Analytics Attributes Transition 2 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 Key Take- Away The CMIO needs a game plan to formalize Health Informatics 19

20 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 20

21 From 1.0 to 2.0: Health Informatics & Analytics Operating Models 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 Key Take- Away HI & Analytics Operating Models must align with Clinical Integration Strategies 21

22 Emerging 3.0 Informatics & Analytics Attributes Digital Health & Healthcare 3 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 Key Take- Away CHIO partners to achieve convergence of quality, informatics & analytics Local MIOs support service lines, entities, regions, etc. 22

23 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 23

24 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 24

25 Rethinking IT & Quality Roles 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

26 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 26

27 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 27

28 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 28

29 HI s Role in Redesigning the Care Delivery Model Home Monitoring 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. Orders/ Referral Management Patient Identity Information & Workflow Business Intelligence Data Exchange Increases provider interactions to alter care plans, improve patient compliance, and avoid readmissions penalties. Access Management Electronic Health Record Integration prevents rework & billing errors Mobile Health Practice Management Reducing no-shows and improving access by creating multi-channel contact centers that aggregate disparate hotlines (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 Telehealth Patient Portal/PHR Reducing treatments and improving recoveries by monitoring data collected via wearable devices. 29

30 30 Health Informatics is as much about computers as cardiology is about the stethoscope (Coiera, 1995)

31 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 31

32 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 32

33 Clinical Integration Strategic Concept Map Mission: To extend the healing ministry of Jesus Christ Finance Source of Funds Improve Financial Sustainability Use of Funds Grow Health Plan Products Assume Risk in Select Markets Develop Capitation Models Reduce Healthcare Disparities Enhance Clinical Management Physicians Patients, Families & Communities Governmental & Private Payors Customers Enable Me to Deliver Clinical Excellence Improve My Overall Wellness and Quality of Life Be Good Steward of Health Care Spending Growth & Innovation Relationship Management Clinical & Operational Excellence External Impact Strategic Actions Create Market Relevance with Adequate Access Points and Integrated Network Partner With Physicians in a Meaningful Way Provide Exceptional Quality of Care Partner with Payers, Employers and Other Relevant Stakeholders Improve Access to Care Through Health Plans Create a Patient Centric Network Optimize Efficiencies and Reduce Unnecessar y Spend Enhance Our Impact in the Communities We Serve Human Capital Organizational Capital Information/Technology Capital Talent and Technology 33 Create Competent Leaders, Clinicians and Associates Create a Culture of Engagement and Alignment Develop Seamless Technology Platform

34 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 34

35 Value CHRISTUS Health Informatics Strategy Highly Effective Clinically Integrated Risk Management Clinical Operations Care Delivery & Accountable Care Connected Care Meaningful Use Clinical Intelligence Clinical Decision Support Population Health Management Clinical Documentation Strategic Imperatives Micro Macro Clinical/Medical Informatics Health Informatics 35

36 The Strategic View of the CHIO Expand our focus on Value Realization 36

37 37 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

38 Questions Luke Webster, Pam 38

39 Please use this blank slide if more space is required for charts, graphs, etc. Please remember to delete this slide.