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HIT Infrastructure, Optimization Among Top CIO Concerns

"I don’t think our primary efforts should be focused on customizing, modifying or developing transactional systems."

- Among the top current concerns of chief information officers is the build-out of health IT infrastructure needed for participation in value-based care models and population health management. Eight CIOs who participated in the 2015 Scottsdale Institute Fall CIO Summit in late September shared those thoughts, recently released in a summary report.

New payment models and system optimization topped the list of pressing issues, followed by mergers/acquisitions, security and competing for patients. Perhaps somewhat of a surprise, considering that the meeting took place just one week before the transition deadline, ICD-10 was not mentioned as a top challenge.

In some areas of the country, payers are getting involved with IT assistance. For example, Blue Cross Blue Shield is building collaborative provider partnerships in Michigan, providing infrastructure for IT systems, disease registries and other tools. However, the overall results have been mixed in various locations.

Jon Manis, CIO at Sutter Health, noted that his organization outsourced much of the IT infrastructure for population health management — but not without headaches in the areas of vendor responsiveness, prioritization, integration and costs. In fact, Sutter Health is moving to bring support systems and infrastructure back in-house, according to the report.

Bon Secours Health System launched its Medicare Shared Savings Program in partnership with a major insurer to outsource care management. Bon Secours found patients wary of working with an insurance company for care management. “We spent a lot of time integrating with them for less than optimal results,” said CIO Laishy Williams-Carlson.

The CIO panelists agreed that participating in value-based care models brings new challenges in providing data for health plans, which formerly managed costs using delayed claims-based data. Health plans now want real-time data — and not just from claims. Payers seek the integration and management of clinical and other data, too.

Emphasis on optimization

Meanwhile, summit participants also worried about optimization of existing systems. For instance, David Bensema, MD, CIO at Baptist Health Kentucky, shared what his seven-hospital organization has been going through with its Epic EHR implementation. In the past, the seven hospitals in the system functioned individually. They’re working toward “a more system-wide approach” in regard to governance and reduction of variability. The Epic installation will bring added focus to clinical measures and user experience, Bensema said.

Kyle Johnson, CIO at Eastern Maine Healthcare Systems, reported a major optimization effort with the existing Cerner EHR implementation, which includes a great deal of customization. Eastern Maine is pursuing more of an “off-the-shelf,” easier-to-maintain platform. Bruce Smith, CIO at Advocate Health Care, noted his organization’s divergence in EHR implementation, with the primary system being Cerner, but the medical group using Allscripts.

At Avera Health, CIO Jim Veline said physician productivity is a priority among optimization efforts, with a significant upgrade integrating tablet devices coming soon.

And with all of this optimization work comes the common issue of how to pay for it. Many of the panelists said they are looking for innovative ways to stretch their IT budgets with solutions that deliver high value. Case in point: St. Joseph Health System chose not to invest in implementing a new EHR when providers complained of usability issues, according to CIO Bill Russell. Instead, his developers are building a web layer on top of the legacy Meditech EHR to improve the user experience.

At the same time, Manis of Sutter Health pointed out that part of the solution for many healthcare organizations would be getting more from existing systems.

“I think what healthcare needs is more standard work,” said Manis. “The truth is, the EHR systems available today offer basically the same functionality. These are transactional systems and we need to use more than 30 percent of the features available in these systems before we start modifying standard systems or developing our own software solutions. Chances are, our requirements are really not unique and the functionality may already exist in the standard version of an installed system. I don’t think our primary efforts should be focused on customizing, modifying or developing transactional systems. Where we should be developing software solutions is in those areas that differentiate us in the marketplace, improve the efficiency of our clinicians or, perhaps most importantly, provide additional access and higher value to the patients, customers and communities we serve.”

Overall, the CIOs agreed that optimization efforts should focus on standardization and reduction of variability, along with improvements in workflow efficiency, EHR usability, IT systems education and tool adoption — all while preparing for value-based care.

Click here to gain access to the full report.




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