CIO Roundtable Maps Out 2008 Imperatives

By Adam Stone

Feb. 12, 2008 | Linking business and clinical technology systems, dealing with data security, and coping with new government requirements lead the list of 2008 challenges according to a roundtable of health care CIOs held last week and moderated by HIMSS Analytics President and CEO Dave Garets. The discussion was sponsored and hosted by Picis.

Participating in the wide-ranging discussion were Novant Health CIO Richard McKnight; Sharp HealthCare CIO William Spooner; Saint Barnabas Health Care System CIO Joseph Sullivan; and William Olser Health Center CIO Judy Middleton. Perhaps not surprisingly this year, concerns about business issues shared center stage with questions of technology.

At Novant Health, a not-for-profit integrated group of hospitals and physician clinics, McKnight said, there is a growing expectation that technology can deliver everything, all the time. In an ideal world, "everything is up and working 24 hours a day every day of the year," he said. IT will have its hands full meeting that demand.

At the same time, this year will see Novant continuing to press for a paperless environment, with greater use of electronic medical records and other means to taking paper processes digital.

Saint Barnabas' top IT exec Sullivan is seeing a push to keep systems secure and operational. "What are we doing about disaster recovery and business continuity?" he asked. Even the best systems are flawed if they cannot be kept running in case of emergency, he insists.

As important as these technology systems may be, it is equally important that they be tied to fiscal and business outcomes, especially recent evolutions in the revenue cycle.

Moderator Garets pointed especially to the demands of HIPAA claims attachments as a likely area in which technology tools and revenue cycle needs might coincide. Others saw the issue as one of customer service.

"We are taking this as one of our bigger initiatives," McKnight said. As patients re-envision themselves as consumers, they will want to understand the details of their bills, which in turn drive the need for software that can accurately estimate the cost of services.

As New Jersey's largest integrated health care delivery system, Saint Barnabas provides treatment and services for more than 225,000 inpatients and same day surgery patients and over 1.5 million outpatients each year. Sullivan said the leading issue at Saint Barnabas is one of accuracy, with new contract management systems in place to ensure the system is running the appropriate charges.

Given these pressures, Garets suggested it makes sense for changes in clinical systems to be paralleled by upgrades the revenue-cycle systems. This may be easier said than done, however, thought panelists.

Spooner for instance said he would welcome a reimbursement system in which clinical indicators could be tightly integrated into revenue systems information. "Unfortunately, a lot of those products haven't quite gotten ready for prime time yet," he said. "But we are going to continue to look at them. "This is going to be a very, very careful evaluation."

All the CIOs said they would be carefully looking at the ongoing issue of preventable medical errors. Government regulations have spotlighted this problem and the continued government scrutiny promises to put the pressure on CIOs to find technological remedies.

Sharp HealthCare is ahead of the curve on this said its CIO, Spooner. Three years ago the health system implemented a web-based tracking system to follow the trajectory of suspect events.

Now Spooner is pushing the question further, looking deep within core clinical systems in order to flag systemic problems that might be causing preventable error. Those reviews may lead to the implementation of precautionary measures. Along those lines, Spooner said, Sharp would have a method for tracking hospital acquired infections within the next year and a half.

Also in the realm of government mandates, the CIOs said they are busily implementing systems that can accommodate new requirements linking reimbursement to clinical outcomes. Executives at the upper echelons are giving the matter serious attention.

"The CEO definitely sees the reports and he meets regularly with the 'number ones' of all of our hospitals" to review scorecards and compare performance against similar-sized health systems, Sullivan said.

CIOs described the increased use of business intelligence software and other data capture methods for tracking clinical outcomes. Sharp HealthCare is devoting four to five full-time equivalent employees to maintaining and expanding data capture efforts for performance indicators.

On the financial front, the pressure of ROI likewise bears mentioning. New systems can improve patient safety and quality of care. Physicians may become more efficient. But how do we turn those often intangible virtues into fiscal facts?

"It is really tough to do an ROI on many of these systems in a hard calculation that would make an accountant comfortable," McKnight said.

Even as CIOs consider business processes, reimbursement, and medical error, there is another priority weighing heavily on their minds as a new calendar year begins. That is, the ever-growing threat to security.

"I worry continuously about illegal access into my wide area network and from there onto my local area network," Sullivan said. With black hats far out-manning his internal protective resources, Sullivan has begun to think beyond merely building fences. Looking ahead, security will mean getting a jump on the enemy, "sniffing what is going on, rather than being reactive."

At Novant Health, McKnight has taken the problem beyond his own staff, bringing in outside security firms to run random tests on the security of his systems. At this point, he fully expects some degree of failure. "The first time that firm finds no problem, I change firms," he said.

Ironically, all the technology fixes in the world still may not be enough to overcome the present challenges, Spooner said. "There is a whole industry of identity theft under way...whole teams of people that are out there networking, trying to hack systems," he said, and yet "we are still vulnerable to a good employee gone bad."

Reimbursement, performance metrics, security: What do all these themes have in common? In each the issue transcends technology, reaching into the very core of a hospital's business needs. As a result, the CIOs said, the role of the technology executive in the coming year will continue to expand beyond mere bits and bytes.

"The CIO more and more is engaged in the business," Spooner said. The tech exec these days is "engaged in change management, in process and workflow design."

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