Health Care IT Checkup

By Michael Hickins  |  Posted 2008-06-26

Health Care IT Checkup

All CIOs are charged with aligning technological operations with business needs. In the health care industry, the stakes are about as high as they can get.

eWeek recently conducted a virtual roundtable discussion with two prominent CIOs in the health care field: George Conklin, CIO of Christus Health, and Rich Temple, CIO and vice president of IT at Saint Clare's Health System.

Conklin, who recently oversaw the deployment of server virtualization at Christus, is undergoing the project of integrating information from across the organization.

Temple implemented a computerized EMR (electronic medical records) system at Saint Clare's, deploying 17 different clinical solutions in four different hospitals. Temple also has been involved in bringing workflow automation technologies to the hospital.

eWeek Executive News Editor Michael Hickins posed several questions to the CIOs in a recently conducted e-mail exchange.


Health Care IT Checkup

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Which is more urgent: portable electronic health records owned by patients or electronic health care records in the hands of health care providers?

Conklin: These are two very different things, for very different purposes, and so I need to say both are important. In both cases, though, they need to be affordable and have a business model attached to them that makes sense for all parties.

The PHR [personal health record] is important given the increasing mobility of American citizens-also, being very sensitive as a Gulf Coast health care provider, as a source of information in the event of a catastrophe of some kind.

The EMR is necessary, in spite of the recent CBO [Congressional Budget Office] report, because we do believe that it makes care more efficient across the entire service delivery spectrum and increases care quality, as well.

When I say "service delivery spectrum" I mean the entire cycle of care as defined by Michael Porter in "Redefining Health Care." That is, across traditional acute care, through home care and across the myriad other health care services to which a person might go.

So, to me, both these are urgent activities. We approach both as components of our overall strategy.

Temple: Near term, I would say that electronic health care records in the hands of health care providers would be the more immediate priority. I happen to be a huge fan of the notion of PHRs, but I don't think they will be adopted by consumers on a large scale until such time as the various EMR and EHR [electronic health record] systems out in the marketplace can automatically feed data to these PHRs.

In other words, I don't see a lot of uptake by consumers if the PHR mandates that they enter all their own data manually-not to mention that much of what would be inputted would be subject to human error. As EMRs and EHRs get an increasingly large footprint in provider locations and the ONCHIT [Office of the National Coordinator for Health Information Technology] begins to push more on the concepts of standardization and interoperability, I see PHRs taking off. But the first critical event is the increase in provider deployment of EMRs and/or EHRs.


System Interoperabillity

The federal government is encouraging interoperability of health care systems within regions but not on a national level. Do you think this approach is the right one, or is it likely to create more silos of information?

Conklin: As noted above, we are seeing both increasing mobility and disaster response as reasons for a more national answer to the problems we have today. This does not necessarily mean a centrally mandated and driven IT solution, but more thought around the entire system of health care and better answers to the problems that plague it today. The right kind of information systems infrastructure will evolve out of that.

Temple: Frankly, I am ambivalent about the "regional" approach the federal government is employing. I understand their desire to allow different regions to do things their own respective ways (kind of like the concept of "home rule"), but that does open up the unfortunate situation of silos of information and also reduces the ability of these regions to exchange data with one another down the road.

On the other hand, while there is much appeal to have a single standard that all health information exchanges in the country would have to adopt, the burning question then becomes, "What entity defines that standard?"

Who is involved in making the tough decisions that need to be made to come up with a standard that is workable for as many segments of the health community as possible? How involved does the federal government need to be in this standards-creation process? If the feds are heavily involved, that opens a whole Pandora's box politically in terms of data privacy and the notion of government dictating to industry that will inevitably receive pushback.

So, I remain kind of on the fence with regard to this question and am eager to see how things play out.


The Price of Privacy

Do you think patients will trade a certain amount of privacy in exchange for better, less-expensive health care? Do you think this is a trade-off that will have to be made for health IS to provide value?

Conklin: Yes, I think that they will, as long as the information stored in records can be kept private and we answer very fundamental questions about how information can be used against individuals (for example, companies not promoting or hiring individuals with risk factors of some kind known only through medical record).

Frankly, this last point is something that argues from my perspective for removing employers from the insurance mix. Instead, we might have a government-managed pool into which employers contribute and that is allocated to payers based on some criteria. This might, in fact, make payers more competitive and consumer-conscious. Government already has a portion of the needed infrastructure in place with Medicare to manage this.

Temple: It is going to take a real "sales job" on the part of the health information exchanges to instill confidence in the consumer community that their sensitive medical information is safe. 

The finance industry has made great leaps in this regard, but compromising someone's health data can be considered to be an even bigger violation in many ways [than compromising financial data] and even more dangerous if certain entities were to wind up making hiring, life insurance or other key decisions based on data that was legitimately or illegitimately gleaned from a health information exchange.

So, it is going to be a tough sell. Every time I think we may be making progress, there comes along another report of sensitive medical data being compromised somehow-stolen laptops or things of that ilk-and the sales cycle starts all over again.

At some point down the road, we will get there, but we as an industry really have to improve our security safeguards and articulate the message to consumers once we are confident that we have mitigated the lion's share of the risk that people might experience with having their medical data potentially accessed "pervasively," so to speak.


Reducing Cost and Inefficiency

Do you think that electronic systems can be implemented to help take cost and inefficiency out of health care billing and payment systems? Have you seen any that hold promise?

Conklin: There is an assumption here that we are paying too much for health care. I am not sure that we necessarily are. While I do believe that systems can make care more efficient and effective, I am not sure that it will cost less as a result (except if we somehow slow expectations of speedy return on investment dollars for the big systems developers).

We are in the process of implementing an architecture that will support services across our entire organization, including traditional acute care, community services, retail services and our international markets. These services will provide the capability to create a very customer-friendly, "sticky" environment like that on where we will be able to customize relationships with our customers (patients, clinicians, family members, retail shoppers, and so on).

The challenge we are addressing is to bring exactly the right information to the point of service, whether that is bringing the right clinical information to a retail activity (for example, knowing a patient's allergies when he or she is buying vitamins from our e-store) or into a clinical interaction (such as remote monitoring of a patient to ensure compliance or that we can intervene with a lesser level of service before a patient's condition deteriorates).

Temple: Absolutely, positively, unequivocally. The challenge is that every inefficiency and dysfunction within the health care delivery system has a well-funded stakeholder who stands to lose a great deal if that inefficiency were to be remedied. The technology is here today, but we need a political will to really mandate that it get deployed. HIPAA [Health Insurance Portability and Accountability Act] was supposed to be a big step in that direction, but the HIPAA transactional standards have been around since 2003 and really even to this day haven't enjoyed the traction that we all thought they would to streamline and digitize many aspects of the health care revenue cycle process.


Value for the Dollar

Americans have looked at health care as something for which we'll pay any price-anyone should be able to have the best medical care available to save their lives. Recent moves to publish health care report cards online have come under attack as giving inaccurate pictures of the health care provided by various institutions or for trying to quantify the unquantifiable. Do you think hospitals and other health care providers can be held accountable through means such as online report cards? If not, how else can we be sure that we are getting value for dollar in an era where health care costs are soaring as a percentage of GDP?

Conklin: We believe in transparency and so have been publishing our quality and performance information for quite some time and making it available on our Web site ( So, yes, we do believe that report cards are important. However, as long as the focus remains solely on physicians and acute care and we do not fix the problems with the underlying health care system, this data will only tell part of the story.

We need a more rational health care system focused on health and wellness, rather than sickness. And statistics ought to be focused on finding out who does a better job keeping people healthy, versus morbidity and mortality statistics, patient satisfaction, measures of efficiency, etc. Until we tie all these pieces together and develop report cards focused around health and wellness, we will continue down the present, untenable path.

Temple: I think the idea that we can enforce accountability for clinical excellence via "hospital report cards" is a terrific idea on the face of it and should be encouraged, but there are some real issues with it. For instance, could an insurer who may be creating a "report card" for its members gauge its providers based on providing what it deems to be the most "cost-effective" care versus what the safest care might be deemed to be?

Also, even if you get past the notion of possible bias, how do you craft a report card that is robust enough to be useful but not so complex as to be overwhelming to a consumer? Another thing to consider-if you are grading the level of mortality for a given procedure, how would you factor in certain hospitals that get the highest acuity cases and would almost inevitably have higher mortality rates, but really are providing superior care to a much more challenged population?

This may be an opportunity for a credible industry panel to be formed with all relevant constituencies represented to come up with a single report card that would be considered to be the "gold standard," and do it in as unbiased a way as possible. So, yes, let's keep going down this road, but remain mindful of the pitfalls that we will certainly encounter.


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