January 2014

What Can Health Care CIOs Expect in 2014? — A Top Five List
By Dominick Bizzarro
For The Record
Vol. 26 No. 1 P. 8

Health care chief information officers (CIOs) don’t need a reminder that HIT is undergoing seismic shifts. From meaningful use to accountable care and the convergence of payer and provider models, CIOs will face both daunting challenges and exciting new opportunities in 2014 and beyond that will enable more collaborative, connected, patient-centered care.

The shifts in how care is organized and compensated are placing unprecedented demands on health care CIOs. For many organizations, value-based purchasing calls for a new business model and IT capabilities. New reimbursement approaches also highlight the critical nature of managing both clinical and financial risks for a patient population. This requires informed, coordinated, patient-centered care and the interoperable technology to support it.

Through it all, health care CIOs are called on to serve the most challenging of all end users: patients. Today’s patients are dealing with multiple health conditions and receiving care at multiple locations, creating the need for sharing medical and financial records across a dizzying array of disparate systems, data, and devices. Health care organizations are struggling to meet these complex technology requirements while dealing with sweeping regulatory reforms.

So where to begin? Here’s a top five list of the most pressing CIO challenges for the year ahead.

1. The “I” word: We heard a lot about interoperability in 2013—and for good reason. It is the technical underpinning for addressing many of health care’s most pressing problems. But the relentless demand on achieving interoperability will only accelerate in 2014.

Despite the intense media focus on the term, most health care organizations are only beginning their interoperability journey. Most start with basic Health Level Seven International integration engines, enabling simple message passing from one system to the next. But interoperability now is taking on a more strategic dimension, as it enables health systems to fulfill long-range strategic growth plans through mergers and acquisitions, integrating an immense variety of stakeholders. Numerous health care CIOs have told me that interoperability is becoming a board-level issue, as it is the prerequisite for success in key organizational initiatives such as population health management, coordinated care, more engaged patient and physician communities, and even innovative new research.

With interoperability positioned at the intersection of patient centricity and engagement, managing population health, mitigating financial risk, and lowering readmissions, the CIO’s role may evolve into CIIO: chief interoperable information officer.

2. Analytics for Big Data: CIOs oversee an ever-expanding ocean of data, dispersed among multiple disparate systems, in both structured and unstructured formats such as free-text patient notes. Social media content and text messages are finding their way into the patient’s comprehensive health record, all adding to the volume, velocity, and variety of data. And it’s not just about the data in the patient record; the rising demand for genomic data is a new contributor to the data explosion.

Handling such a vast, rich, and complex store of data brings to mind one of the greatest HIT challenges. All of the latest breakthrough technologies in mobile devices, executive dashboards, telehealth, and other new applications depend first on cracking the problem of aggregating, normalizing, and integrating all that Big Data, both at the patient population and cohort levels, down to driving actions at the point of care. CIOs will need to tackle these challenges from the ground up.

There also is increased pressure to garner more and different kinds of value from the explosion of health care data. In the year ahead, health care data will continue to be put to use for new purposes that go well beyond basic medical care. Data will be needed to satisfy the growing appetite for mobile and telehealth applications and patient self-service apps as well as to enable medical research and analytics-based medicine. CIOs will be called on to make these data interoperable, support the engagement of many stakeholders, and drive the right actions. Provider organizations must not only share and understand these data but also have a technical—and cultural—framework to act on them.

3. Population health management: Population health management has been making meaningful strides among forward-thinking health care leaders. They embrace the task of dealing with some of the most challenging cohorts. An early example is CurrentCare, Rhode Island’s statewide health information exchange, a service of the Rhode Island Quality Institute.

CurrentCare was the first statewide health information exchange to share behavioral health information, uploading data from two mental health and addiction treatment centers. The addition of behavioral health data to CurrentCare is part of a five-state, $3 million pilot program funded by the Substance Abuse and Mental Health Administration and the Health Resources and Services Administration. Behavioral health providers can access patients’ medical histories through CurrentCare, including medication histories, and patients control what information they wish to share.

In this example, data analytics plays a key role in providing insights about individual patients as well as populations, ensuring that care teams and other stakeholders receive standardized, actionable, and reliable information about the health care delivery system. CIOs have the power to enable meaningful shifts in the quality of human health across entire populations. The key data challenges to surmount are patient identification, stratification, and analytics for action or intervention.

4. Patient-centered care: From the macro level of population health to the individual patient level, CIOs are positioned to improve the patient experience through IT-enabled patient-centered communities. For example, North Shore-LIJ, a Long Island, New York-based health system with more than 6,000 beds, wanted to improve high-risk obstetric care. It found that automating patient tracking across multiple delivery environments was a prerequisite to high-quality, efficient management of both individuals and populations. Interoperability across different EHRs throughout its vast system is a strategic goal and key enabler for better, more coordinated care. North Shore-LIJ created the interoperable foundation and tools to automatically detect and notify providers of gaps in care or clinical changes even when the patient is not present.

New mobile and Web-based tools now promise to make the patient more engaged and accountable in maintaining his or her health. CIOs can ensure the right infrastructure and interoperable foundation to make these initiatives seamless. From a data perspective, patient-centered care has three parts: aggregating all the data for comprehensive patient records, making sure providers are all operating with the same records and coordinated for an accountable care or patient-centered medical home model, and making the technology easy and accessible through familiar mobile devices and formats. In this manner, providers can proactively intervene and dramatically improve the health and well-being of the people they serve.

5. Lowering preventable readmissions: Progressive health care organizations have proven that they can attack the problem of preventable readmissions. However, using manual processes is not a viable long-term solution. With the right HIT platform, CIOs can sustain readmission reduction initiatives and make them more efficient and effective. The key is interoperability and access to real-time data. Organizations that integrate real-time data from disparate sources and use analytics to drive action can proactively reduce readmissions.

In emerging value-based reimbursement models, the CIO’s organization may look different and include many new colleagues to address the readmissions problem. It’s no longer only about creating comprehensive EHRs but also coordinating care processes at care transitions. CIOs may find themselves working with a new accountable care organization, dealing with a new set of peers and new interactions.

This is a good time to be a health care CIO. Is there any other industry where your work can effect such powerful change for the betterment of people? In the coming year, progressive CIOs will continue to see the early fruits from years of efforts to achieve the promise of more connected care. Comparable with the early days of the Internet, we are only beginning to see what is possible.

— Dominick Bizzarro is managing director of InterSystems HealthShare, leading the development and implementation of business strategies.