Healthcare providers face more and more program and reimbursement requirements—Meaningful Use, quality reporting, accountable care—but most have the same limited resources to deal with an ever-growing plate of responsibilities. We asked hospital CMIOs and CIOs how they will use those resources in 2015 and which health IT projects are their top priorities. It seems organizations are heavily focused on putting their EMRs and data to good use.
Analytics take the lead
Analytics topped the list with almost half (44 percent) of respondents naming it their leading priority. Interestingly, if respondents did not mark it their top priority, they didn’t list it at all.
There are several reasons why the time is right for analytics, says Russell P. Branzell, CEO of College of Healthcare Information Management Executives (CHIME). Analytics has “hit its maturity point because we haven’t had structured data and this magnitude of data before. Now we need to do analysis on it to garner value and make changes.”
This is a good time for healthcare organizations to start heavily investing in an analytics structure which, he acknowledges, can mean a lot of different things to a lot of different people.
“We’ve gone from the data age to the information age in fairly quick fashion. With everything from Meaningful Use to all the things people have been putting in place for years now—we now need to do something valuable with all the infrastructure put in place.”
Nina DiQuollo is the new system director of analytics at Barnabus Health, based in Livingston, N.J., a newly created role. “Our system CIO feels it’s an initiative we need to engage in to support ACOs, population health and cutting-edge partnerships between payers and providers. This whole notion of going from volume to value has made things bubble to the surface in the past six to 18 months. It’s now more important to bring analytics to the next level and having information be even more meaningful to drive care and reduce costs. That’s so important now.”
Carolinas Health Care, based in Charlotte, N.C., also has made significant investments in advanced analytics, according to Carol Lovin, executive vice president and chief strategy officer. The organization began building its team and infrastructure three years ago when they decided that the changing healthcare landscape would require them to be prepared with new capabilities. Advanced analytics is one capability they thought would help them be successful in the future. “We needed information and insights to bring value,” she says.
To establish a centralized analytics team, they pulled in people doing similar roles around the organization and hired data scientists. They built an enterprise data warehouse and invested in other infrastructure. “Building a team is not insignificant,” Lovin says. “It was harder than we expected. The experience and talent is not easy to find and there is a lot of competition.”
The right organizational support is crucial, she says. “It’s too difficult to be successful without that.” They also made sure to have some early wins but knew they couldn’t do everything. A special team prioritizes projects and helped create the vision. Lovin says the new analytics team—now 110 people strong—knew they were helping to create a strategic asset for the organization, which helped them stay energized.
Branzell says that may be one reason analytics may not be a priority for all providers—“analytics is beyond the scope and technical skills and timing for small and rural facilities. They’re still trying to play catch-up on Meaningful Use, infrastructure and more.” Meanwhile, he says large academic centers already have been doing analytics for years so it would no longer register as a top priority.
Will ICD-10 happen?
In a distant second place for top health IT priority was ICD-10. CHIME, for one, thinks the implementation should happen this year. “We have wasted time, energy and momentum by restarting this over and over again” due to past delays, says Branzell. If it doesn’t happen this year, he says implementation should be postponed indefinitely and the country should go to SNOMED instead.
“We will continue to apply appropriate hope and pressure” for an Oct. 1 implementation, he says. The eleventh-hour delay last year “had a fairly negative effect on the industry as a whole,” he says, citing figures from the American Health Information Management Association, which said that thousands of people had been trained on ICD-10
and scheduled to be employed.
CHIME is one of several organizations that formed the Coalition for ICD-10 last fall to advocate for implementation of the ICD-10 coding dataset to improve quality measurement, public health surveillance, clinical research and healthcare payment through research, education, advocacy and mobilization.
Stay tuned—while another last-minute delay is not out of the question, a third delay would truly be surprising.
Also on the radar
All the other selections for No. 1 priority were far behind analytics and ICD-10 and included clinical decision support (CDS), Meaningful Use Stage 2 and clinical documentation improvement.
CDS is on the radar of CIOs and CMIOs because once organizations have made the investment in an EMR, they start looking for the benefits, such as improved patient care and cost savings, says Scott Weingarten, MD, MPH, senior vice president and chief clinical transformation officer at Cedars-Sinai Health System in Los Angeles. He also is the co-founder, president and CEO of Zynx Health, a major player in the CDS system market.
“I think the way that EMRs improve patient care and achieve a return on investment will be through clinical decision support.”
Aside from the significant investments, organizations are facing healthcare reform and trying to manage risk. That will require organizations to put their EMRs to good use.
Cedars-Sinai implemented Choosing Wisely, an initiative of the American Board of Internal Medicine Foundation in which participating medical specialties and organizations have produced lists—including evidence-based recommendations—on appropriate care. Cedars-Sinai embedded the Choosing Wisely recommendations into its EHR, and significantly increased its pace of adding new alerts by 50-fold.
They have identified a urologist who wasn’t following the American Urological Association’s recommendation that it is unnecessary to order a renal ultrasound if a patient only has a benign prostatic hypertrophy. In another case they found a physician was ordering numerous tests for Lyme disease despite the fact that Lyme disease is almost non-existent in Los Angeles County.
According to Weingarten, Cedars-Sinai now sees about 320 Choosing Wisely alerts a day. Despite that number, physician complaints have been minimal and they are paying attention to the alerts, with a number of physicians canceling orders immediately after alerts have been fired.
Just from canceled orders alone, Cedars-Sinai is estimating it will save $1.83 million annually, Weingarten says, adding that there is an untold amount of money being saved from the “education effect” of training doctors not to order certain tests in the first place.
For No. 2 priority, the leader was ICD-10 followed closely by new/replacement & integrate EHR systems/modules. This isn’t surprising, says Branzell, because so many organizations are on best-of-breed.
The No. 3 priority was standardization and optimization followed closely by population health.
Write-in responses included vendor neutral archives and reducing health IT errors.
Although not a selection on the survey, Branzell says information security will probably be on the front burner for most organizations this year. “That’s something that’s in the forefront of almost every conversation we hear with every organization and, in particular, every CIO.”
There you have it. While the particular circumstances of your organization differ from others’, all healthcare delivery organizations have plenty on their plate to provide quality care.
Editor’s note: 50 people participated in the survey between October-December 2014