Hospitals, systems and physicians have made significant progress in implementing electronic health records and have received millions of dollars in meaningful use incentive payments. Yet, as executives and boards strategize to build patientcentric systems of care to manage populations and make the transition from volume to value, most realize that they do not have the data they need to reduce costs, improve outcomes and coordinate care.
Physician-led development and use of information technology and analytic tools are essential to harvesting information from EHRs and designing new care practices. That will enable providers to transform the way care is delivered and to achieve the full return on the substantial IT investments hospitals and physician practices have made.
Many organizations have focused on EHRs for the purpose of obtaining stimulus funds. IT has been viewed as an operational resource, and most trustees have left it to senior management to define direction. At best, boards have been passive recipients of reports on implementations rather than assertively asking how they can realize value and mitigate risk.
Yet, IT is integral to the way care will be delivered, managed and transformed, and it consumes the bulk of today's capital expenditures for many hospitals and systems. As boards work to extend their oversight of transformation initiatives, it is important for them to understand the information and technology implications of each transformation strategy. Examples include:
• Patient engagement. As in banking, air travel and retail, consumers will manage their interactions with their care providers using online tools. Easy access to health, wellness and interactive care plans will be enabled through continuous contact and will engage patients in their own care. Compliance with medication regimens and scheduled interventions will be supported through new communication technologies. Televisits, electronic patient records and portals, along with patient-focused mobile applications, will reduce costs and improve the convenience of care delivery.
• Care coordination. As patient-centered medical homes and accountable care organizations are developed to improve coordination across care settings, data exchange will allow prompt diagnostic decision-making and reduce duplication of efforts. Care managers will use aggregated information collected from a variety of EHRs and other advanced IT to identify gaps in care, alert patients and providers, and coordinate treatment across expanded geographies and venues of care. Referrals and follow-up visits will be managed through workflow-based technologies.
• Population health management. To keep patients healthy as long as possible, prevent patients with chronic diseases from getting sicker and manage the care of the sickest patients, hospitals will use registries and analytic tools to collect clinical, behavioral and financial data across a predefined group of people. Populations will be stratified according to risk and need, and care will be mass-customized based on care gaps, evidence-based guidelines and the most cost-effective setting. Information will be analyzed based on historical patterns in real time at the point of care and in a predictive manner to model implications of care decisions.
Meet Your CMIO
To realize the value of the investment in IT, hospitals and systems must integrate systems into the care delivery and clinical decision-making processes. No longer a new position, the chief medical informatics officer long has been considered "the physician that works in IT." For more than a decade, CMIOs have toiled away at a tactical level, encouraging the adoption of EHRs by their peers. According to the Journal of the American Medical Informatics Association, clinical informaticians transform care by analyzing, designing, implementing and evaluating information and communication systems that enhance individual and population health outcomes, improve patient care and strengthen the clinician-patient relationship.
Many CMIOs have evolved beyond the tactical level and are exploring strategic issues alongside chief medical officers, chief transformation officers, chief quality officers and chief innovation officers. When performing at the full scope of the discipline, this physician leader will use advanced analytic tools to make data meaningful, actionable and impactful.
Transformation strategies will depend on the organization's ability to leverage information and technology to fundamentally change care practices, cost structure and relationships with patients. Trustees should ensure their ability to provide oversight of IT as a strategic resource by asking such questions as:
- Do we understand how IT will support key transformation strategies?
- Are we aware of the value IT will contribute to our strategic vision and are we on track to realize this value?
- Do we understand the financial, compliance, operational, security and strategic investments and risks associated with IT?
- Do we have the right physician leadership in place to expand the contribution of informatics and analytics?
- Have we included the CMIO in physician leadership development plans?
Informatics and analytics will play a crucial role in transforming the health care system. By asking a few key questions, trustees can become more effective in ensuring IT value realization and supporting the physicians who lead these efforts.
Pam Arlotto, FHIMSS (firstname.lastname@example.org), is president and CEO of
Maestro Strategies, Atlanta.