Seize the day: Make way for digital healthcare and the CHIO

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 - Luke Webster, MD
Luke Webster, MD, Vice President, Chief Medical Information Officer at CHRISTUS Health

If hospitals and integrated delivery networks are to leverage the potential of big data to significantly improve the health status of populations across the U.S., they are going to need a new kind of physician leader to light the way.

To the point, they are going to need a chief health informatics officer—one under each of their respective roofs.

That was the main message in a HIMSS session at Chicago’s McCormick Place April 15. The impassioned messengers were Luke Webster, MD, a board-certified psychiatrist who works as vice president and CMIO for 60-plus-hospital Christus Health headquartered in Dallas, and Pam Arlotto, CEO of Georgia-based consultancy Maestro Strategies and a past national president of HIMSS.

Titled “From CMIO to CHIO: Information, Integration and Innovation,” the session intimated that one of two scenarios will come to pass: Either today’s CMIOs will soon morph into CHIOs, in effect if not by title, or the healthcare system will build on its acceptance of the first to make room for the second.

The rise of the CHIO will mark a natural next step in the evolution of big-data healthcare, because “you are truly looking at the convergence of informatics, analytics and quality,” Arlotto said. “This is a very, very different environment because of the risk in managing populations. You need the broad perspective of that individual who sees things at a very strategic level.”

Turning down the volume

Arlotto outlined ways healthcare enterprises’ strategic priorities are changing as they move from volume-based to value-based priorities, referring to insights gleaned from qualitative interviews Maestro conducted with more than 60 CEOs, CMOs, CIOs, CMIOs and CNIOs at leading integrated delivery networks.

Setting the backdrop, she showed a timeline of “enterprise maturity transformation,” illustrating healthcare then, now and soon to come. As recently as 2010, we had “bricks and mortar” healthcare, marked by fee-for-service reimbursement, hospital consolidations and practice acquisitions.

In 2015, we’re in the midst of transition, witnessing the expansion of clinical integration, patient engagement, performance measurement and “cross-venue process redesign and early-stage population stratification,” she said.

By 2020, said Arlotto, “digital healthcare” will be the order of the day. Its hallmarks will be true population health management, retail care, virtual care, risk management and consumer behavior management.

CMIOs will continue play a critical role. Today, however, they’re focused on being “the doctors in IT.” They bridge those two worlds, enabling the dual-citizenship denizens to speak a common language without losing one another along the way. Their work is organized around such discrete goals as designing and integrating IT systems, optimizing and analyzing the use of technologies like EHRs and CPOEs, guiding physicians in the use of software and so on. 

Patient-centered, tech-enabled

Tomorrow’s CHIOs will have broader skill sets and more open-ended marching orders.

To succeed in the emerging role and, in so doing, push one’s provider organization to truly improve the health status of its patient population, “you need to be strategic, systematic and able to drive change,” Arlotto said. “We ultimately believe the CHIO is the individual who should be responsible for value realization. They need to have methodologies for deploying and measuring the value of their [informatics] systems.”

Arlotto said CHIOs will work closely with multidisciplinary teams whose members might include process engineers, change-management experts and even adult education specialists, along with informaticists working not only in the clinical sphere but also nursing and pharmacy.

“We’re truly looking for prevention and wellness across the entire spectrum,” Arlotto said, adding that successful CHIOs will concentrate on identifying emerging trends, encouraging innovation and spearheading transformation. “Eventually they will redesign care around what the patient needs, not around technology.”

Overload avoidance

Webster began his part of the presentation on a personal note. He told how his grandmother suffered for years with poorly managed diabetes. This led to a series of strokes, the effects of which were compounded by medical mismanagement and outright care errors. Long hospitalizations and deteriorating quality of life followed.

“I was deprived of her in what should have been another 10 to 15 or even 20 good years of her life,” he said. “That’s what this [presentation] is really all about today. It’s about fixing those problems, improving the way we deliver healthcare so that not only do we avoid harming patients. We can deliver fantastic care and keep people healthy, happy and out of the hospital.”

He told how his accepting the CMIO position at Christus Health in 2010 flowed from what he thought would be a consulting engagement of six to eight months to help the organization meet meaningful use requirements for attestation. Five years later he’s still at Christus and functioning more like a true CHIO every day.

“Health informatics really isn’t about computers, technologies, wires and boxes, mobile phones, any of that,” Webster said. “It really is about how we bring value to people, process and change.

“Strategy is, in my opinion, more about what you choose not to do than what you choose to do. There’s so much coming at us constantly, all the time. We must filter through it and choose the right direction.”

Alignment mantra

Webster described how Christus Health created a “map” of concepts underlying its clinical integration strategies. He stressed the criticality of the layer at the map’s starting point. This lays a foundation of “talent and technology” comprising human capital (“create competent leaders, clinicians and associates”), organizational capital (“create a culture of engagement and alignment”) and information/technology capital (“develop seamless technology platform”).

“We really work hard in health informatics [at Christus] to align ourselves very carefully with the organizational strategy,” he said. “We are part of that strategy and we are deeply embedded in it. It’s all about improving the experience of care for the populations we serve—and doing it as safely and cost-effectively as possible.”

It’s vital to avoid failing to realize value, he said, by failing to communicate to the rest of the C-suite how health informatics figures in improving care while reducing costs. A CHIO never wants the CFO to wonder what on earth “this doctor is doing in IT—‘I like all this Meaningful Use [incentive] money, but isn’t IT already taking care of all that?’ We really have to embed ourselves in the [organizational] strategy,” he said, “and then talk about it as part of our mantra.”

Let the ROI do the talking

Drilling down from all the “big picture” talk—suggesting that the CHIO’s day-to-day isn’t divorced from the need to secure tactical victories—Webster said Christus has taken in close to $89 million in MU Stage 1 incentive monies. It missed its first chance to follow suit with Stage 2, struggling with electronic transmission of the summary of care, “like so many of us here in this room. Other than that, we are ready for it now. Talk about value creation, I might add—$89 million is a pretty hard-dollar ROI.”

He added that Christus has built a powerful enterprise data warehouse that is “taking pretty significant data feeds constantly, and we are working out from the health informatics perspective how to leverage that—how to push it back to the point of care.”

“All of this is rolling up to what we see as a strategic vision for how health informatics plays a part in managing populations, delivering better care for populations,” he added.  “It’s not about the technology. The Holy Grail is keeping patients healthy, not waiting until they get sick and then treating them. Let’s keep them healthy and happy and at home.”