The digitization of patient records, combined with more sophisticated analytical tools and vendor offerings, makes today an exciting point in health IT’s development. “It’s an incredible time to be in a position like a CMIO,” says Dr. Jeana O’Brien, who fills this role for Baylor Scott & White Health. “The technology available today offers incredible opportunities.”
Whether those opportunities are fully realized at Baylor Scott & White Health depends greatly on the work of O’Brien and that of the informatic clinicians and information-systems staff alongside her. It’s a huge responsibility, as their work impacts the organization’s compliance with Affordable Care Act regulations, boosts quality of care, makes operations more efficient, and strengthens financial stability.
“There’s a lot of innovative technology out there. We need to be judicious and accurate with our decisions and help achieve the promise of HIT for our patients and clinicians.”
In addition, O’Brien must contend with the 2013 mega-merger of Baylor Health Care System with Scott & White Healthcare. The new entity, Baylor Scott & White Health (BSWH), with a combined workforce of 40,000, presents technical and cultural convergence challenges. With her background as a physician, and a master of medical informatics, O’Brien is well qualified, prepared, and eager to bridge the worlds of medicine and IT.
In 2009, with some leeway from leadership to define the role, O’Brien became the first CMIO for Scott & White Healthcare. Incorporating a breadth of duties, from health-IT (HIT) strategy to data analytics and population health, O’Brien has seen up close the value of collaboration between clinicians and information systems—an endeavor that has never been more important. “There’s a real need for physicians, nurses, and other clinicians to work together with leaders in informatics to help the organization achieve its strategic goals related to technology adoption and innovation,” she says.
O’Brien’s chief responsibility is to understand the technological needs of clinical users—not just physicians, but all clinicians—and help deliver IT solutions for them. She is the a translator between the two sides, helping each understand the other’s terminology: a function that was especially critical when she first stepped into the CMIO office.
“Clinicians had particular needs within their area of focus, and had difficulty translating them to our internal HIT builders or vendors,” O’Brien says. As time has gone by, the blending of IT with healthcare practitioners has increased, but gaps remain.
One of O’Brien’s key accomplishments was helping the enterprise prepare for the Affordable Care Act—particularly the “Meaningful Use” (MU) requirements that created standards for digital healthcare records. She had to educate organizational leaders on it, devise compliance strategies, and identify necessary resources. MU created penalties and incentives to prod healthcare organizations further down the road of electronic records. “We couldn’t afford to take penalties,” she stresses.
As the MU project began, Baylor Scott & White had digital-records systems dating back to the 1990s, but those systems were not capable of meeting the new MU requirements. The organization was well accustomed to using these systems, though, and O’Brien knew making a change wouldn’t be easy. “They didn’t do all the things we wanted, but they were very comfortable, like a well worn pair of shoes,” she says.
Part of her strategy to upgrade digital records capability was to identify change agents—or at least those not averse to change—in every function of the enterprise. She tapped some of these individuals to participate in an MU workgroup. Some worked in operations, some in information systems, and a few reported to her. This strategy served her well, as input from all aspects of the organization was essential.
An ongoing challenge has been optimizing electronic medical record systems and analytics tools that glean insights for improvements in quality and efficiency through use of data. Differences in pre-merger terminology that still echo in the organization increase the degree of difficulty. When dealing with multiple systems from each precursor organization, the employee sometimes has to know which system data originated from in order to precisely define the term, she says.
Under the committee leadership of O’Brien and her co-chair, the Business Intelligence & Data Analytics Committee established a data governance group to develop a glossary of consensus data definitions as part of the organization’s integrated data warehouse project. Many definitions are identical across the organization, but some critical ones are not. As O’Brien points out, the precise definitions of data points like “adjusted mortality” or “length of stay” can have implications on regulatory and quality of care data, and can even cause financial implications. The glossary allows analysts to understand specific data definitions when using the integrated warehouse and modify accordingly if the data is pulled from a source system.
There’s a wealth of electronic data now available—lab results, imaging, primary care and specialist records, and pharmacy records—that can improve patient care when it gets to the right people at the right time. Across the integrated BSWH organization and BSW Quality Alliance, this is accomplished with implementation of dbMotion for HIE. Beyond use for immediate patient care, this system provides data from many disparate systems for analytics and reporting.
“We selected Allscript’s dbMotion due to its ability to allow information to exchange with less interruption to the clinician’s workflow. It directly accesses the HIE from within the patient’s EMR record and easily imports updates to the local EMR,” O’Brien explains. But the work doesn’t stop there. “As a next step, we want to further streamline [our] ability to provide feedback on quality metrics to Quality Alliance members and care coordination to their patients.”
O’Brien is also excited about possibilities using Artificial Intelligence tools to further enhance patient care outcomes. One example: systems that utilize care algorithms can take an action when a high-risk patient has indicators of decline.
“If a patient is not taking medications consistently and correctly, that information may not get to the provider until the patient ends up in the hospital,” she says. The idea is to prevent hospital readmissions by keeping track of patients when they are at home and facilitating access to care utilizing technology. “These systems still need refinements but provide opportunities in select circumstances.”
One of the biggest challenges in the next few years will be to evaluate and choose new IT offerings wisely. “There’s a lot of innovative technology out there, but not all will meet expected deliverables,” O’Brien says.
“We need to be judicious and accurate with our decisions and help achieve the promise of HIT for our patients and clinicians.”