While no two providers are alike in their IT footprints, everyone longs for regulatory relief in one form or another. Following are the wishes and concerns of a widely disparate group of HIT leaders during the holiday season.
Senior Vice President and Chief Information Officer
Ohio Health, Columbus
Wish List Items: Virtual Desktop, Natural Language Processing
One thing Michael Krouse does not wish for is another hospital to oversee. He's got a full plate now, as Ohio Health spans 17 hospitals, employs some 500 physicians, and maintains affiliate relationships with another 2000. The $2.5 billion health system runs a McKesson EHR at eight of its inpatient facilities with its ambulatory practices running on either GE or athenahealth. Several of the hospitals run under co-management agreements, and maintain their own IT infrastructure, Krouse says. The system is moving ahead full bore into the digital era, as several of its facilities are now all-digital operations, with no paper charts present.
Like many CIOs, Krouse cites regulatory certainty as his top wish list item for 2013. Closer to home, the CIO's top need is what he calls "the extension and maturity of the virtual desktop." Ohio Health has taken a step in that direction already, by converting many desktops to a virtual environment in which monitors function much like the dumb terminals of the past. Rather than having software loaded locally, the monitors connect into a central server where core applications are run.
The problem, Krouse says, is that many applications are not designed to run well in such environments. And beyond connecting to standard workstations, Krouse would like to open up his network to whatever devices clinicians feel most comfortable using, be they iPads or smartphones.
"I would like to open up our infrastructure to become more device agnostic," he says. "I don't want to limit devices, but I would like to expose our applications without exposing our security." To that end, Krouse longs for mature access management tools, software that could regulate and monitor network access and grant it based on role.
Software vendors lag when it comes to adapting their applications to run in virtual environments, he says. "Our legacy apps are about 75 percent compatible with a virtual environment, but not in a well-orchestrated way," he says.
"They are compatible in that we can figure out a way to make it work. But we don't want to support PCs and desktops. We want to support apps and connectivity. I just wish that space would mature." Krouse would love to enable physicians to connect to his apps with the device of their choosing. But there's more to that than making use of the EHR easy for physicians, he says. To wit, his second wish list item is a maturity of natural language processing software and technology. That software would enable data mining of dictated and transcribed reports, freeing up physicians to tell the patient story in their own version and not be beholden to discrete data fields. "I would like to mine data in transcribed reports rather than telling physicians you have to document in a certain way and put it in this box. That is time consuming for physicians. There is more pressure on physicians to document more, do more and be paid less. We want to deliver technology that makes the process easier."
Enabling physicians to dictate a progress note would free up their time. And if NLP software were more mature, other staff could use the technology to extract key data for billing or quality reporting purposes, Krouse says. That would support Ohio Health's foray into population health management, which requires deep analytics capability to identify patients with certain disease states.
Krouse's other wish list item is only partly related to technology. "I would like to deepen clinical collaboration among caregivers and collaboration among the workforce," he says. Ohio Health does offer some tools, such as Share Point, to enable that. And better integration of applications would help too. But the wish is deeply rooted in culture, he says. "Caregivers have to open themselves up to unified communication," he says. "Ten years ago, hospitals were hubs. Caregivers and physicians saw each other in the hallway, the dining room or during grand rounds. Physicians don't come as often to the hospital. But they are slow to adopt technology that keeps them well connected. To maintain that culture of being one big family in one digital space would require that they would open up their cell phone numbers or their schedules, or give the broader community ability to share data with them."
Toward the goal of fostering collaboration, Krouse envisions one other piece of technology-social networking platforms. "We are oriented now the targeted message," he says. "If I have a message, I need to know who I am sending it to. It is all about email." Instead, Krouse wishes he had a type of social networking tool which would enable him to broadcast messages pertaining to a wide audience, and let the audience opt in when relevant. The tool might facilitate communications with patients sharing common disease states or even staff. "We need to have the toolsets align with how the next generation of the workforce is accustomed to working," he says.
Chief Information Officer
Cornerstone Health Care, High Point, N.C.
Wish List Items: Interoperability, Cloud Security
Tim Terrell's holiday list is small, but critical to the future of Cornerstone Health Care, a 250-physician group practice. The practice embraced the EHR in 2005, and has been running its Allscripts system since then to good measure, the CIO says. But the practice continues to grow, adding new physicians and merging other groups-about one per month, he says. Increasingly, the practices joining Cornerstone have been on their own EHRs and the list of vendors in play is long, including GE, NextGen, eClinicalWorks and Greenway Medical Technologies. As Terrell points out, importing data from other systems is often very difficult, and in some cases, impossible. "Having better interoperability standards across the industry is my top wish," the CIO says. "Every EHR has its own structure."