No one can ever say that the leaders at Barnabas Health System didn’t do their due diligence in selecting a next-generation clinicals system. It took more than a decade for the system to decide on Cerner, but when you’re the largest integrated healthcare delivery system in New Jersey, making the right decision trumps making a quick decision. In this interview, interim CIO and CTO Tom Bartiromo talks about the organization’s aggressive schedule for rolling out clinicals, and how they are trying to balance “the power of the big and the agility of the small” and apply lessons learned from one go-live to the next. He also discusses the importance of having strong clinical partners, Barnabas’ long-term goal of enabling data analytics and BI, and going from CTO to CIO.
Chapter 3
- Business and clinical intelligence — walk first, then run
- Setting expectations
- ACO/HIE work, reading the tea leaves
- Moving from fee for service to pay for performance while staying solvent
- Going from CTO to CIO
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It really takes a lot of time to engage on the important and not lose sight of the urgent. And in this particular case, data warehousing and analytics is definitely one of the important items.
What’s interesting on ACOs is it’s far from uncomplicated as you’re pulling in data from multiple disparate areas. But we are trying to drive a much deeper and assertive approach as it relates to how we stratify the patient population, which is going to be a heavy emphasis on analytics.
If our healthcare system was to join one of the state-chartered exchanges, it could be upwards of a million dollars a year. There’s just not a strong enough return to warrant that kind of investment, even though philosophically the need to exchange information in a broad way makes sense.
Dropping out of my EMR to go into another portal doesn’t save me time. It’s cumbersome. If I have no choice, I guess that’s what I’ll do. But what we really want to do is continue to drive it into their EMR so that’s really their one-stop shop.
The compensation model right now is still ‘keep them in and bring them in.’ So I think there’s a difficult challenge in trying to make that leap in that chasm and go where you know the ball is going without bankrupting your organization.
Guerra: Let’s talk a little bit about data analytics and business intelligence tools. You mentioned you’re launching a strategic initiative to evaluate these things. That makes sense to me. You’re just rolling out your major clinical systems now, so it’s the concept of, you have to walk before you run. I would imagine the deep analytics is the running and that’s going to be in a bit of time, right?
Bartiromo: Absolutely, yeah. This is definitely a crawl, walk, run approach, and I think we all crawl, walk, fall down, walk, crawl, and get up again. Ultimately, as a data-driven and information-dependent industry not unlike others, healthcare really lags behind many other industries on the maturity around data analytics. For us, it’s really about trying to drive more rigor around the road-mapping and planning that often gives way to the other pressing items — urgent versus important. Urgent tends to eat important’s lunch frequently. It really takes a lot of time to engage on the important and not lose sight of the urgent. And in this particular case, data warehousing and analytics is definitely one of the important items. As someone coined it I think very well in 2006, data is the new oil. I don’t think that’s an understatement at all.
Guerra: We talked about getting clinicians excited about using the systems and helping to get them on board. Have you had situations where physicians were asking you for advanced data analytics and you had to tell them, ‘listen, that’s down the road. Right now we’re just getting going.’
Bartiromo: Absolutely, yeah. Some truly have an appetite for it and that’s really encouraging. They’re not what I would say the majority, but they’re bright spots, and we want to cultivate the bright spots. We have point solutions, like others, from Crimson and MedeAnalytics and the like, but I think we’ll see more of that emerge, quite frankly, as we drive on the ACO strategy. I think we’ll see a little bit more nimble, a little bit more agile capabilities then boiling the ocean of our seven-hospital institutions around a much deeper and broader data repository. What’s interesting on ACOs is it’s far from uncomplicated as you’re pulling in data from multiple disparate areas. But we are trying to drive a much deeper and assertive approach as it relates to how we stratify the patient population, which is going to be a heavy emphasis on analytics.
Guerra: So you’ve got some ACO work. Now when we talk about HIE, which is mentioned in your newsletter, are we thinking of those separately at this point?
Bartiromo: Yeah. I tend to frame it maybe more on the context of the connected strategy as opposed to an HIE strategy, of which HIE is a component of that connected fabric. We have our private-based HIE or exchange, and then we’re connecting to at least two of the state-chartered exchanges: Health–e–cITi and Jersey Health Connect. And then along with that you’ve got your interfaces, your interface engine, as well as the connectivity out to the employed and independent physician providers. All of that starts to weave together this fairly elaborate fabric by which to connect. Connect is one part, and it’s hard enough in some cases just to connect, but connect is a means that sometimes gets lost as the objective. But it truly is a means by which to share and gather and analyze. So we ultimately talk about connect, share, exchange, report, and analyze being a major part of that connected strategy.
Guerra: You’re a board member and are very active in New Jersey HIMSS, correct?
Bartiromo: Correct.
Guerra: So certainly that’s an area where you get a lot of exposure to the HIE work in the state. And I’ve heard that described in different ways. Some say it’s all over the place in New Jersey. Part of the art of being a CIO these days is figuring out what’s real; what’s worth investing your organization’s money in. It’s not easy and nothing is certain and people make mistakes and that’s okay. But tell me your thoughts around figuring out this ACO-HIE framework or environment that you have to operating in. You have to move forward but you have to figure out which way to move forward and there’s no sign post for you. You have to figure it out on your own.
Bartiromo: For me, being exposed with the NJ HIMSS board and the team — which is a good composite of thought leadership in the state — I don’t think anyone has it all figured out, but it allows us to bounce things off of each other. Even though technically we might be competitors in certain areas, there is still a tremendous collegial relationship among the CIOs to help advance on a topic that’s part of the greater need. So when we talk about things like the HIE, for example, I do think the state lags quite a bit in its approach, but if our healthcare system was to join one of the state-chartered exchanges, it could be upwards of a million dollars a year. There’s just not a strong enough return to warrant that kind of investment, even though philosophically the need to exchange information in a broad way makes sense. This is something I think the state obviously struggles with; to make it so that your hospital organizations can participate but not do it at an unreasonable or cost prohibitive expense.
So there’s still work that needs to be done there. We also have capabilities where we don’t have to join a state exchange. We can go IDN to IDN, and there are some in the state that are taking that approach. We are building out our capabilities so that the more options you have, hopefully the better position you’ll be in, which is why we chose to do a private exchange as well as connect to the state-chartered ones; to give us more flexibility to move between and among systems. And then when we get out to our physician base, which is a mix, we’re driving on our connected integration plan for our employed practices. They’ll get Cerner PowerWorks, so that drives on the integration strategy, a higher degree of integration. And then for those are the independents with the foreign EMRs — NextGen, eClinicalworks and the like — how will we best connect to them to not just give them a portal, which is a lot of what’s going on, but get that information, get those results, and drop them into their EMR so that they’re not having to jump out workflow-wise.
And that goes back to your earlier point: what’s in it for me? Dropping out of my EMR to go into another portal doesn’t save me time. It’s cumbersome. If I have no choice, I guess that’s what I’ll do. But what we really want to do is continue to drive it into their EMR so that’s really their one-stop shop, and you don’t have to be a Cerner PowerWorks EMR to be able to get that kind of value. If you do choose it, that’s great, and we can offer that. But quite frankly we’re never going to convert everyone, so we don’t want to beat ourselves up about it. We just want to make sure if you are a foreign EMR, we can still connect and we can still drive those results into your EMR, and over time — back to the crawl, walk, run approach — drive and provide analytics-appointed care for you.
Guerra: I was just thinking about what you were saying regarding HIEs asking for a million bucks a year. It just makes me laugh because it seems that organizations that spring up as not-for-profits built on grant money that shall soon expire are really bad at coming up with a good value proposition.
Bartiromo: Yeah.
Guerra: It’s just not in their DNA. Even a not-for-profit can have a for-profit soul in the sense of staying solvent and providing value — I’m not talking about banking excess profits. But to come to you and say, ‘hey, look at this cool thing.’ ‘Oh great, interesting. What’s that cost?’ ‘A million bucks.’ What? That’s just funny.
Bartiromo: Yeah. Again, if you’re one hospital, you may say, ‘All right, this isn’t great, but I can stomach it. I can make it work. I can try to get something out of it.’ But as you aggregate — for us with our six core hospitals, and run the numbers, that’s almost a million dollars a year. And that’s just prohibitive. Now I’m no longer in the philosophical debate. I’m thinking, let me try to see if the CFO would even want to not have that as a very visceral conversation. It just doesn’t make sense.
Again, to me, this is where the state ultimately has to take a more active role, and I know the NJHIN (New Jersey Health Information Network) RFA just came out recently, and hopefully there will be more movement there. Even when you look at Jersey Health Connect, four or five years ago, it was a lot of jockeying for position, and good or bad or right or wrong, today Jersey Health Connect has the market share. We’ve got the majority of the hospitals in the state in Jersey Health Connect. So whether I personally like it or not is not the point. It’s almost like water finding its own level. If that has the market share, then maybe that’s what we should just talk about. Check our egos at the door and say that that makes sense as the default NJHIN for the state and stop fighting among these disparate views and get organized, because as a state, we’re not organized.
Guerra: Yeah, and it’s just a question of little pots of money. That’s all it is.
Bartiromo: That’s exactly it.
Guerra: Just follow the money.
Bartiromo: That’s exactly it. That’s right. So there are opportunities there.
Guerra: Okay, let’s a little bit about the Minute Clinic stuff.
Bartiromo: Sure.
Guerra: I saw a release come out a couple of weeks ago that you’re going to do some stuff with Minute Clinic. Is that a big initiative or to you is that a small thing?
Bartiromo: Right now, it’s a small thing, and I’m not as close to that one. Our executive vice president for Business Development is more in line with that. But it is a part of — for lack of a better term — the connected and outreach that as we are, not unlike others, looking at an acquisition strategy for physician practices, I think partnering, whether it’s the Minute Clinic or what’s going on with Walgreens and others, is important to get the presence out there in a much more broader way as we continue to move from volume to value as a whole. Those components that are very well distributed and placed in the right geographies are only going to help to make a more viable institution.
Guerra: It’s a fundamental shift from ‘we get paid to bring them in’ to ‘we’re going to get paid to keep them out.’
Bartiromo: Exactly, and the compensation model right now is still ‘keep them in and bring them in.’ So I think there’s a difficult challenge in trying to make that leap in that chasm and go where you know the ball is going without bankrupting your organization.
Guerra: Hoping that the ball eventually gets there.
Bartiromo: That’s exactly right, and hoping you don’t get to the other side and say, ‘I’m here,’ but there’s no compensation for you being there yet.
Guerra: Right. You get a note from CMS that says, ‘That whole value thing? Never mind.’
Bartiromo: That’s right. Everybody go back.
Guerra: Okay, let’s talk a little bit about moving from CTO to CIO. I’m sure a lot of CTOs will listen to this. Certainly our audience is CIOs, but probably many of them came up through the CTO role. Tell me about the transition. Is it really a major transition to you as far as what you’ve noticed? What are your thoughts around that?
Bartiromo: I still retain the CTO role, although it has a different emphasis to me of late. The biggest part of that transition is ensuring the right people are taking care of that body of work; that I didn’t leave a void or create a vacuum. And when I looked back and reflected, with Joe Sullivan, who is here again as a major influencer for this organization — very politically astute and a great business acumen as a CIO — it was in some cases easier for my dialogue because of Joe being there. He and I had a great relationship. We could bounce things off each other in a variety of different ways, whereas when I assumed this role, it got quiet very quickly. I did notice that. So my first hundred days was more of a focus on making sure I didn’t create too big of a vacuum in the CTO area, getting a strong person to take over the vice president of our technology resources arm, and having he and I start to develop that relationship that Joe and I once had.
I think that that’s really important. Again, I think the overarching technology architect role still stays with me, at least at this point to keep the fabric from unraveling a bit. But there are some really good people in place and I think the first part of that puzzle was just making sure we had the right people in the right seats and that everyone knew what was expected of them. And that came around the time of reorganizing the IT organization and centralizing, which was not a small change event. And that threw a little bit of disruption into some of the things that were already working well and some things that needed to be disrupted.
But to me, I think the CTO-to-CIO role is largely dependent on what the CTO-CIO relationship was like. Joe and I were very close and we shared a lot of time on strategy building, so to me it wasn’t a major shift. I think what was more of a major shift is that Joe was almost a 40‑year seasoned CIO veteran and I did not have that depth. So I brought different qualities, but quite frankly, I miss the sounding board. I still have it, but in a different capacity.
Guerra: We see CIOs have varied backgrounds. There are some MD CIOs who can relate to the clinical side. Probably you’ve gone the more traditional route, which is through the technology side. I’ve discussed with a lot of CIOs how basically you just have to make sure that the areas in which you’re not as strong you have supplemented by a good partner. So for someone like you, you would want a very strong CMO. For a CIO who’s an MD, they would need a very strong CTO. Does that make sense?
Bartiromo: Absolutely. I think that’s a big part of checking egos at the door and just knowing what you do well and knowing what you’re not doing well, and making sure you partner well to fill those voids.
Guerra: It’s been a couple of years of very interesting growth for you. When you look back, it’s probably been a couple of pretty amazing years since Joe left.
Bartiromo: Absolutely. We just ran into each other last week and it was nice to catch up.
Guerra: Well, that’s great, Tom. Is there anything else you want to add? That’s about all I had for today.
Bartiromo: No. I had a chance to look more at the podcasts that were done, and candidly, I think they’re really well done. I think they’re very informative. I actually sent the links out to our management team as well as our CMO, and said I think it’s worth a good listen in the IT ranks. It’s good perspective and it’s nice to see a vehicle to share it out there.
Guerra: I appreciate that. That’s very kind of you. Well, I hope to see you again soon. We’re very close.
Bartiromo: Absolutely.
Guerra: We’re about a half-hour away, so we’ll have to grab lunch one of these days.
Bartiromo: That would be great. I appreciate it, Anthony.
Guerra: All right Tom, have a wonderful day. Thank you.
Bartiromo: You too, thank you.
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