Mitchel Krieger, Associate CIO, Cleveland Clinic, Chapter 1

Mitchel Krieger, MD, Associate CIO, Cleveland Clinic

Mitchel Krieger, MD, Associate CIO, Cleveland Clinic

These days, it’s not difficult to find a consultant to help implement an EHR system — one with years or even decades of experience. But what providers need are concrete best practices and at-the-elbow support. It’s precisely the goal of MyPractice Healthcare Solutions, an entity that leverages the expertise of Cleveland Clinic staff to provide consulting to outside practices. In this interview, Mitchel Krieger talks about the business development work he does for the Clinic, what it takes to successfully roll out and optimize IT systems, and what it’s like to be part of such an influential organization. He also discusses the path that took him to Cleveland, what C-suite leaders need to know about any major project, and why “you have to eat your own cooking.”

Chapter 1

  • About Cleveland Clinic
  • His role as associate CIO
  • EHR & imaging consulting through MyPractice Healthcare Solutions
  • Offering Epic to non-affiliated docs
  • Reporting to Dr. Harris — “The architect of our IT strategies.”
  • Early Epic adopter
  • Creating “customizable EHR solutions”

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Bold Statements

It’s a mix of really taking the best practices and technologies that we’ve developed in the Cleveland Clinic and trying to offer those types of services and those types of technologies to other health systems to improve their abilities to take care for patients.

If you’re working in a large organization like this, it’s important to make sure your efforts are strategically aligned with other goals and other efforts within the clinic, and that requires coordination between different groups.

We’ve come very far in developing the functionality and really understanding how to use EHRs to impact the practice of medicine. It’s no longer just a tool to document or a tool to store information, but it really becomes a tool to enable us to provide better care.

Our goal is to take patient data and essentially to really transform it into actionable information; it’s the caregivers and the end users who really understand the type of information that is most helpful for them to make better decisions.

Gamble:  Hi Mitchel, thanks so much for taking the time to speak with us today.

Krieger:  Sure. I’m happy to speak with you.

Gamble:  To get things started, can you give us a little bit of an overview of Cleveland Clinic? Obviously everybody is familiar with it, but just in terms of what you have at the main campus.

Krieger:  Cleveland Clinic is a large health system located in northeastern Ohio. Our system comprises, in the Ohio region, somewhere around 10 hospitals, our main campus hospital being the largest, and then a number of regional hospitals and family health centers in the surrounding area. We also have facilities in Las Vegas, in Western Florida, in Toronto, Canada, and we have a large hospital opening in Abu Dhabi some time next year. So we’re fairly diverse in our footprint, but certainly most of our organization is centered around our main campus facilities.

Gamble:  In the Ohio area, what do you have as far as other facilities and physician clinics?

Krieger:  We’re built around a series of family health centers. We have, I believe, 16 family health centers in and around the Cleveland area — it’s roughly a 50-mile radius around Cleveland. There are numerous ambulatory practices that are owned by the Cleveland Clinic within that area, and a number of outpatient surgery centers, many of which were attached to our family health centers.

Gamble:  Do you have physician practices that are affiliated with the system?

Krieger:  Yes. The Cleveland Clinic is structured as a large group practice model. We have roughly 3,000 employed physicians and scientists at the Cleveland Clinic distributed among the various facilities, but at least at our regional hospitals, there are also opportunities for nonaffiliated physicians to practice and care for patients. At our main campus, all of the providers are Cleveland Clinic employed physicians. So it’s a bit of a mix.

Gamble:  Tell me a little bit about your role as associate CIO. What are your primary areas of focus?

Krieger:  My role really focuses on projects related to the external development and business development for the Cleveland Clinic. So I focus on consulting opportunities. We have an entity called MyPractice Healthcare Solutions that provides external consulting to outside healthcare organizations and large group practices. It helps them develop strategy and implementation plans for their EHR systems. We provide content for them and really help to make them more capable in their own functionality.

Underneath that umbrella we also offer the ambulatory Epic product. Our EHR is based on the Epic EHR System, and so we offer that to nonaffiliated or essentially non-employed physicians in the Cleveland area through our MyPractice Community Model and we have several hundred physicians that are now a part of that network. We also have imaging consulting through MyPractice Imaging that offers Enterprise Imaging Strategy and Enterprise Imaging Solutions for other health systems. So it’s a mix of really taking the best practices and technologies that we’ve developed in the Cleveland Clinic and trying to offer those types of services and those types of technologies to other health systems to improve their abilities to take care for patients.

In addition to that, I also get involved with the technology component of expansion opportunities for the Cleveland Clinic, so things centered around merges and acquisitions or partnerships with other health systems, I become involved in some of the IT-related integration activities that are part of that planning. So there is a pretty sort of wide range of things that I get involved with.

Gamble:  Who do you actually report to?

Krieger:  I report to Dr. Martin Harris, who is our Chief Information Officer and has been with the clinic for many years. He’s really the architect of our information technology strategies. 

Gamble:  Are you in contact with him fairly often, or do you work somewhat independently?

Krieger:  I work somewhat independently, but certainly I’m in contact with him. I think if you’re working in a large organization like this, it’s important to make sure your efforts are strategically aligned with other goals and other efforts within the clinic, and that requires coordination between different groups. If you don’t work together, then you tend to end up working in a silo and that tends to be somewhat non-productive. So certainly we’re in communication quite a bit and I communicate with the other health IT leaders in our organization and so we try and coordinate our efforts.

Gamble:  Let’s talk about MyPractice Healthcare Solutions. That’s really an interesting thing. How did the Cleveland Clinic get started doing this external work?

Krieger:  The Clinic was an early adopter of electronic medical records. We installed the Epic platform more than 10 years ago, going back I think to 2001 or 2002, gradually rolling out the functionality in our health system over the years. It’s been a very long process, and we’ve come very far in developing the functionality and really understanding how to use electronic health records to impact the practice of medicine. It’s no longer just a tool to document or a tool to store information, but it really becomes a tool to enable us to provide better care, to have better decisions, or to allow providers to make better decisions because of the information that’s provided. So as we’ve developed those capabilities, we started getting questioned and approached by other health systems that are starting down this journey.

After the American Recovery Act, many health systems started to look at implementing electronic health records; we had  a bit of a head start because we had started that journey several years before. So we thought there was an opportunity to take our experience and to use that as a vehicle to engage other health systems.

Our focus is really three things: one is on leveraging the EHR to support clinical decision making, which ultimately is what you’re trying to do to make the EHR more of a functional tool for providers. Most of our work at the clinic in how we’ve developed our EHR and how we’ve modified our EHR has really been guided by our clinicians and by our caregivers. So these are very customizable EHR solutions. Our goal is just to take patient data and essentially to really transform it into actionable information; it’s the caregivers and the end users who really understand the type of information that is most helpful for them to make better decisions.

The last part is really how do we use this technology to better engage patients and to better align care teams to provide better care and to get better outcomes and create greater efficiency. So those three things really guided the development of our EHR and it guides the type of things that we look at when we engage other health systems to try and provide those types of solutions and those types of capabilities.

Chapter 2

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