At Indiana Health Information Exchange (IHIE), Chuck Christian has found what could possibly be a dream situation. Not just because he gets to catch up with the many “old friends” he made while serving as CIO at Good Samaritan for 20-plus years, but also because he’s at an organization with an outsourced data center — something he’s been looking for throughout his career. In this installment of our quarterly chat, Christian talks about what he hopes to bring to the table as VP of technology and engagement, how IHIE is working to achieve a long-term plan without losing sight of its main priority, what he thinks of the 21st Century Cures Act, and the importance of sharing best practices.
- VP of Technology & Engagement
- Outsourced data center
- CIO evolution — “It’s much more than technology. It’s about the business.”
- Wading through policy — “I try to keep people informed.”
- Breaking down the 21st Century Cures Act
- “I think it was everything that people were looking for.”
- IHIE’s 5-year plan
LISTEN NOW USING THE PLAYER BELOW OR CLICK HERE TO SUBSCRIBE TO OUR iTUNES PODCAST FEED
The really interesting thing about the role of a healthcare CIO is that it’s no longer about just making sure that the computers work on the desktop and you’ve got the latest and greatest operating system, or even about protecting them from their own selves by keeping the malware and the bad actors out. It’s about how that technology is applied to make the business successful around cost savings.
What I try to do is keep people informed. Here’s what I think I’m seeing, what are you seeing? Are you seeing something different? Through that kind of Borg collective of looking at this regulation from different perspectives, you can get a better idea of what it truly means.
You just can’t read it like a novel, because it’s actually amending other regulations and replacing language. And so you have to flip back and forth to really get a full picture of it. Sometimes you have to really wait until you see someone else’s interpretation and say ‘oh, that’s what that means.’
Physicians and other clinicians want to see the information about that patient within that architecture — that infrastructure — without having to go somewhere else and look at a different user interface or log onto another system.
Gamble: Hi Chuck, thanks again for taking some time to speak with healthsystemCIO.com.
Christian: Not a problem. I’m more than happy to do it.
Gamble: Great. When we spoke a few months ago, we talked about the Indiana Health Information Exchange and some of the services it provides. This time I’d like to talk about your role as a VP of technology and engagement. What are some of your key priorities in that role?
Christian: Sure. It’s kind of like CIO, but it’s a little bit different. I’m the VP of technology, which means I’m responsible for all the infrastructure that it runs on. We’ve outsourced our data center to AT&T/IBM, and it’s actually worked out really well. Since we’ve got a hardened data center, that means I have no actual physical equipment on site. It’s somewhere else, but we still control it. And it’s basically compute and storage as a service, which is very helpful. It’s something I’ve been looking for all of my CIO career, and finally found it. And I can’t take credit for it — they had it in place before I got here, but what we’ve been able to do is fine tune it. When they stood up the service, they felt they would need it more than they actually did, and so we’ve pared it down and saved some significant cost.
The other component in my role as VP of technology and engagement is that I have oversight of the customer relationship management team — the help desk, and I’m also the one that interfaces from an efficacy standpoint or policy standpoint. I work with the folks here in the state, working with the CHIME policy group, with the Strategic Health Information Exchange Collaborative (SHEIC) policy group and the folks in DC. I get to go out and have some conversation with them, and it’s around not necessarily just around health information exchange, but just interoperability in general.
Gamble: When you speak people from health systems and hospitals in your state, what are some of the really big topics in those conversations?
Christian: Everybody is doing the same thing we’ve always done. We’re trying to figure out ways to leverage the technology, to make the organizations successful. And a lot of the big questions have been around Meaningful Use and how some of the EHR vendors are driving some of the changes and innovations in the organizations, but it’s also about the application of innovation around affordable care organizations and other advanced payment methodologies that may be out there. And now we’ve got MACRA and MIPS, so we’re trying to figure that out and how technology comes into play.
The really interesting thing about the role of a healthcare CIO is that it’s no longer about just making sure that the computers work on the desktop and you’ve got the latest and greatest operating system, or even about protecting them from their own selves by keeping the malware and the bad actors out. It’s about how that technology is applied to make the business successful around cost savings, or how they work with the various ancillary departments to look at analytics and other opportunities for either service line enhancement or other things.
So it’s much, much more than technology. It’s more into the business of it. Now, there are those smaller organizations where the IT folks are still doing the usual and customary tasks of keeping the compute cycles going, but for the most part, in the medium to large size organizations they’re thinking more strategically. I’m actually going out and having conversations, and the really nice thing is since I’m back in Indiana, a lot of the people I talk to I’ve known for years. They’re still in the same position they’ve had for years, and so it’s kind of like going to visit old friends. We sit there and shoot the breeze and we can talk about a lot of different things. Since I know how to think like a healthcare CIO, we can have a little bit different conversation from a partner standpoint rather than if I were trying to sell them something, which I’m not. They’re already a member of the organization, so I need to go out and help them figure out how to leverage it and even get more value out of what they have.
Gamble: I’m sure it’s a really interesting range of conversations you’re having, and then you take all of that into account with your role with advocacy.
Christian: Absolutely. When the 21st Century Cures Act dropped on Friday evening, I started looking at it and found sections that may be applicable to folks in healthcare — particularly around the IT organizations — around interoperability, around some of their vendor relations, and around what the new certification requirements are going to be. At one time one version of, I think it was the House bill version of the Cures Act, they actually had a star rating system for the EHRs. I haven’t found it yet. Of course there’s 900-plus pages to wade through, but I think there’s going to be some increased monitoring of usability and those types of things. And so what I try to do is keep people informed. Here’s what I think I’m seeing, what are you seeing? Are you seeing something different? Through that kind of Borg collective of looking at this regulation from different perspectives, you can get a better idea of what it truly means and how well it was written so it can be interpreted the same way from all aspects.
Gamble: There’s really a lot to pour through in something like that. And as you and I talked about earlier the timing is a little tricky, too, with it being the Friday of a holiday weekend, but it seems like that’s the way things go.
Christian: That seems to be the usual and customary timeframe they drop these things out. They’ve been promising it for a while and everybody’s been kind of waiting to see if it was actually going to come out. And of course now the votes, I understand based upon what you read, the House and Senate votes are scheduled for this week, so we’ll see if that actually get out. Then of course, if both sections of Congress pass it, and it has to go to the President’s desk for a signature. But I think it’s got everything in it that people were looking for. And like I said, depending upon how you read it, there are some changes in the FDA oversight, but I haven’t gotten to that section yet.
Gamble: You haven’t been through all 900 pages yet?
Christian: No. I just passed about 360, 370, so I’ve got a little bit more yet to wade through. These things are written in such a way that you just can’t read it like a novel, because it’s actually amending other regulations and replacing language. And so you have to flip back and forth to really get a full picture of it. Sometimes you have to really wait until you see someone else’s interpretation and say ‘oh, that’s what that means.’ It’s like trying to proofread your own work. You just miss words or you put words in that aren’t there. You know they should have been there, but they’re just not.
Gamble: So the way it’s set up, members of Indiana HIE could look to you guys for some guidance or interpretation on that, at least just on a general level of what the Cures Bill means for them?
Christian: Yeah and that’s conversations that we have. Most of the CIOs I talk to are a member of CHIME and every Monday morning, there is a beltway debrief that Leslie Krigstein and Mari Savickis put out that are really nice concise summaries of what’s been going on and what we can expect. And that comes out of their work on the Hill, as well as the policy steering committee. There’s a group of CIOs or CHIME members that offer input into what they see and we have a lot of conversation around some of this stuff.
Gamble: Always a lot to talk about.
Christian: Yes, lots to talk about.
Gamble: Within the organization, IHIE is somewhere in the midst of a five-year strategic plan to support the mission. Can you talk about some of the key components of that and where the organization is with that plan?
Christian: Absolutely. We basically had three key components of our strategic plan. One was around EHR interoperability, which means putting the data back into EHR. In conversations we’ve had with the health systems, they spend millions of dollars — if not hundreds of millions of dollars for the larger organizations — on their EHRs. And the physicians and other clinicians want to see the information about that patient within that architecture — that infrastructure — without having to go somewhere else and look at a different user interface or log onto another system.
And so we’ve taken an interim step and we’ve done some integration with both Cerner and Epic, we’re working on it with Allscripts right now, and we’ve done it with Athena Health, where there’s a button, and if a physician is looking at a patient’s record, all he has to do is click on that button and it actually launches the web browser into the data repository in context with that patient. It just logs him in securely and so they get to that patient’s information with one click.
The other thing that we’ve created is a Google-like search feature for the patient, so that regardless of where they have care, particularly in Indianapolis or anywhere in our service area — which is about a total of 109 hospitals and 140 different data sources — they don’t want to have to go looking through the filing cabinet to go find something. And so we created a Google search where they can put in key terms and do safe searches, and they can do that today within the browser application that we have. We’re also putting that search bar inside of Epic and Cerner where they can enter their search terms or their safe searches and it will actually open up our what we call Care Web with that search results page.
I’ve seen the ER physician at Eskenazi do this on a couple of occasions. He has a protocol search that he has named chest pain because he’s an ER physician and he has people walk in with chest pain. The chest pain protocol goes out and looks for any other admission at any other hospital inside the data repository where the patient had chest pain as the chief complaint. It looks for the most recent troponin level, which is a lab test that shows you if there’s been a recent muscle damage. Then it’ll look and see if the patient has had an echo or a cath and if they have an injection fraction. It pulls that information to him rather than him having to go and look in a different section. So it makes it far more convenient for the physician to get to the information they need based upon their pre-saved searches.