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.
- “A challenge is an opportunity in disguise.”
- Cutting through the noise — “Tell me what I don’t know.”
- Deep learning to improve workflow
- The high cost of customization
- “Vendors don’t want to do one-offs.”
- Collaboration — “We’re always willing to have conversations.”
- 2017: “We’re going to keep on keeping on.”
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They don’t need noise; they need information that’s appropriate and timely about what’s going on. If you’ve got a patient in the emergency room that’s got a sprained ankle, the physician doesn’t really need to know that they had an appendectomy 10 years ago.
The big vendors like Epic and Cerner need to be able to write code in a very standard way. Because every time they go and create customizations, there are costs associated with it — not only in writing the code, but maintaining and supporting that code. They don’t want to do one-offs.
It makes us a little bit different in the fact that we can quickly respond to requests from our members and incorporate that into the underlying platform that we’re running. But we’re more than willing to share ideas and information, and we do that on a regular basis.
We’re not in business to make a lot of money. We’re in business to have an impact upon the quality of care that can be provided to the folks that live in Indiana and figure out ways of having that data follow that patient wherever they go.
Christian: We’ve got a CMIO for one of our members and he comes up with so many great ideas. It’s wonderful. I’ll give you one example. We call it clinical decision support, but I think that’s not a really good moniker. So one thing we’re looking at is, in the not-too-distant future, if you’re a Medicare patient and you’ve had a CT scan of the head in the last six months, and you’re now seeing another doctor and he wants to do another, they’re not going to pay for that second one. I don’t know what the time frames are going to be, but it’s going to be a little bit different depending upon the test. And so that means the second person to do that test is going to do it for free, because they’re not going to be able to bill the patient for it and they’re not going to be able to bill Medicare for it. They’re going to have to eat that cost, and so it’s going to become far more important for them to know that the patient had that study.
Now because CT scans use ionizing radiation, it would be really great to know that before you give that patient another dose of ionizing radiation. And so wouldn’t it be wonderful if when that physician is actually ordering that study, something in the background could go out and look in a repository that has information about where that patient could have services in the state of Indiana, and bring that information back in real time to say, ‘this patient had this very study done at this other facility two weeks ago. Would you like to see it? And would you like the report?’ And if you’re going to use it for medical decision-making, do you want to bring it into your EMR and then keep the providence of that study, knowing that it didn’t occur at this facility, but it was done somewhere else, and is now part of the patient’s medical record.
What I just mentioned is something that’s doable today and that’s something that we’re looking at. But how do we do that? And I’m going to use the word unfortunately, but it’s really not unfortunate — it’s just a challenge, which is really an opportunity in disguise, of us having conversation with the EMR vendors saying, okay, how do we build these hooks inside the ordering systems or wherever else that would help inform the physician about what they don’t know? And that’s one of the interesting conversations I’m having with the physicians: don’t tell me what I already know. Tell me what I don’t know.
We have what I call a data pile. It’s a resource that can be used to help inform the clinicians at the time that they’re providing care for the patient. They don’t need noise; they need information that’s appropriate and timely about what’s going on. If you’ve got a patient in the emergency room that’s got a sprained ankle, the physician doesn’t really need to know that they had an appendectomy 10 years ago. They need information that’s germane to what’s going on at that point in time.
One of the things the Regenstrief Institute is working on right now is deep learning — here’s a physician, and every time a patient comes in with this chief complaint, they go look at these six things. Okay, so rather than make the physician go through those steps to go look at those six things, just bring it to him because if that’s their habit, then let’s inform that habit. Those are things that can be accomplished to make our technology smarter and also have a very good impact on the physician’s workflow.
Gamble: A lot of really interesting stuff, and you’re touching on so many different areas. You talked about working with vendors on things like a hook and it seems like there’s going to be more and more need for CIOs and other leaders to get into it more with the vendors and say, ‘listen, this is what we need,’ instead of just looking for a different solution.
Christian: Right. One of the things we’ve talked about is using FHIR, because the big vendors like Epic and Cerner need to be able to write code in a very standard way. Because every time they go and create customizations, there are costs associated with it — not only in writing the code, but maintaining and supporting that code as well. They don’t want to do one-offs. They want to do something that’s standard, so something like FHIR or another standard API call that, at those trigger events, would do something that is standard, because it doesn’t make any difference what the data source is behind that call. If we do it in the standard way and the data is returned in the standard way, they can react to it. They shouldn’t have to write specific code for anything every single time. They’re just not going to do it. They just can’t afford it, because it adds costs to the vendor, which are then passed along to the client. And it makes upgrades and a whole bunch of other things far more difficult.
Gamble: And going back to the Google search tool, that seems to make a lot of sense. Is that something that you want to try to expand out or help enable others to use? Obviously there’s going to be a cost, but it seems like it could really make a pretty significant difference.
Christian: One of the things that we’ve been asked is, can you search both the EMR data base and the INPC (Indiana Network for Patient Care) database, which is our clinical data repository, at the same time. And the answer is probably. We just need to sit down and have meaningful conversations with whoever it is in a standard way so that when we do it once, it’s repeatable. So it is very much something we are more than willing to have conversation about.
Gamble: IHI is really one of the better known HIEs and is that something where you have been asked to share certain practices with other HIEs or organizations just kind of keeping in that spirit with not reinventing the wheel and then sharing these ideas?
Christian: Sure, we’re always willing to have conversations with anybody that calls us up and asks for help. That’s one of the reasons that we’re providing leadership in a variety of ways. John Kansky, who’s our CEO, just got elected to the board of the Sequoia Project and he’s on one of the committees for the eHealth Exchange as well. I’m involved in a couple of different ways. John is on the board of SHEIC and I’m the chair of SHEIC’s policy steering committee, and so yes, we’re more than willing to have conversations.
But the interesting thing is we develop our own code, and sharing that out with someone else is a little bit more difficult, because a lot of the HIEs are using vendor-driven solutions. And there are only two HIEs in the country I know of that write their own code. So it makes us a little bit different in the fact that we can quickly respond to innovation or requests from more of our members and incorporate that into the underlying platform that we’re running. But we’re more than willing to share ideas and information and we do that on a regular basis.
Gamble: So looking at 2017, you mentioned so many different areas where IHIE is looking right now, so is it really a matter of just keeping on with all of that, along with anything else that comes up?
Christian: I think we have a lot of opportunity, but we have limited resources and bandwidth. I come up with what I think are great ideas every week, and so do a lot of other people in this organization and other organizations, and so we have to vet those among our own selves to say, okay, where does this fit? Is this a good idea? And we’ve got three different advisory groups with our membership. We have CMIO group where we talk about all things clinical. Then we have the CIO group where we talk about the technical and the business aspects, because a lot of these folks are helping drive a lot of innovation and creativity within their organizations. And then we have another group that’s focused on usability. They could be case managers, they could be people that work in physician offices a little bit closer to the surface of the earth than the CMIOs and the CIOs related to actually using the applications and the information that we present.
We’ve got a variety of other organizations that we work with on a regular basis. We have the Indiana Coalition for Patient Safety — I’ve gotten involved around how we can help them in their safety initiatives. It’s a really great and there are some interesting ideas they come up with. And so we’re just going to keep working with our members and the folks here.
We also have a new governor. Our previous governor (Mike Pence) didn’t run for reelection; he’s now the VP-elect. Eric Holcomb will be our governor. I knew Eric down in Vincennes for a while, but I’m sure he doesn’t remember me. We just crossed paths a couple of times. And so we’re working with the state of Indiana in a variety of ways, and we’ll continue to do that. We have some initiatives with the Indiana Hospital Association around how we can improve the health of Hoosiers. We’re a non-profit supporting organization. This is what we do. We’re not in business to make a lot of money. We’re in business to have an impact upon the quality of care that can be provided to the folks that live in Indiana and figure out ways of having that data follow that patient wherever they go.
Gamble: You mentioned the change in governor; that’s another thing that a lot of organizations are going to be dealing with. But usually it seems to be that nothing changes all that quickly, but kind of everyone has to maybe keep their ears open.
Christian: That’s absolutely true. There’s an awareness that you have to have to build those relationships in the industry and locally and nationally.
Gamble: So you’ve got your work cut out for the next year and beyond.
Christian: Oh yeah. We haven’t got lazy yet; we’re just going to keep on keeping on.
Gamble: Definitely. All right, well, thanks so much. It’s really great hearing about everything you guys are doing, and I look forward to the next time we get to chat.
Christian: Okay, great. We’ll hit on a couple of other topics around that time, too.
Gamble: Definitely. There’s always more to talk about.
Christian: Absolutely. All right, Kate, thanks very much.
Gamble: Thank you.