When Bill Spooner stepped down as CIO at Sharp Healthcare in 2014 after spending 35 years with the organization, he had mixed feelings. Although he was ready for a change from the frenzied pace of the CIO role, he hesitated to leave because “there were so many exciting things going in healthcare.”
Fortunately, Spooner found a way to remain involved in the industry — and pass on some of the wisdom he gained from his tenure — through his work as an advisor with Next Wave Health Advisors, and as an active participant with CHIME’s advocacy initiatives. In this interview, he offers insights on a number of pertinent issues, including why workflow is still a significant challenge for many organizations, the factor that most slows down the optimization process, and the surprising area in which healthcare is still far behind. Spooner also reflects on his own career, where we stand in terms of interoperability, and why perspective can be the best gift for leaders.
- CHIME Advocacy efforts: “The work we’re doing is rewarding.”
- Interoperability – “It seems like we’re trying to boil the ocean.”
- CCD-A’s slow but notable progress
- The flawed ATM comparison
- Patient matching – “It’s scary from a patient safety standpoint.”
- Physician dilemma – “They weren’t taught to be robots.”
- Retired, but still involved
- “There are so many exciting things that I continue to want to be a part of.”
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The ATM has one unit; it’s called dollars. In healthcare, you’ve got a few thousand data elements that need to be standardized across organizations. That’s a much more challenging job.
We’ve been proclaiming the potential for IT to improve patient care for so many years, and then HITECH came along and that really accelerated it. But the expectations weren’t very realistic in terms of how fast you could get to some of the standardization that’s required to exchange data effectively.
When you’re looking at this idea of a trusted framework that embraces the whole nation, you’re likely to get some really dangerous data matching with patients that are totally different and have different conditions. That’s scary. We need a solution for that.
They weren’t taught to be robots. They were taught to be resourceful and innovative and find a way to heal patients, and we’re trying to move them into a model where their data become more standardized.
Gamble: When you look at the policy work you’re doing with CHIME, I imagine interoperability is something that comes up a lot. Do you think the industry is taking steps in the right direction to deal with what has been an enormous challenge?
Spooner: If you look back 5, 10, or 15 years ago, it’s night and day. Clearly, we’re not there yet, and sometimes I get disappointed because it seems like we’re trying to boil the ocean. Some of these policy groups come together and try to think of every single use case, as if we’re going to solve it all before we solve anything. But when you look at the basic exchange of data, it’s happening so much more, and it’s so much more effective than it was. Of course, it’s still far from perfect. The CCDA document is a large chop of the data rather than the precise data physician may need to treat their patients, so it’s a little bit cumbersome, but it’s still making progress. You don’t realize just how much work it takes to get to a standard in so much detail.
I get a kick out of the long-term comparison of healthcare data exchange with the ATM in banking. The ATM has one unit; it’s called dollars. In healthcare, you’ve got a few thousand data elements that need to be standardized across organizations. That’s a much more challenging job. I heard someone compare it to the railway system, with the argument that ‘we had standards that got us the railroads. That’s not any different than the standards that get us healthcare.’ And I thought, come on. You can’t compare the width of the track and which way it’s going with having to deal with thousands of data elements.
The work we’re doing in trying to drive healthcare in the right direction is really rewarding. But I think it’s a little disappointing for all of us that we’ve been proclaiming the potential for IT to improve patient care for so many years, and then HITECH came along and that really accelerated it. But the expectations weren’t very realistic in terms of how fast you could get to some of the standardization that’s required to exchange data effectively.
Gamble: It seems like an area where it’s really helpful to have some perspective and point out even though there’s a long way to go, we have come a long way. What about patient matching? I’m sure there’s frustration that we haven’t been able to work through that challenge.
Spooner: Yes. Well, I’m glad to see organizations besides CHIME and HIMSS are now pointing that out. I saw a letter from Pew Research recently that called it ‘patient matching.’ They call it that because everyone’s afraid to use the term ‘patient identification’ because of the opposition from people concerned with privacy. When organizations do analysis and show that their matching rates are only in the low to mid 90 percent, it means at least five percent of your patients may have an incorrect medical record, because either data has been left out, or merged with somebody with a similar name. That’s scary from a patient safety standpoint. And when you’re looking at this idea of a trusted framework that embraces the whole nation, you’re likely to get some really dangerous data matching with patients that are totally different and have different conditions. That’s scary. We need a solution for that.
Gamble: Right. But it’s encouraging that organizations are talking about it so it isn’t just CHIME beating the drum.
Spooner: And there’s some influence in Congress that’s still gets in the way. I’m not sure exactly where it is, but it’s really a barrier, and somehow we need to overcome it. I will acknowledge that a numbering system isn’t going to be perfect, because not everybody will have a number. There will be errors. But it’s got to get better if we expect to truly exchange data. Even when people who try to make a healthcare exchange as simple as sticking your debit card in an ATM machine — the reason that stuff works is because you’ve got a number on it unique to yourself.
Gamble: You still hear those comparisons, and I’m sure it’s frustrating because we’re talking about such different worlds. It’s not even apples and oranges; it’s apples and something very different.
Spooner: The other challenge that I think we all recognize but we don’t talk about a lot is that within an organization, the way providers document and the terminology they use varies from provider to provider. Think about it — you have these physicians who are the brightest people in the room. They went to medical school and went through years and years of training so that they can deal with almost any kind of a condition. They weren’t taught to be robots. They were taught to be resourceful and innovative and find a way to heal patients, and we’re trying to move them into a model where their data become more standardized. I wouldn’t like it if I were a physician and I was told I suddenly had to change, and that everything I learned needed to be adapted. And so some of the delays in getting the technology in place are probably good, so that we can nudge the providers along to a little bit more commonality; semantic interoperability and artificial intelligence help, but again, that adds to cost of healthcare.
Gamble: The most important job of a physician or nurse is patient care and of course, the last thing leaders want to do is make that more challenging or make them feel like data entry clerks.
Gamble: Well, we’ve covered a lot. It’s been really interesting to hear your perspective and honest assessment of where we are as an industry. On one hand, we’ve come a long way and there’s a lot of potential, but on the other hand, there are a lot of barriers. So it looks like you’re going to be busy for a while.
Spooner: I think a lot of us are going to be busy for a while. When I retired from a full-time job four years ago, I hated to do it at that time. I was ready, but I hated to do it, because there are so many exciting things going on in healthcare that I continue to want to be a part of. That is exciting.
Gamble: I’m sure it’s good to be a part of it in a different way. Well, thank you so much. It’s been really interesting and fun, and I hope we can speak again in the near future.
Spooner: Thank you, Kate. It’s good to talk with you.