Gerald Higgins, PhD., MBA, MS, is not your typical CIO — that’s because Higgins is a chief innovation officer. Getting paid not to carry out EMR implementations or persuade physicians to embrace CPOE, Higgins is remunerated to “see what’s happening one or two hills over the horizon.” With a dizzying array of jobs and accomplishments already behind him, Higgins has a non-traditional perspective for chief information officers, and a hearty dose of sympathy for the pressures they currently face. Recently, healthsystemCIO.com editor Anthony Guerra talked with Higgins about what makes a good innovation officer, meaningful use, and much more.
HIMSS is really, in part, an industry lobbying group, and I’m not a fan of them being involved in specifying what certification should be when they are the ones developing the systems.
(Meaningful Use) is requiring quite sophisticated functionality that a lot of these places are not going to be able to meet.
… companies like IBM, Microsoft and HP will absorb the EHR vendors. I think the plethora of EHR vendors will go away.
GUERRA: So tell me more about your impressions of the meaningful use definition.
HIGGINS: For example, take reporting to public health epidemiological entities, if it’s about infectious diseases, that stuff is already in place in all hospitals. If it’s not that stuff, then you are really talking about secondary use of EHR information, and that is a new field, so to have it be part of a requirement for EHR certification now seems to be a bit premature.
GUERRA: So you think some of the things in meaningful use don’t make sense and others are too aggressive?
HIGGINS: I think they did a good job. I have to sit back and be a bit smug and say that Azyxxi could do these things at the turn of the century. It’s a little confusing to me that all this should now be required for the EHR.
There is also a conflict of interest between HIMSS and CCHIT, because HIMSS is really, in part, an industry lobbying group, and I’m not a fan of them being involved in specifying what certification should be when they are the ones developing the systems. I know the ONC has allowed other opinions in and this is not just CCHIT, it’s a combination of different things, but I would hope they would be more open to open-source types of technology and other kinds of folks like myself that may be thinking too far out of the box.
GUERRA: You talked about Azyxxi, but that’s a high-end product for large institutions. ONC is trying to get everyone up to a certain level. I’m not sure I get your point about Azyxxi.
HIGGING: I’m just saying the horses have left the barn already, in a sense. It seems to me that in healthcare, we try to make standards as specific as possible so they apply across the board. You said this was trying to put in place basic functionality that everyone had to meet. I’m saying that it’s not doing that. It’s requiring quite sophisticated functionality that a lot of these places are not going to be able to meet.
GUERRA: So you think the meaningful use objectives are too aggressive.
HIGGINS: Way too aggressive.
GUERRA: And the goals look to be too aggressive for the aggressive timelines. Does that make sense?
HIGGINS: Yes it does.
GUERRA: Do you think we’ll see implementation failures due to this aggressiveness?
HIGGINS: Yes. You have to be very careful with how these things are implemented, deployed and maintained, because this is not trivial stuff. I’m not just talking about security, in fact I have a whole take on that which does not reflect my employer’s position (laughing), but there have been issues of people looking at their relatives’ records or celebrities, things like that.
You have to know there are certain things you just don’t do if you are working in a clinical informatics environment. There are so many different kinds of filters and so many different ways of looking at things, you can really get into situations that pose ethical issues. If we’re having that in a sophisticated system that’s been around for a long time, imagine trying to now supercharge everything using this list of meaningful use objectives. I just think there are going to be a lot of problems.
GUERRA: From my observations, CIOs are under tremendous pressure to get every dollar of HITECH money their organizations are eligible for. Do you agree? What advice might you have to offer?
HIGGINS: I would say it’s been my impression that we don’t really have a good trained workforce out there that can meet the need. I have been offered the CIO position at a number of large hospital systems, and the fact that that is happening tells me there is a lot of need out there. I think the CIO is in a really tough spot now, especially if they are in a hospital network that is used to generating a lot of revenue and having lots of high-value procedural volume, or an academic medical center that has been getting a lot of NIH funding, for example. I think the solutions will come after these meaningful use objectives are in place, and I think that’s the problem.
GUERRA: You’re saying the timing of it is a problem?
HIGGINS: Yes. I think in a lot of places we see clinician resistance to what’s going on, especially in the smaller practices, because they will have to spend a lot of money, if they are paper-based, to meet even a fraction of this stuff. They don’t have CIOs in those places.
What I see happening is the leading institutions that have academic research components and have had EHRs in place for awhile, they are going to be in step with the timing of this, even though they are under tremendous pressure right now. What I’m worried about are smaller hospital networks because there really just aren’t the people to make this stuff happen in this timeframe.
GUERRA: We talked about the idea of bringing non-healthcare perspectives to healthcare. Do you think healthcare can benefit from the experiences of CIOs outside the industry?
HIGGINS: I feel many CIOs in hospital networks are not trained in information technology but have picked it up along the way, they have been in healthcare their whole lives. In some cases, they are clinicians, and I see the domain being very resistant to bringing in people from other industries. There is a conservative attitude that says only if you’ve worked in a hospital your whole life or done clinical practice can you really understand what it means. So even someone who has been the top healthcare administrator in the hospital is seen as a better bet for the CIO role than someone who has been a CIO in a top company outside healthcare. I don’t agree with that.
So the whole reason Peter Neupert went to Bill Gates to start the Health Solutions Group is he had been outside healthcare and implemented a lot of technology. He said that healthcare was 20 years behind the times, but my fear is because of the culture of the people who are in positions of authority in the hospital, they are more willing to deal with other people who have clinical backgrounds than CIOs from other industries.
GUERRA: And there are also a few very entrenched vendors. The big seven HIS vendors probably make up 90 percent of the market.
HIGGINS: That reminds me of a story. When I was at Johns Hopkins Hospital (1998), Intel wanted to donate many workstations, but the president of Hopkins Hospital said to me that if we were going to accept the donation, it had to come through GE Medical Systems. To me, that was preposterous. That showed me a lot of medicine is very conservative, certainly in how it does business.
GUERRA: And that relates to certification. Do you fear it will freeze the existing vendors in place with their existing products?
HIGGINS: I don’t think so. I think what will happen, as does John (Moore) from Chillmark Research, is that companies like IBM, Microsoft and HP will absorb the EHR vendors. I think the plethora of EHR vendors will go away. Instead, the larger IT companies will be deterministic in how these things get played out. It’s already happening right now.
GUERRA: I just pictured a bunch of small children playing with a ball. All of a sudden a bunch of bigger kids see the ball and just take it away.
HIGGINS. Right, and the reality is you can’t fight it.
GUERRA: And why would you want to if the price is right?
HIGGINS: Sure. It also means some percentage of them will disappear. I predict it will be the majority, at least on the ambulatory side.