As someone with nearly three decades of health IT experience, Mary Anne Leach knows that accomplishing anything worthwhile means being willing to learn from the past, and not being afraid to lead the way. Children’s Hospital Colorado was one of the first pediatric hospitals to fully implement an EHR and was a participant in Colorado’s first RHIO. Now, the organization is drawing from that experience to help build an improved HIE, and leveraging its relationship with Epic to extend its pediatric network. In this interview, Leach talks about the complex Meaningful Use picture in Colorado, how Children’s is partnering with vendors to develop a clinician-friendly mobile device strategy, why it’s critical to participate in advocacy initiatives, and how her background has given her a “well-rounded view.”
- Lessons learned from consulting
- EHRs have come a long way
- “It’s difficult for legislators to understand our world”
- Childrens’ ICD-10 efforts
- Maintaining a healthy work-life balance
- How data leaks impact consumer confidence
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When I’m negotiating contracts with software vendors and consulting firms, I’ve been in their shoes and can say that legitimately, and that helps build those partnerships and foundations of mutual understanding.
I’m very excited to hear about Judy Murphy and David Muntz joining the Office of the National Coordinator. I think they’ll be great representatives. They’re friends and colleagues and they have some real world, boots-on-the-ground experience in our shoes and know how difficult this is to implement.
I think all healthcare CIOs should participate on one of those levels, if not at the community level, then join the advocacy leadership team, because we really have to implement and support and optimize everything that’s being created, and we have to be consulted in the creation of these rules.
The other big push for all of us is around analytics. Now that we have all this great data, how do we leverage the data in an immediate, real-time, visual way so that providers can make better decisions and business leaders can make better decisions?
You have to balance access — providers and families and others need access to information when and where they need it, and physicians and faculty aren’t always crazy about some of our security policies. On the other hand, we’re really trying to maintain the integrity of our environment.
Gamble: I want to talk a little bit about your background. You have a pretty interesting background; it looks you spent some time implementing clinical applications for hospitals, then went into consulting for a while. As far as your experience from consulting, were there certain things that you took from that that you can apply to your current role, and were there certain things you didn’t like about it?
Leach: It’s interesting you should I ask about that because I think in many ways, a CIO’s role is advisory and consulting as well as leading. I’ve spent about half of my career on the provider side and about half on the consulting side, and I actually started in this industry on the software vendor side. I think all of that gives me a well-rounded view of the world. So when I’m negotiating contracts with software vendors and consulting firms, I’ve been in their shoes and can say that legitimately, and that helps build those partnerships and foundations of mutual understanding.
It’s been an interesting time. Thirty years ago, we said we would have electronic health records. It’s fun to finally realize that vision and see that we’re really deploying health records at a very quick pace. Dr. Farzad Mostashari from the Office of the National Coordinator was out in Denver a couple of weeks ago and he mentioned that we’ve made more progress in deployment of EHRs in the last two years than we’ve made in the last 20 years. And so, I think that’s a testament to the advocacy work that’s been going on from the industry from HIMSS and CHIME and other devoted work toward moving the dot and toward the incentive program that came out of the American Recovery and Reinvestment Act of 2009. Those EHR incentives are really, really effectively spurring adoption, and it’s just exciting to see. I think we’re going to see some transformational changes through information technology in our lifetime. So I’m pretty excited about that.
Gamble: Yeah, it’s a really interesting time to be involved in the industry and I agree with what you said about the last two years. I think that’s when things really just seemed to pick up, and like you said, advocacy does definitely play role in that. Is that something that you try to get involved with?
Leach: Yeah, I’m on the CHIME advocacy leadership team. I participate in some advocacy through NACHRI, which is now part of Children’s Hospital Association. So I sit in advocacy groups there. Way back I participated the 2006 Stark Safe Harbors and exemptions that really allow us to deliver the community health records. So it’s been an interest of mine for some time. And it’s really exciting to see my colleagues on these work forces and task forces in Washington really developing some standards and moving those dots forward.
I’m very excited to hear about Judy Murphy and David Muntz joining the Office of the National Coordinator. I think they’ll be great representatives. They’re friends and colleagues and they have some real world, boots-on-the-ground experience in our shoes and know how difficult this is to implement. So I think having them now joining the Office of National Coordinator will be fantastic.
Gamble: Yeah, I can imagine that for CIOs who have so much on their plates right now, that there’s just not a lot of time available. But how important do you think it is for CIOs to provide input and to participate in advocacy initiatives just to really help move things along and help make sure that they’re going in the right direction?
Leach: I think it’s critical for CIOs to actively participate. This is complicated stuff and it’s difficult for legislators to really understand our world and the impact of regulation. CHIME has recently redeveloped their advocacy function to be tiered so that really everyone in CHIME can participate, either directly in the CHIME advocacy community or through their StateNet organizations. And currently, I happened to chair the Colorado StateNet, we call it C4, the Colorado CIO Collaboration Committee. It’s a collection of CIOs locally but also directors and other health IT leaders from a variety of stakeholders, including hospitals, clinics, oncology, services, laboratories, medical associations — really a lot of independent stakeholders who come together and help drive health IT in the state of Colorado.
But going back to CHIME, they’ve implemented the advocacy leadership team and the policy steering committee. So I think all healthcare CIOs should participate on one of those levels, if not at the community level, then join the advocacy leadership team, because we really have to implement and support and optimize everything that’s being created, and we have to be consulted in the creation of these rules. We’ve offered to the Office of National Coordinator the use of CHIME. I mean, if they want to run some preliminary rule language by us, we’d be happy to give them some pre-comments to help shape that. I don’t think they’ve taken us up on it, but we actively participate once the interim rules are published and help, through public comment, shape the outcome of those rules. We’ve also responded to the rules and helped CMS develop the FAQs and clarifications that have been required.
Gamble: Yeah, CHIME is an excellent resource and I hope that there are plans to take more advantage of that type of resource.
Leach: And if other healthcare leaders don’t have an opportunity to participate in CHIME, I know that HIMSS has an advocacy group as well that is very active, and AHIMA is very active. Advocacy has kind of become a part-time job for many of us as we continue to move this ball forward. There is a lot going on at the state and federal level.
Gamble: Absolutely. And that kind of leads into one of the last things I wanted to ask you. As CIO of a pretty good-sized organization and someone who is involved in advocacy, do you find it tough sometimes to maintain a healthy work-life balance?
Leach: Yeah, I would say there is no work-life balance at the moment. There’s a lot going on. It’s an exciting time to be a CIO in healthcare, but it’s also a very challenging time. We’re also in the middle of our ICD-10 transition; that’s a huge, huge effort for all of us CIOs to not only address all the systems that need to be upgraded and modified, but all of the workflows, physician documentation, etc. So ICD-10 is a big project for us right now — much bigger than I think Y2K was.
And then the other big push for all of us is around analytics. Now that we have all this great data, how do we leverage the data in an immediate, real-time, visual way so that providers can make better decisions and business leaders can make better decisions? So there is a lot going on in our world, but I think the net result will be better, safer care at a less costly price point. And as CMS says, it’s really our triple aim: improved quality, improved outcomes, and improved population health, all at lower cost and higher value. So it’s an exciting time, but we certainly all have lots going on.
Gamble: Absolutely. The ultimate goal is something that everybody wants to reach but it’s going to take a lot more work and it’s got to be extremely intense for CIOs right now. I imagine there’s really probably not many options of being able to just turn the Blackberry off.
Leach: Not really, no. But we have to maintain our health and maintain a good work-life balance so that we can come to the workplace inspired and refreshed and motivated and insightful. And we don’t know we have those good days but I think it behooves all of us that work in this industry right now to strive for a work-life balance and take good care of ourselves because we can’t give our best to our industry if we don’t. So there is a lot going on for all of us, but it demands some thought leadership as well.
Gamble: Okay, before we wrap up, were there any other issues you wanted to address—either projects you’re working on, and we did touch on a lot, or any of your thoughts in industry trends?
Leach: The only other thing I might mention that’s going to be of interest to all of us is the additional release of the HIPAA rule around accounting of disclosures. That has the potential to be another really large regulatory effort for all of us. Most of our EMRs have pretty good audit trails on who viewed what at what point in time, but there are many, many other systems and devices now that store PHI that could potentially be a source of disclosure. So if you think about IV pumps, scanning machines, copiers, medical devices—that’s another area of regulation. More medical devices and mobile aps will be regulated by the federal government. So I think there’s more coming, but in terms of accounting of disclosures, I believe the final rules were released and that will hit us pretty soon. Those regulations determine a lot of the activity we do here on the ground and how we might build our analytics environment to make sure we’re factoring that in.
Gamble: Especially since we were talking a little bit about how you’re starting to roll out more applications for mobile devices, and that is another really huge issue — making sure that information on there is kept safe. That’s an enormous issue right now.
Leach: Yeah, security and privacy is our other day job. It’s critical to have a really great security and privacy program because the fines are significant now, and in addition to the fines, we are starting to see class action lawsuits. Recently I read an article, I think it was about Stanford, that there was a database or a laptop lost or a database disclosed with PHI, and there were 20,000 patient records. Well, 20,000 patient records in a class action lawsuit comes to about $20 million. So the penalties and fines and repercussions are significant, not to mention consumer confidence in going to that organization, knowing that your data is safe.
It’s absolutely a huge area of focus for all of us certainly as we get more and more users on their EMRs, using their personal health record on their iPhone, etc. There’s a lot of exposure there. So CIOs would be well served to have a great security program, and we’re lucky here at children hospital to have a really great security and privacy and compliance program at the hospital.
Gamble: That’s so important. I would bet that as a CIO, when you see stories like that that must really run a chill to your spine, just seeing what that can do to an organization.
Leach: Absolutely. We are constantly vigilant about security and privacy, and of course it’s a balancing act. You have to balance access — providers and families and others need access to information when and where they need it, and physicians and faculty aren’t always crazy about some of our security policies. On the other hand, we’re really trying to maintain the integrity of our environment. It’s so easy for that to go awry quickly. And as mobile devices become prolific and people access data that way, hackers are absolutely leveraging that platform. So we’re ever vigilant.
Gamble: Yeah, you have to be. All right, we’ve definitely touched on a lot. Is there anything else that you could think of?
Leach: Those are the hot topics. Those are the top priorities — Meaningful Use, ICD-10, growth, analytics, and security and privacy. I think that’s pretty much the HIMSS conference in a nutshell. And mobile apps, of course, don’t forget that. I think we’ve covered it all.
Gamble: Well, this has really been great. Thank you so much for your time.
Leach: Thank you, Kate. I’m honored to be asked and I hope this audio publishes in a publishable way.
Gamble: Me too. I’m sure that people will definitely find it interesting to read. Thanks again for your time.
Leach: Thank you.