If you think most hospital CIOs have a lot on their plates, you’d be absolutely right. And if you also think cancer center CIOs have even more, you’d win another prize. That’s because not only must they sate the clinical side of the house, but a voracious need for data on the research side constitutes a thirst that never gets quenched. As such, Mark Hulse, CIO at Moffitt Cancer Center, is a busy man. In this interview, he talks about the center’s march toward ever greater degrees of automation, and how every step marks an advantage in research that means hope for cancer patients.
- Measuring up to Meaningful Use
- Patient engagement
- Privacy, security and research
- Decision versus deliberation
- New challenges, new scenery
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We’ve learned that, if you’re going to do it, don’t focus on specific percentages, just do it the right way.
The joke about academic medical centers is that a 9-1 vote is seen as a tie.
… we often joke that there’s got to be a technology solution to fix pretty much any challenge we have, the whole idea that there’s going to be an app for that …
Gamble: I know that when I’d spoken to a couple of CIOs about some of the proposed rules of Meaningful Use Stage 2, one of the things they talk about is the requirement that a certain number of patients have to access their record electronically; and a couple of them have said, “We don’t have 10% of patients asking for their records on paper,” so guess that it depends on a lot of factors, but it seems patient engagement really can be a challenge on a couple of different levels.
Hulse: Yes, I think that’s absolutely true; we’ve obviously talked about the specific component of that with cancer. I also think though, some of this is probably demographic based, and involves a whole variety of different things.
I look at, for example, http://www.patientslikeme.com/, which is really all patient data around specific diseases, and it is just a phenomenal resource, not only for patients who might be newly diagnosed so they can understand what kind of what treatment options are available, but just in terms of a support.
So it’s really allowing patients to drive based on what their needs are and, as I’ve mentioned, we’ve tried as much as possible to engage with patients, and they have been so generous, particularly in terms of consenting to Total Cancer Care and allowing us to study them; we ask what can we do to give back that data to them.
Gamble: And, of course, the more they know about how the data is being used, the more willing they are to share that information.
Hulse: Absolutely, and they don’t want to necessarily know how their specific data is being used but how is the data in general benefitting other patients in terms of research, and what difference is that making.
Gamble: In terms of attestation for Meaningful Use, are there different deadlines or requirement being in a cancer research facility?
Hulse: They are not different; it’s still largely based on Medicare service or Medicaid. Our goal is to attest next year. We’re wrapping up, we probably have three or four more clinics to complete the EMR rollout to; for us the big knot is going to be CPOE. Thankfully, we’re informed by those who have gone ahead of us. We’ve learned that, if you’re going to do it, don’t focus on specific percentages, just do it the right way. The challenge here has to do with concerns around chemotherapy and the links between the ordering physician, the pharmacist and the nurse administering the chemo — all that will have to be in place, so there are some additional workflow components.
Gamble: You’re looking at the end of next year?
Hulse: Yes, planning on attesting around the September timeframe.
Gamble: I want to switch gears a little bit. You previously worked as a CIO at NorthShore Medical Center, which is part of the Partners system, and it seems that there really are a lot of differences between being a CIO at a Cancer Research Center as opposed to a facility like NorthShore. In the couple of years that you’ve been there, what do you think are the biggest challenges with your job now as opposed to your past roles?
Hulse: That’s a great question. I was at NorthShore Medical Center for five years; it was a phenomenal place to work; prior to that I had really spent most of my career both as a clinician and an IT professional at an academic medical center. So just taking one step back before I answer your question, the different between being involved in an academic center and community hospital such as NorthShore was the ability to make decisions very quickly. I was a newly minted CIO at the time and I would say “Here are some ideas I have,” and people would just say, “Ok, great, let’s do it.” I’d say, “Wait a second, I’m just thinking out loud here.” The joke about academic medical centers is that a 9-1 vote is seen as a tie. So it’s really all about consensus and taking time and making sure everyone’s engaged, and that’s important regardless of the organization, but it’s particularly true in the academic settings.
So I really enjoy the agility and the ability to be able to influence decision making. I was there for five years though and started getting a little bit itchy to get back into more of an academic setting, and really did want more exposure to the research side, so when the opportunity at Moffitt presented itself, it seemed ideal.
In terms of challenges, on the clinical side, you’re very focused on privacy and security and protecting patient information; but on the research side, it’s all about collaboration and openness and sharing and all of that.
When I see the work that’s being done whether it’s in basic science, we’ve actually got a group of mathematicians who are in a field that’s called mathematical oncology, who deal with high end computer system for their work, it’s just fascinating and the challenge of being able to support that is great.
Gamble: That’s really interesting, the data; I mean, one of the debates we always hear is access versus security; so you’re having to deal with both ends of that; that’s got to be interesting.
Hulse: It is interesting, and I think we’ve worked through a number of those things. I mean, there’s still a lot of work we’d love to be able to do around appropriately, for example, segmenting our network so that you have sort a research network and a clinical network.
On the other hand, it’s an exchange of data that has to be able to occur over a period of time; so the key piece to that, obviously, is how you de-identify but then also have the ability to re-identify data; so that was a key functional requirement that we had for health and research informatics back then; but in many cases, we have physician scientists.
So on one side, until they have the approved study, they have to really be working with de-identified data.
On the other side, the clinicians want to be able to understand the clinical outcomes for their patients with the identified data; so how do you make that happen?
Gamble: I would imagine your experience as a clinician come in handy when you are dealing with these types of issues.
Hulse: There’s no question that having the RN credential certainly buys you credibility with clinicians as a CIO, but I think, as you indicated, it’s really more about the experience in different clinical and operational administrative roles that I had that helps me understand the challenge and needs, particularly of our clinical staff.
It’s really important for them, I think, in our conversations as I work with our clinical leadership and so forth to know that I get their worth; and so we often joke that there’s got to be a technology solution to fix pretty much any challenge we have, the whole idea that there’s going to be an app for that, but the reality is that the technology is just one piece of the puzzle, and often a minor piece of that puzzle, that will drive true transformation. We also need people to think differently about their day-to-day processes.
We often focus on the tasks rather than the outcome of what we’re trying to achieve. And we can’t get that by having a technology orientation when you come into a discussion. It’s very important to have a much broader view than that. That’s not to say every IT leader needs to have a clinical background, but I think it’s important that they certainly have some experience or gain the experience in actual clinical world, as well as the research world.
Gamble: I’m sure that the more well rounded of a view you have, the easier it is going be to relate to different people and to see things in a holistic way.
Gamble: You said you’ve been at Moffitt for three years?
Hulse: Three years, yes.
Gamble: You’d spend most of your time in Massachusetts or at least that general area, so what was the move like, that’s pretty different going from Massachusetts to Florida.
Hulse: It is. I joke that I hadn’t spent a whole lot of time in Florida prior to the opportunity that Moffitt presented, which is also why I took a little bit of time at the beginning of our call to let people know where Tampa was, because I certainly didn’t. Having said that, I think this past winter was pretty mild, I have to tell you probably the big a-ha moment for me in terms of the transition was a couple of years ago when my wife and I were doing some Christmas shopping at one of the malls down here. We had on our shorts and short-sleeves and looked at the TV to see a huge blizzard in Boston; and so the reality of that just hit us, but it’s been a change certainly, and it has pluses and minuses. But certainly Florida, and Tampa specifically, has a lot to offer, and is a great place to work.
Gamble: Boston winters can be brutal. I live in New Jersey, but I spend a lot of time in Massachusetts — the winters are no joke.
Gamble: We’ve really touched on a lot here, but I want to just give you the opportunity to add anything else you like.
Hulse: I think we’ve probably touched on all the things I would have liked to speak to, so I really appreciate both the question and the opportunity to respond to them. I think I would probably re-emphasize that we’re facing a time where creative collaborations will abound, whether they are public/private partnerships or ACO-like organizational platforms.
Gamble: Thanks again so much for your time. I really enjoy this, and I think that the listeners are really going to enjoy hearing about everything that you’re up to.
Hulse: Great, thank you for the opportunity Kate; I really enjoyed our conversation as well.