Jeffrey Ferranti, MD, CIO & VP for Medical Informatics, Duke Medicine
For most organizations, having a CIO with a background as a clinician and a passion for research would be viewed as a plus; at Duke Medicine, however, it’s practically a necessity. Not only did Jeffrey Ferranti meet those criteria, but as the CMIO, he knew the organization well and was prepared to guide it through a major implementation. In this interview, Ferranti talks about how his team created its own set of best practices and applied them during the Epic rollout; how he has benefited from his experience as a clinician; why it was a “really natural transition” from the CMIO to the CIO role; and what it’s like working for an organization where innovation is part of the DNA.
Chapter 3
- Leveraging IT to improve outcomes
- His passion for analytics & data warehousing
- “Innovation is part of our DNA”
- Pillars for the future
- “I think we’ll be optimizing forever.”
- Looking back at his first year as CIO
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Bold Statements
The fun part of being in an academic medical center is that you have that continuum of research and clinical care, and you can really leverage some of the expertise that you have in research to make the way you take care of patients more efficient and more effective.
If I had to describe where we’re going in the next three years, it really comes down to data and analytics and health intelligence and how we’re going to leverage the warehouse that we’ve built for so many years.
Innovation is part of our DNA at Duke. We need to be able to support that in an environment where it’s secure and it protects the privacy of our patients and it allows us to provide new tools, new technologies, and new platforms.
Being a health system CIO affords you a unique opportunity to participate with some extremely smart people, all working toward a really worthy cause. It’s been remarkable, and I’ve enjoyed every day of it.
Gamble: Looking at your LinkedIn profile, it seems that research is something that’s been really important to you for a while. I wanted to talk a little bit about the research work that you’ve done in the past especially focusing on things like using IT to improve pediatric critical care. Do you think that this is an area where we’re going to start to see a lot of traction soon?
Ferranti: I certainly hope so. I think that there is huge potential for IT to really help the way we take care of kids. A lot of EHRs start out being built around adult medicine and then pediatric functionality is added over the years. I think Epic has done a good job of adding pretty robust pediatric functionality, but there are still areas we can improve in.
Part of what we’re doing — and we have several pediatric champions who are leading this effort — is thinking critically about what tools do we need to more effectively manage sick infants, sick children, and sick adolescents, because that’s really an area that I think is important. A lot of my early research was focused around how IT systems can help us aggregate and coordinate data caring for critically ill newborns, but I think that experience and the way we approach that applies to lots of different realms of medicine, including adult critical care patients. And so I think as we’re building out our EHR and as we’re optimizing our EHR, there will certainly be a focus on the tools that we can use to make us more efficient, effective, and safe in the care that we deliver.
Gamble: I would think it’s a really nice thing being part of an organization that is doing so much with research and where you have all of this information at your fingertips.
Ferranti: I think the line between research and clinical care is becoming more and more blurred week after week. As we think about implementation science and you think about health services research and you think about how do you change the way you care for a population of patients to make the overall health of that population better, that really straddles the fence between research and clinical care. This idea of translational medicine and speeding discoveries to the bedside faster is central to what we’re trying to do here at Duke. We’re a CTSA award site. We have a Clinical and Translational Science Award, and a lot of that work is around how do you use your information systems to better manage populations of patients, to better integrate research into your care activities, and ultimately, to be more innovative in the ways that we deliver care. The fun part of being in an academic medical center is that you have that continuum of research and clinical care, and you can really leverage some of the expertise that you have in research to make the way you take care of patients more efficient and more effective.
Gamble: As far as analytics, is that a big focus of yours right now? Do you have fairly robust data warehousing capabilities?
Ferranti: Part of my background is that I was running the data warehouse team as an associate CIO here for several years. I think that data warehousing, health intelligence and analytics is really my passion. I spent most of my research time working on how do we better empower people with actionable information using all the tools that are at our disposal. We have a data warehouse that dates back to 1996 and has over 4.5 million patients in it. The question really is, how do you leverage your tools and techniques you have on the IT side to securely and safely utilize that data so that you can better impact the care that you’re delivering?
We use business intelligence tools like BusinessObjects to provide leadership reports on how our patients are doing. We use some of the Epic-native tools like Reporting Workbench to dynamically ask questions of cohorts of patients. And then we have homegrown tools like DEDUCE, where we can identify cohorts of patient with similar issues so that we can look at how do I take better care of this population or how do I understand when there are opportunities to improve the care that we’re delivering. So I think that moving forward, we’re going to really differentiate ourselves to how we leverage our information and our analytics to improve care.
That’s one of the pillars we’re going to focus on. If I had to describe where we’re going in the next three years, it really comes down to data and analytics and health intelligence and how we’re going to leverage the warehouse that we’ve built for so many years. And also patient engagement through the portal and mobile devices and then innovation around the EHR — how are we going to start building new technologies, mobile apps, and such that we can actually move the needle a little bit more using some of these new innovations and technologies.
Gamble: It seems like there truly is a culture there of innovation and ideas are encouraged. That seems like something that’s tremendously important.
Ferranti: I think innovation is part of our DNA at Duke. We need to be able to support that in an environment where it’s secure and it protects the privacy of our patients and it allows us to provide new tools, new technologies, and new platforms to improve on healthcare as a whole. I think it’s part of our mission as an academic medical center to do that.
Gamble: As far as the priorities on your plate for the next couple of months or next year or so, with the two hospitals going live pretty recently, are you focused primarily on optimization at this point?
Ferranti: I would say we have several priorities. I do think that the community hospitals are doing well. There are certainly some opportunities to optimize, and I think we’ll be optimizing forevermore — it’s just part of the natural lifecycle of an EHR that you continue to optimize. But where we’re really focusing our project effort is around Beaker, which is the Epic lab module. This summer we have Beaker going in at Duke Regional and at Duke Hospital, so we’ll be moving that project forward.
We’re focusing on the patient portal — we talked about some of the enhancements there, and around the enterprise data warehouse reporting and analytics. We have several focused initiatives around there. We’re upgrading to the new version of Epic. I think there’s a lot of great functionality that comes with Epic 2014 and we want to get that in as quickly as possible. There’s obviously been a delay in ICD-10, but I think that doesn’t really delay our planning around ICD-10, and so we have some focused work and effort to have to go in to our continuing to get prepared around ICD-10.
And then we have a lot of internal service delivery projects that we’re working on like service-based costing — how do we start charging IT back to our customers as fully baked IT services as opposed to just cost allocating things like data center operations and network infrastructure? We try to bundle things together so that the services we deliver resonate better with our customers. That’s obviously a big project and one that we’re spending a lot of time working on. There’s also health information exchange, particularly beyond Epic’s Care Everywhere. That’s a big area of focus for us, along with getting our HISP up and running and participating in eHealth Exchange. So we have a lot of things on our plate for the coming year.
Gamble: It certainly sounds like it. Now you had said before that you wanted to be CIO for a long time. Has it gone somewhat the way you expected? Were there any major surprises?
Ferranti: I think it’s been better than I expected. I feel very privileged to be in this role, and I learn something new every day. There are exciting challenges that come up every day. I have a fantastic group of people who I work with every day. I think this is the greatest job in the world; being a health system CIO affords you a unique opportunity to participate with some extremely smart people, all working toward a really worthy cause. It’s been remarkable, and I’ve enjoyed every day of it.
Gamble: It’s great to hear. You can hear the passion in your voice, and I think that that’s something that’s really going to be a plus for you and probably already is.
Ferranti: It’s been a lot of fun.
Gamble: Okay, well, we’ve covered a lot. It sounds like you guys have a lot of really great work going on. I wanted to thank you so much for your time. I’d like to try to check up with you a little bit down the line to see how everything is going and what else you’re up to.
Ferranti: That sounds great. Thanks very much, I appreciate it.
Gamble: All right, thank you. I’ll be in touch soon.
Ferranti: Have a great day.
Gamble: You too.
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