“Change is hard. It’s always hard.”
One of the most important lessons Jim Noga has learned during his 17 years in health IT leadership is that no matter how much education and planning go into a project, there will be a period of adjustment — and there’s no way leaders can avoid it. What they can do, however, is take steps to ease the burden. When Partners embarked on a five-year initiative to implement Epic across the system, Noga made sure that various stakeholders were at the table, providing input. The goal was to have a system that didn’t just meet the needs of clinicians, but all users — including patients.
In this interview, he talks how Partners viewed the Epic project as a “foundation” on which to build future functionalities, why innovation can never take a backseat, and why data governance is “necessary for the sustainability of the entire organization.” He also speaks about the key challenges in transitioning from Mass General CIO to Partners CIO, why it’s time to stop viewing IT as a component of the organization’s strategy, and how something as simple as wayfinding can have a huge impact on patient care.
- Research as a “key stakeholder” in the Epic rollout
- Building a “solid research platform”
- Data governance as a foundation — “It’s necessary for the sustainability of the entire organization.”
- Cybersecurity: “We can’t take our foot off the pedal”
- Consolidating HIM as part of Partners 2.0
- “Standardization sometimes gets a bad rep.”
- Site CIOs as “business relationship managers”
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They understood that they had a niche solution that had, from their perspective, better functionality. But that in the end, by having that single record and not having to use bailing wire and gum to cobble together interoperability, they would be better off, the patient would be better off.
They’re sourcing data not just from Epic, but genetics and genomics data — things like social determinants, imaging with metadata tagged to it, and patient-reported outcomes. There’s much more data available than just what’s in the core EHR.
It’s necessary for the sustainability of the entire organization that we do it well, because it can support clinical decision making, it can support population health management, it can support making business decisions, it can support clinical trials, and it can support basic research. So it’s really a key component.
Standardization sometimes gets a really bad rap. What we try to communicate is by standardizing some of the core services and the underlying infrastructure, that allows us to actually innovate more quickly.
Gamble: Was moving to an integrated system a tough sell for the academic medical centers, especially the ones that had homegrown systems? Or was there an understanding that this is why we’re going to an integrated system?
Noga: It wasn’t a difficult sell when they understood that this was all about the patient experience and being able to deliver better and safer care to our patients through that one record, through the whole continuum of care. People got it. They understood that they had a niche solution that had, from their perspective, better functionality. But that in the end, by having that single record and not having to use bailing wire and gum to cobble together interoperability between a variety of niche products, they would be better off, the patient would be better off. And it provides a great platform for generating data for our academic and research missions.
Gamble: Right, and I would think that when you’re dealing with academics and research, there’s probably a hunger there to want to get to that next point with the data, and want to get into some of the predictive and even prescriptive analytics and be able to do more with the information.
Noga: There is, and we have a solid research platform. We’re able to take data and anonymize it and really re-instantiate into what we call our RPDR (Research Patient Data Registry), and that then allows our investigators to identify cohorts of patients for potential research or for potential clinical trials. So it’s worked out well. And I think importantly — and probably different than was done in past efforts — research was one of the key stakeholders as we went through the implementation process to make sure we engaged them so that we didn’t build a system that only met the needs of the clinicians. We wanted to meet the needs of the clinicians, the researchers, other healthcare providers, revenue cycle, the administrative aspects of healthcare, and most importantly, the patient.
Gamble: Okay. So it sounds like there are a couple different things going on as far as big data and how the information is being used to do things like develop better protocols. Is it a multiple-burner strategy at this point?
Noga: Yes. There’s AI and machine learning and then there’s the Partners Data Lakes, and those are two initiatives where the teams often talk. I think what’s important is they’re sourcing data not just from Epic, but genetics and genomics data — things like social determinants, things like imaging with metadata tagged to it, things like patient-reported outcomes. There’s much more data available than just what’s in the core electronic health record when we talk about research.
Gamble: Right, and with the size of the organization you have separate groups, but is a specific data team? And as far as how those decisions are made, who are you really talking with most?
Noga: Those groups, obviously, talk to one another. One of the things we’re focused on is — and I’m not going to say we’ve solve it — but how do you put together data governance so that people know the source of truth; that they are able to determine, for what they’re trying to accomplish, where should they source the data? Should it be from an electronic warehouse, should it be from RPDR, should it be from the data lake, should it be from Epic Clarity or other sources? And the whole are of BI/analytics is something where we’re truly starting to up our game and focus on getting that right, because we feel that it’s really strategic that we do that well. And actually, I think it’s necessary for the sustainability of the entire organization that we do it well because, again, it can support clinical decision making, it can support population health management, it can support making business decisions, it can support clinical trials, and it can support basic research. So it’s really a key component. When I think about what has changed in the past five years in terms of what’s important, it’s that population health management, it is the analytics, it is the evidence-based medicine, and it is the artificial intelligence and machine learning in terms of our new focus.
At the same time, there are a lot of things for which CIOs are responsible that have to be done well, and we continue to focus on those. One is cybersecurity — we’ve made substantial advancements over the past five years, but we can’t take our foot off the pedal, because the threats are changing on a daily basis both in the type of threats they are and the damage that they can do. And so it just takes a lot of effort in terms of determining, ‘Where are my risks, and where am I going to invest in terms of a cybersecurity strategy?’ So that’s near the top of our list, ones you get behind or next to everything we’re doing in the clinical space.
And then we’re making a lot of investments in terms of Partners 2.0 and trying to be a more efficient enterprise organization. What comes into play there often are IT solutions. So we consolidated all our health information management departments across the enterprise into an enterprise HIM function. We’re looking at components in credentialing for doing that. Where do we have shadow IT across the organization that we want to pull together into an enterprise solution? How do you effectively deal with new affiliate integrations quickly? So we’ve developed a playbook for when we do have a new affiliation, what’s the order in terms of what to put in first? Do we focus on the network, do we focus on the human resources component? What components need to be in place even prior to pushing Epic out into that organization? Where are we able to standardize on infrastructure, whether it’s the service desk, whether it’s voiceover IP, or whether it’s Office 365 or Exchange Online? And how quickly can we move new affiliates over to those various platforms and make sure that it’s cost-effective for them as well as Partners as a whole in terms of moving them to what I would call IS infrastructure and application standards?
Gamble: Right. I imagine the whole Partners eCare initiative has driven this need to consolidate the enterprises as far as HIM, and really try to standardize infrastructures. I’m sure it’s been a necessity when you’re moving to one integrated system.
Noga: It has. In some respects, it’s been a forcing function into moving more toward an enterprise solution. We want to make sure standardization doesn’t mean the least common denominator, and that we still do focus on optimization and innovation, because standardization sometimes gets a really bad rap. What we try to communicate is by standardizing some of the core services and some of the underlying infrastructure, that allows us to actually innovate more quickly. But most importantly, when we have an innovation that works, we can scale it across the enterprise more quickly. Previous to having these standards and Epic in place, someone may have had a really great idea that worked in their environment but did not easily scale across Partners. In today’s environment, once we have agreement that it’s an innovation that we can scale, we can do that much more quickly than we could five years ago.
Gamble: How does the governance component work in terms of the consolidated HIM enterprise?
Noga: The HIM works with all the sites. Many of those staff were employees at each of the sites; they’re now a part of a Partners group and are employed directly by Partners. We figured out the various tasks, whether it’s request of information, whether it’s chart correction, or whether it’s managing the integrity of the EMPI. And then across the enterprise, staff applied for various positions, and we created that HIM group, because we realized we couldn’t have people at each sites doing chart corrections. They were going to be stepping on each other. We really needed to move to an enterprise solution. So that consolidation actually went very well and I think they’re a better organization because of that consolidation.
Gamble: Now, in terms of how it’s structured, most of or all of the hospitals have a site CIO at this point, right?
Noga: Yes, all of the hospitals have a site CIO. And because infrastructure is often managed centrally, essentially their role has really morphed into a business relationship manager. Now, the two AMCs — Massachusetts General Hospital and Brigham and Women’s Hospital — continue to have development teams locally and have innovation hubs. That isn’t necessarily the case at all the community hospitals. And so the role of a site CIO can vary in terms of responsibilities based on where you are and at which entity you’re the site CIO.
Gamble: Right. You’re dealing with different organizations with different needs and sizes.
Noga: Yes. Spaulding Rehab is different than McLean, which is focused on behavioral health, which is different than home care. Even with the community hospitals, some are in regions with a high percent of commercial payers, and others are in regions with high Medicaid. So yes, the needs vary.