In an industry where change has become the norm, it’s rare when an individual can identify the most “powerful transformation” that occurred during the course of a career. But for Carla Smith, who has served as Executive Vice President of HIMSS since 2001, it’s a no-brainer. The game-changer, she says, came when the conversation shifted from implementing EHRs to optimization, and strategic thinking now revolved around how to harness the power of data to improve access to care, increase clinician satisfaction, and improve outcomes.
In this interview, she talks about the enormous effort it took to reach the tipping point, how some organizations are leveraging data to “change the world,” and what she believes is the next direction the industry needs to take. Smith also discusses HIMSS’ increased focus on advancing women in health IT, what we’re learning about gaps in compensation, and how we can take steps to close them.
- Disruptive Women in Healthcare
- Healthcare IT’s tipping point – “People spent entire careers getting to that point.”
- AI, blockchain & genomics – “It’s freeing the data so people can do amazing things with it.”
- IT’s role in workforce development
- Healthcare Without Walls
- MetroHealth’s efforts to promote diversity in leadership
- Putting schools in computer libraries
The ability to talk about how to harness the power of the information and to increase access, increase clinician satisfaction, increase the wellness of patients, increase the quality of the care and the outcomes of the care that’s provided, and to find ways to do it without breaking the bank — that’s so meaningful.
We’re focused on freeing the data so people can do amazing things with it, of course while keeping the Hippocratic Oath of ‘do no harm’ at the forefront.
These organizations have to demonstrate quantifiable value, which can be defined in terms of care quality, cost effectiveness, physician satisfaction, or any area. The key is to be able to express that value.
The idea is to create a health system that is right-sized and right-structured for the reality of 2018 and beyond, because we don’t have that today. We have disparities, we have barriers, and it’s not right.
Gamble: About a year ago, HIMSS acquired the rights to Disruptive Women in Health Care. Why was HIMSS interested in this particular organization?
Smith: Sure. They are now part of our community, which we believe positions us to more effectively provide education, mentoring, and leadership to guide women in making career and hiring decisions.
Gamble: The industry has evolved quite a bit since you first started with HIMSS in 2001. Is there a time period that stands out to you as being the most transformative?
Smith: For me, it was when the technology was installed in enough healthcare organizations; when it reached the fulcrum where the conversation was no longer around implementation. I remember distinctly when we shifted our strategic thinking to optimization, using the power of the information coming out of that technology to change the world, from a healthcare perspective. That was the most powerful transformation.
That’s not to demean, in any way, the time, effort, and resources that went into the implementation phase, and how heavy a lift that was. That period was several decades in the making; people literally spent entire careers getting us to that tipping point. I have great admiration for that community, and was honored to be part of it. The ability now to talk about how to harness the power of the information and the technology to increase access, increase clinician satisfaction, increase the wellness of patients, increase the quality of the care and the outcomes of the care that’s provided, and to find ways to do it without breaking the bank — that’s so meaningful.
Gamble: Sure. None of what’s being done today would be possible without those efforts to implement EHR systems, and so it’s understandable that it was the focus for so long.
Smith: It had to be. We spent years on things like how to write an RFP, how to propose a technology acquisition to your board of directors, how to evaluate systems, how to determine what technological solution you need — basically, what are the problems you’re trying to solve. We spent so much time on that, but it was worth it. And of course, we also worked with policymakers to understand how technology could change the entire conversation.
Gamble: I can imagine it’s been encouraging to start to see some of the fruits of that work with these initiatives that are utilizing data to improve outcomes.
Smith: It’s wonderful. I recently did a site visit for the Davies Award program, which recognizes outstanding achievement by organizations that have utilized information and technology to improve clinical outcomes and drive value. These organizations have to demonstrate quantifiable value, which can be defined in terms of care quality, cost effectiveness, physician satisfaction, or any area. The key is to be able to express that value. The organization I visited was able to harness the power of information coming out of their technology systems to reduce urinary tract infections from Foley catheters down to about two or three a year. That’s incredible.
Gamble: I agree. And of course, the focus also has to be on what’s coming down the pike and preparing for that. We’re hearing so much discussion on digital health — will that be a big priority for HIMSS?
Smith: There are a few topics that are generating a lot of interest throughout the industry. Artificial intelligence has enormous potential. Blockchain is a game-changer. And there’s genomics, and the digital health implications. And of course what we’re seeing with the Apple Watch. It’s no longer a timekeeper or an accessory — it’s a medical device.
We’re focused on freeing the data so people can do amazing things with it, of course while keeping the Hippocratic Oath of ‘do no harm’ at the forefront. It’s unleashing the young, creative minds of developers to effect positive change. For example, the Chicago Public Health Department now uses data algorithms to identify restaurants with a higher likelihood of food violations and send inspectors there. That’s a great application of technology.
These are some of the topics we talk about. Another big one on the horizon is workforce development. For example, the way clinicians are trained and what they are trained to do — that’s going to change. Should we have a clinical discipline known as a virtualist — someone who is trained to provide care in a non-face-to-face setting? It’s interesting to think about. And of course, there’s a lot of conversation around radiology as a clinical discipline and the value-add of human radiologists. That field is rapidly changing.
Gamble: It is changing, as are the digital habits of our society as a whole.
Smith: Very much so. I used to joke that the reaction you get from students coming out of medical school and starting their internships was, ‘dude, where’s my EHR?’ because they were already digital natives. Now, there are digital natives who are in their upper 30s. They’re not 19-year-olds; they’re functioning adults. They’re parents. And yet, they were educated in medical school on paper, even though every other aspect of their lives involves technology. That shouldn’t happen anymore. We’ve reached that fulcrum; technology has been embraced by faculty, and it should be part of the curriculum.
Gamble: Let’s talk about Health Care Without Walls, which is something you spoke about at HIMSS earlier this year. It’s focused mainly on technologies that haven’t been deployed to the fullest extent, correct?
Smith: Yes. I spoke about it with Susan Dentzer, who is CEO of the Network for Excellence in Health Innovation (NEHI). She invited me to co-chair one of the work streams for the Health Care Without Walls initiative, which I was honored to do. The work streams are focused technology, payment, regulatory issues, workforce, and human factors. The idea is to create a health system that is right-sized and right-structured for the reality of 2018 and beyond, because we don’t have that today. We have disparities, we have barriers, and it’s not right. I’m co-chairing the workforce stream, along with Julene Campion (VP of Talent Acquisition at Geisinger Health System) and Anita McDonnell (former VP of Government Health Initiatives with Sanofi). We’re looking at what type of workers are needed to fill the gaps, and how they’re going to receive training. It’s been fascinating to talk about the next steps around that. There’s a book coming out this month, and then we’ll dive in again to collaborate on how we can take these concept and pilot and disseminate them.
Gamble: It’s great to see such a strong focus on building the workforce and making sure we have the right structures in place to grow the next generation of leaders.
Smith: That’s exactly what we need. I remember a site visit I did a few years ago with MetroHealth System in Cleveland, which is a public health system. The CIO at the time, Don Reichert, explained that gender and racial diversity on his team was mission-critical because he needed IT workers that represented the community that MetroHealth served. So he recruited people from different cultural backgrounds to help him understand what type of IT solutions would work for patients and clinicians.
Gamble: That’s great. Hopefully it’s something that will start to catch on more, because the need is certainly there.
Smith: Exactly. We want to enable healthcare organizations to provide services that are culturally respectful and meet the patient where he or she is. MetroHealth also partnered with public schools to make computers available in libraries for parents to use. Elementary schools are a natural gathering place for parents; this allows them to access their children’s medical records and make appointments, which many of them can’t do from home.
Gamble: Luckily we’re starting to see more attention paid to areas that have been under-represented in health IT and policy discussions, whether its underserved communities or rural settings.
Smith: It’s a big challenge. In Alberta, Canada, there’s a massive Epic implementation underway that spans across the province. This is fascinating to me because Alberta is made up of rural communities, and it offers the ability to provide better care for so many people.
Gamble: It sounds like something that could become a model going forward. Very exciting. Well, I want to thank you so much for your time. HIMSS is doing some incredible work, and it will be interesting to see how things continue to unfold.
Smith: Absolutely. Thank you, Kate.