For many CIOs, there are about a million reasons not to get involved in advocacy. The most commonly cited, of course, is time. But to Pamela McNutt, who was instrumental in developing CHIME’s policy committee and has long been a champion for health IT legislation, those reasons are far outweighed by the positives. Not only does it help leaders stay educated on key issues, but by sharing “boots-on-the-ground experiences” with political leaders, CIOs are forging a better path for the entire industry.
Recently, healthsystemCIO spoke with McNutt about the enormous transformation healthcare has undergone in the past three decades – the vast majority of which she has spent with the same organization – and how she has evolved her leadership strategy. She also discusses the critical lessons she has learned about vendor management, the keys to working for a new CEO, and what excites and scares her most about the future.
- Focus on leveraging existing tools, not layering on new ones
- “The first question you really need to ask is, can this be done in Epic?”
- Eyeing predictive analytics
- Healthcare’s “digital revolution”
- Balancing interoperability with security
- Policy involvement: “It’s better to control your destiny that to have to react to it.”
- 26 years with Methodist
- “It feels like I’ve been in 3 different organizations”
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You’re bombarded with opportunities to layer things onto your Epic system, but the first question you really need to ask yourself is, can this be done in Epic?
With this digital revolution we’re seeing, we have to be able to empower patients to be able to access and use their data, and access us digitally.
We discovered it does make an impact to get involved; to talk with people at CMS, to develop those relationships with ONC, and to have meetings with them. They’re hungry to hear how it’s really going out there.
I would rather be involved in helping steer this or giving feedback to make what the government is putting into regulation a better product, than just sit back and react.
That’s what has kept it exciting — having strong core values and mission, while also having strategic initiatives that are exciting. That is what has kept me here.
Gamble: Right now, what would you say are the key priorities for your team?
McNutt: We have two primary initiatives. One is to continue to leverage the tools we have in Epic. In other words, we’re not looking for outside tools to layer over Epic until we’ve optimized all the new features and functionalities. Like many organizations across the country, we’ve recently gone live with Epic 2018. That brought a lot of new features and functionalities, and we need to work on exploiting all of those. We also need to exploit all the other features inside of Epic when it comes to things like predictive analytics. We can use their data analytics tool to a much deeper degree than we have. We need to work on all of these things.
So that’s probably our key focus — optimizing everything we have. Epic is now on this quarterly release cycle of even more features and functions, and it would be foolish for us not to leverage the tools that we already own. I think everybody’s looking at this. You’re bombarded with opportunities to layer things onto your Epic system, but the first question you really need to ask yourself is, can this be done in Epic?
Gamble: Sure. It’s a big investment.
McNutt: That’s the journey we’re on. Epic, in particular, is continuously releasing more and more tools for interoperability and furthering patient engagement with their data and records. I would say that’s one of our big priorities, and I really think it’s critical. With this digital revolution we’re seeing, we have to be able to empower patients to be able to access and use their data, and access us digitally. So that’s a key focus for us.
Gamble: Right. And when you’re dealing with different patient populations in different areas, I’m sure it can be challenging.
McNutt: That gets into the whole issue of interoperability and patient access, which of course becomes a policy discussion as well. There are regulations, and then there’s the desire for data to be seamlessly exchanged and always available to clinicians and the patients, but you have to balance that with HIPAA privacy and security at all times.
That’s becoming one of our most significant challenges, I think. With the patient experience or the patient access revolution, if you will, and this interoperability is making sure that that things are secure and that the patient’s privacy is adequately protected and not just globally but also down to perhaps the data element or test level of which things are appropriate to release or not. I think that’s a modern challenge we have over the next few years — balancing security and privacy with this open data sharing journey that we’re all on.
Gamble: Right. It’s such a big issue, and it’s the type of thing that has to be tackled in chunks. You have access and security, which are both important, so it’s finding that balance.
McNutt: When we talk about major initiatives in general, I think many organizations are on the same path. And as more of us enter into value-based contracts where we’re being held accountable for the entire patient experience, and healthcare systems desire to have a closer linkage with their physicians, it’s becoming much more difficult to have an independent practice. And so continued growth in physician employment is definitely something that we’re seeing a lot of as part of our plan. It’s consuming a lot of our resources, but in a good way. It’s a good opportunity to have.
Gamble: Right. Switching gears a bit, you’ve done a lot of policy work. What is it that made you become interested in advocacy?
McNutt: The way I see it, it’s better to try and control your destiny than to have to react to it. What we found many years ago when Meaningful Use came out was that the government is actually hungry to hear the boots-on-the-ground experience and reaction to their policies — not only as they’re in a proposed rule state, but also after they’re implemented. We’ve found that CMS and Health and Human Services are very interested in hearing how it’s really going.
Pretty quickly, we discovered it does make an impact to get involved; to talk with people at CMS, to develop those relationships with the Office of National Coordinator, and to have meetings with them. They’re hungry to hear how it’s really going out there. I think over the years we’ve seen the impact of that with regulations being tweaked and fine-tuned as we go along. Like I said, I would rather be involved in helping steer this or giving feedback to make what the government is putting into regulation a better product, than just sit back and react.
Secondarily, I wanted to deeply understand what is going on because it was so important, and remains important. There is money, and now even condition of preparation in CMS, associated with what we’re doing, particularly in the interoperability realm. I think it’s imperative that there are people who are deeply involved in this who can help other CIOs, and others in healthcare leadership, to understand what the implications are of these regulations to their plans and operations. It’s imperative that we educate.
Gamble: I think for some time there was a perception that policy is what the government is doing to us. It’s so important, as you said, to recognize that they want to hear about these experiences.
McNutt: They don’t want to legislate something that is going to fail. They want to know what’s working and what’s not. Another thing that’s really important in the advocacy space is to give positive feedback as well as negative. You can’t just beat the negative drum. You have to tell them, ‘This is working,’ or ‘this would work even better if you did this.’ Or, ‘Sorry, but this isn’t working and here’s why.’ And the ‘here’s why’ is really important. They need real-life examples of why something isn’t as easy as everyone thought it was going to be.
And I have to say, they’re very open to hearing that. The government, for instance, did not understand how difficult it is for organizations and also how costly it can be to gear up for major software upgrades. We’ve had to continuously upgrade software to meet the regulations over the last 10 years — they really didn’t understand that cycle. Now they do, and that’s why we saw delays in some of the time frames. That’s also why we saw a 90-day reporting period come out rather than a full year. They realized the type of cycles we were on, and that the whole country can’t be ready on January 1. The vendors’ ability to help you with those upgrades, your budget cycles, and so many other things play into that, and so it’s not realistic to say the whole country will be at a certain place on January 1. That’s the type of thing we’ve worked on over the years where I think there’s been impact.
Gamble: That’s so important. When I speak to the policy team at CHIME, they’ve said that it’s so encouraging when a change or update is made, especially for the people who invest time into advocacy.
McNutt: Right. Instead of just letting things happen to you.
Gamble: Another thing I want to talk about is your career. Being with the same organization for an extended period of time is rare in this industry. Is it interesting for you to reflect and say, ‘wow, I have been here for quite a while?’
McNutt: It is. Because in some ways it seems even longer than the 26 years I’ve been here, and at other times it feels like time has flown by. We’ve been through a lot of change during those 26 years. And although the core values of the organization have always been the same — and quite frankly, that’s what keeps me here, and has kept others here for a long time — it feels like I’ve been in three different organizations. As we’ve evolved from a two-hospital system when I first came here to what we are today, with some of the other service lines we talked about, and of course the physician practice arm that sprung up, it feels like I’ve worked at three different organizations. But that’s what has kept it exciting — having strong core values and mission, while also having strategic initiatives that are exciting. That is what has kept me here, and has made this an interesting and fulfilling job.
Gamble: You talked earlier about Methodist’s dramatic growth period about 10 years ago, and so I can really see how it would feel like being with different organizations.
McNutt: We’ve also had changes in the CEO role; along with that comes changes in direction. But that has kept it so interesting.
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