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David F Carr
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CIO To CIO: Advice On ACOs

Healthcare CIOs share their advice on coping with the rise of accountable care organizations and the crush of regulation.

"Do everything you do really well," advises David Lundal, vice president and regional CIO at Dean Health System in Madison, Wis. That way, when you're undertaking one of today's great healthcare IT challenges, "the organization trusts you, in IT, and has confidence you're going to be able to pull it off."

That would be good advice at any time, but I was particularly asking him and other technology leaders I spoke with for advice they would give other CIOs for my recent story Healthcare IT In The Obamacare Era. In it, I looked at the rise of accountable care organizations, the broader population health management trend, and the regulatory pressures hitting healthcare IT organizations from all sides this year.

"Get over it," advises Bill Spooner, CIO at Sharp HealthCare in San Diego. "We've seen other industries go through these revolutions, and you're either agile or you're done -- that's the real world. Everybody's got to be a lot more progressive and aggressive. That said, we're in a really crazy time."

He acknowledged that 2014 looks like a particularly tough year, with requirements like the transition to ICD-10 diagnosis and claims coding and additional meaningful use deadlines hitting while a sweeping transition to value-based, accountable care is under way. Regulators and lawmakers "seem to be thinking that, as quickly as they can imagine it, we can implement it in healthcare."

[Q&A with Jim Noga: Partners HealthCare CIO: Inside Our Clinical Transformation.]

I cited Spooner in another recent column, What Consumer-Driven Healthcare Really Means. He recognizes that patient engagement is going to be more than a nice-to-have frill; it's an essential component as healthcare organizations take more responsibility for ensuring the health of a population of patients. In Medicare ACOs, patients aren't compelled to stay within the network of the healthcare organization taking responsibility for them. That makes it imperative for the organization to persuade patients that it is the best, most convenient, and most responsive organization.

Successful ACOs also need some more basic things, such as a good master patient index they can use to develop a registry of the patients enrolled in the ACO so their care can be tracked effectively, Spooner said. "My advice to fellow CIOs would be talk to your colleagues. Look for the pioneers, and learn from them. Like with every area of strategy, get yourself at the table, so you're part of the process." Otherwise, a healthcare organization's leaders have a tendency to charge ahead into "very clever business arrangements, and sometimes in IT, we've had to catch up."

(Source: Flickr)
(Source: Flickr)

David Muntz, a former hospital CIO better known for his tenure as deputy director of the Office of the National Coordinator for Health IT, agrees that the job of healthcare CIO is getting much harder. He now serves as senior vice president and CIO at GetWellNetwork, an online service focused on boosting patient engagement. He said he regrets being part of the process of piling so many regulatory requirements on healthcare organizations so fast. The number of initiatives hospitals must undertake is increasing, while margins are dropping and new reimbursement models are being imposed. "All these transitions are happening simultaneously."

How to cope? One thing he suggests is putting an emphasis on change management -- and not just for the IT staff. "When are we going to teach the physicians how to do change management?" Leaders in the ranks of doctors and nurses also have to understand "the science of getting people to change both behavior and attitudes" to achieve real change in how the organization does business, beyond what is programmed into the software they use.

What I see is the need for more partnership. The CIO now really needs to do partnerships with the chief medical officer, chief nursing officer, and chief financial officer. That's always has been important, but now having partners in all the different operation areas is going to be critical. The CIO is not going to be successful by focusing on the technology, but by focusing on how the technology is going to help all those other parties.

We used to say IT is the backbone, and that was actually true. Then we would say IT is the nervous system of the organization, and that was true for a while. Now when I speak, I say we're part of the messenger RNA. We're in every cell of the activity of an organization.

Shafiq Rab, CIO at Hackensack University Medical Center and technology leader for Hackensack's ACO, put it this way: "There has to be a common cause, common belief, common vision."

Lundal said Dean Health is fortunate to have experience managing ACO-like risk-based contracts, because it operates its own health insurance plan. For those whose organizations will be making a bigger shift to this new model, he suggests adhering to the KISS (keep it simple, stupid) principle. "Identify a roadmap, and understand you're not going to be able to do it all at once."

Though a solid electronic health records implementation will be important, business intelligence and analytics are also key, he said. For example, one of the essential tasks of an ACO is to track chronic conditions and manage them better. "You need to identify your patients -- say, your diabetic population -- and come up with a really good problem list."

A successful ACO needs to be able to do that despite inconsistencies that might exist in the data, such as the same condition being captured with different diagnosis codes. "As part of your BI strategy, you have to be able to get at those outliers -- and then think about how can we improve our data entry" to clean up those records.

James Noga, CIO at Partners HealthCare in Boston, sees a bright side: If you can deliver software tools that have an obvious connection to quality care, getting physicians to adopt them is not so hard -- certainly not compared to electronic health records. "The initial implementation of EHR is hard. But once the baseline is in place, when we offer tools supporting population health management, caregivers really see it as a value added for them, so that has been a pretty easy uptake."



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