It isn’t news that the health information technology field is constantly changing. Who better to ask about these changes and innovations other than the leaders of the industry themselves? Health Management Technology sat down with Pamela Arora, Senior Vice President and Chief Information Officer of Children’s Health; Nader Mherabi, Senior Vice President, Vice Dean, and Chief Information Officer of NYU Langone Medical Center; Dr. Sudeep Bansal, Chief Medical Informatics and Quality Officer for Saint Francis Healthcare Partners; Lynne Gordon Thomas, CEO of AHIMA; and Paul Black, CEO of Allscripts to discuss their careers, challenges being faced in the healthcare information technology field, rewarding aspects of their job, and perhaps most importantly, where the future of healthcare is headed.
Going mobile is trending quickly
The one thing that most everyone seems to agree upon is that healthcare is going mobile and changing quickly. Pamela Arora said, “Healthcare is going mobile, but we need to understand how the business model is shifting.” Lynne Gordon Thomas voiced much of the same, “Whether everything is on our phones, like EHRs, or whether its telemedicine and you’re talking to your doctor on your phone, things are changing and they are changing quickly.” Paul Black touched on interoperability regarding value- based care. “There is only one answer to successfully make the shift to patient-centered, value-based care: open and interoperable solutions.”
Embrace change
These three industry leaders really hit the nail on the head; we need to embrace these changes and advancements, but ensure that everything “running in the background,” is keeping up and making things easier, not harder.
Nader Mherabi adds an interesting point as well, “It’s not always easy for a large institution [NYU Langone Medical Center] to adapt to the digital world. We’re not Uber or Amazon, so we didn’t start digitally.” He adds, “Healthcare is more complex and personal, which is why it’s important to work together as an institution to provide world-class medical services to our patients, leveraging the most innovative technology.”
Saying that it is a challenge for organizations that did not start out in a digital space to move to one is an understatement. New technologies are always emerging and changing. Organizations need leaders, like those we interviewed, to lead the way into the future.
Continue reading to see what insights each C-Suite innovator gave us into what can only be described as an ever changing, constantly evolving, and frankly fascinating industry.
What’s your background up to your present role?
My career spans 35 years, and I actually began working in computer science when I was a student at Wayne University where I was a programmer. After I graduated, I went to General Motors as an application developer, then on to EDS, Electronic Data Systems, as a team lead. Then I moved on to Perot Systems, where I had several different positions over 14 years—from team lead to marketing strategic manager, and ultimately, I became CIO for Perot Systems.
In 2003, I was the interim CEO for my own company, Liquid Agents Healthcare, which still does placement of travel nurses in the healthcare field. I wrote the business plan when I was getting my MBA from SMU. But I missed being a CIO, so I moved to MA to become UMass Memorial Healthcare’s SVP and CIO, and from there I came to Children’s Health in Dallas, where I’m the Senior Vice President and Chief Information Officer. I have been here for more than 10 years.
I’ve really enjoyed all these experiences, including those I had with consulting, because they applied well to CIO roles. When it comes to my current role, I find the greater purpose of making life better for children very compelling. It’s great to be applying information technology tools to a mission like that.
What is the biggest challenge in the HIT field today?
I think this is true across any industry, but cybersecurity is one of the biggest challenges that every organization is experiencing. It’s changed dramatically, and you have to be constantly working that area. Children’s Health has worked to bolster our cybersecurity defenses; we are using a multilayered approach to security, but beyond technology measures that we have in place, it is also really key to have great training and education to address the human element. We’ve been working through that aspect, and our team has been strengthening our defense to ransomware, especially email. When you take a look, healthcare has had increased interest from the bad actors—it’s one of the biggest challenges—but every industry is finding this difficult.
It isn’t a matter of if you will be compromised, it’s when. Children’s Health has implemented a security operations center that has enabled us to closely monitor our environment to achieve early detection. If we find out early, we can detect risks and attacks before they become a big problem.
Where do you see the future of healthcare going?
Healthcare is going mobile, but we need to understand how the business model is shifting. It is moving outside the walls of hospital systems. From a patient standpoint, we need to be able to allow patient families to take accountability of their wellness, and we need to be a partner to them. We want to be there as a support, where they live, learn, and play. It isn’t the health system that should be at the center; the patient family should be at the center. Because of this, we need to go mobile and deliver care in the home.
Healthcare organizations must look at ways to innovate care delivery. For our part, we’ve embarked on a significant number of telemedicine programs. Our TeleNICU program connects our neonatal ICU and UT Southwestern physicians with remote areas of the state. Basically, we are allowing patient families to stay in the community where their support network is. Not only is it better for the patient, but it reduces the cost of healthcare.
We also have school-based telemedicine programs. Primary care physicians at Children’s Health partner with the school nurse so when a child is sick the student can be seen by one of our providers while he or she is in the nurse’s office, and the parent can even stop by the pharmacy and pick up their medication on the way to pick them up from school. Or if the child is well enough, they can go back to the classroom.
What’s your background up to your present role?
I’ve been at NYU Langone Medical Center for more than 18 years, in roles that have ranged from becoming the head of application development and overseeing the Medical Center’s software placement, to being named Chief Technology Officer, to getting promoted to the Chief Information Officer seven years ago. Before that I worked in finance on Wall Street for major financial firms. My passion has always been in technology and how it is ever-evolving and improving things. In finance, the focus is improving profits, but in healthcare, it’s improving patient’s wellbeing. I started working in healthcare nearly 18 years ago ago, thinking I’d stay in the industry for a year, and I never left it. Every day is another challenge or problem to solve, which has made this a fascinating journey. When my journey began, healthcare was so behind in technology, and that’s why I never left. I thought I could make a difference, and I still do.
What are some of the biggest challenges that you are facing today in the field?
One of the biggest challenges I face is making sure there is alignment on a strategy that supports everyone’s goals from a technology perspective. NYU Langone has made a substantial investment in technology, so it’s my job to ensure we leverage it in every way possible. It’s not always easy for a large institution to adapt to the digital world. We’re not Uber or Amazon, so we didn’t start digitally. Healthcare is more complex and personal, which is why it’s important to work together as an institution to provide world-class medical services to our patients, leveraging the most innovative technology.
What’s the most rewarding part of working in the healthcare field?
There are so many smart people in the healthcare field and particularly at NYU Langone. From clinicians, to scientists, to staff—most people in healthcare are highly educated, and I like that. It’s easy to find someone who’s smarter than you, and that’s very rewarding. I’m often faced with opportunities to solve unique challenges by working collaboratively with our colleagues, and I find it incredibly motivating and fulfilling to problem solve in innovative ways, working on a team.
Another rewarding aspect of working in the healthcare field is the willingness of my colleagues to teach each other new skills and share helpful information. The academic side of this institution is always teaching, so instead of asking, “Why don’t you know this,” they’ll help you. We all help each other, and it’s rewarding when people explain and teach others.
Where do you see the future of healthcare going?
I feel that a lot of people or companies are trying to “disrupt” the healthcare technology space. Uber did it with transportation, Amazon did it with shopping, and the list goes on and on. However, healthcare is much more complex and is constantly advancing, so it has been very difficult to disrupt it in a major way like we’ve seen in other industries. The transactions made in healthcare are personal, complex, and unique, which makes the entire industry personal and unique. And there’s also the question of how we regulate it that adds another layer of complexity.
As I mentioned, healthcare technology is constantly evolving. While surgeons are completing same-day surgeries, we are developing technology to improve patient monitoring and recovery methods from home. Our goal is to make same-day surgery a more common practice whenever possible. Of course, care will still be provided in the hospital, but ideally, the available beds and rooms would be for those patients who are very sick or need specialized care. My prediction is that we’ll see significant changes in healthcare technology within the next five to fifteen years.
Other key technologies that have promise are AI, robotics, and virtual reality, including predictive analytics, machine learning, mobile and intelligent devices, and real-time simulation. When those converge, we will see a major change in how healthcare is delivered. For example, when we were growing up, all our mothers used a thermometer to take our temperature. Imagine a device that is much smarter, able to take all vitals (temperature, pulse, etc.), and connect to an app on a smartphone and provide first-level diagnosis.
MD, MS, is the Chief Medical Informatics and Quality Officer for Saint Francis HealthCare Partners
What is your background up to your current role?
I am an internal medicine physician and started my professional life as a Hospitalist physician at Saint Francis Hospital and Medical Center in Hartford, CT. When the HITECH act was passed, I took on the role of Physician Informaticist and helped with implementing Meaningful Use in the hospital. When we made a decision to switch our hospital EMR to Epic, I took on the role of Chief Medical Information Officer to help implement Epic. In the interim, I also became board certified in Clinical Informatics and completed a Masters in Health Informatics from Northeastern University, Boston, MA.
Currently, I work as Chief Medical Informatics and Quality Officer for Saint Francis HealthCare Partners (SFHCP), which is the Physician Hospital Organization and ACO. I am also currently enrolled in a certificate degree program in Population Health at Jefferson School of Population Health, Philadelphia.
What are you doing to lead St. Francis’ journey from population health to precision medicine?
SFHCP is leading the change from volume to value. All our major contracts with insurance companies are value-based contracts, and therefore we are responsible for the population that is attributed to us.
We are using care coordination to take care of our population. The care coordinators talk to patients that need help, develop a rapport with them, assess their individual needs, and then attempt to address these needs. To me, that is precision medicine—tailoring interventions to the needs of a patient. For example, we had a patient who kept going to the emergency department for uncontrolled diabetes. Our care coordinator spent time with the patient to find the reason why she would not take her insulin. The patient did not have a refrigerator at home to store insulin so she could not stock insulin at home. The care coordinator was able to procure a refrigerator with the help of community resources, and the patient stopped going to the ED.
Every patient is different, and they have socio-economic needs, values, and preferences. For me, precision medicine is attempting to identify individual patients that need help the most and then creating programs to help them. It is not about genetic analysis and targeting medicines based on your genome. That part of precision medicine, for the most part, is still experimental, and there is lot we can do in the interim.
Where do you see the future of precision medicine going?
Precision medicine, in my opinion, is still a theoretical framework on how to think about “personalized healthcare.” In five to 10 years, this framework will be developed further to use patient-generated health data and biologic data (genomic, proteomic, metabolomic data) and attempt to target therapy to an individual. The difference between the five and 10-year span will be that we will add more data to the mix. While we will have some success, especially in treating genetic disease based on mutations, we have to remember that most chronic diseases are caused by interaction of multiple complex factors consisting of individual’s biology, behaviors, and environment.
Precision medicine, in my opinion, is a very narrow interpretation of complexities of what constitutes health and disease. Health begins where you live, work, and play (Source: Robert Woods Johnson Foundation).
The solution to improving health of the people needs to be multifaceted and will need to target an individual’s biologic profile (including precision medicine), changing behaviors, (individual, family and cultural behaviors) and improving public health services.
CEO, AHIMA
What’s your background up to your current role?
I started out my career in health information management, and I was in that role for quite a few years. Then, I went back to school to get my MBA and started taking on more departments in addition to health information management, including revenue cycle, social work, quality, child life, and clinics. To make a long story short, as I grew in my career, and I took on more and more responsibility, I morphed into a director of operations job. So I was responsible for everything in the hospital except medical staff, human resources, and nursing.
Then I moved to become COO of a hospital, running the whole operations team. At my next job, I was a hospital administrator. I then worked at Rush University Medical Center for childrens’ and womens’ services and all of their related clinics.
Finally, AHIMA asked me to consider the CEO job. They needed someone to lead our association who really understood and had been in our shoes, which is how I knew I fit the role. I’ll be finishing up my sixth year this fall. It’s gone quickly, and I’m really excited to see where the profession is going. As you know, technology is changing our world, making it a very exciting time to be in health information management.
What are some of the biggest challenges that you are facing today in the field?
One of the things we always say is that we need to be moving faster on the inside than on the outside. If you’re not moving fast enough internally, you’re not going to remain relevant. Our biggest focus at AHIMA is to provide expertise to ensure trusted information for healthcare, and the best way to do this is through information governance. We feel information is a strategic asset and the key that unlocks the door to driving down costs, improving quality, and taking care of the communities we serve. In terms of adapting with technology to meet information needs, we’ve gone from the horse and buggy to the model-T, and we’ve lost the rules of the road. We’ve adapted electronic health systems, and they are in the clunky phase, similar to when the first cell phones came out. We need make electronic health records like the iPhone or the Ferrari. Information governance is the answer.
Where do you see the future of healthcare going?
Technology is changing healthcare so much. Whether everything is on our phones, like EHRs, or whether its telemedicine and you’re talking to your doctor on your phone, things are changing, and they are changing quickly. We are not going to be Blockbuster. At AHIMA, we’re getting ready for the future before it’s here. Technology is going to change us so dramatically; I think it will seem like “oh that happened quickly.” But like many recent changes in health information management, I feel like we’ll be prepared and look back and say, “it wasn’t that bad.”
CEO, Allscripts
What is your background up to your present role?
Before joining Allscripts in 2012, I was retired for six years, where in addition to coaching youth sports, I served on several private company and nonprofit boards of directors for companies in healthcare services and healthcare information technology, including as chairman of Truman Medical Centers, a 400-bed safety net academic hospital in Kansas City, MO. I spent 13 years with Cerner Corporation and another dozen years with IBM Corporation working in software, services, and health IT.
What are the biggest challenges you are facing in your current position?
Around the globe, healthcare is making a huge strategic shift from traditional fee-for-service models to value-based care. In the United States., many clients are feeling uncertainty over recent activity in Washington and what that will mean for the future. Meanwhile, their waiting rooms are full of patients with increasing demands for transparency, mobility, and quality. Until patients can go anywhere, anytime and know their care team is connected and up to date, our job is not done.
How are you solving these challenges?
There is only one answer to successfully make the shift to patient-centered, value-based care: open and interoperable solutions. This way, providers can exchange data with any system to give a complete picture of the patient’s community interactions. Better clinical decisions lead to better outcomes. We’ll only get there with a truly connected community.
What’s the most rewarding part of working in the health information technology field?
Knowing that Allscripts is building that connected community of health. That our solutions are based on a principal of being open and are enabling smarter care, delivered with greater precision, for healthier patients, populations, and communities.
Where do you see the future of healthcare going, five years from now, 10 years from now?
As patients bear more responsibility for the cost of healthcare, they will act more like they do in other industries: they will act like consumers. This trend will only increase over the next five and 10 years, and providers need open, interoperable solutions to meet increasing consumer demand.
