Chad Eckes faces what is perhaps an unusual set of challenges and opportunities. As CIO of Schaumburg, Ill.-based Cancer Treatment Centers of America (CTCA), Eckes oversees IS operations at a national patient care organization with four cancer-care hospitals scattered across the country. Since obtaining care from CTCA often requires patients to travel long distances, the organization has more challenges to deal with than the average community hospital.

To that end, CTCA has found success in building a care service model that is intensely patient-centric and service-oriented. And its for-profit business model, Eckes says, translates into a greater willingness to invest in technology, facilities and other areas. For one thing, such investments reap large marketing rewards. Take for example the all-digital hospital that opened in December in Goodyear, Ariz., a suburb of Phoenix. That hospital (known internally as the CTCA at Western Regional Medical Center), was designed as a state-of-the-art showcase for IT and facility design, in keeping with CTCA's marketing as a company on the cutting edge in cancer care.

Naturally, Eckes and his team in IS consulted with the organization's clinician leaders, among them Edgar Staren, M.D., Ph.D., senior vice president for clinical affairs and CMO. Only through such collaboration, Eckes says, can systems be implemented that will be fully adopted by clinician end-users.

In fact, he says that using the HIMSS Analytics “seven-stage” model of clinical IT development, the three existing CTCA hospitals are already at stage-six, while the newly opened one is at stage-seven. “We actually designed the hospital in the architectural blueprint around the technology,” he says, “so there's no physical medical records department. Our HIM is two people in a room with a computer and a big scanner for when paper documents come in through the door.” Eckes adds that there are no nursing stations in the facility, which is designed to help keep nurses as close as possible to the patients. “This is the first ground-up build of an all-digital cancer specialty hospital,” he says.

The return on investment (ROI) for all of this is obvious from first glance, Eckes says. “Things like CPOE are a given, because we have an extremely complex model of care that needs to be driven by systems,” and in which multiple clinicians need access to the patient chart in rapid order, and sometimes simultaneously. Given that patients are flying in from all over the country, time must be optimized. What's more, the implementation and upgrading of core clinicals that took place across the existing three CTCA hospitals between October 2006 and March 2008 was accomplished on time and under budget for $15 million (excluding the new hospital's IT costs).

The key to success in investing, Eckes says, is coordination with clinicians in the planning and rollout of such implementations. But he says he does not doubt the ROI of technology for any care organization that wants to offer top-notch services.

In common: strategic approaches

Nationwide, pioneering CIOs are moving to implement clinical information systems to cope with demands for transparency and accountability, pay-for-performance and accelerating consumerism. All these trends require IT to keep pace.

Among the many examples of ROI-friendly initiatives:

• At the 400-bed Heartland Health in St. Joseph, Mo., CIO Helen Thompson has realized $47.5 million in hard-dollar savings to the bottom line from a $54 million EMR implementation (Heartland is using the Kansas City, Mo.-based Cerner Corporation as its core clinicals vendor). Five years into an eight-year deal, she says, the organization has experienced a 50 percent reduction in medication errors; a 24 percent improvement in MRSA infection notification; and an increase in clinician access to advanced directive information from 5 percent to 100. “This is about discipline,” says Thompson, “a discipline that emanates from the entire executive leadership of an organization that encourages measurement and deriving value.”

• At the integrated Denver Health and Hospital Authority system, leaders have seen benefits since the implementation of CPOE across the system, which encompasses a 500-bed public hospital and outpatient clinics. Gregory Veltri, Denver Health's CIO, says the average length of time from physician medication ordering to distribution from the Pyxis/Cardinal Health unit (from Dublin, Oh.-based Cardinal Health) on the hospital floor went from 44 minutes to 7.3 minutes. In addition, the system saw reductions of 54 percent in wait time for availability of lab results and 61 percent for radiology results. “The clear focus has been improved patient care quality, Veltri says. “There's a lot of clinical evidence that, for many conditions, the speed of getting medication into the body is a key indicator of effectiveness; so that speaks to efficiency crossing over to quality of care. From the administrators' point of view, they like the rapidity,” he adds, “because it typically results in decreases of length of stay, particularly with regard to specific conditions. (Denver uses clinical systems from Malvern, Pa.-based Siemens.)

• At the University Hospitals in Cleveland (whose flagship facility, University Hospitals Case Medical Center, is a 482-bed academic medical center), Senior Vice President and CIO Mary Alice Annecharico, R.N., and her colleagues have been busy rolling out a number of clinical systems, including a core EMR/CPOE. One of the organization's signal achievements is the rollout of a physician portal developed by Instant DX/OnCallData of Gaithersburg, Md., which unusually combines the e-prescribing and physician portal concepts into a single tool. The implementation of the Instant DX solution was initiated by Nathan Levitan, M.D., when he was CMO before Annecharico's arrival last year (Levitan is now president of the organization's Ireland Cancer Center). Two factors drove that implementation, says Annecharico: the desire to reduce adverse medication events, and an effort to improve clinician workflow. The result? On average, physicians at University Hospitals Case Medical Center are seeing a two-hour reduction per day in the amount of time they're spending ordering and managing medications, with far greater information and accuracy, she notes.

Link IT investments to goals

The achievements being made and documented at organizations like CTCA, Denver Health, and University Hospitals in Cleveland, might seem diverse on the surface, but they all speak to a sense of urgency about improving patient care on every level. And some CIOs say even the concept of “ROI” needs to be reconsidered.

In fact, David Muntz, senior vice president and CIO of the 13-hospital, 2,955-bed Baylor Health system in Dallas, says that the word a CIO needs to focus on, rather than the term ROI, is value. “I challenge the concept of ‘ROI’ off the bat,” he says, “because it's the classic term that everybody uses, but they limit it pretty much to the costs of investments. I like to talk about ‘VOI,’ the value of investment,” he says. In fact, Baylor has developed an approach called the ‘value realization model,’ which Muntz says keeps the staff focused on more than just return on investment. “People are cost-sensitive right now, but the truth is, if you looked at cost only, you could spend yourself out of business,” he says. “I focus on value, because you look at the total cost of ownership, the total benefits of ownership, including quality, patient safety, physician, consumer, and employee satisfaction, as well as risk.”

In the end, says University Hospitals' Annecharico, “I think that CIOs need to understand that the business of healthcare delivery is not governed in the office of the CIO. We're not the drivers of the change, we're the facilitators. From the perspective of the hats I wear as a clinician and as a CIO, I fully embrace the idea and opportunity of quality that the office of the chief medical officer and insurers are requiring of us.”

Patricia Gabow, M.D., the CEO of Denver Health and Hospital Authority, agrees. “I would say to CIOs that they can't do this by themselves. And it's really hard to get a hard-dollar ROI on a lot of HIT. So at the end of the day, CIOs are going to have to align with clinicians as they articulate what it is that will make the patients safer and reduce variability. And by improving safety and reducing variability, you'll get efficiency.”