One Health IT Leader’s Perspectives on the Current Moment in HIT

Nov. 1, 2023
George T. “Buddy” Hickman, a nationally respected health IT leader and former CIO, looks at the current moment in health IT evolution in the U.S. healthcare system

George T. “Buddy” Hickman, chief strategy officer at the First Health Advisory consulting firm, and a nationally recognized health IT leader who spent two decades as a hospital and health system CIO, spoke recently with Healthcare Innovation Editor-in-Chief Mark Hagland about some of the most vexing challenges facing health IT leaders in the U.S. healthcare system right now. Below are excerpts from their recent interview.

The landscape facing the senior leaders at hospitals, medical groups, and health systems nationwide is at least as challenging as it’s ever been. How should health IT leaders be thinking about the challenges ahead?

When I first stepped into the CIO role decades ago, it was a new and challenging C-suite position with board level of dimension – a first for the former tactical IT director job. Even then we spoke of the challenge of identity and brand dimensions, keeping current with evolving technologies, bringing along our colleague business and clinical executive sponsors through solid shared governance, managing good and difficult vendor partners, and assuring that the technology portfolio ‘fit’ the organization, its aspirations, and its budget. Those same themes are just as relevant today as ever, though the context or subtext has remarkably transformed. Today’s successful CIOs must understand the importance of all those things just named, and they must learn constantly, have presence of mind regarding what are the systems means to create transformation, and stand, articulate and deliver change.”

Keeping the trains running is a base requirement, but that doesn’t mean simply “running in place.”  Our post-COVID world has created dire and even catastrophic fiscal consequences for many healthcare sector organizations, especially providers, those that have high government-pay populations, have not heretofore blended provider/payer capabilities, and have not already modernized their digital platforms.  Keeping the trains running requires application and infrastructure platform modernization, applications rationalization and optimization, and assuring a sound and constantly maturing cybersecurity disposition.  There are some organizations that have good bottom lines, but most do not, and my colleagues, friends, are most challenged by the tightened expense boundaries they are working within.  Some may choose to “run hard just to stay in place.”  My view is that that behavior is not an option as it is also not leadership.

Given the economic climate, it is even more challenging and requisite that optimization and transformation be kept present as an executive suite discussion, and that is a CIO responsibility.  Our abilities to “lean into data” and leave intuitive decision-making cultures assures the “right” decisions are made.  With more time we could talk of data culture transformation as its own topic, and its critical importance to traditional healthcare C-suite behaviors.  Aligning data analytics efforts to use cases that are relevant to organization’s current change agenda and help the bottom-line is mandatory.  You name two of those use cases – population health management and social determinants of health – those opportunities are fueled by good data.  I add other cases - operational optimization to achieve efficiency, improvements in clinical quality, the business case and mission of patient safety, the future promise of clinical research, value-based care delivery, and predictive modeling to change our fiscal budgeting and management paradigms.  CIOs own this – and so do CEOs, CMOs, CFO, COOs, CNOs – vis a vis the collective senior leadership team. 

Where are we in terms of true EHR optimization, meaning, beyond making the EHRs highly functional, but now, making them useful to true analytics and clinical performance improvement work?

We are much better positioned now than we were 20 years ago, 10 years ago, and even three years ago, and I will qualify my statement.  First, if you look at the state of EHR vendor capability 20 years ago, you could never have predicted where our key EHR vendors are today in terms of success, performance or even existence.  A great reference pointer is to look at the vendor attrition tracking that our friends at KLAS have done for several years.  In addition to vendor performance, our sector’s M&A craze wrought much EHR package and vendor turnover as natural biproduct. 

Second, every healthcare organization’s EHR vendor partner is its chief enabler or limiter to EHR optimization.  Our choice to stay with a package vendor that can move us forward or leave us unsettled and incapable is a daily strategic and tactical decision, most likely understood or not by the operations, medical, nursing, financial, and digital/information officers.  If we are stuck, we can blame the vendor and the CIO, or collectively own a different path to improvement.  There is no doubt that vendor organizations and their respectively packaged EHRs can move us forward or anchor us in current state.  Since I mentioned KLAS in the context of vendor attrition, I also offer that its Arch Collaborative data provides straight-forward insights to those EHR, informatics, and IT elements that propel and impede forward momentum, specific to an organization and also aggregated by vendor.  Yet the KLAS data will not or does it attempt to explain the culture and personality behaviors that hold back optimization.

Your question also added the dimensions for “true analytics and clinical performance improvement.”  Data must be accessible, it must be “ingestible,” and we must be able learn from it and have it speak to us.  We must be able to perform “math” with and across the many forms of it, and even “evil math,” like causal and correlative analysis, predictive algorithms and models,  pattern recognition, and machine learning.  Interoperability like APIs and other forms are necessary and evolving, yet platforming is the largest enabler to that list of data requirements. The EHR packages most effectively and economically capable to provide that path are few in number.

What are your thoughts right now about the journey into full inoperability?

Interoperability has always offered promise, and I have participated in leading or critically evaluating efforts across time with the advent of HL7, then HIEs, QEs, Direct Exchange, public/private/vendor API development, CommonWell [the CommonWell Health Alliance], vendor-specific “connect,” Blue Button and other forms.  I am a supporter of the premise TEFCA’s intentions.  I have also held the view that vendor harmonization to standards with the care and involvement of associations, experts, and regulators; and a focus on sometimes selfless principles requires a bit of selflessness that is not consistent with capitalistic economies. 

Consider how here in the U.S., we landed on one accepted design of a two-pronged 120-volt outlet and receptacle, a 240-volt three-pronged outlet, fuse array for safety, and eventual introduction of polarization as that describes our nation’s estate for electricity use.  Then we had much fewer industrialists and regulators sorting out electricity-in-the-home standards, and now there are many more players, thus more human behaviors and opinions, more agencies, associations, and companies to harmonize, and technology is advancing faster than the understandings that require agreements.  On this one, I defer to our friends like The Honorable Micky Tripathi [Micky Tripathi, Ph.D., National Coordinator for Health IT] at ONC [the Office of the National Coordinator for Health IT] to provide that guidance as it will not be solved “in the field” by a local healthcare provider or by major health vendor.