On January 13, Edward Marx, senior vice president and CIO of the Arlington-based Texas Health Resources, was been selected as the recipient of the 2013 John E. Gall Jr. CIO of the Year, an award given by the College of Healthcare Information Management Executives (CHIME) and the Healthcare Information and Management Systems Society (HIMSS).
Marx’s distinguished career in the healthcare industry spans 24 years, 16 of which have been spent as CIO. Concurrent with his career in healthcare, he served 15 years in the Army Reserve, first as a combat medic and then as a combat engineer officer.
Marx has been leading the 14-hospital Texas Health Resources’ innovative technology services professionals in developing and implementing strategies to enhance the patient and provider experience through the application of IT since 2007. Prior to joining Texas Health, Marx was CIO of University Hospitals Health System of Cleveland. He previously served in a variety of IT leadership roles with healthcare organizations such as HCA (Tennessee), Parkview Episcopal Medical Center (Colorado) and Poudre Valley Health System (Colorado).
Recently, Healthcare Informatics Assistant Editor Rajiv Leventhal spoke one-on-one with Marx about his contributions to the industry, why his leadership approach has been successful, challenges he has overcome as CIO, and the current and future state of healthcare IT.
Leventhal: First of all, congratulations on this recognition. What is the significance you take out of the award?
Marx: It’s really an external validation of our organization, and how we have leveraged IT. I get it, it required leadership, and I’m very honored and humbled, but certainly I don’t think of it as an individual achievement. Instead, it’s about what our organization has been able to do over the last six years, with leveraging technology to improve clinical outcomes.
Leventhal: And what has Texas Health been able to do to leverage IT?
Marx: Well, it’s funny, because they call the award CIO of the Year, but it’s really about what you have done year after year in the industry. At Texas Health, we have demonstrated how to master the art of EHR implementation and optimization. We were one of the first to successfully implement, and now we’re going through multiple stages of optimization. It requires the entire health system, including leadership and culture, to make that work.
We were also [one of the first] organizations to [receive incentives] for meaningful use; we are now at Stage 7 [in the HIMSS Analytics Electronic Medical Record Adoption Model] in all of our hospitals; we received the 2013 HIMSS Enterprise Davies Award; and we have won numerous other awards for innovation and technology. It’s an accumulation of things that have led to this recognition, and that’s why I call it an enterprise award. Personally, I have been very involved with CHIME and HIMSS on a national level too, and that has helped further the cause of healthcare IT. It all blends together.
Leventhal: How important is it to plan for EHR optimization post-implementation?
Marx: It’s one thing to implement the EHR, but it’s more about, “How do we optimize it? How do you move the needle on your quality outcomes?” For us, one example was the reduction of venous thromboembolism (VTE), or blood clots, which are the biggest killer of people once they come into hospitals. In fact, it kills more people each year than breast cancer, AIDS, and auto accidents combined. We put alerts in the EHR to help reduce the risk of getting blood clots during hospital stays, and in a few years, post-operative VTE rates were less than half of pre-program rates. The other was catheter-associated urinary tract infections, the most common infection people get once they are admitted to hospitals. Texas Health established criteria for urinary catheter removal by a nurse within 48 hours of insertion, if no physician order has been placed. We then modified and tested changes to 1,639 order sets within the system’s EHR, and deployed the changes to the entire health system. We were also able to identify high-risk readmission patients, and sent them home with technology, which they applied. As a result, readmissions have been reduced by 25-30 percent.
And we’re never done optimizing, those are just three examples. We’re very fortunate that we have progressive leadership, people who said a few years ago that we need to prepare for down the road now. We took a lot of steps to get ready, we were a pioneer accountable care organization (ACO), we were involved in several other ACOs, and we were very active in care management, connected health, and population health. The future is here now and you have to prepare for it.
Leventhal: How would you describe your leadership approach to IT management?
Marx: There are many styles that work, so it’s really about the culture of the organization. I am very collaborative. I know I’m not the smartest person; in fact, I am probably an average person. But I surround myself with above average people. So together, we are able to move the ball forward. It’s amazing what a collaborative approach could do, accepting and embracing the input of others.
Leventhal: Your job is obviously a highly stressful one. How are federal mandates adding to the burden?
Marx: Well, they certainly add to everything else, don’t they? Like it’s not hard enough to do what we do without this other layer! But we prepare for it, we fit it into our schedules, and we work through it. With all of these regulations adding to the auditing, you’re looking at a good percentage of your time taken up by administrative, regulative activities. That’s a bummer, but we try to get through it as efficiently as possible so we can focus more on strategies. And when challenges are presented, you handle them by learning from them. It’s never fun in [the moment], but if you take time and reflect, learn, and apply those lessons to the future, they become valuable. We take two-day retreats to reflect and also look forward. It’s your reaction to the challenges that are really important.
Leventhal: You have been very humble and modest so far. Tell me about your most significant contributions to the industry, from a personal perspective.
Marx: For me, it’s really all about leadership. Somehow you have to multiply yourself. I think I borrowed this from [author] John C. Maxwell, but, “One is too small a number for greatness.” You can do great things, but if you really want to have a greater impact, you need to multiply yourself. I have been grateful and humbled that [several] of my former employees have moved on to be CIOs or COOs. They are all making big impacts in their organizations. I am also a faculty member of the CHIME Healthcare CIO Boot Camp (a 3 ½ day education program taught by CIO health leaders). The idea is to keep the ball moving forward for healthcare IT, and I think in a few different ways I have done that.
Leventhal: This past year in healthcare IT has been full of passion, but also sprinkled with gloom. How would you characterize the state of the industry?
Marx: One of the coolest things that have happened to me recently is becoming a grandparent. My grandson is now eight months old, and can grab onto something and pull himself up. And that’s where we are in healthcare IT. We have finally got our legs; we are past falling, and are now able to pull ourselves up. But we are not walking yet, as this is a transitional state. Until we all have EHRs, we have a long ways to go. Fifty-seven percent of us are there now, so that’s what I mean by pulling ourselves up.
And there are organizations that are beyond that—they are walking, doing mobile health, advanced analytics, population health management. So overall, it’s an exciting time, and the stock valuations of a lot of these companies have gone up. Much more important than that though, we’re trying to have a demonstrative impact on quality outcomes. I’m a believer in healthcare technology impacting people’s lives, and that is what gets me going in the morning. I am very bullish on 2014.
