Dr. Gregory Moore: Sharing the Geisinger Perspective on Clinical Transformation

On September 16, at the McGraw-Hill Conference Center in Manhattan, Gregory Moore, M.D., Ph.D., will present the opening keynote address, entitled “Healthcare Transformation through Analytics and Patient Empowerment: A View from Geisinger,” at the Health IT Summit in New York City, sponsored by the Institute for Health Technology Transformation, or iHT2. (Since December 2013, Healthcare Informatics has been in partnership with iHT2, through its parent company, the Vendome Group, LLC.)

Dr. Moore, who holds the titles chief emerging technology and informatics officer, and director of the Institute for Advanced Application, at the Danville, Pa.-based Geisinger Health System, is particularly well-positioned to deliver such an address. He has a background both as a magnetic resonance physicist and engineer, and as a subspecialist physician in neuroradiology. He first did his doctoral work in radiological sciences at the Massachusetts Institute of Technology (MIT), where he developed new MRI technologies and implemented them at Massachusetts General Hospital. He did a variety of scientific and medical research, before coming to Geisinger Health in 2010.

Gregory Moore, M.D., Ph.D.

Dr. Moore spoke recently with HCI Editor-in-Chief Mark Hagland to discuss his perspectives on healthcare transformation, and the role of technology, including information technology, in facilitating transformation. Below are excerpts from that interview.

Tell me about your role at Geisinger.

I have a couple of roles. One is chief emerging technology and informatics officer, which is really a great role, a future-focused role. Part of that role involves identifying  technologies and informatics—mostly actually from outside healthcare. Healthcare, as you know, can be as much as a decade behind on technology; so there are a variety of technologies from other industries that can be adapted to healthcare. And our CEO [Glenn D.  Steele, Jr., M.D., Ph.D.] wanted Geisinger to become a national laboratory for healthcare transformation, where we can take innovative technologies and test them. And being both a provider of healthcare and a payer, we can test the true value of an intervention, and have really meaningful data come out of it.

How did your background suit you for this role?

I’m a non-traditional M.D.-Ph.D. I did my Ph.D. in radiological sciences; I’m a magnetic resonance physicist and engineer. I developed some new MRI technologies and implemented them at Mass General. That was a blast. I then did ten years of imaging research. And then I was recruited to the National Institutes of Health as a section chief, and the section chief talked me into doing an M.D. I got my medical degree, and then did a radiology residency and a neuroradiology fellowship. I am still a practicing physician, one day a week. It makes what I do very real.

And your other role is at the Institute for Advanced Application?

Yes, that’s right: the other side of what I do for Geisinger is that I run the Institute for Advanced Application. It has three centers within it, Center for Emerging Technology ad Informatics; Center for Reengineering Healthcare; and Center for Clinical Innovation.  I’m also working with the c-suite, and my chief c-suite role is that I make strategic decisions for the Institute. For example, we made a very risky decision when we implemented an electronic health record. We were literally Epic’s third customer, and the first integrated health system to implement an EHR. That was seen as risky at the time. So part of my role is to help make those risky decisions.

I interviewed Dr. Steele when I was writing my first book on healthcare quality, and was very impressed by him.

He’s an amazing CEO; he’s really responsible for what Geisinger has become. He’s announced his retirement, and this Institute for Advanced Application  is part of his legacy. This really hardwires all the innovation and transformation in an institute that’s been going on for a long time, but it brings it under one umbrella with these three labs. It all comes out of Dr. Steele’s vision.

What are the greatest challenges and opportunities facing the healthcare system, and how will technology help in meeting them?

The Institute of Medicine came out with their study a year ago finding that as much as 40 percent of what’s done in healthcare doesn’t do anything to help patients, and sometimes even hurts them. There’s a lot of waste in our system. So that’s an opportunity, right? If you have a rare or challenging disease, well, we have the best technology available. But we don’t use those resources well. Sometimes we don’t treat when we should, and sometimes, we treat when we shouldn’t. And there are six drivers of high cost and poor quality. There are mistakes; unjustified variation in care; fragmented care from multiple specialists; payment incentives that don’t make sense, or perverse payment incentives in the fee-for-service,  rather than value-based, payment system—one I’ll talk about in the talk, is that the patient is the passive recipient of healthcare, how do we engage patients; and the sixth is the supply-demand mismatch. In my speech, I’m going to focus on using analytics and technology solutions to increase value. And we need analytics solutions to do that. How do we take dark data or lazy data and shine a light on it, and take data that’s dormant, and use it? And how do we enhance the data chain? And how do we engage the patient from a passive to an active participant in their care?

As a medical specialist yourself, what do you think of the oft-made assertion that the organization and deployment of physicians supports sub-specialization or over-specialization?

I have to say that one of the reasons it’s such a pleasure to work at Geisinger has to do with the organization’s philosophy. As both a provider and payer of healthcare, working inside the Geisinger model, we don’t have the same pressures as physicians do in many other patient care organizations. We can take care of our patients in the way that physicians, I believe, want to take care of patients. I don’t get more for recommending or doing a particular test; we can do the one right test our patient needs. You might think if you were a private-practice radiologist that it would be good for you to order the most expensive and extensive tests. And Geisinger is going to focus on the right care.

So it’s a real pleasure to come to work at Geisinger without having those incentives and pleasures. I can actually do the right thing for the patient. And knowing that we’re both providing and paying for the care takes those incentives away. And patients stay with us, because of our demography, for a lifetime. And if I know I’m going to take care of a patient for a long time, I’m also incentivized to look towards their lifetime health. I don’t have the solutions for the other problems; I know I’m working in the right kind of organization, with aligned incentives. It’s all about doing the right thing for the patient. This model makes it easier to do the right thing every day; that’s what I would like to see happen nationally.

How do you see the role of IT in clinical transformation?

IT certainly moves from a basement-type operation into the c-suite. It has to do with our success in leadership, so leveraging informatics capabilities will be critical to execute all the analytics and patient engagement strategies, down the list. So it is critical for the organization. In my keynote, I’ll be talking about how on the physician side, the American Board of Medical Specialties has created a new specialty. Five individuals here will sit for the new clinical informatics specialty. That’s an amazing transformation, that clinical informatics is seen as important as cardiothoracic surgery, for example.

Most of our primary care physicians, if you went into their office five years ago, they had a yellow legal note pad, and asked themselves, what do I need to do for my patient, Greg Moore? There was no way to know a lot of information, for example, were orders followed up? We can use technology to ensure that the right things are done. So if you’re a type 2 diabetic at Geisinger, there’s a bundle of things we know you need—a foot exam, eye exam, hemoglobin a1c test—we can relieve you, as a doctor, of having to remember all those things and ensure that all the tasks are done. We can support you through clinical IT. And all these technology-facilitated changes are really changing very quickly how we do things in medicine.

Are you an optimist about transformation coming fast enough? Many industry leaders believe we’re on a path towards financial sustainability of the U.S. healthcare system.

I’m an optimist; I’m a glass-half-full person. Last week, Pat Conway [Patrick Conway, M.D., deputy administrator for innovation and quality and chief medical officer, at the Centers for Medicare & Medicaid Services], came to visit us, and he indicated that there are encouraging signs that we’ve actually bent the healthcare cost curve. I think there will be real data coming out soon indicating that we are significantly bending the cost curve. So I am optimistic. I think it’s going to require a lot of focused attention and work. I think informatics and technology can help, but we’ll also need a culture change. But when you shine a light on the core issues, and you create transparency, and by sharing information, including with our patients—that will be a wonderful model for change.