Charles E. “Chuck” Christian, vice president and CIO at St. Francis Hospital in Columbus, Georgia, and since January, the current chair of the board of the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), spoke with HCI Editor-in-Chief Mark Hagland on Sunday, April 12, during the CHIME CIO Spring Forum, being held at the McCormick Place Convention Center in downtown Chicago. The CHIME CIO Spring Forum occurs every year on the day before the main HIMSS Conference (sponsored by the Chicago-based Healthcare Information & Management Systems Society) begins. This year, the CHIME CIO Spring Forum and the HIMSS Conference are both being held in Chicago.
Christian recently accepted a new position as vice president of technology and engagement at the Indiana Health Information Exchange (IHIE), an Indianapolis-based statewide HIE in the hoosier state. Christian served as CIO of Good Samaritan Hospital in Vincennes, Ind., for 26 years, and began collaborative work with IHIE back in 2010, while he was still in his CIO position at Good Samaritan. Christian, whose term as chair runs for the entire 2015 calendar year, shared with Hagland his perspectives on a variety of issues related to the challenges and opportunities facing today’s CIOs in the current policy and operational market. Below are excerpts from that interview.
What would you like your year as CHIME’s chairman of the board to be known for after the year is over?
It’s really not about me, it’s about the organization. I’ve had the honor of being a charter member of CHIME, so it’s my 23rd year with the organization. I was on the board in 2002-2004, and I rejoined the board in 2013. And this time around, I’ve had the pleasure of serving as chair. And we were moving from more of an operational to strategic board, so I want to finish that work related to moving us over to strategy. We used to contract for management services, but it’s all our own staff now; we brought Russ on board as a CEO, and we’ve built a great number of partnerships, within the industry, with other associations, and with ONC and CMS, inside Congress, etc. I want to continue that path.
I’ve been involved with the policy steering committee for quite a few years and have commented on every NPRM [notice of proposed rulemaking] coming out of the federal healthcare agencies for years. And we want to continue to inform our members about what’s going on in the federal agencies and on the Hill, so I want us to continue to be that voice with the regulators. I remember years ago, maybe in 2002-2003, when President Bush called out healthcare IT and said he wanted every patient to have an EHR. And I remember going back and telling my staff at the hospital that, you know, there’s a light at the end of the tunnel, and we’re going to see how that evolves forward, but now there’s a train attached to that light. And if we don’t move quickly, we’ll be run over. And in terms of the NPRMs that have just gotten released in rapid succession, we’ve got Stage 3 meaningful use, and the stage breath, the 2015 certification criteria; then we had the SGR [sustainable growth rate under Medicare—a guide to physician payment] fix, which is not an NPRM but has many implications; and then the Stage 1/Stage 2 modifications for 2015 that came out on Friday from CMS [the federal Centers for Medicare & Medicaid Services]. And then we have the other things related to the interoperability roadmap, coming out of ONC; we’ve got at least one bill out of Congressman Burgess’s office focused on interoperability.
So there’s got to be some harmonization of all of those things. In thinking about all those things, one thing that comes to mind for me is the piece that John Halamka, M.D. wrote several years ago about boiling frogs. And he said that these things individually aren’t too much going on; but if you take them all cumulatively, they’re very big. And the NPRM that came out on Friday—they spent some time in it talking about how they had analyzed the industry. The thing is, we’re racing forward with the next stages, but we haven’t had a chance to assess how we’ve done so far. But in that document, they recognized that we are racing forward. And they’re realizing that a couple of objectives related to patient demographics and vital signs, everyone’s doing those things so there’s no need to report on those anymore; not that they don’t want people to do it, but they know everyone’s doing it, so they can focus on other things.
And what CHIME is doing through the policy steering committee, is helping membership make sense of all those things. We do that through our limited-size staff in Washington, but also through brilliant volunteers, who read things as I do, and then collaborate on analyzing what things mean. And our volunteers involved represent all kinds of hospitals. And one thing we’ve really started including recently is the view from the physician practice. And now with our partnership with AMDIS, we have an even more robust view from the standpoint of the practicing physician. So the more that we can look at how these things impact the various aspects and facets of care, the better off we’ll be.
Would you agree that there is greater federal healthcare policy clarity now?
There is direction, for sure. We have good direction. I’ve been having meetings with folks on the Hill for many years. And I would say that congressional staffers of our elected officials do get it. They are listening very carefully; they are engaged. We’ve done a number of kinds of listen-and-learns for Hill staffers, and they are engaged. And some of it has to do with our advocacy staff focusing on things. And there is also a focus at CMS on getting this right. And we’re trying to skate to where the puck is going.
And the thing is that, because it takes so long to get it right, we need the patience to go with the process; and there are a tremendous number of competing priorities, per the available funding. So we just need the will to stay the course.
I was talking to Pat Skarulis [Patricia Skarulis, vice president and CIO of Memorial Sloan-Kettering Cancer Center in New York City] last night about when we were on the [CHIME] board together in 2002. And we were having a conversation then about the term “advocacy.” We weren’t even thinking about advocating healthcare IT in politics back then, we were thinking then about advocating the role of the CIO in healthcare [to senior executives in hospital-based organizations]. But so much has changed in terms of the role of advocacy in Washington, D.C. And I’ve had the pleasure of meeting with every one of the ONC [Office of the National Coordinator for Health IT] national coordinators beginning with David Brailer; and I’ll be meeting with Karen [Karen De Salvo, M.D., the current National Coordinator for Health IT] this week, and of course, Russ [CHIME president and CEO Russell P. Branzell] has met with her. And she appears to be an extremely bright lady and wants to partner with us.
There has never a time of greater ferment in U.S healthcare. What would your advice be to CIOs right now?
They need to make sure that they find the sources of good information, as in your magazine, that is good-quality stuff, and pay attention. You can’t depend on somebody else to figure it out for you. And the role of the CIO is to be engaged and to translate that information into strategy for your organization. Because the CEO and the CFO have their own perspectives. So if the CIO is really going to be a senior leader in their organization, they need to translate insights from the world into potential strategy that they can share with their colleagues in the c-suite. And our goal at CHIME is to collectively make ourselves as a group, smarter. And we truly are smarter based on the more people who can eyeball something and figure it out. And there may be something we may not be able to fix today, but we need to be aware of it. And I’ve found that the issues are similar across many different types of organizations; they’ll scale differently, but the issues that CIOs need to focus on are very, very similar.
