It could almost as easily have been in Boston, Bismarck, Billings or Berkeley, as Barcelona, for all that was being said. But it was Barcelona on Monday, and it was at the World of HIT 2016 (WoHIT2016) conference, sponsored by HIMSS Europe (a division of the Chicago-based Healthcare Information and Management Systems Society), being held at the Centre de Convenciones Internacional de Barcelona (CCIB), in Barcelona, Spain.
With about 1,000 attendees from across Europe and beyond, gathered to discuss important healthcare IT and healthcare industry topics, two sessions—“The CIO as Whole Systems Leader,” and “The CIO as Regional Leader”—were among those that put particular emphasis on the challenges and opportunities facing CIOs of both health systems, and of regional and national healthcare organizations, as they work to transform care delivery and community health across Europe.
So on Nov. 21, in the session entitled “The CIO as Whole Systems leader,” Olivier Boussekey, M.D., CIO of the Groupe Hospitalier Paris St. Joseph in Paris, France; Antonio Fumagalli, CIO of ASST Papa Giovanni XXIII in Bergamo, Italy; and Philippe Kolh, M.D., CIO of the Centre Hospitalier Universitaire de Liège (University Hospital of Liege), in Belgium, described their current strategies and operational intiatives at their hospital based organizations. Meanwhile, in the session immediately following that one, “The CIO as Regional Leader,” two individuals who are leaders of much bigger organizations spoke about regional and national healthcare IT leadership—Juan Lucas Retamar Gentil, CIO of the Sistema Sanitario Público y de Bienestar Social de Andalucía (Andalusian Health Service), a regional health authority that encompasses one of the largest regions of Spain, and Seamus MacSuibhne, chief clinical information officer and head of the Council of Clinical Information Officers, of eHealth Ireland, a national eHealth initiative for Ireland, spoke of their work on a broader scale.
Making it all patient-centric
What all three CIOs in the first session agreed on was this: moving forward strategically means putting the patient at the center. As Boussekey of St. Joseph Hospital in Paris said, “For us, creating a paperless record was about the patient. Medical information needed to be available for all professionals everywhere and in real time, and massively shared. And We also had to maintain and prepare for compliance with all regulatory changes in France. And,” he quickly added, “always with a patient focus. Our vision was that we needed to deploy something that was a win for the hospital, a win for the clinicians, and win for the patient. We started by digitizing 8 million pages; we extended the usage of the EMR to everyone, and we connected all the different devices, to avoid paper everywhere in the hospital.”
And “patient-centric” often means rigorous moves forward around clinician processes. For example, Boussekey noted, “All physicians are using voice recognition now; we no longer have secretaries to do any dictation.” Again, the focus here was patient-centric, in the sense that, given limited financial resources, it became clear to Boussekey and his colleagues that the cost of dictation simply had to be eliminated. “So how did we make this project successful? We deployed a strategy as a common project shared and built with all the physicians and nurses in the hospital,” he said. “We also really tried to explain tool usage—that all the tools being put in place were to add value. And of course, we’ve supported not only the project itself, but also the usage. I am using voice recognition every day as a physician,” he added. “I’d like to be able to share with fellow physicians, and when they complain that something doesn’t work, it’s important for me to be able to empathize and share that I understand.” Specifically in that case, Boussekey and his colleagues were able to help the hospital system to reduce staff by 30 FTEs’ worth of secretaries, while ensuring immediacy of data availability. What’s more, they also advanced the hospital towards a goal that is linked to a national mandate in France. “There is a nationwide objective in France to get 80 percent of discharge summaries to physicians on the day of discharge. Our hospital started out at 35 percent, but has been able to reach a level of 70 percent,” through the elimination of dictation.
In the region centered around Bergamo in northern Italy, Antonio Fumagalli has advanced his organization forward on several fronts in the past few years, again, with a strategic focus on patients. Among other things, his organization transitioned from an older facility into a completely new one, and went through that entire transition. What had formerly been the Odspedale Riunti became, in 2012, the Ospedale Papa Giovanni XXIII (named after Pope John the 23rd); the organization is a 1,000-bed public hospital, with 35,000 inpatient admissions a year, 3.75 million outpatient visits, and over 37,000 surgeries a year, along with some of the highest surgical and ICU volumes in the country. The organization moved into its new facility in 2015.
In Italy, as in France, the economics of care delivery and care management have played an important part in the strategizing forward around clinical IT. In particular, Fumagalli noted, the Bergamo region has been required by provincial authorities to streamline services and processes, with a mandate for more fully integrating services across the care continuum in the region. Among other things, the health system had to integrate a range of services, including a legal medicine center (judicial collaboration on violence and abuse), an addiction center, a family counseling center, and a regional vaccination service—all had to be integrated into a single, very broad umbrella of services.
As Fumagalli noted, the demands being made on his organization, as an integrated health system that increasingly is being transformed into a regional umbrella patient care organization, demand that CIO leadership extended into change management and change leadership, with a strong focus on optimally using resources to create the best possible delivery of care to the largest number of people.
In French-speaking Belgium, pushing ahead, with MD consensus
Meanwhile, Philippe Kolh, M.D., Ph.D., CIO of the University Hospital of Liege, one of the largest cities in French-speaking Belgium (known as Wallonia), shared with the audience how it is that he and his colleagues have reached a documented Level 6 on the EMRAM scale of HIMSS Analytics. As Dr. Kolh explained, his hospital is the only academic medical center in Wallonia; the other six in Belgium or in Flanders, the Flemish- (Dutch-) speaking part of the country, which is governed separately.
The journey for the University Hospital of Liege has been an interesting one, Dr. Kolh said. Twelve years ago, the three-facility academic medical center organization was characterized by centralized hospital management, yet also a lack of centralized clinical IT solutions, and no automation of appointments, with a “very fragmented” clinical information system. But the organization’s leaders invested nearly 15 million euros in an institutional strategic plan, beginning in 2003; and, with the appointment of a new CEO in 2013, progress accelerated. The organization is now entirely paperless for patient care, with strong IT governance, and a constant focus on creating greater efficiency, Kolh said.
What have been the top critical success factors? Kolh cited seven. First, general management support: “If you want to deploy a project like this, you need senior executive support for it as a priority, or you get a lot of resistance to change—and it has to support the patient, the staff, and the institution—optimal care quality; better working conditions and data; and more efficiency,” he said.
Second, there must be a “reorganization of IT structures,” Kolh said. “We have a department board,” he noted, “composed of each operational structure head and chiefs of services—I chair it. We have strategic monitoring of the IT department, monitoring of projects, IT budget management. And,” he added, “we have a ‘department commission,’ composed of a president, the CMO, president of the Medical Council, dean of the Medicine Faculty, the CIO, assistant CIO, department heads, etc., to greenlight activities and projects.”
Third, inevitably, Kolh said, implementation of the electronic patient record, or EPR, must be gradual. At the University Hospital, he helped lead his colleagues in starting with what he called “easy functions: a results server—clinical biology, medical imaging, nuclear medicine and pathology—in pure receive mode. Then we deployed the medical record—that took two-and-a-half years. From the start,” he said, “we decided to move into a paperless model. We have also been integrating up to 200 different medical devices into the EPR. And we are connected to the RSW, the Walloon Region Network. We also provide data analysis. That’s important so physicians can see the academic value of the EPR as well. Real-time bed management. Then drug order and administration [CPOE], and computerized medicine cabinets. CPOE—drug-drug interaction, drug-allergy, drug-lab information.”
The remaining factors that Kolh cited as critical success factors: a strong IT architecture; end-user involvement; support and training structures, and ergonomics, for user-friendliness. Of end-user involvement, he said, “You want to involve the users from the beginning. How can we do that? Each aspect of the project was shared with key stakeholders for input. We have a users’ group with representatives from every department, including doctors and nurses.”
Massive challenges—and opportunities—in Andalusia
Things are moving forward on an even broader scale in Andalusia (Andalucía), the large region that covers the southern quarter of Spain. There, Juan Lucas Retamar Gentil, CIO of the Andalusian Ministry of Health, is leveraging information technology to facilitate changes on a region-wide level. Importantly, the federalist system of Spain gives the regional governments a very large measure of autonomy and control, enabling tremendous flexibility in strategic planning and implementation of projects—though within the limitations of constrained budgets.
“When HIMSS invited me to come talk about the CIO as a regional leader, I thought about things that I’ve initiated since I started my job,” Retamar Gentil told the audience. “Many people see us like the guy from the IT staff. Butwhen you arrive to a position like CIO, it’s not just about IT. You have to design the IT strategy for the organization, but you also have to be fully aligned with the business strategy. I used to talk to people who worked with my organization, and people normally always talked about projects, one at a time, but never talked about the path, where the organization was going. So I took a couple of months to think about where we wanted to go,” he continued. “And I started to talk with the general manager, and the people on the policy staff, to design a strategy for the next three or four years. It wasn’t easy at all, because people started to talk about many different things. But I wanted to make sure everything was aligned. In the end, we got it. But it’s harder to write a short plan than a long one, yes?”
Looking at the broad outlines of what he and his team are facilitating in Andalusia, Retamar Gentil said, “The three main things for me as a regional CIO are to design a good strategy, to build a good team, and to find the resources,” pointing to a graphic of a triangle with strategy, team, and resources, as the three points of that triangle.
“In terms of strategy,” Retamar Gentil said, “I didn’t have time to write a short one, so I wrote a long one instead! Strategy has to be aligned into different lines of action. I wanted everyone to feel a part of the strategy. The IT strategy is a big puzzle, and everyone needed to know in which part of the puzzle he was. And Strategy without tactics is the slowest route to victory, while tactics without strategy is the noise before defeat. And you have to reevaluate the strategy every few months.”
The main principles in the work that he and his colleagues are continuing at the Andalusian Health Service: equity, accessibility, and transparency. “For example, to provide equity to all the citizens, and to the healthcare professionals,” he said, “we had to improve communication to little towns in the mountains. And we had to segment the population through algorithms, to find a better way to assign the budgets. All of that work continues, with progress being made at every step, he noted.
Meanwhile, at eHealth Ireland, MacSuibhne, a psychiatrist, is leading a collaborative of clinician leaders who are attempting to reframe that country’s push into the healthcare future. “You’d think that in a country with a small population like Ireland, it would be relatively easy to create transformative change; but in fact, as elsewhere, a lot of cultural changes have to take place,” he noted. Meanwhile, he and his colleagues are very actively involved in moving forward such initiatives as the Health Tech pre-accelerator, which the organization’s website notes is “an initiative with the aim of surfacing digital health technology that has the potential to disrupt and solve global healthcare challenges. The aim of this initiative was to bring together health and technology experts to work together to find digital solutions to healthcare challenges,” eHealth Ireland’s website notes. Another initiative is coalescing around a national push for e-referral, which could save the Irish as much as 2.6 million euros a year.
