How are hospital CIOs shaping IT priorities in the era of meaningful use and ARRA? In this podcast, David Muntz, senior vice president and CIO of Baylor Health Care System in Dallas, TX, shares his perspective with Hospitals and Health Networks Executive Editor Alden Solovy.
This interview is part of a podcast series developed by H&HN and www.whatismeaningful.com
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Podcast transcript:
Alden Solovy: How is your strategic plan addressing and preparing for meaningful use?
David Muntz: Great question. We actually are not doing something specifically in the strategic plan. Not surprisingly, the strategic plans that we had aligned already pretty well with what was going to be required from the meaningful use matrix. And so if anything what it will help us do is accelerate some of the activities that were already underway. And oddly enough I think you would not be surprised, probably, that we're already going to do many of the things in the order that had been anticipated, with the possible exception of the degree to which we were going to do some things. So I don't think we're really making a significant change in direction because of the meaningful use activities.
Solovy: Give me an example of one of the items that the degree of emphasis has either gotten greater or lesser as a result of your anticipation of meaningful use.
Muntz: Sure. The easiest place to see that is in the health information exchange activities. We have decided that it's really critical for us as an organization, which is, by the way, very large and spread out, to be able to communicate with all the participants. And there's no question that we wanted to create at least a parochial health information exchange so that everybody who participates at Baylor was going to be able to exchange information. But we didn't anticipate that the level of integration would be great. And the term that I used is actually "eye-level integration" which means that we would present the data to a clinician like we do now through our portal and they would actually do the integration of pieces that come from a variety of sources I think the matrix would suggest that we need to be able to create particular kinds of documents, the continuity of care document, continuity of care record are much more precise than what we had anticipated, and so that's the best example of a pretty dramatic switch for us.
Solovy: To summarize: essentially you're moving from this eye-level look at it -- E-Y-E level -- and going to the more defined set of documents as they've been developed?
Muntz: You bet. And obviously it's going to help the clinicians, who are more interested in trending and those kind of things. When they're looking at a specific patient it will help the institution because as we look at disease and population management it fits real well in that particular kind of activity.
Solovy: Is there an example of something you might be slowing, rather than accelerating, as a result of your anticipation of meaningful use?
Muntz: Oh yeah. And by the way, great insight. The fact is that we also had other projects that may have to be slowed down in order for us to accelerate some of the other things we've been involved in. This is user-led demand management system in place at Baylor, so we've had to educate the users about what the implications are. And so there are some projects that are going to get pushed off that would have been done in, I guess, a quicker timeframe that won't be done because of result.
Solovy: And that's essentially capacity issue, just how much an organization can get done at one time?
Muntz: Exactly. And if you wonder about the concerns that I have, one of the major concerns I have is focus. We have a lot of good initiatives going on here, and yet we also have a lot of things being regulated. And so the appearance of ICD-10 has already got our attention, the new HIPAA regulations are a little more stringent (or a lot more stringent) and require us to do more work than we had anticipated, and then trying to accelerate some of the activities related to the ambulatory setting will push aside some of the things that we might have otherwise done.
Solovy: Is there one thing, David, that just has you going: "I really have to push that off but I really wish I didn't have to"?
Muntz: No. I think we're pretty good. Every year we get about five times as much request as we have capacity to do, and we usually work with our customers and prioritize those things. So they're used to doing an expected amount; we don't leave things, if you will, in a queue waiting to get done. So I'm pretty happy with the maturity of the demand management process here.
Solovy: Great. Any special concerns for, as you describe, a large, spread-out organization, university medical center that need to be taken into account as you think about meaningful use?
Muntz: Actually just a little more complicated by the research activities. I think it probably helps in that regard. As I've said, we are going to have to look at more structured data and as the research activities are ginning up it probably helps us in that regard. So I'm actually excited for that purpose. We are talking about trying to, again, organize the data in a way that will allow us to do better disease management, population management. And I think if you had to look at one of the other things that large institutions like ours are doing, if they're not already they will very soon be having discussions about accountable care organizations. And so I think this is a perfect opportunity to kind of consolidate all activities and make sure that we're doing the right thing at the right time.
Solovy: Does that become a unifying theme for management, or clinicians, for technologists, this notion of essentially making care better and making care more seamless for patients?
Muntz: Absolutely. You know I think those are part of the goal for the ARRA, but they're also part of the goals that we have to survive as a organization. We have just got to do a better job at collaboration, coordination and communication. And so I think all of these things are working in concert, not conflicting with each other.
Solovy: So the clinical analytics measurement of quality outcomes become pretty key down the road?
Muntz: Absolutely. And we've been publishing papers about preparing for the electronic health record as well as our experience in the ambulatory setting and trying to build up a body of evidence that would have prior to the ARRA encouraged people to go ahead and pursue the same course we are, because we have enough evidence to show that even preparation for electronic health record has great advantage.
Solovy: From all this research and the papers you've published, are there three top-line take-homes for hospitals who may not be as far along as you: do this, don't do that and I learned such-and-such?
Muntz: I guess the number one on my list -- I'm not sure if I can list all three, but it's this idea of collaboration with the medical staff -- that's just paramount. And we were lucky enough to have this discussion underway for about five years now. And as an example, when we were preparing for EHR we knew that we had to create standardized order sets. It's just going to be a necessary requirement in order to make things easier to deploy in a very large, complex system like ours, with multiple participants. But we, I don't think, would have forecast the kind of results that we got. We started looking at pneumonia order sets and we found out that if a patient came in without any particular order set and was treated as such they got one particular result as it related to mortality; if a physician was using their own standardized order set they got a significantly better outcome as it related to mortality. But if they used the Baylor-designed order set they still got significantly-improved mortality outcomes as a result of that. And so that preparation work, that kind of collaboration and the kind of conversations that need to occur that might not have occurred otherwise are the most critical factor. I guess if I had to put a second thing to be aware of, again it's focus. An organization can only absorb so much change at one time, and if you have too many initiatives going on and don't focus on the EHR as something specific, I don't think you can be as successful. And so all of our strategic plans now include elements from IS and are not separate and apart from the IS strategic plan. And having that kind of buy-in has been a huge thing. And the other thing that we worry about that might not affect other organizations is the impact of scale. And so trying to prepare to do something at 1,100-bed hospital versus a 100-bed hospital is significantly differently, and you have to modify your efforts to recognize those differences.
Solovy: Exciting time to be a CIO?
Muntz: A great time to be a CIO.
Solovy: Well good luck with your work.
Muntz: Thank you very much. I appreciate your interest.
[End of Audio]
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This podcast with David Muntz, senior vice president and CIO of Baylor Health Care System in Dallas, TX, is part of a series of interviews with hospital CIOs about IT strategy and preparing for meaningful use, conducted by H&HN Executive Editor Alden Solovy, and featured exclusively on www.whatismeaningful.com.
