3 questions for CHIME board members on CIO roles in accountable care

Editor's note: This is the second in a three-part series on the changing role of technology and IT leaders in healthcare. In the first part of the interview, CHIME board members discuss how the role of the member organization has changed since its inception 20 years ago. Here, in part two, they talk about how technology can enable new models of care and the CIO's role in preparing for and executing them. In the next article, the CHIME board members will discuss the changing professional roles and responsibilities of healthcare CIOs and other technology leaders.

We've all heard that technology will play a huge role in accountable care and medical home models, from enabling information exchange to maintaining accurate patient records to harnessing all that data to improve outcomes and reduce costs.

But the nuts and bolts of the technology is one thing. Most CIOs and other healthcare technology leaders are confident in their ability to manage those systems.

The fact is, there's more to it than technology and systems. The modern CIO is playing an increasingly important role in guiding an organization toward creating a strategy and roadmap for implementing the momentous change facing hospitals today.

At the College of Information Management Executives fall forum, held last week in Indian Wells, Calif., I met with the member organization's three newest board members to discuss the changing landscape of healthcare technology.

In today's excerpt from the interview, Pamela Arora, vice president and CIO Children's Medical Center, Dallas; George McClulloch, Jr., associate director and deputy CIO, Vanderbilt University Medical Center in Nashville; and Charles Christian, CIO of Good Samaritan Hospital in southwest Indiana talk about the role of the CIO and healthcare technology in preparing for accountable care and medical home models.

We kicked things off with a fairly simple question:

FierceHealthIT: What issues are going to be most important to CIO and other health IT leaders in the next year? In short: What's freaking them out?

George McCulloch, Jr. (right): They're freaked out about ICD-10, as they should be. They're freaked about Meaningful Use Stage 2--or Meaningful Use Stage 1, depending on where they are. Aside from those, we're all struggling with the whole revamp of care delivery models.

So now it's "what's my role?" in whatever size organization I'm at, whether I'm going to be part of an ACO or I'm trying to pull together smaller hospitals into a network that survives--I think that's the biggest challenge people are facing. So Meaningful Use pushed me in a particular way, but it's really about delivering care differently. And what's my role as a CIO in helping my organization decide what we're going to do differently than we do right now? Because the current financial model is unsustainable. I've got to partner with my clinicians and say "what do we do different?"

You've got to find the nexus of control within your organization. You need to find partners that want to help and have a vision of what they want to get done. It's finding those people in your organization and saying "That's my leader" and helping them frame the questions that they have and the ways they want to exercise their options.

FHIT: So what is the role of the CIO is shepherding these new care delivery models and organizational strategies? 

Pamela Arora (right): In most organizations there is a version of the strategy--some of them are more fleshed out than others. But as an IS shop, an IT shop, we're in a position to be able to help leaders understand the implications of the tools and how they factor into those strategies. And whether you're talking about ICD-10 or ACOs and population health, having an infrastructure around IT is fundamental to achieve the objectives that are laid out.

McCulloch: It's people, process and technology--in that order. We really need to work with the business leadership--which we're certainly part of--and say what are the people, process, and governance things we're going to tackle? And then we have to figure out how the technology can or cannot support those things. We don't like to have poorly defined people roles or process. So if we have a problem with hand-washing and someone says get these little infrared gadgets and put them in the sinks and it's going to go away--we know that it's not.

Arora: Getting the EHR and the EMR in place is just the start of it. And from a people, process and technology standpoint, you're getting the tools in place but it's an ongoing journey.

We're embarking on that strategy. We're in the early stages, but the leaders across Children's Dallas appreciate that it requires a lot of IT infrastructure to be able to mine that data, and marrying data from other sources, that's very necessary to manage the risk of this model.

McCulloch: We're just as focused on the care delivery part. If we're financial partners and partners in care with people, things have got to change. Not only having an appropriate technology to support that clinical process, but what is that clinical process? Who are we going to credential to do what? What's the delivery mechanism? Who's going to do what on the patient and how do we get agreement on what the care plan is for this particular patient? And then getting the tools and technology in place to document and coordinate care.

Charles Christian (left): We're in a rural setting, so we're going to be accountable regardless because we own the physician practices and we own the hospitals so we own the care in the region anyway. But we're looking at what everybody else is doing to make sure we can see the way. One thing we are doing is moving forward with our medical home, making sure that we get the care right, such as ongoing care for chronic patients that doesn't require a visit to the ER.

FHIT: What should CIOs know about the financial stakes of accountable care and medical home models?

Christian: We're paying for all of this with cost avoidance. Particularly in the medical home we're not doing it because of reimbursement. We're doing it to avoid the cost of providing that care in different places, which is an interesting model. We're doing more stuff so we won't get paid or we won't acquire the cost. It's trying to reduce the cost of the ER and then move those patients out so we can provide care for those patients who don't need to be there.

Arora: We have a similar model and we've been growing our primary care facilities for kids that don't have a medical home quite rapidly. It's a model from the standpoint of cost-avoidance, certainly, but United Way is actually contributing quite a bit because they know the impact it's going to have in the community. Getting the right care in the right place at the right time is better for the patients because they're healthier--they really are--and the cost is so much more in line with what's appropriate.

McCulloch: That's where the ACO model tips it. So now we have financial incentives to do what needs to be done, the way an HMO would have managed it from the outside. We're going to take risks as providers and now we're going to be accountable financially and clinically for that patient population. As providers, we're now at risk for things we were never at risk for before.

Editor's note: This Q&A has been edited for length and clarity.