Don't ask Dr. Shafiq Rab an easy question.
The vice president and CIO of the Hackensack (N.J.) University Medical Center has achieved stage 1 of meaningful use at the 775-bed facility, which is the largest provider of inpatient and outpatient services in New Jersey. He's also completed two Epic Systems electronic health record (EHR )implementations and has some big ideas about bringing EHR to the cloud - a bit of a radical idea, considering that Epic says large customers don't buy into the cloud.
Ask Rab, a member of the Becker's 100 Hospital and Health System CIOs to Know, to describe the impact of a single product that Hackensack UMC uses, and he's liable to answer, half seriously, "You don't know who I am, do you?" - as he did when speaking to CIO.com during a break at the College of Healthcare Information Management Executive's recent CHIME CIO Forum.)
That's because the 15-year healthcare CIO has a vision for the future of healthcare, and it means much more than any one single piece of technology.
Rush to Digitization Hitting Healthcare Hard
Healthcare should have digitized long ago, Rab says, but the need for revenue trumped the need for innovation. Without funding from the meaningful use incentive program, he surmises, only the most advanced health systems would have EHR systems today.
As EHR adoption has risen - today, 80 percent of eligible hospitals and 50 percent of eligible providers participate in meaningful use - so, too, has the realization that, as Rab puts it, "It's time to get wisdom out of [the EHR]."
Wisdom has always been in the head of providers, Rab says: "There's a journey from information to knowledge to wisdom." Transferring that wisdom from an individual physician to an entire healthcare system starts with documentation, which is a burden for many EHR users. "That learning curve, that way to do things efficiently, lies in the hands of very few," he says.
Healthcare's rush to digitize revealed a startling truth: Most doctors can't type, so "seeing a patient" often becomes a long process wrought with hunt-and-peck notation. Additional challenges emerged - namely, security and passwords, which were shared, posted publicly or simply kept at the factory default. Thumbprints and eye scans emerged as viable options, Rab says, until infection control entered the picture. "It should be easy," he says, "but there are unintended consequences."
Easy or not, it needs to happen - and quickly, Rab says. Healthcare is coming around on the encryption of data at rest and in motion, in part because of the updated HIPAA Security Rule, but there are still access controls to implement and Wi-Fi networks to lock down. Moreover, the process must resemble sublimation - water's transition from solid to gas without becoming a liquid - or else it will take 10 years.
'Let End Users Run the Show,' But Keep Executives Happy, Too
As healthcare tries to catch up, CIOs need to "let end users run the show." CEOs have the money, Rab says, but physicians and nurses have the power. They are the real decision-makers, he says, and they're the ones from whom you need buy-in.
"Let them yell and tell [you] the mistakes," Rab says. "You have to get to the power. You change the mind of the decision makers by manipulation or emotional blackmail."
You accomplish this, he says, by making them a central part of training. Hackensack did this when rolling out Imprivata OneSign single sign-on key tab technology. Actual training lasted but a few minutes, Rab says, with the remaining time devoted to real-world use cases emphasizing efficiency and accessibility benefits.
That said, healthcare CIOs must get executives on board when they have big technology plans. Rab's first two users of the SSO technology? The CEO and the CFO.
Many Sources of 'Wisdom' Poised to Power Predictive Analytics
Speaking of plans, Rab says healthcare organizations need to focus on "total connectivity." By and large, this means mobility, which physicians and patients alike are demanding.
Connectivity matters because EHR systems are far from the only source of wisdom available in a healthcare ecosystem. Hospitals, for example, get data from revenue cycle management, patient outcomes, wearable technology, payers, affiliated primary care physicians and, increasingly, health information exchange. Put it all together, Rab says, and you lay the foundation for healthcare big data analytics.
This matters, too, as analytics is the backbone of the accountable care organization - the model of coordinated care and shared savings that's central to healthcare reform. Hackensack UMC is part of the larger Hackensack University Health Network ACO, which generated $10 million in Medicare savings in 2013.
Medicare reimbursements are "the easiest way to live" in healthcare today, Rab says, but healthcare reform and shifting care models will emphasize efficiency as the new way to live. Healthcare IT innovations such as streamlined appointment scheduling, SSO technology for clinical systems and a rentable cloud-based EHR systems that complete the "circle of information" will standardize and modernize longstanding processes while lowering administrative costs.
Accomplishing this, Rab says, is "all about trust and then transparency." This, in turn, requires "possibilities, opportunities, relationships and behavior change," none of which will be accomplished overnight.
"This takes time," he says. "You need to stick around to make it happen.
Brian Eastwood is a senior editor for CIO.com. He primarily covers healthcare IT. You can reach him on Twitter @Brian_Eastwood or via email. Follow everything from CIO.com on Twitter @CIOonline, Facebook, Google + and LinkedIn.
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