Retiring Owensboro Health CMIO shares thoughts on revenue cycle, IT challenges

Owensboro Health Senior Vice President and Chief Medical Information Officer David Danhauer, MD, has known he wanted to be in healthcare since sixth grade. 

Dr. Danhauer said passion has carried him throughout his career, first as a pediatrician for 27 years and as a CMIO for the last 10. At Kentucky-based Owensboro, he leads a clinical informatics team focused on improving patient engagement, care and safety and physician satisfaction. He oversaw the implementation of an enterprise EHR for ambulatory and inpatient settings; helped design a new $500 million, 450-bed regional hospital, and supported the growth of an ambulatory group of 180 providers in 30 locations.

Ahead of his retirement in September, Dr. Danhauer spoke with Becker's about how health IT and the revenue cycle have changed over his career and how the role of CMIO has evolved. 

Editor's note: Responses have been lightly edited for clarity and length.

Question: How has Health IT and the revenue cycle changed over the course of your career?

Dr. David Danhauer: When I started, we used what's called a pegboard system. You used a ledger card, where you would write the office visit on the ledger card through copy paper, and it would write it three times on the sheet below. And so you kept track of your ledger across that with a pegboard system. And from there you would then copy that patient's ledger and mail the copy of that ledger to the patient for them to pay. That was even before filing insurance. The patient would file their own insurance, and it was their responsibility, it wasn't my responsibility as a practice. Then we'd receive checks, and we would record the check back onto that ledger card. That's how we kept it. It was all paper.

It worked. It was pretty simple and made it nice, but very quickly I learned that I could do it probably a little bit more efficiently and accurately through an electronic system. And so we got our accounting system put on, and that's where my IT work started. I love computers. I thought this was fun, and I built them, played with them. So I thought, 'let me do this in the office.' So I got a simple accounting system, and installed it on an [Intel] 286 — one of the first computers.  And it took me a long time to get my staff comfortable in using it. I realized that I needed my own computer, so I got a 386 in my office to run payroll and all the other things. And I actually networked those computers years ago. I networked them together, had a lot of fun in that, so it was cool.

From there, we then went to EMRs. The EMRs that we dealt with had both the electronic medical record and also the billing systems in the background associated with that. The first systems we had with GE, we had two linkages between the accounts payable, accounts receivable, etc. and the actual medical record. But that was what was needed. That's all I had to have, was the balance of what the charge was. It worked, but it was primitive. 

And then from there is when Epic came in for our organization, and with that we gained access to the full revenue cycle associated with Epic. And that's how it blossomed into, 'Oh my gosh, everything runs through Epic.' It's so integrated. 

Q: What challenges do you see in those fields currently, and where do you think they're heading? 

DD: I think probably the biggest issues here are insurance regulations and then governmental regulatory requirements and the impact that has on your revenue cycle. So the quality measures and all that, that is absolutely ludicrous trying to keep up with that. And we seem to get new ones almost every week. That challenge is probably what drove me from my practice into IT.

As a private practice, we had eight providers, and I could not any longer run the practice and keep up with all those regulatory compliance issues. And I was done. It was hard enough seeing patients, but just trying to keep abreast of all those as the physician-manager. I was done. That was enough. So to me, that continues to be a huge challenge. And when you throw all the COVID work on top of that now and the reporting that we have to do, I'm not sure how our systems are going to be able to keep up with that and get the interfaces built quick enough, fast enough and able for them to communicate with each other. That feedback mechanism, that that's really the toughest thing we're trying to manage right now. 

Q: How has the role of CMIO changed over the past decade?

DD: When I started, my role as CMIO was to handle the docs as we instituted a new EMR. The administration did not want to manage them. They wanted to dump every bit of those issues from the physician adoption to somebody, i.e. a physician. And I was excited about that. That was very intriguing. I had a lot of passion associated with getting this access and interoperability for my providers. That was a huge passion for me to make that happen. So I gladly took it. 

My docs, they came to every meeting and said, 'I don't know how you put up with this. Why would you want to do that?' I just said, 'This is great. I don't want anybody else wanting my job.'

This is awesome because I'm having way too much fun and enjoying what I do. But they couldn't believe somebody was actually interested in putting up with griping doctors all the time. But that was my role, was getting docs to onboard and get live and get trained and be proficient at using an EMR. 

CMIO version two is now very strategic. Everybody's got their own EMR. We've got it installed. Docs have used it now long enough and we're comfortable with it. We're past that engagement phase. But now, what are we doing to take our systems to the next level? What are the newest technologies that we can incorporate to move clinical care to that next level? What are the new technologies? What are the main functionalities? How do I make it more ergonomic and easier to use? How do I get better patient engagement and all of those things?

It's the strategic nature of taking all of this clinical IT work to the next level. That is now the CMIO's role. And trying to stay current, being knowledgeable, reading, listening, engaging, networking, all of those things from the outside of the organization as well as inside the organization. I've got to be able to listen and know what's going on and have my finger on the pulse and help make strategic decisions going forward. 

Question: What makes a good leader, and has that changed over time? 

DD: I don't think it's changed. I took a little time and thought about this one, and I think listening is the No. 1 thing that you've got to have. I learned that in my pediatric practice, in trying to listen to my patients, I had to listen and not jump to conclusions. And I think that's helped me be successful in my role as a CMIO as well. I had to listen, not just to one side of the story. I had to learn very quickly that if I didn't listen to both sides of the story, I would always make a bad decision, and I would get trapped. I got burned several times not doing that. And so boy, I learned that one very quickly. 

I think what's been successful for me is being a servant leader. You know, you have to listen first, and then you know that your client — whether it's a physician, a patient, leadership, whatever it may be — that I had to be a servant leader for them. They are the most important, I'm secondary. I am not critical in my role. That they are the most critical. And how do I make my clients successful? That probably is the second piece. I've always had an open-door policy, and I think that comes back to listening. It did make a difference. If I get a phone call, you know, I'm going to drop what I'm doing and get that phone call. If I have somebody knocking on my door, I'm an open door. I'm going to take it. Even if I'm in a meeting that's important, I need that availability, and I've hopefully been able to do that. 

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