5 questions with Brian Jacobs, CMIO and CIO of Children's National Health System

Brian Jacobs, MD, chief medical information officer and CIO at Washington, D.C.-based Children's National Health System, wasn't always an IT strategist. In fact, he began his career in pediatric clinical care.

"I was working in the intensive care unit with a lot of sick kids and a lot of devices — ventilators and dialysis machines and heart monitors and bypass machines and so forth. It's a place where there is a lot of data and a lot of potential for errors and harm. Some of the sickest kids in the region end up in that unit," Dr. Jacobs says. That experience, he added, provided him with valuable insights into the technological needs of both clinicians and patients.

Reminiscing on those early stages of his career — around the late 1990s — Dr. Jacobs explained that ICU nurses and clinicians would chart data manually by scribbling numbers with pencil in tiny cells on four-page, front-and-back flow sheets. That health data would then be added up by hand — with significant error rates.

"I think we calculated once a 57 percent error rate," he says. "[So,] I started to say, 'Hey guys, you really need to invest in computers and EHRs.' I talked enough about it that they said, 'Fine, do it; you go ahead and do that'."

This is where Dr. Jacob's career as an IT strategist began.

Dr. Jacobs became the first CMIO of Children's National, a position he has held since 2006. He is also the medical center's CIO and vice president, as well as the executive director of the Center for Pediatric Informatics and an attending physician in the pediatric critical care department.

Before joining Children's National, Dr. Jacobs served as the director of technology and patient safety at Cincinnati Children's Hospital Medical Center, where he managed the go-live of its EHR and was the principal author on a project awarded the HIMSS Nicholas E. Davies Organizational Award in 2003 by the Healthcare Information and Management Systems Society.

Dr. Jacobs recently spoke with Becker's Hospital Review about the hospital's unique EHR partnership, the importance of health IT in a hospital's strategic plan and his biggest concern for the healthcare industry.  

Note: Responses have been lightly edited for clarity and length.

Question: What is Children's National's relationship like with its EHR vendor, North Kansas City, Mo.-based Cerner?

Dr. Brian Jacobs: In 2013, we started something rather unique with Cerner — a true partnership, in the form of an institute — called the Bear Institute, based off our logo here at Children's. The partnership focuses on two [components:] operational excellence and innovation. We do a lot of development and innovation in the pediatric health IT space, and we've got an operational team that manages all the nuts and bolts of the organization — from the data center to storage and telecommunications wiring, critical informatics and biomedical engineering.

Q: What has been your biggest challenge as a CIO?

BJ: Clinician engagement and culture change is probably the most challenging. The technology is generally very sound, but being able to transform clinicians, who are very good at what they do, but who work in a paper-based environment, to using electronic tools in a different way and in a different style, with integrated decision support that is more holistic about the way we deliver care, has certainly been a challenge. But our clinicians can be very technology hungry. We give them something, and they adopt it. They're always looking for the next challenge or the next technological solution to what they do.

Q: What advice would you give to other hospital CIOs?

BJ: The most important thing is that the CIO is intimately involved in strategic discussions within the organization. Health IT requires engagement and communication; it needs to be part of the strategic part of the organization. IT really needs to not be an afterthought, but part of the strategy and part of the planning process for every major initiative in an organization.

Q: Which IT trends are you most excited about?

BJ: For us, it's harvesting the power and the energy in all of the data we have now, which will allow us to do very high-level big data analytics, both characterizing our opportunities now and predicting where we are going. Then, it's being able to use that information to help drive important initiatives in the organization, whether that is care delivery, quality, safety, research or education.

Q: What is your number one concern in the industry?

BJ: [Cybersecurity] is always top of mind here. That problem is becoming very challenging. There are a lot of organizational vulnerabilities that can really disrupt your business continuity and potentially cause you to have a significant downtime or financial loss. We are continuing to invest an ever-increasing amount in security and IT security. Certainly, as the CIO, that is one of the things that keep me up at night.

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