Beth Israel Deaconess CIO Dr. John Halamka on Learning From Mistakes

Dr. John Halamka on his 15-year tenure at BIDMC, learning from mistakes and the silver lining in the troubled HealthCare.gov rollout.

When John D. Halamka, MD, started as CIO of Beth Israel Deaconess Medical Center in Boston in 1998, technology was "mysterious."

His job as CIO, then, was to demystify and harness available technology to begin to automate certain processes and develop necessary infrastructures and IT networks. Under his leadership, BIDMC became an early tech adopter, implementing an electronic health record system in 1999, and it initiated one of the first health information exchanges, CareWeb. BIDMC was also the pilot test site for several federal initiatives, including Blue Button and Direct messaging technology. Being the first with new technologies "allowed us to figure out what works and what doesn't," says Dr. Halamka.John Halamka, MD

Early in his tenure, a couple missteps also provided Dr. Halamka with insight into what works and what doesn't in regard to technology. In 2002, the hospital's network collapsed, and for 15 days, physicians could not order medications or labs electronically or access clinical decision support software. Many of the network components were out-of-date or underfunded, but Dr. Halamka acknowledges it was a learning experience for him on the necessity of good vendor relationships, the benefits tested downtime plan and the importance of investing in a solid IT infrastructure. "Our system is much more resilient now," he says, "and we definitely learned a lesson."

He also recalls a major privacy breach that occurred on his watch. In what he calls the early days of bring-your-own-device, a physician lost his mobile device that contained patient data. "He lost it, but I was accountable for it," says Dr. Halamka. "It could have been avoided if I had been faster on putting better BYOD policies into place."       

Today, BIDMC is a national leader in health IT adoption. A humble Dr. Halamka calls the hospital's technology "robust." Now, Dr. Halamka's job has transitioned from an IT project manager and self-described technology geek to an executive focused on keeping the hospital in line with government expectations. "Today it's all about overall strategy and regulatory compliance," says Dr. Halamka.

By his count, since he became CIO of BIDMC, the federal government has implemented more than 300,000 new rules and regulations. Implementing technology to automate hospital processes has been replaced by implementing technology to meet government requirements. "I have a new mandate, and a new set of priorities," he says. "Like all CIOs, I'm now focused on meaningful use stage 2, ICD-10, HIPAA and ACA [Patient Protection and Affordable Care Act]."

Looking forward to 2014, Dr. Halamka hopes the healthcare industry as a whole will begin to learn from missteps. Discussing the troubled launch of HealthCare.gov, he hopes the restrictive timeline the exchange site was developed and launched under will reveal the inherent dangers of trying to move technology projects along too quickly — namely, meaningful use.

According to the Healthcare Information Management Systems Society, while up to 68 percent of eligible hospitals and 41 percent of tethered ambulatory facilities have purchased the software necessary to attest to stage 2, concerns remain that many are waiting for the necessary upgrade to a certified version of the software, and many will struggle to attest to stage 2 during 2014. "Right now, it's going to be impossible for a lot of hospitals to meet the requirements on time because of the vendor they're using," says Dr. Halamka.

Dr. Halamka is hoping the troubles with HealthCare.gov will cause the federal government to reconsider the meaningful use timeline and grant the six-month attestation period extension he and HIMSS have called for (others, including a coalition of 17 senators and the American Hospital Association, have called for longer extensions or delays).

"I like to think there's no such thing as a bad event," he says. "The HealthCare.gov problems could end up being a really good thing."  

More Articles on Hospital CIOs:

The Life of a Healthcare CIO: KishHealth System's Heath Bell
The Life of a Healthcare CIO: Mt. San Rafael Hospital's Michael John Archuleta
Beyond the EHR: Sentara Healthcare’s IT Strategy 

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