Creating an IMPACT Through HIT: Q&A With Tenet's CIO Paul Browne

Achieving meaningful use, conversion to ICD-10 and implementation of electronic health records are just some of the issues facing chief information officers as they lead their organizations into the brave new world of healthcare information technology. While each healthcare organization's experiences and challenges with health IT is unique, the overarching issues remain the same for all of them. 
Paul Browne serves as the CIO and senior vice president of applied clinical informatics for Dallas-based Tenet Healthcare. Here, Mr. Browne talks about Tenet's health IT strategies as well some of things he has learned while serving as CIO.

Question: What are some of the health IT strategies that you will be focusing on in the coming year?

Paul Browne:
Right now, Tenet's biggest focus is meeting the federal government's requirements for meaningful use. In 2010, we formally launched our health information technology initiative — IMPACT, which stands for Improving Patient Care Through Technology. While the primary objective of this initiative is to help our hospitals achieve meaningful use, the broader vision is to ensure we're providing the right information when and where it's needed to improve the quality of care for our patients.  

In line with the stages of meaningful use, our next steps for implementation are focused on how we advance clinical process improvement and prepare for new payment methodologies that link payment to clinical outcomes. The scope and scale of the IMPACT initiative creates an unparalleled opportunity for analytics-driven clinical process improvement across all of Tenet's 49 hospitals and other facilities nationwide. We'll use the data that we have captured in our systems to improve quality and safety, identify and eliminate unnecessary variation in care, and by doing so, reduce costs, free up resources to care for more people, and drive efficiencies.  

Q: How has Tenet been dealing with meaningful use requirements and stages?

To a large extent, meaningful use has helped to define our plans and timelines around Tenet's IMPACT initiative. To date, more than half of Tenet's hospitals have satisfied federal criteria for meaningful use and qualified for incentive payments, and all of the remaining hospitals are on target to complete implementation by mid-2014.

Electronic medical records allow us to get granularity in the data and understand what care was delivered for the patient, and how we can link that data to actual outcomes to drive efficiencies, effectiveness and, ultimately, reduce costs and improve quality and safety. Already as a result of our efforts, we are seeing a substantial reduction in duplication of lab tests, radiology tests, potential medication errors and the faster administration of drugs after they've been ordered at our hospitals. But, we realize that we are just scratching the tip of the iceberg right now and within IMPACT have established a Value Realization Team that's diving deeper into the data and doing analytics work to identify opportunities and the different rates of performance to determine why outcomes differ and how we can drive further improvements.

Q: What are some of the biggest challenges that healthcare organizations are facing in terms of IT?

Besides meaningful use, an additional challenge that Tenet, and the industry, is facing is the conversion to ICD-10, which takes our coding structure from somewhere in the neighborhood of 30,000 codes that drive most of billing to more than 200,000. The complexity of our clinical documentation and operations is going to increase dramatically. This is one of several other regulatory mandates that we are preparing for and we have engaged experts in this area to help us navigate these changes.  

Additionally, we're also working closely with hospital staff — the doctors, clinicians, nurses and others — to adopt and implement new technologies. These are very busy people with a lot going on in their environments and day-to-day jobs, and the technology is still relatively new to them. We've identified point people at each facility to work with the teams on-site to ensure that there is familiarity with the electronic medical record systems, and to facilitate adoption of the technology and accuracy in the data that we're capturing.

Q: How will Tenet deal with those challenges?

For ICD-10, Tenet has two concurrent sets of activity going on. First is systems remediation, which confirms that our technology will work with all the new coding and regulatory requirements. At the same time, we're also making sure that we're ready from an operational perspective, and we are working with hospital staff to make sure they are properly trained to work within the framework of the requirements.

We've also learned that the key to success in rolling out all of the complex health information technology initiatives and programs is having clearly defined people at the hospital who are responsible for success at the facility level and can serve as the focal point for making sure all the operational activities are getting completed in a timely, efficient manner. Additionally, it's important to engage hospital leadership teams and ensure that these initiatives are on their agendas, that they are receiving frequent updates and that they also have clearly defined accountability for the success of the initiatives locally. We always try to have someone on the executive team, normally a CNO, COO or, in some cases, a CEO, who functions as the executive "champion" at the hospital, and they typically rely on someone called the clinical informaticist to serve as the day-to-day, week-to-week "traffic cop" to make sure everything gets done.

We also try, as much as possible, to implement the electronic medical record systems and technology in a standardized way in all of our hospitals. While we recognize that there are differences that need to be taken into account, every hospital system in the country is on this journey together and are experiencing similar difficulties in implementation. Due to Tenet’s size and national network, we're able to learn from the experiences at all of our hospitals and share best practices across our facilities. This has enabled us to rollout our systems and achieve meaningful use at a much more rapid pace, while also tackling the challenges we come across head on.  

Q: What is the most surprising thing you learned after becoming CIO?

Most of the role is not specific to technology. What I mean is that CIOs really need to understand the business they serve, how to motivate people, how to organize large teams for success, how to lead through influence and how to make difficult trade-off decisions. Being a strong CIO is about being a strong leader as much or more so than it is about being a strong technologist.

Q: What is the biggest challenge you have faced as CIO? How did you overcome it?

Tenet's size and strength has a lot of benefits, but there are also challenges when managing information systems across a large healthcare system. Every hospital and their staff is unique. While we can share key learnings and resources, we're dealing with very busy people, and the technology is still relatively new and not yet as "user friendly" as many would like it to be. Additionally, the clinical thought process that healthcare providers go through and their workflow is enormously complex and full of variables, so their thinking and process is not always adaptable to computer systems. It's also important but challenging to try to gather the data from the hospitals in a common way. There is still variation in the data and we need to identify a streamlined approach to clean this information, understand it and be able to compare "apples-to-apples" to make the information that we are collecting meaningful and actionable to provide benefit to our patients and the communities that we serve.

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