How WakeMed is leveraging data, CMIO Dr. Neal Chawla shares insights

Neal Chawla, MD, was appointed chief medical information officer of Raleigh, N.C.-based WakeMed Health & Hospitals in January 2018.

He came into his role at WakeMed with a wealth of knowledge after spending 11 years at Fairfax, Va.-based Inova Health System as associate CMO for clinical effectiveness and associate CMO.

Here, Dr. Chawla discusses how WakeMed leverages data to improve workflows as well as insight into how he has changed his perspective as CMIO over the past year.

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

Question: How are you leveraging your EHR data or other data sets to improve efficiency and clinical care? 

Dr. Neal Chawla: Our team’s capabilities continue to advance as we build toward a robust data-driven system. This increased analytic capability allows us to look retrospectively at data to figure out what happened, as well as proactively, through cleaner data, better definitions and improved data literacy, ask better questions and better understand what the data is really telling us.

At WakeMed, we send data to multiple registries. This allows us to benchmark our clinical data against similar health care organizations and look for opportunities to improve the care and services we provide.

Internally, we are using data to become more operationally efficient. Additionally, we are beginning to use data to standardize our care. We are also increasing our use of data to monitor our interventions in terms of processes and metrics related to health outcomes. We are in early stages with predictive analytics but want to be careful to have a solid foundational layer before we shift towards a larger focus on these more advanced capabilities.

For so long, healthcare has been a paper-based field. It's only become electronic in the past five to 10 years for the most part. We are still trying to figure out how to provide optimal care in the digital world. A big piece of learning how to operate in the digital world is data. Not just having data, but ensuring democratization of curated, accurate, impactful data, in real-time, while also minimizing the burden to those who are paying the keyboard price to input the data. We want to make sure we are analyzing the right data at the right time and using it in the right way.

Q: What is a piece of data or information that can go overlooked at a hospital? 

NC: Healthcare organizations can find themselves in situations where they simply don't know what they don't know. With each new data set, we often learn a few more insights about our care delivery, and usually have more questions.

Once you have an EMR, there is a good chunk of data that clinicians can easily access. One type of data that we are starting to track is our alert data. A nice aspect of an EHR is that you can put alerts and decision support to help deliver optimal care. However, we know these alerts can often be annoying, and we are finding that many alerts are being overridden. If alerts are not effective, they do not change behavior as intended. It’s this same data that is helping us ascertain why some alerts are not impactful and actively explore ways to optimize these alerts.

Q: Looking back at your first year as CMIO, what would you do differently? What do you wish you had known?

NC: I try to make decisions knowing there are almost always pros and cons. As I think back on the decisions I have or have not made, it's hard to say if I would approach them any differently, even though the ultimate decision may have changed.

When I got to WakeMed, I noticed a few holes where we needed additional physician informatics support. Cardiology, ambulatory and surgery were three areas where we didn't have great physician informatics expertise. We were able to get an expert for the ambulatory side, but I was careful to not ask for an all-hands on deck support in my first weeks. Instead, I worked slowly and methodically, knowing we live in a resource-constrained environment.

Since then, we've been able to start up a cardiology IT optimization group over the past few months. We are also looking to establish a surgeon IT optimization group. Even though I noticed the opportunity for these solutions when I first got here, and others, I wanted to balance limited resources with where we needed them most, and I didn’t want to make too many quick decisions up front. I hope I made the right calls, and data will help tell the next chapter of the story.

Q: Who do you go for advice? 

NC: To put it simply, everyone. 

Over the years, I've built up a network of CMIOs and other technology experts who I often go to for advice. Since I'm the only CMIO at WakeMed, it's helpful to know others in the same role outside of our health system to bounce ideas off of. At the same time, I have a great group of Associate CMIOs who know the clinical and IT sides of things well and have great insights and great relationships throughout our system. 

My CIO along with our IT leadership team and IT analysts have a wealth of information. I'll often go to them for advice because they have different skill sets and viewpoints that give me more perspective. Our chief medical officers are great partners. When things come to me that are more operational than IT, I often seek their counsel. Additionally, our group of clinical informaticists provide thoughtful feedback and advice. And of course, it’s our frontline staff who pounds clinical footsteps and mouse-clicks and understands the workflows and hurdles best.

Obviously, my wife is great sounding board. When I'm completely lost and need to know where to start, I trust her to send me down the right path.

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