NewYork-Presbyterian's Aurelia Boyer on how being CIO is kind of like being the president of the US

NewYork-Presbyterian Hospital has been a champion of healthcare innovation. The hospital recently launched the NewYork-Presbyterian Innovation Center to deliver both clinician- and consumer-facing solutions to enhance care delivery. In 2014, NYP hosted the first hackathon for New York City hospitals. Aurelia Boyer, RN, senior vice president and CIO of NYP, has led the hospital through on this journey toward healthcare's future.

Ms. Boyer has served as CIO of NYP since 2003, but she joined the hospital in 1993 as a project manager for clinical information systems. Here, she talks about NYP's innovation efforts, how being in New York presents both opportunities and challenges, and the parallels between being CIO and being the president.

Question: Innovation has become part of the lifeblood of NYP, with the new innovation center and hosting hackathons. Can you talk a little bit about innovation? Why is it so important to support and bolster innovation?

aurelia boyerAurelia Boyer: A lot of our innovation focus has been around information technology, and I think it's pretty standard to understand that healthcare has been lagging most other industries in its use of IT — which is an interesting contrast to medical care, where innovation is standard practice. They are always trying to move medical care forward and discover new cures and better approaches. One of the things we're trying to do is bring that natural innovation — innovative tendencies of medicine — to do some exciting things around healthcare IT.

We've all madly gone out and implemented our EHRs and done our meaningful use work, and the industry tells you a lot of doctors and hospital users are not thrilled with the technology we put in their hands. I don't think it's such a bad thing. I know people react to it very negatively, but it is sort of a step along the way. We had to build a transaction system around clinical work where we never had transaction systems. When I think of an industry like finance, they had transaction applications and systems for years, but when it came time to interact across all the areas and systems, they added new things. So one of the things that had great success is…a way of adding workflow on top of transaction systems. That's the stage healthcare is at right now.

The EHR vendors and standard clinical vendors are working in this area, but there's so much to do. We felt like, let's not wait. Let's start building and doing some things ourselves using the new kinds of technology available to us. That's where we've been spending time innovating, and it allows the users to have more direct input. We meet with young innovators who just want to help the industry and they get caught up in something like, "What if we redesigned the user interface for the EHR?" Well, I don't know how much value there is there. Really, doctors have been involved in it. We have to teach the industry and our users what workflow is — which is a little harder to put your brain around — and allow them to figure out the best ways to do things themselves. It allows them to control their destiny a little bit more. One exciting thing about the innovation process here is giving people a sense they can control these technologies they interact with on a day-to-day basis, just like they do at home. We want to bring that into the hospital environment.

Q: What differentiates leaders in healthcare innovation? What are the characteristics of the big movers and shakers in health IT?

AB: You have to be willing to be a little bold. Innovation requires that. It requires you to give up a little bit of control, which I think is very hard for an organization because there's a certain amount of risk associated with that. How do you manage risk? You control things. That's a normal bureaucratic approach. You have to have leadership commitment to allow some [risk] to happen.

Of course there's some cost associated with that. It doesn't have to be $50 million in order to do innovation, and I think startups have shown that, so that's an approach we've been trying to take. You can develop a small mobile app without spending a couple million dollars. You can't develop an EHR for that, but you can develop small mobile app. When our users say we can buy this at the Apple Store and it's a simple thing and saves my life, that's what we're trying to tap into. It's the same with doctors who develop their own apps.

Q: Can you weigh in on the EHR and vendor climate right now? From the perspective of a hospital, what needs or obstacles would you like to see addressed in these systems and platforms? And, what are they doing well or have improved on?

AB: One of the pushes I've always had on the EHR vendors is for them to have an open architecture. The more they open up web services and [application program interface] and things for us or external people to work with, the more benefits you get. If there's a vendor out there who's doing medication bar coding and the vendor you're working with doesn't open up their API to chart back into their EHR, they force you to use their version of medication bar coding. That should be open, because we should be able to use the best one, and if a newer one comes in, it should be able to be put into play easily and not with a lot of money. Things have to be open, they have to give you web services, they have to give you API. They have got to let other people develop around their systems.

Q: How does being in a city like New York influence or affect your innovative processes/capabilities?

AB: Early on when we decided to do some of this innovation we developed a relationship with [startup accelerator] Blueprint Health here in New York where they're trying to help people who want to innovate. Going there, seeing and interacting with those people just really ignites excitement within the hospital. When we first started going, a few of us went and now lots of people go to lots of different events, things I didn't even know about. They get so jazzed up and excited to say, "Look at what people are trying to do! I can use that and how would I use this?" It has brought a lot of excitement. So many things like that are available now in NYC. It's wonderful.

Q: At the same time, the health disparities in New York are abundant and evident. What role does IT have in helping to close that gap?

AB: One of the projects NYP has done is a Washington Heights initiative where our Columbia University Medical Center campus is situated. We redesigned the care model there to be around the medical home concept where you would provide more services around staying well and staying out of the hospital. Everybody says, of course you have to have an EHR to do that, and we did, but the EHR as it stood wasn't enough. This goes back to the notion of open systems: We developed new views within the EHR specifically designed to manage specific populations and their health, whether it was diabetes or asthma. We had to create new views which weren't part of the standard record. That was one piece.

The second one was taking the data out of the EHR and everything else and presenting it back to [staff] in a way that let them see what results they were getting on an ongoing basis. One was considered a registry that showed what is going on with this population of patients, and one was a specific clinical view that allowed them to see things across multiple systems. In some cases that helped them manage the care when the patient was in front of them or when looking at their history and deciding what to do next. A lot of healthcare IT work needs to be done to make this change.

Q: As a CIO, what is the biggest challenge you face today?

AB: It's really around doing enough things across a very large series of needs. What I have to do in the infusion center is different from what I have to do to make the OR work. It's different from how the inpatient floor works. It's different from how the ambulatory environment works. And at the same time, there are pressures to change all of those areas to address greater inefficiencies. Having the ability to be broad enough is the biggest challenge, to keep a number of things moving forward — which again is another reason we ended up in innovation.

The fun part of that for somebody like me is to look at other industries and what they've been able to accomplish with new technologies and transform our way of thinking to say, "How does that apply here, and how might we benefit from that?"

Q: What are some of those industries?

AB: The finance industry has done things that are appropriate for us, and sometimes some of the consumer industries are more applicable than we realize as we talk more and more about patient engagement. We could go and see something in the beverage industry, something they did with Coca-Cola and say, "Gee, that's an interesting thought. How can I do that here?" And I've been kicking around ideas of the Internet of Things: Is everything going to have a sensor on it going forward? The shipping industry is tracking and anticipating things by information they're getting on sensors. There's something there we can learn from. It's really amazing how many industries can give you fresh new ideas, whether we're moving supplies or trying to utilize our beds more efficiently.

Q: What is a lesson you've learned that you'd like to share with other CIOs?

AB: Being a CIO is a lot more than just trains running on time. If, as a CIO, you can't get beyond everything being reliable and available and understood by your organization, you're going to end up living there. Be open to what's next, as opposed to just looking at projects. You can do your projects — that's one part of the CIO job. But can you transform what's happening in the hospital and be in sync with the transformation your institution wants? Getting to that transformation part of your job is really where you want to live. But you have to have everything solid for that to work.

When you trust your people, when you lead instead of directing, I think that's a growth that I went through. When I started, I was directing a lot. Now I feel like I lead and inspire more. It makes me think about the presidential election relative to my job. Do you have to hire a president, so to speak, who can do every part of the job? Is that even feasible? Or do you hire a leader who makes sure all those parts of the job beneath you get done by really great people? That requires great leadership. You're not going to run the State Department and the military and the Department of Education by yourself. But if you can lead all those people, that's where you want to get to.

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