Technology as means to achieve highly reliable care: 6 questions with Presence Health's CMO, CQO Dr. Sam Bagchi

Though he has no formal informatics training, Sam Bagchi, MD, a board-certified internist and health system executive, has always been interested in how technology can be part of the solution to providing highly reliable care without hindering the physician or patient experience.

Dr. Bagchi is currently the CMO and chief quality officer of Chicago-based Presence Health, where he oversees not only clinical and quality standards but also information services, telehealth and clinical analytics, among other responsibilities.

He will take his leadership and health IT expertise into a new role at Christus Health later this month — Dr. Bagchi will join the Irving, Texas-based health system as its CMO and CMIO on April 24.

While he realizes technology is often seen by physicians and other clinicians as more of a hindrance than a help and that health systems often adopt certain programs just to meet regulatory requirements, Dr. Bagchi works tirelessly to ensure technology is a means to an end of achieving highly reliable care and less of an end-game in itself.SamBagchi 2015

Here, he discusses that philosophy and more.

Note: The conversation was edited for length and clarity.

Question: What about your new role makes you most excited?

Dr. Sam Bagchi: Christus is a larger health system than where I am today — it crosses three states: Texas, New Mexico and Louisiana. What's intriguing and challenging is Christus also has international relationships in Mexico, Chile and Colombia. So the challenge is how to drive clinical standardization and evidence-based best practices and drive value across not just state lines but across countries with different regulations and cultures in general.

Q: How will your role at Christus differ from your role at Presence?

SB: There is a larger scale to my new role, because of the international health system components. Although larger, it's very similar in the sense that I'll be focused on quality, physician development and leadership, along with healthcare technology. My span of control will be different in that my informatics role will be focused on clinical applications and technology and less on the basic IT operations and infrastructure I have responsibility for at Presence. I learned about basic blocking and tackling within IT operations and it's been a wonderful experience at Presence, but I'm excited to focus on what I'm passionate about — connecting technology to help physicians, nurses and pharmacists improve patient experience and serve the community.

Q: As a physician, what made you so interested in technology in healthcare to begin with? How did you evolve this interest into your eventual roles of CMO and CMIO?

SB: I was lucky. I grew up with two parents who were systems analysts who were interested in technology when computers and the internet were breaking into mainstream culture. We had two computers in the household before most people had any computers; I've always been around them.

When I went to college I was passionate about going into medicine, but along the way, I kept up with technology and felt it was always part of the solution. I feel lucky to be around organizations and people who use technology in an advanced way. I went to Indiana University for undergrad and medical school, and it had an advanced computing landscape and informatics program along with proprietary versions of an EHR and CPOE — I took it for granted and thought that was how most academic medical centers were working circa 2000.

I went to Beth Israel Deaconess Medical Center for residency and was an intern when it launched its proprietary EMR and CPOE, designed by clinicians. It was intuitive and natural for me that we would use computers to automate care delivery and make it consistent and reliable.

It wasn't until I left the training program that I realized most healthcare delivery was still being done on paper-based systems. I was uncomfortable in less-automated environments, but that distilled my focus on identifying the best ways to make the transition to value without creating obstacles to care.

I'm lucky that I've worked at hospitals with proprietary technology, designed around local workflows of hospitals. [The systems] are intuitive and are a natural experience for users. My experience after that was with out-of-the-box technology, designed from a vendor's point of view. I saw gaps in how the clinical caregiving experience could be disrupted by technology that wasn't really designed with the specific clinical workflows in mind.

[Technology is] a natural part of what I thought healthcare should be and it really hasn't been until the last five years or so that it's starting to become more mainstream in terms of how clinical automation can drive value. The industry is catching up to deliver value after we implemented technology under the meaningful use program.

Q: How do you see technology playing into providing highly reliable care?

SB: Technology represents a means to an end to me — I'm more interested in how technology can drive better efficiencies for doctors and how we can make the right types of care elements easy to do, not just check-box medicine. For me, the informatics work I do is all about delivering evidence-based care to our patients and making their care better instead of turning on a technology product just to meet a regulatory obligation.

I think the concept of high reliability is really important for healthcare. We've been so focused on just slamming in EMRs and catching up with regulation that we've lost sight of why we're doing these projects and how impactful they can be if we do them well.

I want the right thing to do to be the easy thing to do for clinicians, but unfortunately a lot of EMR technology just adds steps. That's not the expectation we have in our personal technology experiences — we expect technology can start to learn about what we're doing without us having to tell it that we did it. That's where clinicians feel a little left out, in that technology has added complexity to their lives instead of making their lives easier.

Q: What types of technology did Presence Health invest in to further improve care delivery under your leadership? Where should other hospitals be looking?

SB: There are two areas we've focused on. One is telehealth. I think Presence, based on being a Catholic health system, is concerned with serving communities with limited access to care. The focus with telehealth has been solving clinical access problems and improving access to care with technology. We have a long-established eICU platform we've been able to invest in and refine clinical pathways. We've also built out capacities for specialties like behavioral health and neurology and started to partner with other organizations to try to help them access scarce specialty resources remotely.

The other big investment over the last couple of years has been around physician credentialing and automating the credentialing process. We focused our efforts there because as we look at where healthcare reform is going and how we get reimbursed, we feel even more pressure to make sure we understand the quality of physicians joining the medical staff. Physicians on staff need to be able to count on the fact that the doctors they work alongside, refer to or consult with are top-quality physicians. It's an important clinical strategy in terms of quality care.

It's also a business strategy, since a robust high-quality network is important to insurers and employers, and the board is passionate about making sure they cover their fiduciary responsibility to vet physicians. Vetting physicians' quality performance and citizenship in terms of how they interact with others in the hospital and how they work on following the rules and regulations we're all held accountable to is an area of strategic import that's been neglected in the past.

Also, as you see hospitals merging into larger health systems, physicians are working at more than one site in the system. It's a waste of time for them to apply to each and every hospital with inches-high stacks of paperwork to fill out and do over and over again. Now that we've automated it, physicians can reapply for membership with one electronic app shared across all hospitals. That's a huge time savings for them and our staff.

Q: As a CMO and CMIO, what are some health IT and general trends you want to learn more about?

SB: The physician-specific quality story is really interesting. How do we collect quality data on physicians, share that with them, get them engaged on improving performance and ultimately impact public perception of physician care? And how does that drive reimbursement? It's an interesting topic to keep up on.

Related to that, regulatory and governmental uncertainty over healthcare reform and how that's going to impact access to care, health insurance and payment in general is an area of interest. It's important to me, and it's hard to be too certain about it right now with all the different political issues going on.

Also, for me as a health system leader as we're watching health systems merge and get bigger, it's interesting to consider when the size of the health system stops adding value and scale and adds complexity and bureaucracy. That dynamic is interesting. Consolidation is creating new challenges for healthcare — new opportunities, but new challenges.

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