Fall 2014CxO Corner
by Karen Keating
This new column highlights Southern California’s HIT leaders. If you’d like to suggest a CIO/CMIO/CNIO for a future interview, please contact the Marketing and Communications committee.
In this issue, we have asked Dr. Vikram Kumar to speak with our Chapter to share his perspective and insight on the Healthcare transformation underway.
Vikram R. Kumar, MD, FAAP, is the Chief Medical Information Officer (CMIO) at Arrowhead Regional Medical Center (ARMC) in San Bernardino County, CA. He is also a practicing, board-certified Pediatrician with post-graduate training in Clinical Informatics (Health IT). In addition to degrees in Medicine and Pediatrics, Dr. Kumar is completing his MBA in Medical Management with an emphasis on Quality and Health IT. He is working to become board-certified in Clinical Informatics in 2015.
Dr. Kumar’s professional interests include Patient Safety, Patient Engagement, Population Health, Pediatric Asthma and Pediatric ADHD. He is professionally involved with AAP, ACPE, CHIME and HIMSS. In his current role, Dr. Kumar oversees clinical informatics initiatives at ARMC and participates in Health IT initiatives across San Bernardino County.
Getting to Know You
After attending medical school in southern India, Dr. Kumar (Vikram) came to the U.S. as a Research Fellow to study at the Medical College of Wisconsin. He went on to complete his Pediatric residency training at Marshfield Clinic in Wisconsin. In 2005, he relocated to northern California to practice Pediatrics and later joined Sutter Health as a practicing Pediatrician and Physician Informaticist. Sutter Health is a large health system of 25 hospitals, numerous clinics and physician practices. While at Sutter Health, Dr. Kumar became involved with Quality Improvement and Patient Safety initiatives as part of the enterprise-wide electronic medical record (EMR) deployment.
In 2013, Dr. Kumar was recruited to Arrowhead Regional Medical Center (ARMC) in San Bernardino County. ARMC is the ‘safety-net’ provider for the Inland Empire, where population health measures lag behind many other California regions.
Dr. Kumar shared with us that the transition from Sutter Health System to Arrowhead Regional has taken time - time to understand the ARMC systems, the culture and the people. He cited that, “Everyone understands health IT is a necessity”.
Vikram now spends 80% of his time working on health IT with the remaining time seeing patients as a practicing Pediatrician. He works closely with nurses, physicians and ancillary staff to support the deployment of the electronic medical record across the health system, including the hospital and its 40 clinics.
As a healthcare leader, Dr. Kumar strives to “guide projects and activities from a clinical standpoint, with the goal of improving processes along the way.” He sees his role as “both patient-centered and population-centered, reflecting how Health IT needs to evolve”. Like most Health IT leaders today, he is focused on achieving compliance with Meaningful Use (MU) and meeting physician attestation requirements. His next focus will be to optimize the current deployment and achieve additional return from the systems deployed.
“One big question we need to solve is defining how we manage high risk patients”, who have various conditions and unique health histories. Identifying solutions will require savvy “information management and communication (messaging) across care teams, including the primary care Physician (PCP) specialists, ancillary providers (i.e. physical therapy, pharmacists, home health), nurses, patients and their families. Comprehensive patient care may also include public health, social service agencies, law enforcement and/or mental health organizations.”
Coordinating Care and Communication
To coordinate care and establish consistent communication will require new guidelines and policies along with appropriate education and governance. “We must overcome security and privacy issues” in order to exchange information outside the enterprise health record, to give providers the clinical information necessary to make informed decisions and provide comprehensive care.
The Health Industry Transformation
“Prior to the HITECH Act and the Affordable Care Act, providers were paid by encounter and the services rendered. There were limited incentives to keep a patient healthy at home and prevent admissions and readmissions. This new legislation shifts the emphasis away from quantity toward quality.”
Healthcare is becoming more patient-centered and focused on prevention. “Physicians increasingly need to attend to specific patient and family needs, while simultaneously becoming more efficient.” Change is also driven by capitated reimbursement and quality-driven models (ACOs). Bottom line: “the responsibility of a physician doesn’t end with a prescription.” Meanwhile, patients are being offered incentives (i.e. insurance discounts) from employers, to improve their diet, exercise more and attend wellness classes.
Patients are connecting electronically with health organizations via Patient Portals, Apps and other methods to view their personal health information (PHI), make appointments, review and pay bills, and receive personalized health education and increasingly exchange messages with providers. “It’s in the best interest of providers to engage with their patients, especially children and those with chronic illness. Some of the best care can be delivered in the home. Keeping sick patients out of clinics or the hospital enables them to rest, heal and avoid exposure to other illnesses.
Telehealth enables physicians to remotely check on patients, day or night. At ARMC, telemedicine in the Emergency department supports the Stroke Center. If a patient is admitted via the ED and has a stroke, “we use a Tele-Neurology consult to determine if they meet Stroke Center criteria. A ‘Code Stroke’ is called and the care team meets in the patient’s room. Typically this includes the Attending Physician, Resident and Nurse(s). A video conference cart is rolled into the room with a Board-certified Neurologist connected remotely. The team views the patient’s CT scans together to determine the best management for that specific patient.
“Technology needs to keep up. We need strong encryption to protect patient health information (PHI) and privacy. We must bridge technical hurdles to meet clinical needs. We need to be high tech and high touch, to know the patients and provide individualized care.”
“Billing and coding have to keep up with the new ways we are practicing medicine. We need EHR products that can integrate. “Too often, the focus is still on ‘vending’ rather than supporting the effort to provide care.” If a product doesn’t accommodate clinical practice and end-users, clinicians will struggle and won’t support it.
“Another challenge is communicating clinical needs and their workflow to IT staff and vendors. Products are rolled out from an IT standpoint. We need clinicians to speak for what is needed.”
“The real challenges are related to people and managing relationships and projects. To get end users trained and involved at a large teaching hospital requires patience. When moving from manual to electronic records, there are inevitable inefficiencies and pain. It’s important to help teams understand ‘there’s a light at the end of the tunnel’. This applies to physicians, nurses, residents, students and ancillary staff. Not everyone can envision how a new system will impact their work or improve things, so they cling to current practices.” Getting people to change is a challenge.
What’s at the top of your ‘To Do’ list?
“Number one is to make HIT work for everyone within the organization, within its boundaries. This includes optimizing the enterprise health record to work the way it’s meant to – delivering hardware and software to meet clinical workflow requirements and satisfy the end users. It’s still evolving. There are gaps in processes and/or in the EHR functions.”
Also, “to meet new patient engagement requirements, Patient Portals must have a level of functionality that is not too laborious for the average doctor, nurse or patient. Most important, this must be done within budget constraints, while knowing some benefits aren’t quantifiable.
“Third, is getting governance and leadership to buy in to the long term benefits of health IT initiatives. Leadership is coming around to the fact that HIT is necessary for the long term success of healthcare.”
What have you learned? Any advice for future HIT leaders?
“In Clinical care, I could impact 20-30 lives a day. As an administrator, I can make changes that impact a lot more people, like a snowball, channeling energy to create positive change and move people and the organization in the right direction.”
Collaborating with Clinicians
“It’s very important to communicate in a manner that is understandable; i.e., don’t use technical terms in email. You need to know your audience.”
“If you’re not a clinician, get someone with clinical experience (an MD or RN) to attend meetings with you, if possible. It’s critical to understand what happens in the clinical environment, the workflow, the processes, and the political culture (chain-of-command) before implementing change. As a decision maker, it’s best to look at existing resources and consider how to best optimize them before changing products.”
How can someone get involved with Informatics?
“Work closely with quality and health IT initiatives as a subject matter expert (SME), physician champion or participate on a Quality Improvement committee.”
What does the future hold?
Dr. Kumar considers himself a young person in HIT. “Informatics is something you learn as you practice. Training alone doesn’t provide complete clinical skills”. In 2013, the American Board of Medical Specialties established Clinical Informatics as a Board Certified specialty. By 2020, Clinical Informatics training will be integral to medical education. “We can expect the number of Informatics Fellows to expand significantly.”
The number or organizations recruiting clinicians to lead IT initiatives (CMIO, CNIO etc.) will continue to grow. One of Dr. Kumar’s goals is to establish an Informatics Fellowship at ARMC, which is a large teaching hospital with 800 students and several hundred residents.
“Coming from a country where basic health services are considered a luxury, providing health services to an underserved U.S. population offers experience and perspective on how IT tools could be used in health systems outside the U.S." Dr. Kumar hopes to give back to patients here and perhaps one day, in India. We wish him all the best in his endeavors.
Dr. Kumar will be speaking on the upcoming HIMSS National webinar Driving Consumer Health and Wellness in a Connected World on September 24th 9:00 AM – 11:00 AM PT.
The connected device for consumer health and wellness is experiencing dramatic growth. Healthcare organizations are adopting the technology to drive consumer health and engagement. This virtual briefing will discuss the trends in consumer connected devices and their impact on patient care, as well as introduce one provider’s journey to consumer health.
Please plan to support this initiative and register in advance at Driving Consumer Health and Wellness in a Connected World.