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Maestro Strategies

Healthcare Innovation – New Chief Officers Are Blazing New Trails

Pam Arlotto is quoted in a May 23rd, 2023 article, by Mark Hagland, in Healthcare Innovation.
Below is an excerpt of the article.

 

Want to follow the trajectory of change around data analytics in healthcare? Just converse with Oscar Marroquin, M.D., who in September 2011 was named vice president, clinical analytics in the Health Services Division at the 40-hospital UPMC health system in Pittsburgh, and who in July 2017 was named the Health Services Division’s chief clinical analytics officer, and then who in July 2020 was then named chief healthcare data and analytics officer for the entire UPMC health system (which encompasses both the provider side of the organization, the Health Services Division, and the UPMC Health Plan).

Marroquin’s professional trajectory (and Marroquin still practices clinically 20 percent of his time, as a cardiologist) reflects the growing ascendancy of data analytics, especially clinical data analytics, in healthcare. Since he began spending a considerable proportion of his time leading data analytics work, Marroquin says, “Given that I had already overseen how we used our clinical data and had done analytics in that space, we had a pretty clear vision that this current role needed to be expanded so that I could have more oversight as to how we managed the whole stack of data.” In fact, he says, “In order to do analytics, you need to manage your data efficiently, and to govern your data efficiently.”

Marroquin notes that the data analytics journey at UPMC has evolved forward organically, with a focus in their case first on analyzing clinical data to improve clinical performance. Nevertheless, he notes, “The COVID-19 pandemic changed everything. My expansion of the role began at the beginning of COVID; COVID has transformed everything. And one of the things to note is that, yes, while we are very much aligned in the direction we wanted to go when we expanded the role, there’s still a lot of change management and organizational alignment that has to happen to achieve the goals envisioned.” And he adds that “By consensus, our organization has been gravitating more and more towards this single-source-of-truth concept, displacing having multiple teams working on things. So there’s much more of an agreement on what the gold standard of truth will be. And as a result, the organization is able to function more efficiently without multiple reports, etc. And whether those resources are people or IT processes and computing power, we’re not duplicating processes. I would put that at the top.”

What’s happened at UPMC mirrors activity across the U.S. healthcare delivery system; the leaders of patient care organizations, seeking to improve the outcomes quality and cost-efficiency of care delivery, have found that they needed to create new roles to help lead their organizations forward in key areas: thus the titles chief data officer, chief analytics officer, or, in the case of UPMC, chief data and analytics officer; as well as chief digital officer, and further afield, chief innovation officer, and even chief value officer (see sidebar). What common patterns are emerging?

“What’s happening with all of these new roles is following the pattern of how the CIO and CMIO roles emerged and evolved forward decades ago,” – Pam Arlotto

Indeed, says Pam Arlotto, CEO of the Atlanta-based consulting firm Maestro Strategies, “What’s happening with all of these new roles is following the pattern of how the CIO and CMIO roles emerged and evolved forward decades ago,” as specific needs then and now have prompted the creation of new roles. Just as when the implementation of large, complex electronic health record (EHR) systems propelled forward the CMIO role, and later, the need for improved clinical performance elevated that role, these chief data and chief analytics officer roles are being summoned by the performance needs of the present moment. There is also the chief digital officer role, which as she notes, is more about the need to govern processes that will respond to increasing consumerism and consumer awareness among patients and families. (continued..)

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Download PDF of article: New Chief Officers Are Blazing New Trails _ Healthcare Innovation

Howard Landa

Physician Satisfaction with EHRs: Finding Balance in a Digital World

Dr. Howard Landa, MD, CMIO Vice Chairman of AMDIS

As Vice Chairman of the Association of Medical Directors of Information Systems (AMDIS), Howard Landa frequently discusses with CMIOs the challenges and opportunities they face in leading informatics and analytics initiatives at their health systems.  We asked Dr. Landa to address physician satisfaction with EHRs and the emerging technologies that may help improve the value of these systems. 

While we have succeeded in providing healthcare systems with a plethora of health information technology pathways designed to improve the efficiency and quality of care, we have also managed to make patient care much more complex. At a recent AMDIS symposium on the evolving role of the CMIO in physician leadership, a discussion regarding the impact of the Electronic Health Record (EHR) on medical practice yielded interesting results.  When polled, many front-line clinicians will tell you that they have a love-hate relationship with the EHR.  They don’t want to give it up completely and return to the ‘old school’ days of paper, but the way it has impacted their workflows has simultaneously improved efficiency and caused a complete shift in the care paradigm.

What are the issues causing the physicians and clinicians to feel this way? One is the transition from Clinician created prose to standardized and structured documentation. EHR templates structure the documentation process by capturing data in drop-down boxes, checked or unchecked boxes and prefilled templates.  The templates provide consistent documentation methods, speed up documentation time and allow rapid analysis of large groups of patients via automatic analytics tools.  Yet they leave little room for interpretation regarding the nuances of the patient’s specific case.  In the analog world, a physician would dictate findings which would later be transcribed and become part of the record.  The dictation process allowed the clinician to share why certain decisions were made, the timing of the care process and “if/then” statements which could guide steps in clinical decision making.  As other care team members provided care to the patient, these aspects of the story were often useful in providing clinical context and understanding.  While the structured data provided by the usage of the EHR is very valuable from a data analytics side, we have lost the physician’s intellectual input into those notes making it difficult to “individualize” the patient.  One patient’s notes-over-time may be almost indistinguishable from each other, raising both cognitive and coding concerns.

So what can we do to swing the pendulum back toward the middle and find a balance between free prose “storytelling” and the high value of structured data?  Natural Language Processing (NLP) is one option. NLP is a practical application which can process free text that is entered or dictated into the record.  NLP enables physicians to extract the data in a more evolutionary and biologic way – i.e., the way a human brain would work as opposed to a computer.  When NLP is combined with nomenclature codification schemas such as SNOMED, structured data can be extracted incorporated into the patient’s record. Leveraging the “OpenNotes” patient engagement/empowerment movement and applying analytics to this data, clinicians will be able to improve the accuracy of the patient story and connect what the patient says with what the physician hears. The patient engagement with the process makes the requirement of clear and individualized information all the more important.

So to find balance and truly deliver the promise of EHRs, NLP and other tools will allow the care team the ability to read the notes and extract data while keeping track of the nuances of patient care due to the specificity of prose.  We will also be able to ask the systems to categorize, store, prioritize, codify, and place structured extracted data where it can be redelivered when needed while still retaining the physician’s intellectual thought processes.  Health systems can then use the findings to improve weaknesses in clinical documentation or care processes, further stratify population health risks and outcomes, provide input into clinical research and more.

Dr. Howard Landa, MD is an accomplished CMIO with a proven record of leveraging innovation, technical expertise and operational knowhow to deliver HIT solutions.  Industry recognition including 20 years as Vice-Chair of the Association of Medical Directors of Information Systems; two years as the chairman of the HIMSS Physician Community, and recipient of  Modern Healthcare’s Top 25 Medical Informaticists Award in 2010, 2011 and 2012.