Allina’s CIO on Patient-Focused IT
Chief information officers (CIOs) often say that it’s just as important for them to understand the business they work for as it is to understand technology. Only with a full picture of a company’s goals and functions can they offer thoughtful solutions to business problems.
Susan Heichert, senior vice president and CIO for Minneapolis-based Allina Hospitals & Clinics, has a leg up in that respect: She started her career as a nurse. “We have such opportunity in health care with technology,” she says. “It’s really fun for me to be able to look at the potential and possibilities of what we can do for patients.” Heichert started working for Allina in 2004, just in time for the company’s ramp up of its electronic health records system. The move to electronic health records (EHR) is perhaps the biggest evolution in IT for health care providers in recent years. Heichert calls Allina’s effort “massive”; the transition for all of the company’s metro-area clinics was completed by 2007.
Now, Allina is working with providers outside of its network. “Lately, we’ve started extending our electronic health record to other hospitals and clinics that don’t have an electronic health record [and] that are not Allina,” Heichert adds. “For example, Regina Hospital in Hastings, United Family Medicine clinics in St. Paul. We just came up in Grand Itasca, up in Grand Rapids. We have several more in the queue.”
The idea, Heichert says, is to improve the ability to exchange information among providers. Under federal “meaningful use” standards—which promote the spread of EHR to improve health care—Allina is able to use some incentive money from the 2009 federal stimulus package to assist non-Allina providers with implementing EHR. The federal government is “very interested in everyone getting onto electronic records, so they’ve allowed us to do what they call a ‘donation of technology,’” she says. “No one in health care is making a whole lot of money right now, and when you look at smaller regional providers, sometimes the reason they don’t have an EHR is they can’t afford it.”
Heichert by the Numbers
- Time in position: Joined Allina in 2004 and became CIO in 2008.
- Number of IT staff: Heichert oversees 550 people in information services.
- Number of users: 24,000 employees in multiple locations, including 11 hospitals and 90 clinics in Minnesota and western Wisconsin.
- Major software: Epic for electronic health records, PeopleSoft for HR, Lawson for finance.
The government incentives don’t cover the whole cost of the implementations, she notes. And eventually, carrots turns into sticks. “Every year the bar gets higher,” she says. “The first year, we just had to say we could measure quality criteria. The second year, we have to actually prove it—measure some things and say, ‘Here’s how we’re doing.’ The first year, I think it was 10 percent of physicians had to be using computerized order entry. The second year, that bar goes higher. The third year it will go higher still, and then at some point you go into the penalty phase. ‘We’re going to give you carrots to get on the record, and then if you’re not using the record, we will penalize you.’”
Heichert sees EHR and other technology advances as important, but also bemoans how long it’s taken to adopt them. “We have not provided good [enough] tools for our care-givers, really. I mean, when you look at some of the tools you see in other industries, and then if you saw what we ask our caregivers to do . . . it’s gotten better and better and better, but the progress has been slow. I’m still waiting for the day when it’s intuitive, when I don’t have to send a nurse to an eight-hour training class to learn how to use this stuff.”
Improving the patient experience is a touchstone for Heichert. Health care providers want patients to be partners in their care, and she’s looking for ways to empower Allina clients. “We have something called MyChart, where you can schedule your appointments, you can see your medications, your allergies. You can do an e-visit with us so that you don’t have to leave work and come into the clinic.
“But even as we expose that information to patients, they’re coming back to us and saying, ‘It says I’m allergic to these three things, but, actually, there’s another thing that’s not listed.’ So it’s just one more set of eyes. How can we work together if we’re the only ones with the information?”
Heichert talked to Twin Cities Business about her work at Allina and the opportunities she sees for technology to improve the patient experience.
Mary Connor: Tell me about your role at Allina.
Susan Heichert: I’m responsible for all of our technology, computers, phones, software that runs on it. We call it [information services] here versus [information technology], because we are a service organization. Everything that we do in information services is a service to our patients and our caregivers.
There are other things that I’m not responsible for that a typical CIO might be, and that’s things like reporting and our data warehouse. We made a conscious decision to split those off. That’s an extremely important area probably for any industry but for health care in particular. The saying always goes that health care is five to 10 years behind everyone else in automation. From a reporting and a data warehouse perspective, we had a lot of time to make up there. So we put a particular emphasis on that so we could have some intelligence about our business operations, and we’ve invested significant time and money in that area and have it reporting up to a different vice president.
MC: What is different about IT in your organization compared with other types of companies?
SH: Probably the biggest thing is our electronic health record. We first came up in 2004, and we use a system from a company called Epic. They’re based out of Wisconsin, and in 2004 we brought up our first hospital and group of clinics and rolled it out over the next couple of years.
We’ve since had some acquisitions and different things with the Aspen Clinics and the Quello Clinics, and as those came into the system, then we extended it to them—we’re never finished rolling out. Lately, we’ve started extending our electronic health record to other hospitals and clinics that . . . are not Allina.
Also, imaging is big for us—radiology services that we offer, we have cardiology services that do a lot of imaging, and it’s not just still imaging but video imaging. And then all of the ways we connect things into our electronic health record.
If you were in our [intensive care unit] and hooked up to a monitor that is . . . tracing your cardiac rhythm or a ventilator that’s monitoring your breathing, we collect all that information from those devices and feed it into the electronic health record.
We’ve just finished rolling out our medication and blood bar-coding system. If you’re a patient in our hospitals, we’ll scan your wristband to make sure it’s you, we’ll scan your medication, and then the computer will help the nurses by saying things like, ‘Someone just gave this medication, so you don’t want to give it.’ They have to remember so much. There are so many opportunities for [mistakes] to happen, and if technology can help them reduce that, that’s where we want to apply technology.
MC: How is your information services department organized?
SH: We try to align our groups to be customer-focused, so we have a group that works on clinical applications, we have a group that works on business applications. We need to bill people—that’s a big group. We have our HR system [and other] traditional systems.
We have an infrastructure group, which is the hardware and all the storage, the networking, the phone systems. Our infrastructure group is where we put our customer relationship management. We have folks deployed out to each of the hospitals and then cover regions of clinics, so that when our caregivers need to ask a question or when we’re doing an upgrade, that’s our communication.
We have a security, compliance, and quality group, because in health care, privacy is a huge issue. And as we go wireless, for instance, what does that mean for confidentiality, privacy, and security? They also are responsible for our service desk, our traditional help desk.
We have a collaboration and community access group, so that’s all about how patients use MyChart and some of the other collaboration tools, as well as internally in the organization. And the web services group is in that as well, so we’re aligned with Dotcom, Web Presence, and some of the other web tools that we have.
And then, of course, our [health information management] group, which does our medical records—the release of information. [They also handle] any scanning, because people bring paper into our system, and we need to scan it so that it can be available to our caregivers in the electronic record. We still have HIM operations in each of the hospitals and in our ambulatory area, because, for example, people who have a work-related injury need some kind of paperwork. Our EHR, radiology systems, cardiology systems—that is all in a clinical group.
At any one time, we’re running about 150 projects, and they can range from anything like the meaningful use program, which is pretty massive, to a new clinic renovation . . . to an upgrade of our PeopleSoft system. We do have a group of people, a business solutions group, which is our project management group, so we can keep our eyes on our project portfolio, and they advance all of those different projects.
MC: What do you see as your biggest challenges?
SH: I would say just trying to prepare for the new world of health care. Not that it’s been easy for the past 25 years, but we’ve all been moving in a general direction, and now we’re trying to change direction. And we’re going to have to do it with a lot less money.
I would say another challenge is having the laws keep up with the capabilities of technology, regarding just sharing information, for example, I mean, there’s a lot of hoops to jump over and through and make sure we’re doing the right thing. And that’s always good, don’t get me wrong. I think patients need to have the ability to say, ‘I’m comfortable sharing this, I’m not comfortable sharing that.’ I absolutely completely support that, but the ways in which we need to configure the systems to meet the current requirements, you know, that’s an issue.
Keeping online information safe, that’s always a big issue. We are constantly vigilant about that, but you see that in the press all the time about records being exposed, so it’s concerning.
Just more and more government regulations. I mean, 10 years ago, I didn’t really have a whole lot of contact with things going on in Washington, D.C., and now a big part of every day is keeping on top of that.
Even in extending our EHR, you know, we have to be careful, and we’ve essentially become a vendor, so we write contracts with these folks, we have service level agreements.
MC: What kinds of projects are you working on now?
SH: Extending the EHR is a big one, just continuing to improve the tools that our caregivers have, because health care is changing dramatically. We’ve got to find a way to get costs out of the system, and I would say a huge priority is just looking at ways to decrease the costs of technology. If you watch the trend over time, the more tech we use, the more expensive it gets. So how do we keep that at a reasonable level? At the same time, we need to be looking ahead to what tools . . . our caregivers and our patients want. That was one of the reasons we went into e-visits, because people want convenience.
We are looking at wireless—what do we deploy on these little devices? We have applications that clinicians want to use on tablets and on devices.
We’re one of the pioneer ACOs. There’s 32 around the country—accountable care organizations. [In an ACO, a health care provider takes responsibility for improving the health of its patient population and controlling costs as part of a shared cost model.] We have to understand what is it that the ACO is going to need to support their information needs. And a big piece of that is really understanding our patient populations better. Who are the sickest patients here in the areas that we serve, and how do we best help them stay out of our hospitals and maintain their health? It’s more the health view versus the illness view. It’s a big shift in focus for us.
You’re seeing a big emphasis on things like care coordination—so if you’re a cancer patient just trying to figure out all the different places and people that you have to see and putting that together when you’re already ill, how do we support you in that journey and in that period of illness? What tools does that person need to connect up to what happened in the clinic and what happened in your oncologist’s office and what happened in the lab and what happened when you went to surgery? It can’t be a one-size-fits-all kind of a health care experience.
MC: How can technology help with the patient participation side?
SH: I really think . . . the ability to document [information] into a place that’s then available to anyone who’s treating you, the ability for you as a patient to put information into the record about your needs and wishes.
When you’re in a health care crisis, your ability to hear, I swear, it just decreases. I know this as a nurse, because physicians will come into the room, and they do a great job in informing the patient, and half an hour later I’d be being asked the same questions about, ‘Well, now, what did they say about this, and what did they say about this?’ It’s impossible to take it all in. Just as we ask our providers to be omniscient, you know, the same from the patients. I mean, you’re a newly diagnosed diabetic or you have three chronic diseases—come on, how do I manage all that?
We’re doing a lot of [e-visits and telehealth], where we provide specialists to some of the rural or regional areas that don’t have that capability. You’re seeing a specialist over a video camera, but now you don’t have to journey down here to the Twin Cities from wherever you happen to be, and you can still get the specialist consultation that you need.
Another piece is the ability to have data drive how we treat you. That’s something that we haven’t really had a lot of luxury in. There’s massive research in health care, but [it takes time] to get something from that research—about what is the best thing to be done for patients—into the hands of a caregiver, when you’re not automated.
You can shorten that time frame significantly by automating and spreading those best practices. And having an organization like Allina, where our ambulatory caregivers are connected to what’s happening in the hospital and connected to the rest of the community, that’s powerful. That is powerful information for being able to treat patients at the highest quality level that we can.
So you can see [my nursing background] relates to all this, because I feel like I’m doing things to improve patient care. That’s why I want to work.