East Coast CIO Forum – Nov 21, 2013

Hi Everyone,

As a follow up to our November 21, 2013 meeting, we would like to extend a special thanks to our fabulous panelists, Dan Hirschfeld, President of Genesis Rehab Services and Respiratory Health Services,  Doug Torre, Chief Technology Officer of North Shore-al LIJ Health System,  Michael Lesk, Professor of Library and Information Science at Rutgers University,  Dr. Robert Sideli, Chief Information Officer for Columbia University Medical Center (CUMC),  Dr. Sachin Jain,  Chief Medical Information and Innovation Officer (CMIIO) at Merck, &  Dr. Stuart H. Ditchek,  Faculty at NYU, Dept. of Pediatrics;  Chief Medical Officer and Co-founder, Kids of courage.   Special thanks to our fabulous moderator, David Yakimischak, Executive Vice President and General Manager, E-Prescribing, for doing an exceptional job keeping us on track.     Additional thanks to McGraw Hill for making available their wonderful facilities.     Last but not least,  thanks to all who attended the event and helped create an atmosphere of passion,   factual awareness,  concern,  and hope,  as we discussed the current and  future impact of health care reform in the U.S.      The audience interaction, and thought provoking discussions, provided a level of reality that many of us did not necessarily expect.  One thing is certain:    Healthcare, as we currently know it, will never be the same.   (see meeting summary below).

Meeting Agenda:

Consumerization of healthcare  & Healthcare reform,  what will the future bring?

  1. A view from the perspective of the health needs of the individual
  • When will the patients take control?
  • Tracking and obtaining all medical data history across  providers.
  • Epidemiology vs patient privacy
  • Medication
  1. A view from the Doctor and provider perspective
  • The changing critical needs of the Providers and institutions that service the people.
  • What does the Doctor  need to know about the patient?
  • Open access to data
  • Big data in Pharma
  • Tele-health
  1. A view from the transaction processing perspective,  the insurance company.
  • Alternative delivery and payment models
  • The shift of healthcare from fee for service to fee for performance

Meeting Transcript and Summary:  

The moderator, David  Yakimischak opened the conference with several startling facts and statistics about the state of health of Americans versus their peers – 17 high earning industrial nations.  The US ranks quite low in several categories yet spends the highest per capita on healthcare.  The obvious conclusion is that the US has a crisis in healthcare.  This set the stage for opening remarks by the panelists:

Opening Remarks – The state of healthcare from their point of view

Dr. Robert Sideli – Believes the healthcare system is broken, thinks the solution lies in re-engineering  the business process and investing in IT, especially making new tools available for medical students in training now.  The focus should be on fostering an attitude that they can and will change the way healthcare is practiced today and that they will have tools that assist with improved processes and support for better delivery of healthcare.

Doug Torre – Agrees healthcare is in crisis, states that policies are broken.  His opinion is that in the past, healthcare IT was an oxymoron, the systems were built with the goal to get paid, so they perform primarily against that goal and healthcare delivery is an after-thought in those systems.  He believes that systems must change and future success is possible if the data that is collected can be made available for use in Big Data analytics, so that patient health can be maximized through a total view of populations – including behavioral health, life-style.  Today privacy rules get in the way and the policy thinking had not progressed to understand that the data can be used and shared in a manner that protects privacy.  He commented that there is too much change happening too fast.

Dan Hirschfeld – Passion lies with the patient, technology in healthcare has been built around payments, so less support in the systems for patient care.  Long-term care is still battling the stigma of nursing homes as we saw them years ago.  Today they are centers that focus short-term care for recovery and rehabilitation.  In his nursing home system 86% of patients return to their own homes.  He believes that long-term care is under-served in the current conversations, it is overlooked as a segment.   There is not sufficient allocation of funds to Long Term Care.   Patients today are far more informed.   They do their research and challenge doctors, and are willing to challenge their care.

Michael Lesk – Two areas that can contribute to improvement in healthcare are learning from systems outside the US (Denmark has been using electronic health records for 10+ years), and secondly, privacy battles for epidemiology studies.    Most leaders don’t want to learn from other countries. Better standards are needed for interoperability.      In the U.S.  healthcare treats “ billing” as central, and the actual “ care”  is viewed as an afterthought.    We can make great progress if we can use precise data that can be blinded to protect patient details.

Dr. Sachin Jain – Optimistic about readiness to change – transformation and transition can happen now, with the new healthcare (whether you like the law or not) and the huge investment in IT that is happening.  It has been tried many times, but now is when it will happen.  There is great talent looking at the issues, the teaching institutions are tackling the challenges.    New payment models are enabling new business cases for healthcare.  The doctors/patients/facilities cannot be stereotyped in generalized terms, but are quite diverse.

Dr. Stuart. Ditcheck – technology is improving, but there are also many new layers being added.  Physicians are getting more training on technology, perhaps at the cost of training on patient care and interfacing with the patient. The  fear is that clinicians are losing their humanity.  Practitioners need simplicity.

Will Patients Take Control of Their Healthcare – Comments from Panel and attendees

  • Most patients are getting more information, they have that information before they walk into their doctor’s office.
  • True, but the quality of that data depends on the source, the doctor needs to point them to appropriate sources.  Often they have to spend time correcting what a patient thinks they know with the correct information.
  • Too often the view of patients is monolithic, need to address and value the diversity of the patients, technology helps us avoid a singular view of patient populations.
  • There is debate and change happening.  It used to be that the doctor always had to view lab results before the patient would be notified.  Technology now allows us to move those results directly to the patient.  This can be good – the patient gets information quickly.  It can be bad, pediatric testing is done on same scale as adult, the doctor interprets the results to achieve proper results.
  • Clinical records for mental health could flow too  broadly in electronic records systems.  Need to ensure some protection, and heightened privacy.
  • Patients should be able to see their records, the doctor should be able to document detail notes.
  • For Physical Therapists,  50% of treatment time is consumed by documentation.  Unintended marketplace impact of recent policies are producing consequences that are affecting supplies, and patient care.

Privacy

  • Security and privacy has been driving IT budget growth to address all the regulations.  Budget has growth 10-fold, but it doesn’t work to lock up the data.  The data is needed to make improvements in healthcare.
  • The data can be used in an anonymous fashion, by 2015 all medical records are to be exchangeable.  After much discussion,  members of the panel questioned whether it would actually be possible to unify platforms so that all medical records are exchangeable.
  • There are a lot of loud voices on this topic, but we need to step back and ask ourselves what do we need here.  If you ask the question “do you want your personal medical information kept private?” the answer is yes.  If you ask “do you want a doctor who is about to treat you to have access to your personal medical information?” the answer is yes.  The questions we are trying to answer matter.  We need to do the right things in the right way.  What is the use case?  Patients should have some control and we should be able to use anonymous data to make improvements.
  • Access grids are used everywhere for allowing permission to get to information.  That same approach can be used with medical data.  It can solve all of issues.

Why is Healthcare Technology so bad?

  • Complexity is hard and EMR in hospital systems were built around getting paid.
  • Hospital Systems were designed around billing, with reimbursement requirements for all supplies and services.  The systems were built intentionally complex so that change is hard and the client is locked into the system they bought/built. The tedious nature of hospital based medical record adds huge amounts of time to the already taxed clinicians.
  • There are “no really good systems out there”, they have picked “best of the worst” in LTC.  They are clumsy and difficult to use.
  • In an effort to avoid home-grown systems, they looked across vendors and found companies that heavily market their solutions, but don’t’ focus enough on content so the product is pretty bad.
  • “Medical software companies are often focused more on marketing than on software development.”
  • The market is finite:  100 large healthcare networks/customers need these systems along with 5000 hospitals.  The innovation is low and the retention is high.
  • Innovation needs a market.  The old systems were clunky.  They need new development and they need to reward based on results instead of activities (the old model, get paid for everything you do).
  • Side commentary of “how did financial services industry transform?” – seen as smooth, lots of investment in technology, ROI drove changes, the effort was huge but it was “well managed,” maybe not as complex and fractured as healthcare.

Reimbursement – discussion and Quotes from the panel:

  • How to measure performance is key, tort reform matters seen as key for practitioners.
  • “ACO’s are the return of the capitated model that was first implemented as managed care, there may be a way for it to work in this model.”   It was noted,  however,  that the capitation model of the early to mid-1990’s was a failure with little patient and physician satisfaction.
  • “Managed care failed due to utilization.  It’s different this time, if large networks can treat patients as needed and the incentive has changed to “do the right thing” vs. transaction driven.  Employers are part of the mix today in a more meaningful way (they too have to be involved to improve costs).”
  • “We’re making it hard, ACO’s might work, but it’s complicated and we can make it simple.”
  • “It’s like going into a mortgage pool”
  • There are lots of tools springing up we can see online tools already:

Hospital compare

Home care compare

Physician compare

  • There was extensive discussion regarding the fact that the ACA was built without the input of “physicians in the trenches”.    There was push back from both the panel and the audience claiming that there should have been more of an effort and responsibility to include the voice of the private practice physicians.   It appears that the physicians that were included, were primarily those who are dealing with Medicaid, and stand to gain from a national Medicaid expansion.

The majority of spending on healthcare is always in the last 12 months of life

  • “Good luck estimating when those months are, nobody likes to talk about end-of-life, it should be part of the conversation.  Outcomes would improve if we could talk about it more.”
  • “Patients and family make those decisions”.

Google Glasses – Future Forecast:

Dr. Robert Sideli: – Optimistic, he likes the change and disruption, it’s a national ride we’re on, there are resources and given the US culture and who we are, we will make it happen, it’s a 10, 12, 15 year process.

Doug Torre:  – Optimistic, we’re in a perfect storm, different than other times of transformation, there is a lot of change in a very compressed period of 12-18 months, it’s turbulent, but the long view is optimistic.

Michael Lesk: – Optimistic, quotes a good manager he worked for “if it’s going well, do nothing.  If it’s broken, do anything”.

Dr. Sachin Jain – The current work is being done from very specific points of view.    Everyone is protecting their own turf.  Trade-offs are not being discussed enough.  Change will come with disruption. We will reach a higher level of crisis before people realize that they need to work together in order to accomplish the greater goal.

Dr. Stuart Ditchek – Passion is leaving, quality is down.  Lots of cures will be found and available over the next 15 years, gene therapy will be maturing.  Dr. Ditchek noted that the quality of the care is deteriorating as physician dissatisfaction is leading to early retirement of some of the best physicians.  He believes that while technology is improving, patient access to their own doctor and the quality of care will likely suffer under the ACA.

David  Yakimischak– Optimistic, progress is being made.

Final Observations:

We are in a new era of Healthcare.   Data is critical to all.  Loss of data can mean a matter of life and death.  Technology is even more critical now than before,   in both front office and back office.    Let’s not forget about the human factors.  Let’s focus on simplicity.   Let us all remember that no matter what business or industry we are in, or what job function we hold,  at one point in our lives we will each be at the receiving end of the new health care reforms.    Let us not lose sight of that which is most important. Quality.

Wishing you all health and happiness for the New Year.    Looking forward to seeing you all at our events in 2014!

-malka
Malka Treuhaft
Executive Director East Coast CIO Forum &
President
Truision Inc.
646.942.2625 (office)
917.589.1069 (mobile)
718.375.1529 (fax)
www.truision.com

The following companies are currently registered for the November 2013 meeting:

McGraw-Hill Companies,  Genesis Rehab Services and Respiratory Health Services,  North Shore-LIJ Health System,  Rutgers University,  Columbia University Medical Center,  New York University,  Merck & Co., Inc.,   Surescripts,  First Round Capital,  Kita Capital Management, LLC,  MSD Capital,   Moore Capital Management,   Morgan Stanley,  Promontory Financial Group,  Alliance Bernstein,  McCann-Erickson Advertising,  AEGIS,  Alvin Ailey American Dance Theatre,  Dun & Bradstreet,  Capital District Physician’s Health Plan,  SBLI USA Mutual Life Insurance,   Deerfield Partners,  Broadridge,  World Education Services, Inc., HUB International,  Imagineer Technology Group,  Hotel Funds,  Black Rock,  Deutsche Bank,  Ionic Capital,  iQ Venture Advisors, L.P.,   Bank of America,  Eton Park Capital Management,  Thomson Reuters,   Fir Tree Partners,  NYSE Euronext,  MacAndrew & Forbes Holdings Inc.,  Instrux, LLC,   First Data Corporation,  Good Energy,  Johnson & Johnson,  Express Scripts,  Harvard Management Company,  JP Morgan Chase,  Apollo Global Management, LLC,  Remedi SeniorCare,  Massey Knakal Realty, Financial Guaranty Insurance Company,  TPG Capital,  Compassionate Ob/Gyn Care, PLLC,  New York Police Department,   St. John’s University,  Yeshiva University.

David Yakimischak’s Bio

David Yakimischak is Executive Vice President and General Manager, E-Prescribing, is responsible for the business strategy and P&L of the core e-prescribing businesses, as well as additional pharmacy and PBM services.  From 2009 to 2012, Mr. Yakimischak led the Quality Office at Surescripts, and from 2006 to 2009, he was Chief Technology Officer.  Mr. Yakimischak has 25 years of experience in technology management and product development in healthcare, financial services and publishing.  He is a founding member of the CTO Club in New York City and mentors students at the graduate level at Columbia University.   Mr. Yakimischak completed his B.A. in computer science at the University of Toronto.

Dan Hirschfeld’s Bio

Dan Hirschfeld is President of Genesis Rehab Services and Respiratory Health Services which combine for $1.1 billion in revenue while operating in 44 states with 1,600 locations. Dan joined Genesis Healthcare in 2005 as Senior Vice President of Rehab Services.  Dan has an extensive background in a variety of healthcare settings, ranging from acquisitions and business development roles to management of an ancillary services business.  Prior to joining Genesis, Dan held President and CEO/COO and Founder positions with several privately held and publicly held companies with operations throughout the United States including Bill Me Later and Hallmark Senior Communities.  He is a national presenter and panelist for the healthcare industry and for national investment conferences, and has been an industry representative to various state and national government bodies.  Dan serves on the Board of Directors for Harcum College, The National Association for the Support of Long Term Care (NASL) and The Assisted Living Federation of America (ALFA).  Dan holds a Bachelor of Arts degree with a concentration in accounting from Duke University, and both Masters of Business Administration and Masters of Finance degrees from Loyola College of Maryland.

Doug Torre’s Bio

Doug Torre is the chief technology officer of North Shore-LIJ Health System, the largest healthcare provider in the region. Torre brings over 18 years of relevant experience to NorthShore-LIJ. Prior to this, he was the chief information officer and vice president of the Catholic Health System (CHS).  There he managed all aspects of technology, including implementing advanced high performance regional networking and the implementation of an Electronic Medical Record.  Prior to CHS, Torre served as senior technology staff at the State University of New York and Sisters of Charity Hospital. He has also served in various leadership positions and on the boards of health care and charitable organizations. He holds a B.S. in the management of information system from Canisius College and an M.B.A. from the University at Buffalo.

Michael Lesk’s Bio

After receiving the PhD degree in Chemical Physics in 1969, Michael Lesk joined the computer science research group at Bell Laboratories, where he worked until 1984.  From 1984 to 1995 he managed the computer science research group at Bellcore, then joined the National Science Foundation as head of the Division of Information and Intelligent Systems, and since 2003 has been Professor of Library and Information Science at Rutgers University, and chair of that department 2005-2008.  He is best known for work in electronic libraries, and his book “Practical Digital Libraries” was published in 1997 by Morgan Kaufmann and the revision “Understanding Digital Libraries” appeared in 2004.  His research has included the CORE project for chemical information, and he wrote some Unix system utilities including those for table printing (tbl), lexical analyzers (lex), and  inter-system mail (uucp).  His other technical interests include document production and retrieval software, computer networks, computer languages, and human-computer interfaces.   He is a Fellow of the Association for Computing Machinery, received the Flame award from the Usenix association, and in 2005 was elected to the National Academy of Engineering.  He was the first chair of the NRC Board on Research Data and Information.

Dr. Robert V. Sideli’s Bio

Robert V. Sideli, M.D. became the Chief Information Officer for Columbia University Medical Center (CUMC) on June 15, 2007.  Bob was a resident and chief resident in Pathology at Presbyterian Hospital, completed a fellowship in Medical Informatics in the Center for Medical Informatics, and was then an Assistant Professor of Pathology (in the Center for Medical Informatics) from 1993-1995. He played an important role in developing and installing the clinical information systems that were built by the clinical informatics group in the Center for Medical Informatics. He spent several years with a consulting firm, and then held the position of Chief Information Officer at the Metropolitan Jewish Health System in Brooklyn. In 2003 he took a senior position at Cerner and has led the implementation of Cerner information technology products at a major hospital system in Indiana.

Dr. Sachin Jain’s Bio

Dedicated to harnessing the power of data, technology, medical science and collaboration to improve patient health, Sachin Jain, M.D., M.B.A., is chief medical information and innovation officer (CMIIO) at Merck.  His charge includes developing strategies and global partnerships to leverage health data to improve patient health.  Dr. Jain’s work emphasizes understanding of real-world patient experiences and outcomes and applying that knowledge to appropriate use of medications, medication adherence, and advancing medical discovery.   Medicine is at the core of his efforts, and in addition to his role as CMIIO at Merck, Dr. Jain continues to serve as an attending hospitalist physician at the Boston VA-Boston Medical Center, and is a lecturer in healthcare policy at Harvard Medical School.  Prior to joining Merck, Dr. Jain was senior advisor to the administrator of the Centers for Medicare and Medicaid Services (CMS), where he helped launch the Center for Medicare and Medicaid Innovation, briefly serving as its acting deputy director for policy and programs. He also served as special assistant to the National Coordinator for Health Information Technology at the Office of the National Coordinator for Health Information Technology (ONC), supporting the agency’s implementation of the HITECH Provisions of the Recovery Act, which provide incentives for physicians and hospitals to become meaningful users of health information technology.

An advocate for faster translation of healthcare delivery research into practice, Dr. Jain has been drawn to the transformational relationship between a patient and caregiver, and ensuring patients’ access to both medicines and to caring, comprehensive treatment. To that end, Dr. Jain is a founder of several non-profit healthcare ventures including the Homeless Health Clinic at the Harvard Square Homeless Shelter; the Harvard Bone Marrow Initiative; and ImproveHealthCare.org. He also co-edited the book, “The Soul of a Doctor,” which has been translated into Chinese.   With expertise in the impact of reimbursement and access on patient health, Dr. Jain worked previously at WellPoint, McKinsey & Co, and the Institute for Healthcare Improvement, and served as an expert consultant to the World Health Organization. He has authored more than 50 publications on healthcare delivery innovation and healthcare reform in journals such as the New England Journal of Medicine, JAMA, and Health Affairs, and is co-editor-in-chief and co-founder of Health Care: The Journal of Delivery Science and Innovation.  Dr. Jain graduated magna cum laude from Harvard College with a B.A. in government, and continued on to earn his M.D. from Harvard Medical School and M.B.A. from Harvard Business School.  While completing his medical residency at Brigham and Women’s Hospital, he maintained a faculty appointment at the Harvard Business School and remains affiliated as a senior institute associate at the school’s Institute for Strategy and Competitiveness.

Dr. Stuart H. Ditchek’s Bio

Dr. Ditchek completed his pediatric training at the State University of New York Downstate/Kings County Hospital Center.  He is a board certified diplomat of the American Board of Pediatrics,  a Fellow of the American Academy of Pediatrics, and a long standing member of the prestigious New York Pediatric Society. He is a recognized expert and national lecturer in the field of Pediatric Integrative Medicine (the incorporation of western, traditional, and nutritional medical practices) as well as the area of Jewish genetic diseases and screening programs.  Dr. Ditchek served as the medical director of the Jewish Genetic Disease Consortium (www.jewishgeneticdiseases.org)  In January 2008, Dr. Ditchek launched the first ever DNA salivary mass screening program for Jewish genetic and occult disease identification. He was appointed to the medical advisory board of Genzyme Corporation as a consultant, is an active member of the Genzyme Speakers Bureau.  He is also an active participating member of the National Gaucher Disease Registry.  Dr. Ditchek has a strong interest in care for the medically complex child and young adult in his private practice. His clinical practice includes the treatment of children and adults with Gaucher Disease and other Lysosomal storage diseases.  In December 2008 he co-founded Kids of Courage(www.kidsoc.org), a volunteer centric not for profit organization that arranges a year round medically supervised program for seriously sick children at no cost to families. Kids of Courage currently serves hundreds of children worldwide providing trips and programming all year round. Dr. Ditchek supervises a medical staff of thirty physicians, nurses and paramedics as well as a support staff of 1800 lay volunteers.  Annually , Dr. Ditchek trains and monitors clinical specialists in the care of individuals with long-term care needs including specialized equipment and medication strategies. In his capacity as a recognized expert in the innovation of the care and mobility of the seriously sick and disabled, he has recently agreed to provide a series of lectures for the NYC Office of Emergency Management. He is a Clinical Assistant Professor of Pediatrics at the New York University School of Medicine (NYU). Dr. Ditchek is the former assistant director of the Division of Familial Dysautonomia (FD) at NYU, and holds faculty appointments at both New York University–Langone Medical Center and Maimonides Medical Center. Dr. Ditchek has been involved in clinically based research in past years and was an active member of the Vaccine Study Group at State University of New York-Downstate Medical Center. This group studied the safety and efficacy of vaccine innovations under FDA protocols. In 1997, the group participated and completed clinical trials in the acellular DTaP vaccine now available throughout the world. In 2011, Dr. Ditchek began two large clinical studies on Vitamin D levels in pediatric at-risk populations.   Dr. Ditchek spent a one year sabbatical on the faculty of Shaare Zedek Medical Center in Jerusalem, and was the first physician member of the Jerusalem based Magen Dovid Adom First Responders Unit (MDA). This unit is trained in emergency mass casualty response including chemical, biological and radioactive triage and treatment. The unit also trained first responders from the United States for which Dr. Ditchek functioned as a liaison. During 2002-2003, Dr. Ditchek responded and treated on-site victims of terror attacks throughout the Jerusalem area.  He served with MDA First Responders Unit during the 2003 Iraq war as a regional responder.  Dr. Ditchek co- authored Healthy Child Whole Child (Harper Collins 2001), which was named the best parenting book of 2001 by Amazon.com and was listed as one of the top ten health books of 2001 by Barnes and Noble. His second book on parenting and preventative strategies for children’s health was released by Harper Collins. With a  strong interest in medical informatics,  Dr. Ditchek  (in 1998), founded a healthcare technology company which was subsequently acquired by I-Trax/CHD Meridian, one of the largest disease management companies and on-site corporate health care companies in the United States. The software architecture developed by Dr. Ditchek is currently being utilized by I-Trax/CHD Meridian, an AMEX listed public company(symbol DMX), to reduce healthcare costs and improve wellness amongst their client company’s employees. He served on their medical advisory board through 2007. In March 2008, I-Trax/CHD Meridian was acquired by Walgreens Corporation.  Dr. Ditchek has appeared on national television and radio including FOX News, Good Morning America and The Today Show. His work has been the subject of articles in publications throughout the United States including Newsweek magazine, The Wall Street Journal, The Israel Times, USA Today, Parenting, Prevention magazine,  and many others.   Dr. Ditchek is currently in private practice in Brooklyn, New York.