Building a Robust Healthcare System
How did your healthcare journey begin and how has it progressed over the years?
I have been working in the healthcare space for over twenty years, from Cigna Healthcare, Kaiser, and Lovelace Health System, to now spending over eight years at Mount Sinai Health System. We merged with the Continuum Health System about six years ago and have been executing a long range plan to integrate all the hospitals on common platforms, all the way from electronic medical record to financial systems, billing, HR, payroll, and so on. We are already into year six of this nearly $500 million program, with another couple of years to go.
If we can get all the hospitals on the same electronic medical record, it will give us agility and help us respond faster to all tasks.
Throughout this program, we reached a good level of success with the integration. Mount Sinai has started building on top of these common platforms, doing exciting work around population health. We have covered nearly half a million lives at risk in some form with tools that we built. We also got a Delivery System Reform Incentive Payment (DSRIP) program through the state with an incentive of about $300 million to take care of, over a five year period, all the Medicaid patients that were attributed to this program. We built all the technology systems that went with it.
We have delved into advanced work related to emerging technologies like machine learning and artificial intelligence. It started with building models behind the scene to learn and find ways to improve clinical care. For instance, predicting a patient’s high susceptibility to fall, to prevent the patient from falling and improve our healthcare. Our machine learning algorithms give us some identification of those patients so we can intervene early.
Our data mining capability requires us to do complex queries at a high speed. So we have invested tens of millions of dollars in some high performance computing clusters to support our researchers with high performance computing so they can run their models. We get nearly $400 million worth of external grants.
Where does Mount Sinai stand today in terms of its healthcare journey?
Over the last 20 years, I was working in the insurance space with Cigna Healthcare. My initial foray into the provider space was when I became the interim CIO for LoveLace Health System in Albuquerque. Continuing on, I got into Kaiser, the healthcare giant, as the regional CIO for the Northwest market in Oregon with half a million lives there. That is when I got into the healthcare space. In the nine years that I spent at Kaiser, I learnt a lot about the clinical care, how HMOs work, how to build a closed loop integrated system between providers, how to provide total care for patients and population, and more. Kaiser is big into population health and it was a huge learning opportunity for me.
When I moved to Mount Sinai, I carried all experience with me, of learning how to build complex electronic medical records and complex population health systems. I have been working with the Mount Sinai community and trying to deploy those concept systems here. Success was evident as Mount Sinai got recognized as one of the leading IT organizations in the country, winning several national awards. We have been constantly improving as the work never ends. Over the last three or four years, we have been exploiting our increasing impetus to explore machine learning, AI, and big data.
What are the trends that you expect to take over in healthcare as the year 2020 approaches?
There are two areas that I see huge progress in. At the moment, there is still friction in interoperability between entities across the country, so I see some progress being made in transferring data back and forth between different entities that provide patient care. I see continuous evolution in building more complex health information exchanges and being able to share the patient record across multiple entities that include providers, pharma, payers, and so on. We are not there yet but getting much better than we were 10-15 years ago.
Another area I see a lot of improvement in is advanced tools like robotic process automation and AI. These tools will be able to make healthcare more efficient. RPA for example gives the ability to perform tasks faster through some robotic processes where the drudgery can be eliminated for the staff, and the computers can do things faster. And of course AI will provide more learning models and algorithms, which we will be setting behind the scenes and giving providers some advanced tips and techniques to accelerate their own provision of care.
These are long term trends that could take 5-10 years but I can see a lot of shifts happening toward AI and machine learning.
What must professional CIOs do to ensure that their organizations are completely tech enabled and is making the most out of their IT infrastructure?
The first thing should be putting up a defensive front. We must have a good cybersecurity program to protect patient data. We also need to have a mindset of data sharing and building the tools and the open APIs to be able to share data with each other. Lastly, it is important to pay attention to emerging technologies in a particular space. Every industry goes through technological changes but healthcare is in a special situation. With all the money that is spent on healthcare in the country we have an obligation to make things faster, better, cheaper.
What is your word of advice to peers in the healthcare space, and for young professionals looking to embark on the same journey that you have?
For the emerging technology leaders, I would expect everyone to be respectful of the complexity of the platforms and the integration, and think of the big picture, not in isolation.
It's extremely hard to build these platforms and operate them at a high efficiency level. A lot of people are working round the clock to make those basic platforms operational. And people underestimate the integration. It is easy to write an app on an iPhone but making the app work with hundreds of other things that go behind the scene and integrating it into the ecosystem is really complex.
A message for readers from your end?
Technology matters but only to a certain point. It's all about building the relationships. Of course, we have to produce results in terms of the technology projects but we cannot forget the importance of relationships that go with it. Without those relationships we cannot be an effective change agent. A technologist, who is not a good change agent, will not survive for long. Relationships matter, results matter. Last I would mention is resilience. Mistakes will be made, things will go wrong once in a while, but do you have the resilience to be able to recover from the problems that occur?
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