Interview with Steve Smith, CIO of NorthShore University HealthSystem

Date: 05.15.2013 | Zach Urbina">Zach Urbina

Steve Smith is the Chief Information Officer at NorthShore University HealthSystem. We recently discussed the strategy that NorthShore is utilizing to implement IT, including their efforts for accountable care, electronic medical records, patient portals, and securing the best IT staff. NorthShore University HealthSystem is an integrated healthcare delivery system serving patients throughout the Chicago metropolitan area.

Zach Urbina: What is NorthShore University HealthSystem working on with respect to current IT implementation?

Steve Smith: Some of the areas we are working on include Accountable Care Organizations (ACO),  Total Population Health, Data Analytics, Data Integration and Meaningful Use, Stage 2.  We were one of the first organizations in the country to attest for Meaningful Use Stage 1. Currently we have a team working on meeting the requirements of MU Stage 2.  This is one of the larger initiatives on the table at the moment.  Additionally, ICD-10 is on the list. This isn’t required until October 2014, but given the enormity of the project, it’s an area we have started to focus on.

Data warehousing and data analytics is a key area of focus. We see the use of data from our electronic medical record, which has been modeled into our data warehouse as key to improving the quality of patient care, patient safety and as a differentiator going forward.

For data integration, we are implementing solutions to acquire discreet data out of medical devices, including monitors and gas analyzers in anesthesia. This additional data will be incorporated into our enterprise data warehouse for use by our data analysts. .

ZU: Analytics is seen as a cornerstone in delivering more accountable care, what is NorthShore’s strategy to better integrate clinical, administrative and financial data towards this goal?

SS: As I mentioned we have an enterprise data warehouse.  We developed it over 6 years ago. We primarily pull data from our EMR and revenue cycle applications to populate it, which gives us the bulk of the clinical and financial data we need.  The challenge for the entire industry as we look at ACO’s is how do I track a set of covered lives across the continuum of care?

Example: If I have an ACO that covers 10,000 lives, we will need to manage the patients care and acquire the patient’s data regardless of where the patient was seen or treated. This could include data from nursing homes, specialists and other provider organizations. We are investigating solutions to acquire and incorporate this type of data into our data warehouse and EMR to assist with the management and data analytics necessary to run an ACO.

We are focusing on tools that we use at NorthShore including NorthShoreConnect our patient portal and NorthShore OrdersLink a tool we provide to independent physicians offices and to nursing homes to provide and acquire appropriate patient data.

We are additionally looking at HIEs and data integration tools which support the government standards for Direct, a secure email protocol. These solutions will provide similar data, so as a patient transitions care from one organization to another we will be able to provide the kind of data necessary to care for the patient and to support the needs of an ACO.

ZU: Regarding NorthShore’s patient portal NorthShoreConnect, do you have plans to further develop the patient portal as part of your accountable care strategy?

SS: Yes. As you look at total population health and accountable care to conduct health risk assessments. Employers more and more are asking employees to do health risk assessments to gather clinical information related to their health. As an example this could include blood sugar test results for diabetics. NorthShoreConnect will continue to be expanded to collect this type of data and to connect closer with patients.

ZU: Delivering more accountable care necessitates inter and intra-organizational health information exchange, what are the most pressing challenges NorthShore is facing in the sharing of medical data and the protection of patient privacy?  

SS: To start there’s the challenge of transferring data between two separate organizations and the standards for the data transfer. This includes the data format to allow different vendors software applications the ability to recognize and use the data.

Another big challenge is the system capabilities of many of the organizations we need to connect to. Some nursing homes and small doctor’s offices may not have the functionality, IT staff or an EMR to allow them to connect and communicate back to a hospital or even an HIE.

HIEs are also a challenge. We need to determine if they are going to be sustainable. The cost of an HIE is extreme in many cases and currently they do not transfer enough data for accountable care. As an example in addition to continuity of care data you need to share care plans and educational materials for the patient.  The HIE tools today really are not there yet.

ZU: Do you envision a shortage of health IT staff in the coming years or will the workforce rise to meet changing industry demands?

SS: I believe the workforce will be there, but it is always challenging to find and retain the best and the brightest Health IT staff. As the industry’s moving and the regulations are getting stronger and stronger, it is becoming harder and harder.

I just happen to have a son, who is in college now and happens to have chosen this field, who would have thought?  I looked at the amount of kids at the school coming through the program which I know is a very small sample, but currently it does not seem like there is enough students in the program. I assume there will continue to be a strain on getting good quality IT staff, and especially with a healthcare background.

Data warehousing has been around in many industries for many, many years, but its relatively new to healthcare. There are so many variables related to patient care which creates challenges to putting this data in a data warehouse and to make good use of it analytically is a challenge. Staff with that kind of knowledge is going to be at a premium for quite some time.

ZU: From a CIO perspective, what is the one thing you wish you could change overnight that would enable your organization to deliver more accountable care?

SS: The automation of transitions of care; this is necessary to allow sharing of data between different organizations and providers. This includes the sharing of data between nursing homes, hospitals, specialists and other independent physician offices. We need to get to the point where we could do that efficiently and electronically including having the process built into the workflow of the clinician. Our doctors will not want to go through different systems or screens to find the data or send the data related to a transition of care. It must be part of their current workflow.  Many of the HIEs out there today require going to a separate portal to look for data which is a challenge. This must be incorporated in the workflow of the clinician to make it work efficiently.

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NorthShore encompasses four Hospitals-Evanston, Glenbrook, Highland Park and Skokie–as well as NorthShore Medical Group with more than 70 offices and more than 800 primary and specialty care physicians, the Research Institute and Foundation. In total, the health system employs more than 8,000 people.

NorthShore has a teaching affiliation with the University of Chicago Pritzker School of Medicine.

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