C. Martin Harris, MD, has been chief information officer at Cleveland Clinic since 1996. During those two decades he's helped establish the health system as one of the leading-edge innovators in health information technology.
In his new book, "It's About Patient Care: Transforming Healthcare Information Technology the Cleveland Clinic Way," Harris gives firsthand perspective on the ways IT-enabled, patient-centric care can effect big improvements in clinical quality.
He also offers a guidebook, of sorts, for other providers looking to follow Cleveland Clinic's lead, with advice for the design and implementation of IT systems, EHR optimization, care coordination, patient engagement and more.
Harris spoke with Healthcare IT News about some lessons learned in his years as one of the world's most respected healthcare CIOs, and lays out his vision for the future of value-based care.
Q. Why did you decide to write this book?
A. The Cleveland Clinic has built an integrated health information technology network that connects all of its caregivers across many locations. With this infrastructure, it implemented a single, common electronic health record system. We continue to add image management, data capture and analysis, reporting transparency, and an entire menu of systems. Like us, many others across the country are taking this technological journey. I wrote this book to share what we've learned in the hopes that some of our best practices might help speed the creation of a more technology-enabled healthcare system that will better serve patients.
Q. Do you feel we're at a pivotal moment – either in health IT generally, or in your career – that made this a logical time for some perspective?
A. We're in a pivotal moment historically because the power and availability of technology solutions is inviting everyone in our industry to begin imagining how their organizations might benefit from a customized technology transformation. Personally, my path forward became clear when I started my career and applied IT and computerized tools to practicing medicine. Everything that followed – all of my experiences at Cleveland Clinic, my association with my colleagues in HIMSS, both nationally and internationally, the opportunities to work with the U.S. Department of Health and Human Services' Health Information Technology Standards Committee and the director of the National Institutes of Health – has all flowed directly from that moment when I realized that information and its management could transform the practice of medicine.
Q. What lessons have you learned in pioneering healthcare IT at Cleveland Clinic?
A. Every participant in the practice must be a full partner in our shared transformative journey. Communication, at every phase of every project, is critical. Caregivers' needs, patients' demands, and regulators and payers' requirements must all be indexed and considered, analyzed, and resolved in a way that reflects the comfort and consideration of the people who will use the systems we design, build, and implement.
Q. The power of technology is expanding as software, devices, and systems are integrated into coordinated networks. Where is the Cleveland Clinic at in this process?
A. We have a full range of interactions, from a centralized help desk and other support functions, that can be efficiently delivered across the enterprise to highly specialized, highly specific solutions that require the full attention of extremely skilled, onsite resources – so the presence and power of technology systems is woven into the fabric of the Cleveland Clinic practice model.
Q. You say that EHRs are now as integral to the practice of medicine as a stethoscope or X-ray. As a longtime leader in the field, are you surprised it's taken this long?
A. It's taken actually less than 20 years for medical practice to fully embrace technology. The Internet only started becoming part of a significant portion of the population around the year 2000. Smartphones have put that Internet in the palm of your hand for perhaps half that time. We've gone from online banking catching on after the Y2K bug passed without major incident in 2000, to secure online virtual visits that connect physicians and patients through high-speed Internet systems in about 15 years.
Q. Cleveland Clinic is a world-class institution. But what advice do you have for a smaller hospital, with limited budgets and staff, that's still using its EHR for basic care but would like to do more with its IT systems and patient data?
A. Start thinking about your IT investment differently. Traditionally, those charged with running a healthcare organization considered an IT expenditure in terms of a return on investment. They accounted for an IT system much like you would a fixed piece of equipment that could depreciate, and bill for using. But by having that opinion, they will miss a big piece of technology's true value.
The EHR is quickly becoming the one, single practice environment in which every member of a patient's care team comes together in the same place. As this technology becomes interoperable, practices that do not participate in this contemporary virtual practice space will exclude themselves from it – which is not a strategy for success over the long term.
Q. How do EHRs empower patients to take more control of their own healthcare?
A. EHRs are a patient's direct link to the information recorded about them, as well as the ongoing activities that help to keep them healthy and address issues. I can't think of a better way for a patient to become more involved in the activities that will help them to preserve their precious health, than to be connected – anytime, anywhere – directly to their care team. To see what healthcare providers can see and to be able to ask questions about it, either during a visit, or through an online service like the one we offer at Cleveland Clinic that we call "Ask Your Doc," make the relationship active and dynamic.
Q. Telemedicine systems are eliminating geography and physical distance as barriers to expert care. How has telemedicine been used at your institution?
A. At Cleveland Clinic, the idea that we collectively call "distance health" is an organized set of solutions that helps remove distance as a consideration when we connect the right patient, to the right clinician, at the right time and place. Patients with serious health issues are connected directly to some of the world's leading experts. We've also given millions of patients access to their own personal medical information through MyChart. Critical care specialists serve as consulting monitors to intensive care units across our health system through an advanced EHR-based connectivity system called eHospital. And our Express Care Online service, which quickly connects patients to doctors through an Internet-based virtual visit system, helps patients decide how they want to interact with our organization.
Q. You made the statement, "medicine at its most technically advanced is medicine at its best, because it is still rooted in the bedrock principles of compassion and healing." How so?
A. Since its beginning, the concept of providing care to someone in need has remained essentially unchanged. a person with knowledge and experience focuses on a patient's situation, gathers information, applies critical thinking skills to the problem, identifies potential causes, tests each idea until a diagnosis is verified, and then creates and conducts a treatment plan. Technology is simply a set of tools that a clinician has available to make the process of care work better.
Q. Many physicians complain about EHRs, saying their documentation requirements are burdensome, and cause them to have to look away from patients in the exam room. Do their arguments have merit, in your view?
A. Yes, that argument has some validity, but the EHR itself is not the issue. Rather, it's more about the timeline of the EHR as a medical tool's development. Clinicians are being asked to account in much greater detail the care they deliver. As more information becomes available through the EHR and other systems, demand for that information will increase. But because capabilities have been added to the EHR over time, doctors have assumed responsibility. What needs to happen now, which is something the Cleveland Clinic is doing, is to decide who on a care team would be the most appropriate person to do each task. By spreading out the tasks, we can help everyone practice to the top of their license, and free each contributor to the encounter to concentrate on what they were trained to do.
Q. Please shed some light on the coming frontiers of health information and technology.
A. In the last chapter of my book I write about the coming of what I call the Internet of Healthcare – a systematic evolution of a portion of the Internet as it exists today to meet people's healthcare needs worldwide. Imagine "a secure portion of the Internet that uses the web's infrastructure not only as it presently exists, but as it is developing in both its speed and capacity to contain and move information," to bring patients, providers, and everyone else involved in the contemporary medical ecosystem together into "a protected digital practice space that is connected to thinking EHR technologies in a way that will allow us all to transcend the limitations of our current structures and discover ways of doing things that will change the way medicine is conceived and practiced."
I believe this can truly happen if everyone starts moving toward simplicity, while simultaneously making every effort to "avoid the kind of magical thinking that might encourage us to place a totally unjustified level of faith in our technology's inherent ability to design, create, or police itself."
I go on to say that it's important to have built-in mechanisms that can monitor and correct automatically for any deliberate or inadvertent lapses that may impinge upon security and trust.
Finally, I write that "we must demand that the Internet of Healthcare, as it evolves and grows, is simple enough to be used by people with widely varying amounts of experience and sophistication, while remaining inherently flexible enough to support and encourage the kind of ongoing innovation that will lead to entirely new service categories and treatment advances about which we can only dream today, and that will only be imagined tomorrow."
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