Carle Health + HealthCatalyst: We keep hearing from experts that the way to improve healthcare operations is to make sure…
Julie Bonello, RN, MS is a career CIO who is now offering advisory services for integrated care delivery models.
Tell me about yourself and your career.
I began as a pediatric intensive care nurse. I got my bachelor’s at Rush. I also had an art background. I went into research after that, and I found through using all the statistical packages that I was interested in computer science. While I was still in nursing working in research, I completed my master’s in computer science.
At that point, I jumped into health IT and then went into consulting for several years. I became a CIO in 1990 and have had five CIO positions throughout my career, mostly in the greater Chicagoland area, except for recently with Presbyterian Healthcare Services in Albuquerque.
Did your nurse background make your CIO job easier or give you a trump card to play when sorting out priorities?
I guess it was known that I’m a nurse, but I didn’t often bring it out. Not only was I a nurse, but I also had the opportunity to be oversee medical records and rev cycle. Over my career, I had strong operational knowledge. My depth of knowledge in terms of how the business actually operated and how care was delivered was always my greatest strength as CIO and understanding how technology could be used to support the business in a way that didn’t overly complicate and didn’t fragment care. I could speak with the clinicians in a way they could understand.
Sometimes as a CIO or when you’re in IT, you can step into other people’s swim lanes because you are just trying to help figure out how to leverage technology successfully. Sometimes that would happen to me, maybe more so than other people because I understood the operation so much.
How have you seen the CIO role change?
IT has become several areas within a health system. Often you’ll have a digital team. Analytics has grown significantly, so how you divvy up the data side and the analytics side has become important. As you move to cloud, it is important to figure out a consistent IT service model for all IT areas.
As we have parsed out different IT responsibilities into some other areas and as we have also changed our operating model or our IT service model, it is important for a CIO to understand the business, how care is delivered, and health IT. You’ve always had third-party relationships, but now with population health and the move to the greater continuum of care services, many health systems are partnering with third parties that have very different technology platforms. The need to understand how they can all work together simply to improve care is important, as is your relationship with your payers and understanding how your contract strategy impacts your technology strategy and interoperability. It’s very complex and has many stakeholders.
Some health systems bring in technology outsiders who have no healthcare experience, while others prefer hiring C-level IT people who understand the business and how IT can support it. How do you contrast those approaches?
It depends on how you want to structure IT. You can’t leverage technology within healthcare unless you understand healthcare and healthcare IT. If you bring in someone from the outside and make the CIO a technology position, more like a CTO, then you need someone else to help translate how the functional side of your application strategy can meet your business goals. You’re going to have to figure that out. It all depends on how you want to organize all the pieces, but fragmenting IT makes it hard to ensure cost efficiency and consistent service levels while minimizing security risk.
We’ve already seen that with a lot of the technology startups. If they go too far into using technology people without knowing the business or healthcare IT, they’re not going to be able to meet their goals. There’s a balance. You must find out how you can get it all, and there are a lot of different ways that you can do it, but you need to leverage technology to meet your business. To do that, you must understand the business and healthcare IT while driving forward with technology innovation and measuring as you go. Healthcare and HIT is complex.
Health systems have gone from running innovation centers and investing in health IT companies to acquiring and running for-profit companies. What is the impact on the IT department?
There are a lot of avenues that health systems are taking in addition to investing in startups. As someone who has been in the business a really long time, you have to figure out a way to provide healthcare simply. If you can figure that out in a way that you can pull all your partners together into a service model that is integrated and supported by an integrated technology platform that you measure, everyone’s on the same page, and their goals are the same in improving care, then great. But if you’re not all on the same page, then you might not be simplifying care.
How did you, as a C-level health system executive, see value-based care?
I focused on provider-payer integration, leveraging technology for clinical redesign and aligned with the contract strategy. You have a partnership with all your payers. If you design your care, your reimbursement, and your measurement of that and design your contract strategy to go along with that, with your payers included, I’ve seen an improvement in quality. Payer-provider integration is important.
My last three CIO jobs have been focused on understanding payer integration. That can move the needle. Now I will say that often when we design our care and measure our care, it’s not done through integrated clinical workflow with payers and providers together. They’re separate workflows.
What kind of integration or cooperation do you see between health systems and payers?
In 2015 when I was at Rush Health, I was the CIO of the clinically integrated network. The clinically integrated network oversaw the entire contract strategy for the network. We worked closely with the payers on our technology and interoperability strategy. We received information from our payers and then derived intelligence from that. We worked on what was then a rudimentary system to get the derived intelligence back into the record for follow up by the providers and care coordinators.
When you have a feedback loop getting follow up information to the providers and the care team and you’re working on interoperability, bringing information into that record so that everyone has access to it, that’s where I started to see real change.
What are you working on now?
Provider-payer integration, implementing interoperability to support a longitudinal patient record, deriving intelligence from the shared data, and getting that back into the record to improve care. My focus continues to be in these areas because I know it can really improve care. I’ve spent the last three CIO jobs focusing on how you include IT in working together with the business in designing the different governance structures that you need in place and the different service models for integrated delivery.
As we start to think through how we want to provide care across the continuum and we establish new partnerships with new companies, you’re changing the staffing model. You’re changing your care team. You’ve got a lot of different providers, but you need a consistent service model, because your patients don’t understand how you’ve now organized across many different groups of people. You must come up with an integrated clinical workflow and an integrated service design and then ensure the design is built and integrated across the entire technology platform with technology services to manage and monitor across all as well.
Both our clinical/business operating model and our IT operating models are changing. With a shift to cloud modernization, we have new third-party IT relationships, so we are changing the IT operating model, too. A change in the operating model requires new integrated governance, structures, processes. and services to ensure success.
How are you going to manage and monitor that in your health system to do that? Because it’s not just going to be within your clinics now and within the inpatient environment. It’s going to be in your home. It’s going to be all over the place as you establish new third-party relationships. That’s what I’m really trying to do, because I see that there’s more fragmentation now than ever before, and it concerns me. Interoperability or sharing data and getting it into the longitudinal record will be key.
What reflections do you have on your long CIO career and what you hope to see in the future?
I hope to see an integrated care model with a technology platform and interoperability that supports it. When we look at how we manage our healthcare in the future, we will have leaders and management structures that manage across the continuum for all that we are doing for that patient, across all of our partners in the integrated delivery model and ensuring that an interoperable technology platform is managed and monitored across the entire continuum. It requires a more integrated approach across the continuum and one that includes our payers. I think we are getting there.
I’ve been a CIO for over 30 years on the front lines. I’m at the twilight of my career, so I decided to step back and devote my time and expertise in the areas I have mentioned, where I can make a difference. I want to help improve care.