Photo: Johns Hopkins University
Stephanie Reel is the only CIO I know who runs both the academic and healthcare IT organizations for a university, and not just any university at that: Johns Hopkins is always high on the lists of best universities, best medical schools, and best hospitals. Among her many honors, Stephanie was a 2005 HISsies winner for most effective healthcare CIO. It was great of her to share her thoughts with the readers of HIStalk.
Why don’t we start with a little background about yourself and your job?
I’ve been at Hopkins for 18 years. I grew up in Baltimore in the shadow of Johns Hopkins. I always had enormous respect for the place. I remember my mother saying to me, "They don’t call it THE Johns Hopkins hospitals for nothing”. I grew up in all of the science and the wonderful things that happen here, but had no real interest in healthcare. I wanted to be a schoolteacher. So I played around with that for a little bit.
As it’s true with many fortunate people, I happened to meet someone who became a mentor for me. He said, “Boy you really like this IT stuff and you seem to like leadership. Why don’t you consider healthcare information technology?” This was about 25 years ago. I said, “I don’t know if I have what it takes.” And he said, “Why don’t you give it a try?” He introduced me to the president of a hospital here in Maryland, a small community hospital that happened to be searching for a director of information technology.
I talked to them and they thought that I had the right education background, skills, interest, and passion to become a director of IT. I took that job and worked at it for about five or six years. Then someone mentioned to me that Hopkins was searching for a similar kind of position. It wasn’t the CIO at the time. This would have been in the early 1990s. It was another Director of IT kind of role. I was approached to interview for the position and I did. I took the job July 1, 1990 and immediately became overwhelmed by the complexity of a place like this and the opportunities that were available.
I took the job and started out just getting to know the place. I was really placed in a wonderful position where I had an opportunity to sort of serve as an internal consultant for a little while and work at all our affiliate organizations. At the time, the Johns Hopkins Health System was growing up and I was given the chance to bring some of the affiliates into the fold and try to encourage them to work collaboratively together with the mother ship at the time, which was the Johns Hopkins Hospital, and look for opportunities where we could benefit from collaboration or synergy. And I loved every single minute of it.
One thing led to another. The CIO resigned in the late fall of 1993 and Hopkins conducted a national search, as places like Hopkins do. The search committee was kind enough to interview me for the position and ultimately offered it to me. In early 1994, I became the CIO of the hospital and the health system. A little while after that, Johns Hopkins Medicine was formed, which was the coming together of the university’s school of medicine and the hospital and health system. I was offered the opportunity to serve as the CIO of Johns Hopkins Medicine.
In 1999, the president of The Johns Hopkins University initiated a search for the CIO for Johns Hopkins University. I was on the search committee. I assumed I was searching for a partner or a colleague with whom I would work. He or she would be responsible for IT for the university and I would retain responsibility for IT for the Johns Hopkins Medicine organization. One thing led to another and the president of the university offered me that position as well.
I became the CIO of the university in January 1999 and serve in that capacity as well as retaining the role of CIO for Johns Hopkins Medicine and have had a pretty good time ever since then. I have had an opportunity to serve people in all three walks of life: education, research, and patient care. It’s really been a wild ride, but pretty wonderful to get to live in these different worlds that define what Hopkins really is. It’s been fun. I guess that’s why I am what I am.
Is there anybody else that you know of that’s both over academic and healthcare sides of a university?
I don’t know for sure because the way people define their organization is a little bit different. There are a number of CIOs down in Emory and University of Chicago. By example, I know those two CIOs are responsible for the school of medicine and the hospital health system. I don’t know of any CIOs who are also responsible for the undergrad activity — arts and sciences, engineering, business, education, and those kinds of things. It doesn’t mean it isn’t true. I just haven’t met anyone who has that responsibility.
It is a bit of deviation, I guess, to serve that part of the population, but — I know this sounds almost Pollyanna-ish — but it really is amazing how much you can learn from different disciplines. What I do for medicine is absolutely informed by the great work that’s happening in physics and astronomy because they manage enormous data sets, far larger than what we manage in healthcare. They need high performance computing in ways that are somewhat different from what we need in basic sciences and medicine.
Learning from experiences in those other departments and divisions that are very different from medicine has been a really incredible learning opportunity. I don’t know if it’s easy to explain it, but it happens frequently that I get the chance to apply something I learned in one area with what we’re doing in another area.
It’s really been much more beneficial than I thought in the early days. I thought, "The great news here is that I’ll know the enemy." So, when the computer science department is going to do something really interesting with the network or with some high performance computing they are doing, it might have an adverse impact on the rest of the environment, but at least I’ll know about it ahead of time. Or, if there’s going to be some huge security breach that’s caused by one division, at least I’ll know about it.
But that didn’t become the benefit, although there were some opportunities to learn from that as well. The real benefit was to figure out what people were doing in really different disciplines that could be applied to medicine and vice versa. Even some of the issues with security confidentiality and privacy. Students and parents who were applying for financial aid want their information to be protected every bit as much as a patient does. People who are managing grants want their intellectual property to be protected every bit as much as a sick patient does. And so it’s been interesting also to see some of the similarities between those kinds of organizations.
What’s the total size and scope of the organizations that you’re responsible for?
All of Johns Hopkins is about $7 billion in annual revenue. Hopkins employees number about 46,000. The IT organization, IT Central, which is what I’m really responsible for, is about 650 to 700 people in total. Maybe it’s a little bit bigger now, maybe closer to 750. My annual budget, just looking at IT Central, is about $65 to 70 million. That’s the operating budget. Capital budgets run in the neighborhood of $25 to 30 million a year.
So, we spend $100 million a year in IT Central, including capital and operating expense. I would venture a guess to say another $50 million or so is spent out in the departments and divisions where there are small IT shops doing some really clever innovative things to support research or to support some scientific issue, some discovery. Our health system is not that big. We’re only three hospitals in size, plus community physician sites. So it’s a lot of money considering the size of the organization.
I assume that there was a sharp delineation between the academic and medical sides when you took over. How did you bring them together?
There were two completely separate organizations. One Central for the university and one Central for the health system and Johns Hopkins Medicine. They behaved very differently. In fact, even the one that was responsible for the university was somewhat bifurcated. There was a group responsible for academic computing — the teaching side of our world — and there was another responsible for the administrative computing.
Those two were actually pretty far apart even though they both served the university. They didn’t necessarily work well together because the education group perceived themselves as being very mission-driven, while the administrative group was all about business and ROI. So I had to bring together those two groups together with the Johns Hopkins Medicine group.
The first thing that we did was consolidated networking in telecommunications. That is where we knew we would see real value because we were buying Cisco routers on the heath system side and I think UB was the name of the routers on the university side. Purchasing power alone was reason for us to come together and look at opportunities for consolidation.
But aside from that, there were also opportunities for staff development, for user satisfaction, for standardization. Some of our customers had to live in both worlds, even though as IT folks, we didn’t see that. The first charge was really to bring together networking, telecommunications, and then some of the other things that are now considered to be infrastructure, like information security; e-mail services and post offices and gateways; collaboration tools. Things we now take for granted as being part of our infrastructure. They weren’t back then. They were really separately managed applications, so we had to bring all of them together as well. Most of that happened in 1999-2000.
By 2001, we consolidated our data center into one very large data center with a few satellite data centers for disaster recovery to improve continuity purposes. One large, 35,000 square foot data center now serves the university and the health system.
We brought real money to the bottom line in those first couple of years. Data center consolidation alone saved us about $1.3 million a year, some of which we’ve re-invested in more sophisticated tools and technologies. Just bringing those kinds of services together gave people an opportunity to grow and learn more from other people. It really was an attempt not just to improve service to the customers, which obviously it was, but to really improve satisfaction among the staff. I think it did do that. It gave people much broader exposure, and really an opportunity to make a difference, which some of them didn’t feel they had in their smaller organizations. That was actually a positive, maybe unanticipated, consequence. The staff got an opportunity to learn a whole lot more about other technologies and innovative things that they might not have been otherwise able to see.
How much of your job involves some sort of organizational politics?
Maybe 125%. I think there is clearly an understanding among senior leadership at the university and at the hospital health system, that we really are all about … at a place like Hopkins, it might sound trite, but we really are all about knowledge for the world, excellence, and patient safety. The things that are all over our web site are pretty sincere. Even though there may be some different approaches in the way the health system and the university might tackle a strategic imperative, at the end of the day, there really is a tremendous commitment to wellness, to science, to excellence in education.
I read a book one summer called Getting to Yes. I read it probably ten or twelve years ago, but I remember the author saying, “People come to the table with very different positions, but they often come to the table with very similar interests.” And I think that’s proven itself to be true in the world that I serve. People have different positions, but their interest areas are generally much more closely aligned. They want to make a difference; they want to do good things. Maybe it’s curing a disease, or maybe it’s figuring out how to solve global warming, or mapping the universe, or making our national infrastructure better; but most people come to the table because they want to make a difference. I think if you listen carefully enough, you can find those things that make us the same as opposed to worrying about those things that make us different.
It’s interesting that you were a home grown product put into a job that didn’t exist involving two different but highly regarded sides of the house. How would they replace you?
Well, we’re all sort of replaceable. for darned sure. I think the reason I was given the opportunity is because it was obvious that I had respect for the place and I still do. I think finding someone who respects what the place stands for is an important attribute.
I think the other thing that I have hopefully brought to the position is that I am genuinely humbled by the people who work here, It is so easy to be successful because all you have to do is leverage that excellence or that brilliance, the discovery, the passion. The thing that I’ve enjoyed most about my opportunity here is to work with all these smart people who really do most of the heavy lifting.
We have a clinical systems advisory committee, for example, and it’s been meeting for 15 years. This really is a true story. One Tuesday night a month, we have dinner, and that dinner is generally very inexpensive chicken and some potatoes and green beans. We’ve been meeting since 1993 and the group that meets is now larger than ever. At our June meeting, we had 68 people in attendance, half of whom are physicians who practice real medicine at Johns Hopkins. The other half are nurses or administrators or IT people.
We do this one a month and people come together because they see this as an opportunity to influence the direction of information technology at Johns Hopkins. I feel like I have this amazing group of partners and colleagues who are willing to give two hours a month to sit around and eat chicken and talk about what really matters and how our information technology really can make a difference. Honest to goodness, I don’t know any other CIO in the country who is as fortunate as I am in that regard.
These folks come selflessly. They absolutely come to listen, to share, to contribute to the overall strategy of IT at Johns Hopkins. It’s amazing to me. Every single month when I leave that meeting at about eight, I walk out of that room thinking. "I am incredibly fortunate to have people who are willing to give so much of their time to help us define strategies for the future." It makes the job so much easier.
We have similar advisory committees in some of the other areas, but this one has been in existence for the longest. The current chairman is Dr John Ulatowski, the chairman of anesthesiology and critical care medicine here at Johns Hopkins. Not only do all these other people give up their time and energy, but he sits at the head of the table with 65 or 75 people in a room and helps drive us toward the right decisions so that we do more than just support this place. He really drives us towards a vision for innovation and collaboration, collegiality, excellence — all those words that are all over our web site. He really helps the group coalesce around those things that matter. It’s pretty amazing really. I do feel very privileged to be able to learn from those experiences. They are pretty special.
Folks in a community hospital, who see doctors for an hour in the morning and again in the evening, might find it hard to picture that you’re constantly working with people who have won Nobel prizes or led world-changing research. I just remembered that I interviewed Peter Pronovost, for example, and he’s a pretty big star in my mind. That has to be humbling.
It is humbling. It truly is humbling. I remind my IT team all the time that we’re mere mortals here in the midst of all these folks who are doing remarkable science. Think about how amazing it is to be able to work at their elbow. That’s exactly what we do. The other phrase that’s become pretty common, especially here at Johns Hopkins, is “standing on the shoulder” of these guys. That’s exactly what we get a chance to do.
People who come to work in IT at Johns Hopkins either stay six months and say, “This clearly isn’t for me — I can’t live in this whitewater where it’s so intense” or they stay forever because you get so addicted to the adrenaline and to the opportunity to rub elbows with these amazing people.
This really is a true story. Once people are here six months or a year, retention is pretty easy because you get a chance to work with the best. You probably know the name Ben Carson, a famous pediatric neurosurgeon who does amazing work with children who have serious problems with their brains. He was all over the news last week because he did surgery on a young girl from Texas who had some very serious hydroencephalitis or something.
I had a young lady who worked for us about 20 years ago. She was leaving because she was offered a position someplace else. I said to her, “What will it take to keep you, because you’re a great member of the team?” And she said, “If you could arrange for me to meet Dr. Carson, I’d stay.” So I called Dr. Carson and he said, “Of course I’ll do that.” She got a chance to sit down with this amazing guy, who just this week President Bush named as a winner of the American Medal of Freedom. Ben agreed to meet with her and she’s still an employee here. I think that says it all. That’s what makes it so special. People are willing to do that kind of thing because we’re all in this together. People value that. I think it really does make a difference.
Hopkins does another thing that makes it very special. Through Peter Pronovost’s leadership, we created this patient safety institute. We allow senior executives to adopt a patient care unit because we feel it makes them better in their jobs. As CIO, I would have no reason to spend my afternoons in the pediatric intensive care unit except for when we’re implementing CPOE, but the pediatric care unit has been my unit for six or seven years. Once a month, I spend an hour or two with the leadership of the pediatric intensive care unit. I’ll sit down and talk about what are those things that make them nervous. What are they worried about? What’s the next way a patient might get harmed? What can we do to make sure that doesn’t happen?
This is not at all about my day job. We do talk about information technology, but that’s not the purpose of the meeting. The meeting is to say, “Do you have enough needle containers? Is your housekeeper cleaning the floors properly at night? Do you have security if you need it if you have child in the unit who is threatened?” We talk about anything once a month. It’s my job to make sure they feel safe and that their patients feel safe. If there are things that we can do to make them feel more comfortable, it’s my job to make sure we do those things.
I have colleagues around Hopkins who do the same thing in other units. Over time, I’ve encouraged my directors to adopt units as well, so one of my directors adopted the blood bank. It’s his job to make sure they feel safe and they can do what they need to do. Another one of my directors adopted the Wilmer Eye Institute. These were areas where they had a personal interest and they adopted these places and get a chance to participate on a monthly basis on those things that make them special or nervous. It’s a way to remind yourself why you are here. That’s pretty important as we get separated from the mission a little bit when we’re putting in systems.
You mentioned clinical systems. What’s the status of electronic medical records there?
Many years ago, before my time, a number of people at Hopkins were fairly serious about building a homegrown electronic patient record. Soon after I became CIO, we did a major enhancement to it. A gentleman who works for me, Alan Coltri, who’s an amazing guy, decided there were a number of things we could do technologically to make our homegrown electronic patient record a more comprehensive solution.
Starting the early 90s, we began rolling out fairly comprehensive electronic patient record here at Johns Hopkins that ingested information from lots and lost of different ancillary systems. Believe it or not, I think it used a very early flavor of something that we now call Software as a Service. Alan developed this thing that he called a Book of Calls. This electronic patient record would place a call into another application and be able to absorb this service, therefore present to a care provider an integrated look at patient records, even though it wasn’t necessarily all being consolidated into one record or repository.
That system was enhanced over the past 12 or 13 years and, I think, and serves us very well. However, when we signed our contract with Eclipsys to deploy its entire portfolio of systems — beginning with CPOE and then moving into clinical documentation and then into the ambulatory record — it became clear that we were going to have some tension between these two environments. We didn’t want our care providers to be confused about where they should go to get the most accurate, timely, and complete information. We’ve made a strategic decision to move most, if not all, of our transaction-based activity from the Johns Hopkins Hospital into the Eclipsys suite of applications.
We have signed a development agreement with Microsoft to develop with them the Amalga product and use that as our repository, our longitudinal patient record across Johns Hopkins Medicine, because our two community hospitals run Meditech. Having all the Meditech data from those two hospitals, all the Eclipsys data, and then any other ancillary information that isn’t necessarily known to Eclipsys — our primary care sites, for example, use Logician — to have all that data resident in one longitudinal repository, so we can use it for not just comprehensive patient record if patient are seen across the continuum, but also for clinical research. We signed a contract with Microsoft last October and we are expecting the rollout of the first phase of the Amalga product in the fall. It will serve as a research repository as well as the early phases of our replacement of our electronic patient record.
IDNs used to insist that all their hospitals use the same clinical systems, but it seems that the emphasis in interoperability has made everyone realize that it doesn’t really matter what feeds the information as long as you can put it together on the back end.
Absolutely.
Is that the market that Microsoft is going after with Amalga?
Microsoft made it pretty clear at CHIME a year ago and at HIMSS that they recognize that many hospitals can’t afford to throw out the investments they’ve previously made. It’s no longer acceptable. It used to be that you could put Meditech in and it wouldn’t be terribly expensive, so if you had to replace it with whatever the institutional will might have been, it wouldn’t have been a big loss. But that’s no longer the case. I think it changed a little bit when the accounting rules changed and you were given an opportunity to capitalize on all the internal resources associated with the design, development, and deployment of a system.
When you look at the investment that hospitals are making in even some of the smaller information systems, the money is enormous. People are loathe to throw that way. Not just because of the financial investment, but because of the people’s time, energy, commitment, and some of the intellectual property that’s embedded within it. I don’t think we can afford to throw out stuff.
Microsoft enters the scene and says, “We know you’re not going to be able to replace all of the stuff you’ve got in your environment, but we think we have something that will level the playing field a little bit and allow you to keep that other stuff, but give you one common place to collect and present it.” For a place like us, it makes a whole lot of sense. I’m not sure if it works in a community hospital, but I think for a place like us, Amalga seems to make a lot of sense.
The HopkinsOne ERP project has to be one of the most ambitious I’ve ever heard of in healthcare.
Oh, you had to mention that. We’ve had a whole half hour and it’s been so pleasant … [laughs] We implemented SAP in January 2007 after about 3½ years of working at it. It was the first time that the university and the health system as a whole came together around one application. It was a rocky road in the early days. We invested a tremendous amount of money. We put a whole lot of time and energy into it.
When it went live, I would say that it probably served the hospital and the health system reasonably well. Where it fell short — and I think we’re making real progress — was for the research community who had been accustomed to being able to conduct business in a very simplistic way from the administrative point of view. They didn’t have a lot of overhead administratively. If they wanted to order supplies through their grant, it was pretty straightforward. You filled out a little requisition and your administrator processed it. The next thing you know, the right test tube and the right equipment showed up.
When SAP entered into the scene … one of the good things about SAP is it allows your users to be 100% empowered. But that turned out to be the bad news as well because these investigators didn’t have the time to master how you buy things, order things, and pay for things. They were much more interested in doing science. SAP introduced a whole new level of rigor that they needed to do just to be able to conduct their science. I think it was unanticipated by us as to how much of a burden that would really be.
We’ve spent the last 18 months trying to reduce that burden and better inform the work force as to shortcuts and ways to get information out of SAP that are not nearly as cumbersome as in the beginning. I think we’re making progress. People often say how late a system went in, but everyone remembers the things that didn’t work. I think that’s where we are. Memories are still very strong as to what didn’t work in the beginning. And even though we starting to make some progress, people’s memories and the pain is still a little bit fresh. So we’ve got to really prove that we are willing to listen and make a difference.
I’m curious what that project cost and whether you think there’s a chance its actually going pay for itself.
The total cost of the project, looking over the life of the project for the university and health system, is about $240 million. It’s a horrible number, but it does include, as I referenced earlier, when the accounting rules changed back in 1998, it gives you an opportunity to capitalize much of the full-time user involvement. We moved a lot of people from the business units into this organization that we named HopkinsOne and it reported up to finance.
This whole HopkinsOne team was about 150 people from Hopkins and, at some point, as many as 100 people from varying points. So, 250 people over a three- or four-year period of time, all of their costs being capitalized. Along with that, all the hardware, all the software. When you add it all up over the life of the project, it came to $240 million to be allocated out to the university divisions and the hospitals that are within the health system.
When you look at how large Hopkins is, you could certainly argue that’s not a huge investment if we’re a $7 billion corporation, but when you boil it down to the individual departments and divisions and their appreciation for that huge investment, many of them are thinking about buildings they could have built, the faculty they could have recruited, and programs they could have funded. The mission is what matters most to many of these people, so there’s still a little bit of angst associated with the fact that there was such a large capital investment.
Will we get a return on that investment? I think in large part we will. I don’t know if it will ever truly pay for itself. I think the guys in finance are certainly looking carefully at how that will play out. They system was implemented for three primary reasons. One was compliance, because as you know, the regulatory requirements are increasing. The whole regulatory climate is pretty intense.
The second was service. It was clear that we had many different information systems in that ERP space. We had users who were needing to travel between and among all the different systems. It was very cumbersome to do that. There was a belief, and I think there still is a belief, that by bringing all this together in one set of applications, people will be able to do a better job of hiring and firing, paying for travel, and buying things. I think we are starting to see improvements in many of those areas. The research administration is still a little weak, but I think in the other areas, we’re starting to see improvement.
The third reason for doing it was productivity. Therein lies some of the financial ROI. I don’t believe that we’ve started to see those productivity gains yet. I think we will, but we’ve got to spend some more time on business process redesign. We’ve got to spend some more time on training. Those are two areas where we did not invest enough time, energy and people before we went live. Training and business process redesign are critical and that’s where we’re redirecting a lot of our energy.
People in Human Resources are leading a training activity and I think are going to turn out a phenomenal product in a couple of months. They are really building a whole new strategy for training. Business process redesign … luckily, Hopkins has an organization that does that for a living. It’s called Operations Integration. We’re just embarking on business process redesign in a few areas. I think it will definitely help the satisfaction levels and the user adoption.
I’ll just mention, not related to SAP or HopkinsOne, that we’ve put in a new emergency department system. It went live about a month ago in our adult ED and two weeks ago in our pediatric ED at the Johns Hopkins Hospital. It’s the Allscripts HMED [HealthMatics ED] product. Before we went live, this particular time, we all got together and decided that we had to do business process redesign first. The only way to do this right was to make sure we studied all the workflow issues in the EDs and made sure that we redefined and redesigned them before we implemented new technology.
In my career, it was the first time a system came in ahead of schedule and under budget. That’s because there was amazing commitment by the users to really drive change as a part of this technology implementation and really look at the way we’re doing work. It really was another one of those amazing experiences where the system went in, people used it really well … there were definite speed bumps — there always are — but it really has been a success story and I think the technology is a small part of it. It really was because the users were passionate about redefining the way they do work.
When CIOs get in trouble, it’s often because of either CPOE or ERP, which is the business equivalent of CPOE. With those two behind you, what are your biggest challenges and concerns?
I think they’re behind us in that they are implemented, but I think the really big challenge is now related to getting bang for the buck. We’ve got to get value out of these systems. In the area of CPOE and clinical documentation, I think we’re starting to see that benefit. I think it hasn’t come without a whole lot of hard work and pain on the part of the care providers who’ve had to learn how to do all this differently, but I think our patients are getting safer. I think that we’re making far fewer mistakes. We’ve had amazing success with medication error reduction through the implementation of CPOE.
Over the years, we’ve invested so much time and money that I think we owe it to the institution, to the patients, and to the faculty here to really start showing the value of these investments. I think that’s where the rubber meets the road. I think that’s biggest challenge we have ahead.
The thing that worries me is the rate of obsolescence. These systems no sooner get implemented than you have to do the next release, buy the new hardware, or move the web services. You’re never done. Even though we all know we’re never done, it would be nice to take a breather once in a while.
There’s so much change. Change largely driven by our own demand for better, quicker, slicker stuff, but it makes it hard. I worry a little bit about fatigue. We put in a new operating room system release this past weekend, so I had a large team of people who worked all weekend. The previous weekend, we had some major network enhancements we were doing, so we had a whole army of people worked that whole weekend. Sometimes it’s the same people working weekend after weekend.
I do worry a little bit about the fatigue that the staff feels because we’re a pretty high energy place and we have pretty demanding customers. Everybody needs a bit of down time and its getting harder and harder to really get away. Everybody carries a portable device. Everybody’s logged on most of the night, it seems, by measure of the e-mails I get in the early hours of the morning. People deserve some down time and it’s getting harder and harder to get.
If you look outside of what you do at work, what healthcare IT related projects or organizations, conferences do you think are worth your time and attention?
I’m a member of CHIME and I think the world of the CHIME organization. Together with John Glaser and a few other people, we have been able to teach the CIO Boot Camp a couple of times a year for the past maybe five years. That’s really been a terrific opportunity to give something back to the younger people who are coming up in our industry.
I think HIMSS has, over the years, has been strong and not so strong. I think now they are making a difference again and are looking at the right kinds of things. My only concern is that the annual conference is just darned big. It’s hard to take it all in and hard to focus. It bugs me a little bit that the competition for who’s got the jazziest booth is a little bit disappointing, but it is what it is. It’s one way to learn what is happening in the industry. I don’t usually get a chance to go every year, but going every couple or three years has been a good thing. There’s a lot of opportunity to learn there.
I think the folks at AMIA are great. I’m a member of AMIA, but I don’t get a chance to participate actively. We have some physicians here at Hopkins who participate at AMIA. I try to read as much as I can because I don’t get a chance to travel as often as I would like, as there’s a lot to do back at the home front.
I think our industry is getting a little bit better at providing material that’s meaningful. I do read your blog and I really do think that you have a lot of trusted contributors, or people who ate least are willing to be candid with you and share what is happening in their organizations. I tell so many people about your blog. I spoke at an investors meeting last week and, as part of my bio, the gentleman that introduced me mentioned that I won the HISsies award. People ask what that was and I told them about the blog. I said it was a great way for the investment community to know what’s going on in the information technology in healthcare.
How do we make privacy less of an issue when it comes to information technology?
I probably am in the minority about this one. I think it’s much ado about nothing, in a way. I really do believe that until we put healthcare in the hands of the consumer, we’re never going to get better at this. I do feel that the personal health record strategies of Microsoft and Google Health are a step in the right direction, provided there’s not some huge breach. I think that we have to get people to trust and I think the way to get them to trust it is to give them some kind of way to control their own destiny.
I think we need to convince people that there are risks associated in using technology in healthcare, but there are risks associated with everything we do every day and the benefits outweigh the risks. We need to be able to manage our eating habits and our exercise habits and our glucometer readings and our EKG readings, all those kinds of things, to see if we’re managing our health. I think we can do it through better use of technology.
What would I actually do? I don’t know. I would encourage people to use technology to manage their health and do it any way that they are comfortable doing it. But I don’t think that Google and Microsoft are parts of the evil empire. It’s all about the money at the end of the day, but I think they are also trying to make a difference.
I had this amazing opportunity to have breakfast with Bill Gates a couple of months ago. He invited maybe 25 people in Washington, DC to come and have breakfast with him. Half of the room was filled with people who had military uniforms on because I know Microsoft is doing a lot in the national defense space. The other half of the room was people from all walks of life. I was the only healthcare person in the room. He sat right there and said, “We’ve got to do something about healthcare in this country. We have to make a difference.”
He mentioned Hopkins by name. We’re doing some good things at Hopkins with our work on Amalga, but we’ve got so much more we have to do. What I said back was, “You’re darned right. You have so much to do and you have the resources to do it, so do it. Help us dream big.” I said, “We want to dream big, but we need help dreaming big because we don’t have limitless resources or the deep pockets that everybody thinks we have. We’re non-profit organizations trying to make a difference here and you can do it.”
He said he really wants to do it, or he and his company really want to do it. He’s stepping out of that role. Craig Mundie was there as well and said, “We hear you. We really want to make difference in this space.” I hope they are telling the truth.
If you look at that whole aspect of consumerism, are you planning for a different environment where the consumer is more in charge, where it’s more about health and not treatment? And will the paradigm change right about the time we get the basics of pushing orders and paper around?
I think they’re readier than we think they are. We all read the statistics about the fastest growing part of the demographic using the Internet, people over 65 or over 75. Certainly young people are absolutely ready. Some of us in the middle may not be completely ready, but I think that the paradigm is changing. People are doing much more of their business online. Why not do healthcare there as well?
I don’t think they yet trust Microsoft and Google. I think many people who are venturing into the space of electronic patient records or personal health records are doing by the tethered approach, where their payor or their Kaiser Permanente is helping them orchestrate that migration of information into a personal health record. But I think there is also just as many who are doing locally on their own PCs in their own living room and not willing to let it be any place else. But that’s at least a beginning and I think we should be encouraged by that.
If we can figure out how to do the right mash-ups to integrate information from personal experiences and behavioral experience and primary care physician offices and tertiary activity that goes on; if we can figure out some way to bring it all together for patients and allow them to use that information to create a body of knowledge about themselves, then allow them to create social communities where they can get the support they need or search capability where they get the education they need so they get a chance to learn stuff and do stuff by using technology — I do think we’ll get better adoption. Nobody wants to die of anything, so if we make it easier to figure out how to live with disease and how to improve outcomes at a personal level, I think people will develop a little bit of trust. I hope so.
If you look ahead and try to pick out what the most important technologies or the most important change of the next ten years, what would you say?
I guess if you asked me this question two or three years ago, I would have said the PDA-cell phone world. I think it’s going to become, or has already started to become, the way we do almost everything we do. It feels to me like we can connect and learn and do lots of things through these portable devices. I’m not much of futurist, but I guess that’s where there is still a tremendous amount of opportunity.
I think wearable computers is what they are. We’re wearing these very sophisticated devices on our belts and I think it will allow us to do even more in the years ahead. I don’t think any of us understood two or three years ago the power we would have in these small devices.
I was sitting with my 87- and 88-year-old in-laws for Father’s Day. My mother-in-law said, “How old is Tiger Woods?” and within about 30 seconds, I was able to tell them his birthday is December 30, 1975. She said to me, “Wow. You have a window into the world right in your palm.” That’s a pretty impressive opportunity for all of us. I think that’s certainly one amazing technology going forward.
I think in healthcare, the technology opportunities for diagnosis and treatment of disease are the ones more impressive. Today I had a chance to shadow somebody in our Radiation Oncology department and walk through the department, look at some of the amazing technologies they use to target treatment for cancer. You look around and you see a lot of sick people, but you see people who are so hopeful and optimistic about their futures. I think it’s because people do believe there is great promise in these medical technologies that are prolonging life. Life matters, and I think a lot of these young men and women that I saw this morning — an extra year or two with your children or grandchildren really matters and these technologies are providing hope. The young physicians coming out of medical school today are so excited about making a difference in some of these technological areas. So I’m very excited. I think the future has got a whole lot to offer.
Who do you admire in the industry?
John Glaser is a rock star. I more than admire him. I think he’s amazing. I think John Halamka, for a whole different set of reasons, is amazing. He probably doesn’t even remember what he’s been to me in my career, but I’ve called upon him when I needed some advice about certain things that were happening and he’s been very helpful to me as well.
From a technology point of view, I have tremendous admiration for Sam Palmisano at IBM. I think he’s trying to make a difference in an interesting set of ways. I think he’s been successful in some interesting ways that are not obvious to a lot of the customers around the world.
Judy Faulkner. I think Judy is an amazing human being who has stuck to her guns and made a commitment very early in her career that she was going to make a difference and she certainly made a difference. Outside of technology, I love Michael Bloomberg. I wouldn’t have been disappointed to see him run for President of the United States. I think he decided against that, but I think he’s also brilliant and has done some cool stuff.
Is there anything else you want to talk about?
I guess the only thing I would add that we didn’t talk a whole lot about is people. How are we going to nurture, grow, and respect the people who have to do this hard job we have in information technology? How do we make them feel valued? How do we treat them with respect and have a life?
My children are grown and married and have children of their own. I’m grateful that’s the case, because if I had young children at home, I don’t know when I’d see them. These jobs have become so consuming that I worry a little bit that for the young people who are growing up in healthcare IT, the demands are so great that they are making some bad decisions sometimes abut where to be at 6:00 at night. Instead of going to a Little League game, they’re at the office dealing with a tough problem. One side of me loves that — to see their dedication and commitment — but I worry that they are missing out on some important parts of their lives that they won’t be able to re-create.
I think if you'd look at the recent hearings, VA was saying Cerner would require a 10% increase in staff…