The New Jersey health system is using the latest in smart technology, for both the patient and the care team, in its new Helena Theurer Pavilion.
Hackensack University Medical Center recently opened the Helena Theurer Pavilion, a nine-story surgical and intensive care tower that showcases the latest in healthcare innovation for both care providers and patients.
Mark Sparta, FACHE, president of Hackensack UMC and the northern region of the Hackensack Meridian Health network, says the 10-year project offers a good look not only at the hospital of the future but the hospital room of the future. Working with New York-based digital health company pCare, healthcare executives created a patient-friendly environment that focuses on collaborative health and on-demand access to resources and family.
"It was important for us, through that building, to be iconic in design," Sparta says. "But at the same time, what went on inside the building was really most important."
The building features 24 operating rooms, 72 post-anesthesia care unit beds, 50 ICU beds, and 175 medical-surgical beds. The operating rooms are equipped with the latest in robotic technology, as well as intraoperative MRI capabilities, large monitors, video-streaming capabilities, and dedicated CT imaging on the ICU floor.
Sparta said health system leaders worked with doctors and nurses to design ICU rooms to their specifications, right down to the placement of equipment and lighting. In addition, they worked with a patient experience committee, comprised of former patients and family members, to get the patient rooms right.
"Sometimes providers and patients and families look at different things from different angles of the prism," he says.
Mark Sparta, FACHE, president of Hackensack University Medical Center. Photo courtesy Hackensack UMC.
When the pandemic hit, and Hackensack UMC found itself in the bullseye, the project slowed down a bit. But Sparta says hospital executives learned a lot during the crisis, including how to isolate patients and create rooms with negative pressure to prevent the spread of the virus. Because only the framework of the new tower had been built so far, he says, they were able to make subtle changes in room design.
"Some of them may seem relatively trivial and almost like no-brainers," he says. "But until you have a pandemic they’re not as evident."
Sparta says it was important that Hackensack UMC also took advantage of the latest in smart room technology—for both patients and providers. That started with the lighting. The hospital used the latest in LED lighting, which he says was "so far advanced" when compared to legacy lighting systems used in the past.
Of the 24 operating rooms included in the new tower, six were designated specifically for da Vinci robotic surgeries, with six multi-port robotic surgical systems and one single-port system, and four robots specifically designed for joint replacement surgeries.
"That level of technology is really important, because when you can minimize tissue disturbance during surgery, recovery is much quicker, [and there is] much less pain," he says. "It's also much more precise [and there is] much less risk for infection."
"In addition to that, we have the ability to video-stream, within the ORs, the entire procedure," Sparta says. "That gives us the opportunity to have pathologists … come in virtually and explore the surgical field with the surgeon, which is really, really important from a diagnostic standpoint, as well as [for] other consultative specialties. We're able to leverage that technology … to teach folks not just from Hackensack University Medical Center and Academic Medical Center, but also from all around the world. Surgeons can stream in. That was very important to us."
The Patient Room of the Future
Turning to patient rooms, Sparta says each room is more spacious, with enough room for the patient and his/her family. Each room is also equipped for virtual visits not just with the care team, but family members, with a camera mounted on the TV and a special code that patients can give out to family members.
That's a lesson learned from the pandemic.
"So many patients—too many—had to say goodbye to their family members over an iPhone that was being held by one of their nurses through Facetime," Sparts says. "It was horrible for the family, horrible for the patients, horrible for the staff."
"Family support and family visitation is really critical to the recovery process," he adds. "We wanted to tackle that not just when a patient is in isolation, but …every day each and every patient [should have] the opportunity to visit with their family members whether they are 5 minutes away, around the corner and can't get away from their desk on their lunch time to come visit, or … whether they're 3,000 miles away on the other coast."
"It's a technology of convenience, but really a necessary technology to promote the healing process," he adds.
Another change is the messaging process. Sparta points out that typical hospital rooms have dry-erase boards on which the care team leaves important reminders and other messages. Each patient room in Hackensack UMC's new tower includes a tablet in its own compartment on the wall just outside the door, integrated with the EHR, which care team members consult before entering the room.
That dry-erase board is also incorporated into the 65-inch flat-screen TV in each room, Sparta says. Each TV has a split-screen capability, so that patients can access their information through the TV. They also have a tablet mounted to the overbed table that they can use to order food and control the TV, shades, temperature, and lighting and access additional resources.
"When we think of healthcare, we think about clinical technology," Sparta says. "What has surprised me is how much technology is available outside of healthcare that we were able to incorporate into the patient experience. It's fascinating."
"We took a lot of feedback from some of those patients and families that we invited in very early on," he adds. "[They asked] questions that we didn't necessarily ask ourselves. Could you do this? Could you integrate this? What if we did this? What if we did that? It's really, really important to be a great listener, and to be able to invite people in, even if you think you know about what the public expects and our community is interested in. It's really eye-opening when you bring them in and give them a forum to provide that type of feedback."
At the same time, Sparta says it's important to think of technology as a part of the healthcare ecosystem but not the only part, or even the most important part. He notes Hackensack UMC conducts all sorts of drills with its providers and staff in the event of a cybersecurity attack or loss of power.
"It's really important to start from the ground up and understand there's a manual process for doing things when and if the technology is not available to us," he says. "With that in mind, the question is how does all this technology, how does the hospital room of the future, bring back the human side to healthcare?"
Sparta says the biggest lesson he's learned from the process is to involve as many stakeholders as possible, from doctors and nurses to patients and families. They have opinions and ideas that go far beyond what technology can do, and those views will determine whether a certain tool, design, or care plan works or becomes ineffective and wasteful. Too many health systems adopt the latest technology without stopping to think about who will use it.
"You'll never take the humans out of healthcare, because this is a people business," he says.
The Healthcare Transformation Consortium and Wildflower Health are partnering on a value-based care program that will give health systems and OB-GYN offices access to digital health resources to improve care management for expectant and new mothers and their babies.
A consortium of New Jersey-based health systems is expanding its digital health platform to improve maternity care management and outcomes.
The Healthcare Transformation Consortium (HTC), which includes the Atlantic Health System, CentraState Healthcare System, Holy Name Medical Center, Hunterdon Healthcare, Valley Health System, Virtua, and Saint Peter's Healthcare System, is partnering with San Francisco-based digital health company Wildflower Health on the statewide program. The health systems, each of which have self-funded employee health plans, will adopt a maternity bundle developed by Wildflower Health that includes digital health tools and resources.
The partnership will also include OB-GYN practices across the state, including those affiliated with Lifeline Medical Associates and Axia Women's Health.
“This new partnership will allow the HTC to bring all stakeholders together to work for the benefit of expectant mothers, new moms and their babies,” Kevin Lenahan, Atlantic Health's executive vice president and chief business and strategy officer, said in a press release. “Additionally, our physicians, nurses and team members are the most important asset to any healthcare system. Working with Wildflower allows us the opportunity to improve both member and physician experience, while helping reduce the cost of care and improve the quality of care for our employee health plan.”
The program addresses a key pain point in American healthcare. The nation's maternal mortality rate in 2020 was 24 deaths per 100,000 live births, more than three times higher than most developed nations, and that rate was even higher for underserved populations such as women of color. New Jersey ranks 47th in the nation with 46.5 deaths per 100,000 live births, and First Lady Tammy Murphy has launched an effort, called Nurture NJ, to cut that rate in half within five years.
The HTC-Wildflower Health partnership aims to bring digital health resources to bear, addressing key social determinants of health that contribute to these deaths, and create a value-based care program that rewards providers for outcomes.
The bundle includes prenatal and postnatal services and encompasses both the mother and baby. Among the services provided are access to health associates and coaches from Wildflower Health, educational content, virtual visits and remote patient monitoring tools.
"With this bundle, providers can evaluate and design value-based models alongside payers; install both digital health and point-of-care decision support tools; adapt current workflows to value-based requirements and continuously process data, both for leveraging key clinical metrics in real-time, as well as managing financial payments, reconciliations and outcomes measurement," the two groups said in the press release.
“As the demands on OB-GYNs continue to mount, it’s critical that we work together to find innovative ways to offer more support,” Gaurov Dayal, MD, chief executive officer at Axia Women’s Health, said in the press release. “The model being introduced in New Jersey fully equips clinicians to work more efficiently while providing personalized support for every patient, even between office visits. It makes it possible for providers to do their best work and be rewarded for high-quality outcomes.”
The Virginia Consortium to Advance Healthcare in Appalachia includes the UVA Center for Telehealth and several healthcare organizations, and will use $5.1 million in federal grant money to launch or expand a number of innovative programs to improve access to care in southwestern Virginia.
The University of Virginia Health System is joining forces with a coalition of Virginia healthcare organizations to offer a wide range of digital health and telehealth services to residents of rural Southwest Virginia that have been hard hit by the pandemic.
The Virginia Consortium to Advance Healthcare in Appalachia will include the UVA Center for Telehealth, one of 12 federally recognized telehealth resource centers; the Healthy Appalachia Institute at the University of Virginia's College of Wise; the Southwest Virginia Health Authority; Tri-Area Health, Ballad Health; and The Health Wagon, an innovative mobile health program serving Southwest Virginia. The consortium is supported by a $5.1 million grant from the US Department of Agriculture's Emergency Rural Health Grants program.
“There is an urgent need for community-academic partnerships such as this one to assess and respond to health inequities in Virginia’s Appalachian communities,” David Driscoll, PhD, MPH, director of the Healthy Appalachia Institute, said in a press release. “Our consortium is committed to understanding, and most importantly, responding to the determinants of population health disparities in Appalachia, including adequate access to comprehensive public health and medical services.”
The effort will be led by Karen Rheuban, MD, director of the UVA Center for Telehealth and a national expert on telehealth, and include several innovative programs aimed at tackling health inequity and improving access to care for underserved communities. It will serve the city of Norton and 10 rural Virginia counties whose residents face a variety of chronic care issues, including a death rate 30% higher than other regions of the state, a 35% higher rate of death caused by COPD, a 21% higher rate of death caused by heart disease and a 14% higher rate of death caused by diabetes.
“This consortium …is exactly the type of strategic initiative the Southwest Virginia Health Authority seeks,” Terry Kilgore, chair of the Southwest Virginia Health Authority, said in the press release. “Improving access to health care in southwest Virginia through broad-based consortiums will increase healthcare outcomes and improve the quality of life of the people of southwest Virginia. This project will create models that support rural healthcare, expand evidence-based models in telehealth to improve access to care, health outcomes and regional partnerships for resource sharing, equipment deployment, training, and education, as well as update our regional Blueprint for Health.”
With Emergency Department violence at record levels, administrators are turning to technology—and the EHR—to help clinicians identify and treat aggressive or stressed patients.
The Emergency Department is a hectic environment, requiring clinicians to be ready for almost anything. That shouldn't, however, include violence.
With roughly 85% of emergency physicians reporting in a recent survey that ED violence has increased over the past five years, health systems are taking action to protect both providers and patients. And while the most visible response is to increase security in the ED, some are using technology to take a more proactive approach.
At Sturdy Memorial Hospital in Attleboro, Massachusetts, administrators are tapping into the electronic health record platform to identify ED patients with a history of threatening behavior, which pushes out alerts to the care team. Those alerts not only give providers advance warning, but can help them call in behavioral healthcare specialists to help those patients.
"It's definitely led to a lot more awareness," says Brian Patel, MD, the hospital's senior vice president of medical affairs and chief medical officer. "There are a lot of different reasons [that lead to stressful or violent situations in the ED.] If we can improve communication and get ahead of this, we are creating opportunities to improve both safety and care."
To get the most out of its EHR, Sturdy Memorial is working with digital health company PointClickCare. The two began working together in 2017 on ED utilization, and integrated security and care guidelines in 2021.
Once considered more of a hindrance than a help in improving clinical care, EHR platforms are slowly becoming more valuable in the hospital as vendors fine-tune the complex technology and providers learn how to use them. Among the bigger benefits just now being realized is the EHR's ability, under the right circumstances, to capture the entire patient history, collecting not only clinical information but data on social determinants of health, or outside factors that affect healthcare access and outcomes.
That includes behavioral or societal clues that could indicate a combative patient, such as past run-ins with the law, treatment for stress or aggressive behavior, or other clues that could indicate the patient is confused or agitated. An ED doctor or nurse seeing those clues in the EHR could then not only alert the hospital's security personnel, but call in specially trained care providers or social workers to work with the patient.
"There's so much information out there that could be useful," Patel says, "but in the past a lot of it was fragmented." In many cases, ED care teams were forced to piece together past reports or self-reported data, then an educated guess as to whether to take precautions.
Aside from reducing violence in the ED, the platform also improves care coordination and management by bringing in behavioral health resources more quickly to treat a patient. This ensures that a patient is connected more quickly to the right care providers and isn't forced to wait for a long time in the ED—an additional source of stress and agitation.
"The impact of the ED case manager program and our work with PointClickCare for patients with behavioral health challenges has been substantial, even during the pandemic, when behavioral health needs have increased, and staff resources have been stretched thin," Patel said in a separate e-mail to HealthLeaders. "Today, unnecessary ED utilization by individuals with mental health challenges managed through this program remains 44% lower than the six-month period prior to entering the program. And, because of the social determinants of health component of patient assessment, individuals not only receive better care, but also connections with resources that help meet their whole health needs, from healthy food to transportation to appointments or safe shelter."
There are, of course, challenges to using the technology. Patel says the platform was initially intended to reduce bias by giving providers as much objective information as possible so that they didn't have to make a decision solely based on how a patient looks or acts. But technology can introduce bias as well, and providers are cautioned to not jump to conclusions.
"This has to be treated very carefully," he says. "We have to avoid labeling patients. And that comes with learning how to use the technology correctly. We're all getting much more [comfortable] with the technology, but we have to avoid asking too much of it. The system is only as good as what we put into it."
The Centers for Medicare & Medicaid Services has issued guidance changing Medicaid and CHIP coverage for eConsults, or provider-to-provider specialty consults conducted via digital health or telehealth. The ruling could expand the service, which helps primary care providers keep more of their patients and boosts access to care for underserved patients.
Federal officials have expanded coverage for specialty consults between care providers via digital health for Medicaid and Children's Health Insurance Program (CHIP) members.
In guidance issued earlier this month, the Centers for Medicare & Medicaid Services (CMS) announced that interprofessional consultations, or instances when a care provider seeks the advice of a specialist for a patient's treatment, via eConsults can be covered by state Medicaid or CHIP programs even when the patient is not present, as long as the consult is focused on that patient.
eConsults are clinical consults usually conducted via telemedicine (including the telephone) or digital health. They enable primary care providers to expand care management options for their own patients without having to send those patients off to a specialist. And they improve access to care for patients who might not want to travel to see a specialist due to a variety of reasons, including distance and cost.
Alongside helping primary care providers retain more of their patients, the platform is popular with federally qualified health centers (FQHCs) and community health centers who treat underserved populations and in rural areas where access to specialists is scarce. It also helps specialists expand their reach and treat more patients in need of their services.
"Timely access to specialty providers can improve the quality of care and treatment outcomes for both physical and behavioral health," CMS wrote in its guidance. "While access to specialty care has been a challenge across a range of specialties, access to specialty care for mental health and substance use disorders has been a particular challenge."
The ruling changes the payment model so that the consulting provider, or the specialist, can bill for the treatment. Previously, CMS allowed the treating provider to bill Medicaid, which in many case forced the program to pay higher rates to the treating provider so that he/she could reimburse the specialist for consulting services.
To qualify eConsult coverage, both care providers must be enrolled in the Medicaid program in the state where the patient is located, though the consultant can be located in another state.
"Given the potential for improving access to specialty care, a number of states have obtained authority through state legislation for or expressed interest in covering eConsults," the Los Angeles-based Manatt, Phelps & Phelps law firm wrote in a recent blog. "States that choose to cover eConsult codes must submit a state plan amendment to CMS to add a payment methodology for the qualifying service, and should consider broadly communicating any related policy changes to their enrolled provider community."
The Chicago health system and CVS Health are partnering on an ACO that will be part of CMS' REACH direct contracting model, aimed at improving healthcare access for Chicago-area residents on Medicaid.
While some see retail healthcare services as competitors to traditional healthcare organizations, Chicago's Rush University System for Health (RUSH) is launching a partnership with CVS Health aimed at improving health equity for Medicaid patients.
RUSH, which comprises RUSH University, three hospitals, and a network of outpatient care sites, is joining a newly created accountable care organization (ACO) developed by CVS Health. The collaboration is based on the redesigned ACO Realizing Equity, Access, and Community Health (REACH) direct contracting model developed by the Centers for Medicare & Medicaid Innovation (CMMI).
Through the program, RUSH and CVS Health aim to create a care management network for Chicago-area residents on Medicaid. It will enable members seeking care at MinuteClinic locations in Chicago and Evanston to access additional services, including specialty care, through RUSH.
“This provides another option for patients at a time when access to high-quality health care is more important than ever," RUSH President and CEO Omar Lateef said in a press release. "It will help strengthen care coordination for patients, while enabling them to receive services convenient to where they live and work.”
“As part of CVS Health’s care delivery strategy, we are engaging our assets on behalf of this ACO REACH population to help drive high-quality outcomes, promote health equity, and bring healthcare costs down,” added Mohamed Diab, CEO of the CVS ACO. “Our strategic alignment with RUSH has the potential to help improve longitudinal care for their Medicare population of 35,000 beneficiaries.”
The partnership offers not only an interesting example of collaboration in the competitive primary care space, but highlights the efforts of the healthcare industry to tackle barriers to access for underserved populations, including social determinants of health. The program will include access to virtual and home-based care, transportation support for annual wellness visits, cost-sharing options on co-pays, and other incentives and services.
“RUSH has a long-held commitment to improving the health of the communities we serve,” Lateef said in the press release. “This agreement reflects that strong commitment and a terrific opportunity to build upon that foundation of strong community-based programs and partnerships and have impact for patients on day one."
The number of hospitals improving their EHR platforms to enable data sharing, especially from outside sources, has more than doubled since 2017, according to a report from the HHS Office of the National Coordinator for Health IT (ONC).
The number of hospitals improving their technology base to promote interoperability has more than doubled in the past five years, according to a new data brief from the Health and Human Services Department's Office of the National Coordinator for Health IT.
The ONC brief, which details interoperability advances from 2017 through 2021, also found that hospitals have improved the availability and use of their electronic health record platforms to accept data from outside sources, and half of the nation's rural hospitals now have information electronically available at the point of care.
"Hospitals’ rapid improvements in interoperability could be attributed in part to the initial implementation of health IT provisions from the ONC Cures Act Final Rule (Cures Rule) and adoption of 2015 Edition certified technology," the ONC brief, prepared by Yuriy Pylypchuk and Jordan Everson, says. "The Cures Rule updated the Health IT Certification Program to include new and updated criteria and standards that will advance interoperability. Nearly 90% of hospitals have adopted 2015 Edition certified technology and are well positioned to adopt these new and updated criteria and standards."
"Other data show that a large majority of hospitals have already done so," it continues. "Additionally, 74% of hospitals adopted the bulk data export capability, as of 2021. The most common uses of bulk data export were for analytics and reporting (63%) and population and health management (35%), and, less so, for switching EHRs (12%)."
Among other findings in the report:
Health information service providers (HISPs) and health information exchanges (HIEs) remain the most common methods used by hospitals for electronically sending and receiving summary of care records.
More than 60 percent of hospitals have used an HIE to to electronically query or find patient information from external sources.
Hospital participation in CommonWell Health and the Sequoia Project's Carequality increased significantly between 2018 and 2021.
significantly between 2018 and 2021.
An appendix to the report listed the top barriers to exchanging health information. They include:
One partner in the exchange doesn't have an EHR or other electronic system to receive data.
Difficulty in matching or identifying the correct patient between systems.
Challenges of exchanging data across different vendor platforms.
Difficulty in finding a provider's Direct address.
"Policy activities that support cross-network exchange such as Trusted Exchange Framework and Common Agreement (TEFCA) will help reduce the number of different networks and methods that hospitals need to use to support exchange," the brief says. "Other provisions of the Cures Rule are being implemented now to help hospitals shift from simply establishing connectivity to optimizing and simplifying the use of multiple methods of exchanging information. However, some barriers to information exchange remain prevalent. For instance, 48% of hospitals reported one-sided sharing relationships in which they share patient data with other providers who do not in turn share patient data with the hospital."
"Given that a majority of hospitals (74%) reported the ability to integrate information into their EHRs, current policy efforts could increase the value of that integration," Pylypchuk and Jordan Everson conclude. "For instance, recent actions were taken to improve the quality of data from external sources by advancing the use of specific data elements, such as through the United States Core Data for Interoperability (USCDI), and through the required use of standardized application programming interface (API) technology using the HL7 Fast Healthcare Interoperability Resource (FHIR). Efforts such as these should help ensure that information is available, integrated into the EHR, and used at the point of care – all of which have further room for improvement and will ultimately drive improvements in care and secondary use of data, such as for research."
A new report says the proposed Amazon-One Medical deal will reshape the healthcare delivery landscape, and traditional providers will need to make changes to keep up.
A new report from Forrester Research says the Amazon-One Medical partnership could strongly impact the healthcare delivery landscape in the near future, and offer a few tips for healthcare organizations interested in keeping up.
The report says the almost $4 billion proposed purchase of primary care company One Medical by retail giant Amazon, currently being reviewed by the Federal Trade Commission, marks an important stage in the integration of fee-for-service and consumer-facing healthcare. And it places Amazon at the front of a wave of retail-based healthcare services announced or planned by Walgreens, CVS, Walmart, Google, and others.
"The rise of consumerism driven by the pandemic spurred soaring demand for personalization and digital disruption in healthcare," it notes. "Today’s traditional healthcare systems struggle with poor patient experiences, long wait times, lack of transparency, and legacy technology."
Healthcare organizations are paying close attention to the Amazon-One Medical deal, as well as others in this vein, as the marketplace heats up for on-demand primary care services, which can also serve as a platform to other services such as specialty care and chronic care management. Because traditional health systems have struggled to keep up with a tech-savvy consumer population that looks for ease of use and convenience, those consumers are looking to other providers for their healthcare needs. This includes not only retail care centers but self-insured business and health plans.
Aside from not addressing the consumer's wants and needs, much of the healthcare industry still focuses on reactive, episodic services at a time when many consumers—and a good deal of healthcare innovation—is turned toward preventive or proactive care. Forward thinking providers now talk about the patient's entire healthcare journey, which not only includes treating current health issues but collaborating to improve health and wellness and reduce the chance of more serious health issues later on in life.
In addition, the pandemic has shone a spotlight on the challenges of healthcare access for underserved populations, a problem that traditional healthcare organizations have struggled to address. New care pathways and programs are focused on integrating health equity, giving underserved populations more opportunities to access services.
According to the Forrester report, the Amazon-One Medical partnership could address many of the deficiencies in the current healthcare landscape. With a consumer-centric strategy, the platform could make use of an evolving pipeline of new technologies, including pre-built collaborative filtering engine (CFE) algorithms and cloud technologies. Amazon also features an evolving ecosystem of new products and services and a solid platform to introduce third-party products and services.
"Healthcare is moving toward orchestrating long-term loyalty and longitudinal relationships," the report points out. "The more information providers can gather about a specific patient, the easier it is to deliver seamless, proactive care. This is where Amazon and One Medical have not only unlimited opportunity but also a critical responsibility. One Medical’s 767,000 members’ patient data combined with Amazon’s own robust consumer profiles and various healthcare and retail experiences put Amazon in the driver’s seat to transform the patient experience."
To compete in this new landscape, the Forrester report offers three recommendation for traditional providers:
Highlight and adhere to transparency. Healthcare organizations have to invest in technology resources or partner with technology vendors to comply with new price and data transparency requirements—something that only about 6% of hospitals now do.
Make interoperability "the cornerstone of the patient experience." Healthcare organizations need to either pare down the various platforms and products that keep patient data in silos and lead to incomplete medical records and subpar care. "Healthcare data interoperability is the key to creating holistic records, but it is still not commonplace for healthcare organizations," the report says. "To overcome this hurdle, technology executives must leverage vendors and partners with deep expertise in HL7 FHIR and ensure that new technology investments comply with the latest regulations promulgated by the CMS and ONC Cures Act final rules."
Empower patient accountability through education and communication. Many patients are still confused about their healthcare journey, and they aren't taking advantage of new digital health and virtual care tools and services designed to make that journey easier. Providers need to pay more attention to talking with patients, educating them about to use these new tools and giving them the resources they need to improve the journey.
Fairbaugh, who rose through the ranks as a paramedic and nurse before getting a Master's in nursing informatics, has been named chief clinical information officer for the Pittsburgh-based 40-hospital health system.
Fairbaugh had been director of clinical and operational informatics and emergency services at UPMC Magee-Women's Hospital prior to the promotion, and now supports clinical operations across the Pittsburgh-based health system's 40 hospitals and 800 outpatient sites. A former paramedic, he has more than 21 years of experience in nursing, emergency medicine and informatics, joining UPMC as a nurse in 2002 and completing his Master's in nursing informatics in 2013.
HealthLeaders recently spoke to Fairbaugh—virtually—about his role and his priorities.
Q. What are the responsibilities of a Chief Clinical Information Officer?
Fairbaugh: As the chief clinical information officer, I oversee the safe, secure implementation of technology in the healthcare workplace. My teams are familiar with current medical systems, and continually seek opportunities to integrate technology to a greater extent within these systems to improve the quality and effectiveness of care.
John Fairbaugh, MSN, RN-BC, chief clinical information officer, UPMC. Photo courtesy UPMC.
In this complex field, as informaticists, we need to consider the combination of healthcare practices with IT resources and analytics to measure and improve outcomes, drive healthcare decisions, and to provide a high-quality experience for both our patients and providers.
Q. Your healthcare career began as a paramedic, then transitioned to nursing before moving into informatics. How has that career path shaped your view of clinical informatics?
Fairbaugh: This career path has allowed me to see many different aspects of healthcare, both in the ambulatory and the inpatient setting. As the healthcare landscape shifts from a traditional inpatient to more of an ambulatory outpatient approach, having the knowledge of both will help me lead my teams to implement technology that will communicate across all venues.
Digital technology is rapidly changing the way we live, and healthcare is not immune to this. The way providers deliver care will continue to be challenged as more consumers want increased access and convenience to manage their care. This shift will require organizations to implement technology that allows for improved communications and tools that enhance both the clinician and patient experience.
Q. What are your goals for 2023 and beyond in this role?
Fairbaugh: Over the years as our $24 billion heath system has grown, our IT systems have become increasingly large and complex. This has led to a deterioration in usability and created alert fatigue and documentation burdens, while exacerbating some disruptive workflows.
The plan for my team is to work collaboratively with both our IT and clinical leadership to implement standardized technology that supports the mission, vision, and values of UPMC. We will concentrate on taking an enterprise approach that enhances quality and safety, user and patient experience, and financial stewardship. Our people must remain our priority during this time to promote efficiency, usability, reliability, and connectivity for all users and patients.
Q. How has the pandemic affected clinical informatics, and what have you learned from the pandemic that you'll be applying to your job?
Fairbaugh: COVID has allowed healthcare leaders to see how vulnerable we are as healthcare organizations and has escalated the need for technology transformation and the growth of healthcare informatics. As we face today’s financial and staffing demands, we must radically improve our technology to adapt and support clinical workflows. As a leader in technology adoption and innovation, UPMC is well-positioned to drive this change.
Q. How do you define and approach healthcare innovation? What new technologies would you like to use?
Fairbaugh: Healthcare innovation will mean providing patients and providers with technology options that harness opportunity to manage complex health issues. It will be necessary for organizations to provide access to digital tools, apps, and health trackers with embedded artificial intelligence (AI). When providers and patients have this access, it will improve their ability to prevent disease and manage care, while also improving our patients’ ability to make the best medical decisions for themselves.
Q. How has the value and usefulness of the EHR evolved over the past few years? How do you or your department use the EHR? And how could that platform be improved?
Fairbaugh: Technology has become the new normal for our healthcare industry. Although many remember the days of paper charting, we all know the power of data to drive high-quality decisions.
Providers also depend on technology to collaborate and manage care.
Healthcare consumers also want to utilize technology to manage their care to enhance convenience and ensure they are getting the best value possible along with quality outcomes.
We as healthcare organizations will need to look at our technology over the next few years and implement systems that help improve communications and decision-making while providing patients with quick access to their records to collaborate with their providers. For this reason, it will be necessary for organizations to implement systems with standardized technology and interoperability to share information quickly with many different applications and tools to make the technology meaningful for every user.
Q. How do you see the role of CCIO evolving? What more would you like to do in this position in the future?
Fairbaugh: The chief clinical information officer role has evolved from handling day-to-day clinical technology operations to being a key leader in strategic decision-making. Today's technology is changing at an ever-rapid pace and requires more critical thinking about interoperability, security, and usability to ensure our providers have the necessary tools to support clinical practice and to limit disruption that may affect patient outcomes. Our non-IT clinical leaders depend on our expertise to ensure technology supports clinical workflows, evidence-based care, and the best outcomes for our patients and the entire organization.
This position and healthcare informatics in general require that informaticists have a formal knowledge of both clinical and IT models and workflows. We need to be the change agents that mediate the collaboration between clinicians and IT which requires us to have experience in both. Until recently, there has been an abundance of siloed work which has increased our vulnerability as organizations. As we move forward, we need to develop and form a concrete governance structure that improves the collaboration and decision making as an organization to meet our goals.
Q. How does the CCIO impact the evolution of healthcare as we move from episodic to value-based care?
Fairbaugh: As payers prioritize value-based care, hospitals will be charged with aligning their processes and workflows to support this new healthcare delivery model. As a leading integrated healthcare insurer and provider, UPMC understands the need to improve our technology to support consistent medical practice with standardized workflows and to identify and support patients who are most at risk for adverse outcomes.
CCIOs will be challenged by their organizations to improve communication among many different healthcare providers so the care can be shared among many specialists. Placing meaningful data in the hands of physicians and other care providers will give them more control over patient outcomes. This will help drive high quality care and provide benchmarking of value-based metrics, like length of stay and readmission rates, to drive results.
With stress and burnout rampant within the healthcare industry, health systems are looking for new ways to use surveys and social media to boost morale and highlight positive news.
In today's social media-saturated landscape, healthcare organizations need to stay on top of their brand to ensure a positive public image and address any negative publicity quickly. But health systems can also use that platform to improve patient engagement and, more importantly, tackle clinician stress and burnout.
Several health systems from across the country have joined a Clinician Retention Workgroup launched by Feedtrail, a North Carolina-based company focused on experience management technology. The goal of the workgroup is to study how patient experience data, coming from surveys and social media channels, can be used to combat burnout and disengagement, and boost clinician engagement and morale.
"We've been focused for so long on patient satisfaction," says Dennis Lamb, chief experience officer for Texas Tech Physicians, the medical practice network for the Texas Tech University Health Sciences Center School of Medicine, based in Lubbock. "It's time we started looking at our physicians and focusing on them. They want to hear how they're doing, too."
Paul Jaglowski, co-founder and chief strategy officer for Feedtrail, says health systems have typically focused on a generic post-discharge survey to keep track of how they're doing. But with the growth of social media and consumer-centric care, alongside increased competition in the primary care space, savvy healthcare executives are developing better programs that allow patients to rate and comment on every aspect of their healthcare journey.
"Engagement shouldn't end with surveys," he says. "There are many more opportunities now to engage with [consumers and patients], and healthcare organizations can choose their own thresholds. They can get visibility into what is being said and even guide [commenters] to the right person or department."
Aside from monitoring a hospital's or health system's public image, the technology enables administrators to address critical or negative comments by communicating with the commenters and connecting them to resources to resolve complaints. Administrators can also address those issues within the organization, identifying areas where improvement is needed.
These strategies aren't entirely new. Organizations in many industries have used surveys and social platforms to both highlight the positives and address the negatives. The same is true in healthcare, with platforms such as Google, HealthGrades, and Yelp all offering opportunities to rate and offer comments on a healthcare provider.
But with the pandemic and a sour economy causing a wave of stress and burnout and pushing doctors and nurses to their breaking point, health systems are turning the technology around to focus on provider and staff engagement.
"Looking across our patient experience data, 80% of patient comments are positive and complimentary in nature, and this feedback can be an essential component to a healthcare organization's culture of gratitude," Jaglowski said in a December 2022 press release announcing the launch of the Clinician Retention Workgroup, which includes, alongside Texas Tech Physicians, Cedars Sinai, First Health of the Carolinas, and Huntington Hospital in Pasadena, California.
"Best in class organizations are connecting clinicians back to their purpose and battling burnout through the sharing of patient gratitude and we want to help them measure and operationalize this beneficial practice," he said. "Based on demand, we will continue to bring providers in to participate on a rolling basis as the industry continues to build a new blueprint for employee engagement and retention.”
At Texas Tech Physicians, Lamb says his doctors and nurses need this positive reinforcement.
"Physicians want to hear these things, too," he says. "Too often they only hear the negative things. We have to be better at communicating the positive things."
Lamb says the health system has protocols in place to address any negative or critical comments within five days, so that patients know their concerns are being addressed, but there's nothing on the books to pass along good comments. In fact, in one previous survey, more than half of the providers who responded said the health system doesn't do enough to emphasize good news.
"They're the ones on the front lines," he says. "Patients don't schedule an appointment to see your front desk people."
While health systems can gather this information through surveys and online comment portals, many don't know how to use the data. Efforts like the Clinician Retention Workgroup will give them a chance to share innovative ideas on new programs and resources aimed at not only passing along the good news, but boosting engagement and retention.
"Working in the emergency department is stressful, now more than ever, so as a staff member, hearing how you made a positive impact in the life of a patient or family can really give a needed morale boost," Claude Stang, executive director of emergency services at Cedars Sinai, said in the Feedtrail press release. "It is also an opportunity to thank the employee for upholding the values of the profession and the organization. We're looking forward to sharing more patient gratitude, learning from our colleagues in other organizations across the country, and, ideally, replicating this best practice across the organization.”
"It's going to be positive and it's going to mean more," says Lamb. "It's going to make a huge difference in how we can support [staff] because we'll be doing more than just relying on surveys."
