Interviewer (I): We are joined by Arthur Harvey, Vice President and CIO of Boston Medical Center. Arthur, thanks so much for joining us today.
Arthur W. Harvey III, MS, CPHIMS (AH): Thank you. Great to be here.
I: Well, we really appreciate it. We know you're busy and we know there's only about 3000 vendors that want to get a piece of your time. And so may be you are hiding a little bit, may be this is good refuge. But, why don't you start out by telling our audience a little about your background.
AH: Certainly, well I as you noted, am the Vice President and CIO of Boston Medical Center. I have been doing healthcare informatics now for about 30 years… um… I always like to say it's a good thing hospitals need computers because I don't know how to do anything else [laugh]. I started at Brigham and Women's hospital back before there was a partners and have sort of been in the industry both in the provider and vendor side, that whole time. I have been at Boston Medical Center for about five years, and you know, I just, I genuinely love this industry. I think it's a terrific industry to work in and in addition to my work at Boston Medical Center; I am also the chair of the medical informatics program at Brandeis University; so I spend a lot of time teaching the next generation so someday I can retire.
I: That's awesome! As a quick [inaudible], my son was born at Newton-Wellesley. The Boston healthcare community is just an awesome community.
AH: Sure it is.
I: All right, so may be you could give us a 10,000-foot overview of Boston Medical Center.
AH: Certainly. BMC is a Boston safety net hospital and trauma center. We are located in the south end. We are the result of the merger many years ago of University hospital, which is Boston University's hospital and Boston city hospital. So we are, as I said, a safety net, we are a trauma center, we are also the teaching hospital for, we are a full-blown academic medical center, the teaching hospital for Boston University. We share a campus with the Boston University School of Medicine and we also have affiliated set of health centers in and around Boston, our community health centers that we partner with to provide care for a lot of folks in Boston who don't have other places to get their care.
I: Perfect. Well as a CIO who's been at this for 30 years, you can help us direct and probably make people, help people make sense of where they need to go visit while they are here at HIMSS. What are the top three health IT trends as you are seeing as we head into 2016?
AH: That's a really good question. And there's, there are so many of them. So many things going on right now. If I had to pick, I'd say the most important one is the increasing patient focused… focus on healthcare. Now, whether that's patient engagement or whether that's mobility apps for the patients, or just stuff to make patients' lives more convenient, make them, it's easier for them to access healthcare and its also easier for them to be compliant. I think that's probably the biggest trend. Mobility in general especially for providers, healthcare workers are, you know, they are expensive people, they are educated people, they are really important people. But they are, tend not hang around their office. They are walking around doing business. So better quality mobility app locations are always involved. And the last thing is, either integration or interoperability, it's not the sexy part. Nobody, nobody really likes to talk about that, but if the plumbing doesn't work between all of these divergent systems, you know, we are not going to get to where we need to be. Analytics, you know, population health, none of that works if you can't collect the information from a variety of transactional systems.
I: Arthur, you just stomped right on the nerve there. I've been sort of a critic on the meaningful use from the very beginning because I think they left that key part out. We should've designed interoperability in from the very beginning. The fact that, I call it the chicken in every pot EMR, we paid every provider out there to implement an EMR and none of them talked to each other. And as a patient, Boston's a little better example, but as a patient in Alabama, if I want to see my whole medical record I got to log into seven or eight different portals. And, that's just nonsense. It's not how it should've been designed and interoperability is so important. So, its good to see things like FHIR and common well initiative and the sequoia project that are really making advances there.
AH: Yeah. I agree with you. I think all three of those are important and I would look at FHIR. I mean FHIR is the, one of the things that we really should've had a long time ago. And you know, one of the challenges with this is that the technical part of interoperability isn't hard, it's really the politics of it and you almost need a mandate from somebody that you will do this. And you are right. We had the chance with meaningful use to say this is what is going to be critical to us. Now, I do have some hopes for you know as we go looking towards what's going to become of meaningful use three, four, five, six or whatever replaces it. I have high hopes that we are actually going to see more of that useful interoperability as opposed to just meeting a standard.
I: Very well said. So, you are CIO and I am undoubtedly… undoubtedly there's things keeping you up at night and I know one is probably hackers. But, what are some of the top challenges that are keeping you up, that really make you worry and wondering if you can really meet your goals?
AH: I am tempted to say my schnauzer who tends to stand on my head, but the realistically the, when I look at it, it's the, its as I say in my sort-a country bumpkin way. It's the ten pounds of poop in a five-pound sack problem. We have too much to do and not enough people and resources to do it. And this is not unique. I am not whining about Boston Medical Center. This is an industry problem. We don't have enough bodies; we've got too much regulatory compli---Too much is the wrong term. We've got an awful lot of compliance things to do that take away from our ability to innovate and move the ball down the field. So that's certainly one of the things. Security is always a concern. You never know when the next problem is going to come up and whether it's going to be somebody just doing something stupid or if you really do have, you know holes in your system and are you testing them enough. And if I pick the third one, its, its vendors! I mean I think the one of the key things you do as a CIO is to pick vendors you can rely on if, we've all been in a situation where we've got a vendor who is kind of a little squirrely. That doesn't mean you shouldn't take a chance on them, but just need to make sure you've got a fall back position so they can't put you out of business.
I: Absolutely! We haven't yet gone into the topic of data and analytics. But, why don't we venture in there. What is the role of predictive analytics in your organization?
AH: Well, it's critical. I mean anybody who is running a healthcare organization of any size is got to be looking at predictive analytics, and using it to improve healthcare. I mean, for years and years we've looked at claims data and sort of, what you call the basic grade school kind of ok we ran a report, these are the naughty people. But the idea of predictive analytics at the level of the patient where you can take models and say this patient is exhibiting these kinds of behaviors and might be subject to these risks. That is really revolutionary for healthcare. And the ability to predict outcomes or at least chances of outcomes let's you focus; look healthcare's got constrained resources. What predictive analytics does is that it lets you focus your scarce resources where they are best applied to improve outcomes the most. And that's if you think about it really its just a guide to how do I, you know how do I precisely use the resources I have to better my overall patient population the most.
I: Outstanding. Perfect. You know I joke a little tongue and cheek about the 3000 vendors here that are trying to get on your agenda. But kind of is the case as you put together your strategy each year and you think about what actually gets on that agenda, what are the things going through your head that help you prioritize which things you are going to tackle.
AH: And I would point out that its not 3000. It's got to be at least 3500, cause I see them. They are all lined up in front of me here. Everybody waving their business cards. And I don't mean to make fun of vendors because I… you know when I started in healthcare a bazillion years ago, we were building our own EHR. We were writing it in-house. And you just don't do that stuff anymore. And there are lot of reasons not to do that stuff any more. So we rely on good vendors to come up with innovative products. And it's easier for them to innovate than it is for us to innovate because we've got other; we've got other challenges like treating patients all day long. So when I look at coming up in my strategy, the first thing I always like to say is if the CIO has a strategy, he is already lost. Ok, the strategy should be the institution strategy. And one of the things I have been doing at BMC is spending a lot of time working on my governance. So, the decisions about what we should do are being made by clinicians, hospital operations people, our senior leadership. I mean I sit with my peers on a committee and we talk about things, and mine's just one voice. So the key item is what is strategically important to, first of all the industry, second of all BMC within the industry and lastly IT. When I look at that, I am more focused tactically on how do I take the strategies and do them as efficiently as possible at a reasonable cost. And keeping in mind that I do have some duties to the organization in terms of is it robust, is it scalable, is it secure and all those sort of things which I am the arbiter of and that's, that's correct. So if I look at my current strategy, a lot of this is around population health. We have BMC; the overall organization owns a payor. So we are looking at setting up an ACO, we have an ACO. We are looking at how to operationalize it a little more. That's a real key item for us. We have finished an EMR implementation, a clinical EMR implementation put in EPIC and we are looking at doing a revenue cycle implementation. So that would be another big strategic item for us and that wasn't my decision. That was the decision of the organization. And lastly, it's about partnerships for us. It's putting in, it's improving the IT at our affiliated health centers. I provide IT services to them and a lot of that is on my plate for next year.
I: We've both been on the, at this multiple decades and we can, I am sure you'd say it's easy to screw in the systems, the hard part is getting the users to adopt them. What have you found strategies, what kind of strategies have you found are successful to increase your adaption.
AH: That's easy if you... if you do it right. And I say that, the way you do it right is you go ask them what they want first before you put it in. And sometimes we loose sight of that.
I: It's a simple statement but it goes a long way around.
AH: Yeah funny that! The generally speaking if I've got a, if your are putting in a system, I would like to hope; but not always true, but I like to hope its because its been driven by the needs of the organization that we are putting it in for. Now, we do certainly implement things where we get push back from the users who don't like something we are doing. And the real trick here is to try and explain to the users at a variety of levels, from you know higher in the organization right down to rank in file, why we are implementing the things the way we are. It's about transparency. If I, if I am putting in two factor authentication for remote access which all of the propeller heads in the crowd will go “OK that makes sense. We have to do that”. But it drives the… drives the providers nuts, because now they need a dongle or they need something on their phone. But if you explain what the reason is, you know HIPPA requires us to do this to be sure that we are secure. And if you don't you know, you are potential harm to the patients. I find that if you explain that you generally will get better compliance that if you just dictate. Cause IT you know, honestly IT shouldn't be dictating to the clinical people about what we do, that's not our job. It's to enable them
I: Exactly. So we're here in Vegas. Imagine you and me were going out right after this interview. We are going to go to the roulette table. And the numbers represent the emerging technologies. Something you don't have today or may you don't have very mature. And you and I were going to put all our money on that one thing that if we don't do that and get that started this year… three to five years you will be off course. What is that one thing or maybe a couple things that we need to place our bets on?
AH: Sure. Um actually one of my vendors who I do quite a bit with was had a presentation earlier today. And I think it was on point. It's the idea of looking at a digital strategy for patient engagement. This isn't sort of Care Management the way you think about it. It's what's your digital portfolio like for your patients. Are, is it easy to do business with you? Can they schedule an appointment on their iPhone? Can they take a picture of a wound? As a great story, the analyst for this, I should mean the director for this company, you know she had, her son got a cut on his finger that was infected. Well, she had to lug him into the ED. Shouldn't she have been able to take a picture of it with her iPhone and send it off? It's that sort of stuff. That doesn't have to be super cutting edge. Everything I just said, you kind of go; “Well Uber does that! Well, American airlines does that! How come we can't do that?” And, its about coordinating that so it's a good consistent presence. As you said earlier, you don't want to go to 52 different portals. You want this is the answer. So, you know to me, and that's really fundamental patient engagement at the base level. And, its really customer service. It's about how do we make the customers; make the patients want to get their healthcare from us. Cause we provide super healthcare. But in my shop sometimes it's hard to get the healthcare. And we shouldn't be. We should use technology to make that easier. That would be the first thing, I would say and I think the second thing I would say is, you know, population health is obviously the buzzword. But really it goes back to what we were talking about Predictive Analytics. What you are going to see is how do we use this type of technology? How do we use these analytics? These types of strategies to improve patient care without just throwing money at it. How do we more efficiently use our resources to deliver better outcomes for our patients? If I had two, two chips on a roulette wheel, that's where they would go.
I: Perfect. I love that answer. Thank you for that. You make a tremendous investment to come here. Whether you are here four or five days. You know, that's a significant part of your year. What's on your personal to do list while you are here to make sure you get it done while you are here?
AH: You know, I come to HIMSS. And everyone's got a different strategy for coming to HIMSS. The first thing I do, there are a few things. And the first thing is I come for CHIME. I am a CHIME member. I'm a firm believer in CHIME. I think that's a terrific organization and I get a lot out of the presentations, but I get a lot out of the breaks. Talking to my peers, my colleagues, people I've worked with and for in the past. Actually I was sitting the table between two of my old bosses. It was terrific! We had a nice time. So that's number one. And the other thing that I, I use HIMSS to do an awful lot of vendor, vendor meetings. A lot of what I call rhythm meetings, maintain the relationships with my vendors. I can have a quick meeting with somebody here and they don't, you know they don't take offense to that as opposed to and I could maybe investigate something quickly that I wasn't with them, that I wasn't really thinking about I didn't want them to have to fly somebody to my office for 2 hours so that's good. And the last thing and I, you know I'm may be I am odd duck. But I am an engineer by background and I love – Ok all of the big time boots, the Epics and the Cerners; OK those are nice. But I love walking around the small company booths looking for the next interesting company. And its not because I am sure they are going to be right, its just because I love knowing what's going on. I mean I'm passionate about the business. And this is, that stuff, that's the candy store part of my week to be able to walk around and say wow, even if it's something silly like somebody designed a new, a new wow. Oh here's a wow and it has this built into it, whatever. Its solar powered or whatever it is. I mean that's just fun stuff. And I genuinely like doing that. That's always a big part of my HIMSS.
I: That's great! Arthur we are winding down our time here. Before we let you go, where can people go to learn more about the great things you and your team are doing at Boston Medical Center?
AH: Well the best place is our website www.bmc.org. And if you are in Boston, please come see us. We would love to see you
I: That's awesome. That's awesome. www.bmc.org easy enough, right? Arthur, so great to have you. Thanks for sharing your wisdom, your story and all the great insights today
AH: Well thanks for having me. It's been a lot of fun.
I: It has been fun. That wraps this broadcast. Once again, we want to shout out a quick thanks to our sponsor Jvion.
- Intrepid Healthcare’s exclusive coverage at HIMSS16 sponsored by Jvion