At last, 2020 comes to an end. My best wishes to you and yours during the festive season. Here’s hoping that 2021 brings a return to something akin to normal. With that thought in mind, I will turn my attention to something less socially charged than responses to the COVID-19 pandemic or Black Lives Matter—topics addressed in past editorials. For a holiday treat, I look forward to digging in to new research topics. (Expectations management disclosure: I expect to receive socks and underwear as gifts.)
“Data, data everywhere, and not a drop of information to act on” is one of my favorite sayings. Note the difference I am drawing between “data” and “information.” Data is a raw material that cannot be readily applied, whereas information has some utility in decision-making. Administrators, regulators, and researchers routinely ask clinicians and staff to collect all manner of data points that have little or no bearing on what they need to practice. Moreover, saying that “we need the data” to “pay the bills,” “keep our accreditation,” or “make the world a better place through science” rings hollow, as those outcomes are difficult to link to the extra work being demanded. Simply put, those who govern data collection and how it is then used need to do a better job. To that end, a new healthcare professional has emerged: the chief research information officer (CRIO).
The CRIO position started in academic medical centers and departments of medicine where the need to convert administrative data into research information met the greatest challenges. In particular, scientists were unable to extract, combine, and interpret data from disparate sources. The standard data repositories (structured data sets) fed by the electronic health record (EHR) lack many of the fields needed to conduct research as a quality assurance, quality improvement, or scientific endeavor. The information technology departments that maintain the EHR system are not generally trained in the field of biomedical informatics that support research—hence, the need for individuals with skills that bridge the clinical, administrative, and computer science domains.
Given the disparate parts of the health system that CRIOs must engage, they must have authority to direct organizational activity. Therefore, the position generally reports to the chief executive officer, chief operating officer, or chief information officer. Thus, the designation of “chief” in the title signals to the organization that the CRIO has a direct line into most units. Naturally, this works best in healthcare systems that already have matrix or service line organizational schema where units routinely interact with multiple stakeholders.
So, what does the CRIO actually do? Essentially, CRIOs absorb data from the health system, strategic partners, and other sources to create a more complete picture of the work environment than is currently available. They take in these various data streams to create a single “data lake,” then flow the data in formats that end users can readily employ. Sounds simple. It is not. A great example of where a CRIO would be a key player can be found in this issue’s interview.
William Gunnar, MD, JD, FACHE, director of the Veterans Health Administration’s National Center for Patient Safety, oversees one of the biggest quality assurance/quality improvement initiatives ever undertaken. In addition to collecting data on clinical outcomes across numerous institutions, Dr. Gunnar oversees the creation and collection of new data while looking at how employees view their roles in the patient safety domain. It was interesting to learn during our interview how various patient safety initiatives were begun and have evolved, and where they are headed.
In the wrap-up of this year’s series of Future Leader columns, consultant and author Paul B. Hofmann, DPH, LFACHE, of Moraga, California, provides thoughts on the impact of the COVID-19 outbreak on health system leaders. He notes that organizations need the strategic flexibility to deal with the pandemic and the environmental shocks yet to come.
Jennifer Weiss Wilkerson, FACHE, vice president and chief strategy officer of the Sheppard Pratt health system in Maryland, takes up the topic of preparedness even more directly in the year’s final Financial Challenges column. She does a wonderful job of describing strategy’s process and actual aims, which differ greatly from what many people tend to assume. In short, planning matters—a concept that leads directly to our first research article.
No decision is more strategic in goal-concordant care than the completion of advance directives and physician orders for life-sustaining treatment. In their research article, Margaret R. Reed; Samantha Stewart, LCSW, ACM; Stephanie A. Meyer, LCSW, ACM; Edward G. Seferian, MD; and Harry C. Sax, MD, FACHE, of Cedars-Sinai Medical Center in Los Angeles, California, describe why and how to increase the use of these valuable tools. This commitment should be the norm rather than the exception.
Next in this issue is an article by Nir Menachemi, PhD, of the Indiana University Fairbanks School of Public Health in Indianapolis, Indiana; Troy Tinsley of Indiana University Health in Indianapolis; Ann Johnston, EdD, of the Indiana University Fairbanks School of Public Health; and Alicia Schulhof of Peyton Manning Children’s Hospital Ascension St. Vincent in Indianapolis. Their research is a great example of how to conduct a meta-analysis, and the findings are useful for health system leaders. In particular, their conclusion that Lean process improvement practices can generate substantial time savings as organizations become more adept at the process is heartening.
Continuing a “time is money” theme, Yingna Liu of Duke University School of Medicine in Durham, North Carolina, and Harvard Business School in Boston, Massachusetts; Ines Luciani-Mcgillivray of the Department of Emergency Medicine at Massachusetts General Hospital in Boston; Maryfran Hughes of the Department of Emergency Medicine at Massachusetts General Hospital; Ali S. Raja, MD, of the Department of Emergency Medicine and the Center for Research in Emergency Department Operations at Massachusetts General Hospital and Harvard Medical School; Robert S. Kaplan, PhD, of Harvard Business School; and Brian J. Yun, MD, of the Department of Emergency Medicine and the Center for Research in Emergency Department Operations at Massachusetts General Hospital and Harvard Medical School explore whether follow-up phone calls can reduce readmission rates. Indeed, the results indicate that significant cost savings can be achieved. Given the nature of care delivery in the face of COVID-19, increasing socially distanced engagement and reducing avoidable contact are ever more important.
The research by Hamlet Gasoyan, DMD, and William E. Aaronson, PhD, of the Department of Health Services Administration and Policy of the College of Public Health at Temple University in Philadelphia, Pennsylvania, explores another tool for managing readmissions: the EHR dashboard. They take a close look at health systems that are making greater use of EHR data as an information source. I wonder if these organizations had dedicated CRIOs?
The last research article in this issue takes on telehealth in the era of COVID-19. Gregory J. Esper, MD, of the Emory Healthcare (EHC) Office of Quality and Risk, EHC Telehealth Team, and Emory University School of Medicine Department of Neurology in Atlanta, Georgia; Robert L. Sweeney, EHC Telehealth Team; Sarah C. Kier, EHC Telehealth Team and Physician Group Practice in Atlanta, Georgia; Emmeline Winchell, EHC Telehealth Team; Hallie W. Lukens, EHC Physician Group Practice; J. Michael Duffell, EHC Telehealth Team; and Elizabeth A. Krupinski, PhD, EHC Telehealth Team and the Emory University School of Medicine Department of Radiology and Imaging Sciences describe their organization’s transformation to make greater use of telehealth technologies. They found that the rapid and effective transition from traditional care to telehealth modalities has been a financially effective approach to the pandemic.
This issue concludes with abstracts from the 2020 Forum on Advances in Healthcare Management Research. The first is by Sharon S. Laing, PhD, of the University of Washington Tacoma; Ryan Sterling, PhD, of the Veterans Administration Puget Sound Healthcare System in Seattle, Washington; and Carlota Ocampo, PhD, of Trinity Washington University in Washington, DC. They reviewed the use of mobile technologies by physician assistants as a care delivery strategy. Thomas G. Rundall, PhD, Stephen M. Shortell, PhD, and Janet C. Blodgett of the Center for Lean Engagement and Research at the University of California, Berkeley, look at the use of Lean tools and share recommendations for both practice and research.