Tilling the Fields of Innovation
Inside the head of Oliver Degnan, CTO of Marshfield Clinic
California has its “Silicon Valley.” Now Wisconsin has “Silicon Fields,” a hotbed of healthcare innovation and proving ground for new technologies based in America’s Dairyland. It’s the IT Department at Marshfield Clinic, where CTO Oliver Degnan strives to empower everyone in the organization to not just embrace change but to effect it. And help keep the entire clinic (not just IT)a step ahead of the competition.
LEAD IT: So where did the term “Silicon Fields of Wisconsin” exactly come from?
DEGNAN: Previously, I was chief architect for Intuit in Silicon Valley. When I arrived here and saw Marshfield Clinic surrounded by fields, I said, “Let’s tear down the cubicles and call it the ‘Silicon Fields of Wisconsin.’”
I’m hoping with a cool name it’ll help to attract new talent, innovative thinkers, and daredevils (smiling) that is key to innovation.
LEAD IT: Provide a brief overview of your roles and responsibilities as Chief Technology Officer of Marshfield Clinic.
DEGNAN: Simply stated, my role is to introduce innovation. I worry about the technology experience for patients and providers. How new technologies influence their experience a Marshfield Clinic is extremely important. A large part of my role is to establish the mindset that everybody in the organization can be innovative. As an organization, we can reinvent ourselves over and over to align with changes in healthcare and be a true healthcare innovator.
LEAD IT: Your role description clearly illustrates how the role of a CTO has changed. It’s an institutional change, management and leadership role, and it’s clearly not about purchasing technology.
DEGNAN: That’s right. They won’t let me code anymore. I’m one of those CTOs who likes to walk the talk before I preach to the choir. For example, any new technology or device that comes out – I get it myself. I live with it for some time. I actually make it part of my personal life, my work life, and truly translate the innovation behind the technology to what it means to me. Is it enabling me to do a better job? Do I believe in it?
Other employees see me constantly walking around with multiple devices, the typical CTO, but I’m looking at it from a user experience and cost management point-of-view. How can this lower the cost of ownership of the technology? How can it add more value to the organization? How much more likely are we to be innovative with these new devices and technologies?
LEAD IT: In the future, the focus appears to be where patients are taking a more active role in managing their own health; requiring less inpatient admissions and procedures – which all has to be supported by technology.
DEGNAN: Correct. In order for this to be a success, we also have to consider how we see this technology improving the outcomes, effectiveness, and efficiency of the providers.
LEAD IT: The patient use is directly related to the provider use?
DEGNAN: The technology can’t wait for the provider to import data over and over. In the traditional EMRs, during every patient visit the provider asks the same questions and fills out the same fields again and again. We want to automate this as much as possible and have a “smart” system, but “smart” means something very specifically. It means the system actually thinks and offers and distributes advice to the care providers. This is crucial.
LEAD IT: How do you see technology determining whom to target for specific advice?
DEGNAN: Sometimes what the provider wants to know varies from what the MA wants to know, and you have to distribute that knowledge by utilizing analytics. This really is the shift in healthcare.
LEAD IT: The key issue is the integrative function.
LEAD IT: …and how to interface with a scope of patients from all ages, all technology backgrounds, all levels of education. That seems to be the other challenge. You have that huge variation in patient education, background, and economics.
DEGNAN: Technology has to be transparent. It has to be ever present but not in the way. When you look at point-of-care real-time analytics, there will be a point where providers expect technology to always be available. If it’s momentarily unavailable, it will distract the provider from making a decision. For example, the provider is taking a patient’s blood pressure and expects immediate
Information based on the real-time analytics; information on the percentage of patients in that defined population with the same result and information on the best diagnosis or care plan.
At that moment, if the technology is unavailable, the provider’s pace of service is affected.
LEAD IT: To summarize, you’re stating that technology needs to address and integrate three levels: Provider level, Diagnosis/Point-of-care level, and Patient Management level?
DEGNAN: I really hope so. Look at IBM Watson, for example. Watson is actually more than clinical decision support. It looks at unstructured data, text data, and uses natural language processing and points out what’s missing. That attribute is quite amazing! Today the classic EMRs available are just about data input. The second-generation architecture is about the relational and structured data input.
Drawing the patient into the care and managing the patient’s data in front of the patient is a huge opportunity for the provider to educate the patient while truly assessing their risks … and even apply a bit of cognitive behavioral therapy.
LEAD IT: What do you view as roadblocks to getting there organizationally, technologically, etc.?
DEGNAN: There’s a lot of stress on healthcare right now but that’s also an opportunity. Many times innovation comes out of doing more with less. Being put in a spot where you don’t have access to unlimited funds and you don’t have 20 years to test, you’d be surprised what can happen. I truly believe that’s a big aspect of innovation technology.
LEAD IT: Is it like the disruptive technology approach? Instead of making large capital investments, it occurs through elements like innovative software and virtual solutions?
DEGNAN: That’s right. Let’s look at the four generations of architectures. The first generation is hierarchical architectures. Traditional EMRs are a great example. The second generation is structured data input, which is relational architectures – quality in, quality out. The third generation is service-oriented architectures. That is where the organization commits to system integration into an interoperable manner and interoperable data exchange, which is the foundation for an ACO and Patient Centered Medical Home (PCMH).
Fourth generation is cloud computing and distributed processing. In this state, the health record no longer has a home.” The health record lives in the cloud. Somewhere somebody owns one portion and another caregiver owns a different portion. When a provider accesses the health record, they don’t care about where it comes from but instead care about the immediate response with a complete patient record. Complete integration comes into play between the ecosystems of all healthcare organizations.
Somewhere somebody owns one portion and another caregiver owns a different portion. When a provider accesses the health record, they don’t care about where it comes from but instead care about the immediate response with a complete patient record. Complete integration comes into play between the ecosystems of all healthcare organizations.
LEAD IT: That sounds like a utopian, idealized future. How does this directly affect lowering the cost of healthcare IT?
DEGNAN: It is. The third-generation, service-oriented architectures, produces the highest return on investments because the organization can reuse existing services to create new functionality within the ecosystem of care and enterprise. The result is a decreased need to purchase new assets thereafter or at least not in the quantity they have to with the first- and second-generation architectures. Going back to my point of culture, it’s not just the culture of healthcare; it’s also the culture of IT. IT is used to doing certain things, building systems in a certain way, buying technologies based on certain principles. It’s no longer cost effective to standardize on the devices, so we standardize on the network, service bus (interoperability), and storage solutions.
LEAD IT: Is there a cultural challenge where it’s hard for providers to give up control?
DEGNAN: Everyone has to trust the data and information delivery. Our providers are some of the smartest people I’ve ever met. They understand what matters today and what will matter tomorrow. They understand how important the role of healthcare information management is and the quality of data, and that it – if applied correctly to enabling technology – could truly raise efficiency, quality, and care.
LEAD IT: It’s all about managing unstructured data in all different forms and integrating it?
DEGNAN: Traditional data is morphing into something different. We’re moving to incredible amounts of data. Add genotypes equations into the mix and our data will quadruple over the next two to three years alone. That’s when Hadoop comes into play, and we look at big data processing. That’s where Marshfield Clinic is heading. It’s the ability to absorb data and quickly apply certain algorithms to forecast certain behaviors and outcomes. For example, we know that 90 percent of the data we’ll have in 24 months doesn’t exist today.
LEAD IT: And you have to consider your current and future staff that can actually analyze the data and quickly respond. What’s that role within the organization that maybe doesn’t exist today? It’s not an IT role specifically?
DEGNAN: You picked up on something really important. The business of health information management should not entirely live within IT. The business of information management lives within the clinic. A health information management center needs to be created. It has a dotted line to the practice, to the CMO, to the practice of medicine, and to IT. That’s where the CMIO should live.
This is also where the data scientists, analysts, and data architects should live and where the master data management happens. That’s where your glossary and data relationships is being maintained, which is the quality and the definitions of your data.
These roles must live in the business. Only then can we work on health management and health data management strategies and business goals. From an IT perspective, we can then align to those strategies and goals by purchasing the right technologies and setting forth the right capabilities.
LEAD IT: So, it’s an enterprise issue?
DEGNAN: Yes, and we have to have an enterprise view on health data management. IT is no longer that body, at least not the way I see it today.
LEAD IT: The next few years are going to bring an amazing amount of change and development. In the next five years, where do you see the shift in healthcare heading?
DEGNAN: The fundamental shift is moving from the episode-based care model to the outcome managed care model.
If a patient moves from provider to provider, the health record must stay with the patient. If the record stays with the organization then the organization is managing it. Since the patient is no longer with that organization, the record is inadequately managed. As an involved patient, the goal will be to manage their own health record and participate in the goal setting. Health reform is moving the patient into the center of care while establishing a care model surrounding the patient.
Providers must find a way to apply technology where they’re directly connected with patients, similar to a social media setting. Look at it this way: one patient visit is 15 minutes. Let’s say the provider sees 20 or 30 patients a day. What if with the right technologies and social media that raises to 50 patients a day? What if half of the process is automated?
What if the system sends out an email or an SMS page to patients saying, “Don’t forget to pick up your medication today.” Or the system reminds patients of their care goals, even goals as simple as daily exercise. Wouldn’t it be cool for the provider, the system, to suggest a treadmill exercise?
So the patient is more connected and involved. It’s about offering more, but the trick is for the providers to get paid. If the system is interfacing with the patient and connecting the patients with the providers, there has to be a way for the provider to cash in. The moment we have that business model in place, these kinds of technologies will take off.