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CIO Leadership Series: Greg Smith, Wheaton Franciscan Healthcare

Glendale, Wis. - When it comes to health information technology, Greg Smith doesn't have to wonder what the "business side" of Wheaton Franciscan Healthcare is thinking.

Smith, senior vice president and CIO of the faith-based healthcare system, has plenty of insights into the business side of the Wheaton “shop.” Armed with a master's degree in business administration, he once founded a computer resource business, and now sits on Hewlett Packard's healthcare executive committee.

These and other past business perspectives give him an advantage as he oversees Wheaton's information systems, as he aligns business and information technology, and as he collaborates with upper management. Smith, who starts to build IT-business alignment during the planning process, has begun the implementation of a comprehensive clinical strategy for the redesign of care-delivery processes and deployment of a McKesson electronic health record.

While his role hasn't changed much in the seven years since he was elevated to his current position, particularly in terms of his relationship with the CEO and the board, something else has changed dramatically.

“It's really the scope of the electronic health record initiative, and what we're attempting to do with information services, that has really changed,” he said.
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Transforming IS

What Smith and his information services staff are attempting to do is transform IS in a way that better supports operations at a lower cost. The clock started ticking on the $48 million health record investment in July of 2006, and within three years Wheaton expects to revamp critical information systems for care sites in metropolitan Milwaukee and Racine, and operations in the Waterloo-Cedar Falls area of Iowa.

Like football teams at every level of competition, Wheaton would like to have fewer turnovers, and healthcare processes are complex enough to include multiple hand-offs. That's why Smith, who serves on the McKesson Provider Technologies' strategic advisory committee, views the health record project as part of a clinical excellence strategy, with IS playing a supporting role.

“What we're doing is we are using the fundamental clinical logic that exists in these systems to rethink our clinical processes, and then find ways to reduce the number of hand-offs and simplify care-delivery processes, and some of that is done just through straight automation,” he said. “Sometimes, it's by putting information in the hands of clinicians that allow them to make better decisions because they have more information available to them on a real-time basis.

“It's really a combination of the two.”

Even with a combined approach, Wheaton will have to significantly adjust its processes. In fact, about 80 percent of the forthcoming change will be modifications in processes, while only 20 percent will involve supporting those new processes with the McKesson technology.

Wheaton has set the foundation by creating a common data center, consolidating IS as a corporate function, and focusing on technical and application standards that allow it to build a body of technology and deploy it repeatedly, rather than rebuilding it many times and deploying it once.

Promised benefits

Wheaton Franciscan Healthcare is comprised of five regional delivery systems and generates $2.2 billion dollars in net patient revenue. The organization employs 22,000 people, including 600 physicians, with 10,000 workers in metropolitan Milwaukee. In Greater Milwaukee, the system provides care to a quarter of the population through five hospitals and various outpatient locations, including four sub-acute facilities and two home-care agencies.

For the organization, the promised benefits of the health records project include $70 million in revenue, cost reduction, and cost avoidance over the first five years. After that, there will be a gift that keeps on giving, a $22.2 million annual improvement in Wheaton's cost position.

Smith believes in building the business case for IT by creating a performance baseline and tracking performance against that baseline to determine whether the value proposition has been achieved. As he explains, the projected annual benefit wasn't simply pulled out of a hat. Wheaton arrived at that number by taking a look at each software application and identifying opportunities for improvement, whether it was avoiding IV waste in the administration of medications, or an expense reduction brought about by automating a manual process.

“Once we've identified where there are opportunities for improvement, we go into each site and we try to get a baseline on the performance of that site, and how would that performance be improved,” he explained, “and then we calculate the value of the improvement financially. That's how we came up with $22.2 million.”

Going to RHIO

A member of the board of the Wisconsin Health Information Exchange (WHIE), Smith is part of an effort to help area health providers share patient information. A similar effort is underway in Madison, where hospitals routinely install medical record software developed by Epic Systems. In contrast, Milwaukee area facilities have deployed systems from multiple vendors, leading to speculation about how disparate systems impact information sharing.

Smith, however, believes electronic information exchange has very little to do with a common vendor. “You can have a common vendor, and you can build the same software in different ways, using different definitions of certain data fields, and still not be able to effectively exchange information,” he said.

WHIE has decided to pursue a model that blends elements of a regional repository for certain data, and a federated system for other data. The decision is still somewhat fluid, and a proof-of-concept test must be completed, but the fundamental direction is based on the experience of other RHIOs (regional health information organizations).

Smith is more enthusiastic about the potential of RHIOs than some of his fellow healthcare CIOs. He believes they have tremendous promise, but there is complexity associated with fulfilling that promise.

“The technology that is out there to support that kind of exchange is still in its infancy,” he noted. “Do I think that, eventually, RHIOs will evolve and add value? I believe they will, but I think we're at the very beginning.”

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