Icahn School of Medicine

Ashish Atreja

Two decades ago, a technological wave influenced healthcare IT, and fundamentally changed the role of CIOs. This wave - the advent of Electronic Health Records - brought with it a new paradigm, creating new CMIO positions as well as an ever-growing team of analysts, managers, directors, and VPs to help implement and support EHR systems. The expectations of CIOs rapidly evolved from the management of health information to directly supporting clinical transformation within health systems. Despite concerns related to lack of interoperability, decreasing provider productivity, and suboptimal user experience, there has been a huge investment in delivering EHR, with the $28 billion federal investment in health IT and the passing of the HITECH Act being key to incentivizing adoption.

While EHR interoperability has certainly improved, it fundamentally remains a transactional, provider-centric, record keeping system designed for the era of Fee-for-Service (FFS). Given soaring healthcare costs, significant variations in management, poor quality outcomes, and an increasing fragmentation of care, healthcare is shifting towards pay-for-performance (P4P), the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). This large-scale transformation towards value-based healthcare has unveiled a crucial limit to EHRs - that of enabling longitudinal care. The inability of EHRs to meet value-based requirements is, therefore, helping to shape a new technological wave of Health IT: The wave of patient-centered digital medicine technologies.

"While EHR interoperability has certainly improved, it fundamentally remains a transactional, provider-centric, record keeping system designed for the era of Fee-for- Service (FFS)"

In 2003, the Institute of Medicine (IOM) settled on the name Electronic Health Record to help direct the computerization of medical records towards improving the overall safety and quality of care for patients; not just to replace paper medical records. This, along with FFS shaped the EHRs we see today that were developed using a plethora of disjointed lab information systems, billing systems, and result reviewing systems. Much like this early evolution of EHRs, Digital Medicine has been loosely structured around a number of verticals, including apps, telemedicine, wearables, IoT, big data, augmented and virtual reality, AI, precision medicine and more recently blockchain. This amorphous nature makes digital medicine flexible and creates a unique power to address the shortfalls of EHRs.

Traditionally, CIOs have acted as the pivot between the IT team and the siloed health system in which they operate. This is built on the premise that healthcare is centered on the clinical setting necessitating CIOs to be comfortable interacting with the hospital, physicians and other medical professionals. Interaction with patients outside of the four walls of the health system has until now been the domain of general Public Health Policy, which is neither targeted nor personalized. This model is rapidly changing with the new wave of digital medicine which functions to engage patients beyond the clinical setting through digital therapeutics, remote monitoring, population management, and patient-centered engagement to name but a few. Recent FDA approvals of digital sensors to track adherence, to CRISPR, to continuous glucose monitoring, stand as proof that these technologies are now no longer limited to just early pilots but are ready for mainstream adoption.

This new innovation revolution is hitting healthcare IT and presents a rare opportunity for CIOs, who are uniquely positioned to develop the skills and knowledge needed

Shrawan Patel, VP, Medical Transformation, Rx.Health

to lead the wave of digital medicine change. Hospital bankruptcies have more than tripled with the advent of value-based healthcare and organizations can either disrupt by harnessing the power of digital medicine technologies, or they can sit and let themselves be disrupted. Echoing the large-scale job creation associated with the development of EHRs, executive teams are now filling with new digital leaders to take advantage of new digital technologies. Most health systems are seeing an expansion of C-suites with the addition of CDOs (chief digital officers), CTOs (chief transformation officers), chief innovation officers and chief population health officers. Despite these new C-suite roles, CIOs will stay relevant by acquiring knowledge of the rapidly growing digital medicine ecosystem, understanding how different digital medicine verticals can integrate together and with existing systems, and leveraging this to drive fast pace transformation. CIOs can then begin to lead an even more pivotal role than has ever been previously possible.

The final piece of the puzzle, however, is how do CIOs and other executives acquire these new skillsets? Beyond the traditional conferences, literature, and consultants, there is a need to structure awareness and knowledge of emerging technologies. Equally, there is also a need to foster an environment where health systems can learn from each other and openly share both their success stories and failed endeavors. One notable effort has been through NODE.Health, a non-profit coalition of health systems that aims to create a virtual digital medicine university. In summary, it is up to CIOs to take ownership of this second technological wave and leverage opportunity from these technologies so that Health IT and organizations can not only successfully survive but thrive in an increasingly challenging healthcare delivery ecosystem.