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Reimbursement outlook not slowing health IT implementation

A healthcare CIO explains the challenges his organization faces while sticking to its health IT implementation plan and keeping under budget.

This is the second of a two-part interview. The first can be found here.

George Conklin, CIO and senior vice president of Christus Health (Irving, Texas) will be a keynote speaker for the IMN HealthImpact Southwest conference in Houston April 3. We sat down with him to discuss the IT challenges for nonprofit health systems like his in an era of rapid expansion of clinical data systems.

Is there an end in sight to this influx of new demand for health IT implementations while margins stay brutally tight?

George Conklin: There's no end in sight. We are, however, unique with our international play. In Chile and Mexico, our senior VP just came back from a trip and said our dance card's full for the next five years. We have extensive growth there, and our plans involve integrating across the delivery system with them, as well. Medical travel is a great opportunity, because one of our partners is one of the most prominent hospitals in Mexico. In Chile, we're [aligned with] the No. 1 or No. 2 university in South America, kind of like the Harvard of South America.

What advice do you have for your peers at other hospitals or health systems for finding ways to keep funding the large data systems they need to implement right now despite the bleak reimbursement landscape?

Budgets now are made with strategy in mind, and everyone sticks to that.

George Conklin,
CIO and senior VP, Christus Health

Conklin: Stay focused. When it was announced broadly that I was going to have to take a $10 million budget cut, several of our regional CEOs contacted our corporate COO[chief operating officer] and said, 'That's not necessarily a good thing; we rely on George's team to support us to make operational enhancements. Let's make sure we don't cut off our nose to spite our face.'

The ability to focus is key. If I didn't have that and a supportive team here, I would have been chopped up into hamburger by those regional folks and our COO. But we've come together to the conclusion that we need to cut costs across the organization, establish the rules for doing it, agree on it and abide by it. Anybody who tries to circumvent that needs to be called out and held accountable. That kind of focus is very important, across the organization.

How is that different from the past at your organization?

Conklin: We used to have a wide focus as an organization, providing every service you'd want to have. A million flowers blooming. Nobody was able to do fairly well as we went from thing X to thing Y, and then thing X suffered as the dollars flowed to thing Y. Budgets now are made with strategy in mind, and everyone sticks to that. And that's my other advice: You can't go it alone, you've got to be managing it as part of a larger organizational initiative. IT's got to be there to help make the business plan in clinical services a success.

From your vantage point at a nonprofit health system, what do you think the lasting effects of the Affordable Care Act [ACA] will be, politics aside, for IT and the patient population you serve?

Conklin: I started as a clinical psychologist almost 40 years ago, practicing in New York under the late Jim Prevost, who was a student of the community mental health movement. It's something I have always believed in, myself: In health services, we should be pushing wellness, not the typical medical model of disease management. We should have gone that way decades ago.

I see the ACA forcing us to think much more broadly about integrating care, management of populations, success measured not by how many people you see but premium dollars you collect and don't ever spend on the delivery of care. Making us all more accountable.

I had a conversation with the vendor the other day. He was saying that his product was the way it is, and people need to be more accountable for their behavior. I said, 'Well, okay, I don't disagree with that, but at the same time we have an obligation that if we see a problem with a particular product, we fix that.' A great example is, what's been reported in the last few days at GM is another example of what happens when you don't take care of something when you find it out.

We all need to be accountable. We need to take responsibility for ourselves and our care. I come from a family where almost everyone on my father's side has died of prostate cancer and on my mother's, colorectal cancer and diabetes. Believe me, I saw the way my parents died and I'm taking responsibility for myself, because I don't want to go the way that they went. We all need to have those crystallizing moments in our life. If that happens because of what happened to me or because the health insurance program I'm on is forcing me to take responsibility, we all need to take it.

That's what we're moving toward in the healthcare system in the United States.

Let us know what you think about the story; email Don Fluckinger, news director or contact @DonFluckinger on Twitter.

This was first published in March 2014

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