Two of health care education’s best and brightest explain the programs they’ve enrolled in, what challenges they believe technology presents to health care professionals and more.
Autumne E. Smith
Productivity Manager, Palmetto Health
What is your background, what program are you enrolled in and why did you choose to enroll in this program?
I am a 1998 graduate of Winthrop University with a Bachelor of Arts Degree in Psychology. During my sophomore year at Winthrop, I received my first real exposure to health care from the patient perspective. Fast-forward my work efforts to February 2003, when I joined Boyd Management, my professional home for 14 years. This is where I truly began my career path. Initially, I was hired as “the supply girl.” Quickly my proficiency in software programs and process improvement became evident. Unbelievably, when I arrived at Boyd, they were using DOS-based data software. My first major project was to create a database with Microsoft Access to house all relevant information for more than 300 properties. From that moment on, I became the technology expert for Boyd Management, specializing in everything from the basic Excel document training to writing script and uploading forms to Yardi Systems. As much as I enjoyed working at Boyd Management, I realized that my role there was at a ceiling since it was such a small company.
A former co-worker, Sarah Shinsky, who currently works for Palmetto Health, contacted me and informed me there was a position opening up as an assistant for the chief value and informatics officer. She knew I would be a good fit for this division. My first thought was, “What is informatics?” Needless to say, there was considerable Google searching going on! After my initial interview, I was intrigued. Who knew there was another side to health care? I never pursued this field because I thought the only way to be involved was from a clinical aspect (I cannot take the sight of blood, so that was out for me). I have always loved technology and analytics. Often throughout my career, I have led innovation for new initiatives where technology carved the path into new frontiers.
True story! My first day working at Palmetto Health, I was shadowing our manager of telehealth. She was engaged in conversation with BrightMD, which is our asynchronous, low-acuity telehealth solution. They were discussing the EMR and I interjected a question into the conversation: “Pardon me, I don’t mean to interrupt, but what is an EMR?” They were kind enough to explain that EMR stood for the Electronic Medical Record. In that moment, I swore that I was going to become the saguaro cactus of health care and soak up every word I heard. I wrote down everything I understood, researched topics, studied for meetings and asked a LOT of questions. I had the good fortune to begin at Palmetto Health under the tremendous leadership of Dr. Tripp Jennings. He quickly began to include me in meetings, thus growing my health care knowledge. Over the course of my first year with Palmetto Health, Dr. Jennings and I led the business intelligence efforts. Once our business intelligence director, Moh Zaman, joined the team, I became his right hand with the project management of the data lake. This work is what sparked my desire to rejoin the student population and apply for the Masters of Health Information Technology (MHIT) program at the University of South Carolina. While at Palmetto Health, I have served as project manager for the foundational data lake installation and development. This project is still in its infancy, but as far as implantation goes, we have been developing the SOW, business use cases, and KPIs for many months. The knowledge I have gained in just a few short months is truly remarkable. I can now speak intelligently about the difference between descriptive, predicative and prescriptive analytics. I have learned about Hadoop, Spark, and R. This project was the catalyst for my quest in pursuing the MHIT degree.
Through the first portion of my MHIT program, we have learned many different aspects of information technology and how it specifically relates to health care. Through the use of electronic health records and the health information exchange, patients can now be treated from a holistic standpoint, so continuous care can be providing almost anywhere at any time. One major issue facing health care today is the treatment of a patient population not widely discussed: children. Many of my research opportunities have centered on health information technology (HIT) efforts with the pediatric patients. Just this week, we conducted medicine management research and I found significant HIT opportunities by including e-prescribing systems with pediatric functionality. Common errors associated with children are medication therapies that are weight-based in their diagnosis. Furthermore, this patient population may have difficulty expressing adverse effects to the medications. This is an issue very near and dear to my heart, as my young son had a medicine error when he was in the hospital. Had the health system had an e-prescribing system with pediatric functionality that included weight dosing and medication catalogs, he may have avoided the adverse effect.
I grew up in Greenville, South Carolina, as an only child. My father was diagnosed with cardiomyopathy when I was a very young. His disease caused him to become disabled and he stayed at home while my mom worked sometimes two jobs to support our family. Over the years, his condition declined to the point that his only option for survival was to receive a heart transplant. I was a college sophomore and just finishing finals when my dad called to tell me to meet him in Charleston; he was getting his new heart! We spent that summer in a small apartment just outside of downtown Charleston while he recovered at the Medical University of South Carolina. This procedure extended my father’s life far beyond anyone’s expectations. Before he passed away in 2012, he was able to walk me down the aisle and hold both of his grandchildren. Truly, this gift is nearly impossible to put into words.
Looking back now, I understand the data which matched that young man with my father to provide his lifesaving heart. Somewhere, someone connected a nationwide database for all transplant recipients. A person wrote the algorithm that said the heart was compatible. Telecommunication systems were in place for the transplant teams to make the heart delivery and communicate with our family. That is the power of HIT. Putting data into the hands of those with the expert knowledge to save lives — that is how I am going improve health care. Maybe one day, I can look into the face of a child whose parents were just saved and know that I made a difference.
What are some of the biggest challenges that health care professionals face in terms of technology?
There are three key challenges that health care professionals face in terms of technology:
- Technology overload: The ultimate goal for health care providers is to provide patients with safe, high-quality, low-cost health care. Technology should follow these same protocols, which means being present when it is safe for the health care provider to interact and to provide information that yields safe results (e.g., providing the correct medication dosage or treatment plan). Technology solutions should be high-quality, operating reliably and providing meaningful, accurate data in real time. The tricky piece is the cost that surrounds technology. Health systems often try to save money by not purchasing all aspects of a solution, which leads to a workaround that then may affect the first two points of safe and high-quality technology solutions. We often discuss delivering the right health care to the right patient at the right time. The same sentiment needs to pertain to health care technology as well; HIT must deliver the right solution to the right provider at the right time.
- Data standardization: Data is dirty, everywhere. The reason? Very little global data standardization. This could be as specific as how to enter a blood pressure, to as broad as how to define a readmission or length of stay. With the data tsunami that has invaded health systems, we have the ability to begin to understand how to improve our nation’s health by identifying those underlying causes that may affect blood pressure and readmissions. However, so much time is spent “cleaning up” data to ensure accuracy that we lose efficacy. The Health Information Exchange (HIE) is only living up to a fraction of its potential. The federal government has pushed for robust HIEs to help clinicians without laying the groundwork to include data standardization. It is sometimes nearly impossible to match patients because there is not one key identifier for a patient in the HIE. Yes, it is important to look at technology solutions from the overarching systems-thinking approach, but without the foundational standardization and infrastructure, you are building a million-dollar house on top of matchsticks and waiting to light a fire.
- Regulation compliance: In the ever-growing field of regulatory compliance, we find that health systems have to provide excessive documentation. This can vary by agency so much that we have to employ full-time staff to meet these rigorous requirements, which raises the cost of health care. Let’s talk about Centers for Medicare and Medicaid Services (CMS) as an example. We have to submit quality data to CMS on a quarterly basis. However, it is up to six months before we can any analytics back on the data submitted. Hospital systems can often be penalized based on what this data says up to three years post-submission. And as aforementioned, data is dirty everywhere; sometimes CMS is right and sometimes CMS is wrong based on dirty data. If we were able to provide standardized data and reduce data latency from both the health systems and CMS, we could provide actionable information that could actually make a difference.
What are the three most important skills that professionals and students will emerge with after participating in one of these programs?
The MHIT program really is the intersection of health administration and information technology with an emphasis on health care. We have spent time understanding code, user interface design principles and database management, all of which are keys to success. However, I would say the three most important skills that professionals and students will emerge with are:
- Systems thinking: So much of the health care industry operates within silos that do not provide effective operational and technical foundations. It is important as HIT leaders that we understand how any technology initiative affects all aspects of a health system. A HIT solution must first meet the goal to provide safe, high-quality, low-cost health care to a patient, but in doing so, that means the solutions could affect numerous areas of business. HIT leaders must look at the solutions from a systems thinking level, but have the ability to take that approach and break it down to the details to ensure any implementation is effective and meets its goals.
- Applying a growth mindset: Ah, the power of the word “yet.” As HIT leaders, we must continually grow our mindsets and ask questions. The principles we learned in relation to continuous improvement, lean tools and process improvement go hand-in-hand with any HIT initiative. A professional or student must have these tools to know how to process map current state, future state and identify the steps to get there. These are keys to a successful HIT solution implementation.
- Strong communication skills: You must be able to obtain buy-in before, during and after any process improvement or HIT implementation. If you cannot identify the appropriate stakeholders, communicate effectively and gauge buy-in at all levels, you run the risk of failure.
What do you think the future of health informatics/health information management looks like?
I firmly believe that we are on the cusp of providing revolutionary health informatics and technology solutions to all patients that can vastly improve health. The power of real-time analytics to identify patients at risk for readmissions and provide interventions to get the right preventative care to these patients is revolutionary. Technologies such as artificial intelligence, augmented reality and virtual reality are already making a significant impact in radiology and physical therapy. I believe that the key to sustained and continuous improvement is training for leaders in programs like the MHIT. We have to understand the global need for HIT but be able to implement at the foundational level. Through this, we truly will be able accomplish the basic goal identified years ago in “To Err is Human: Building a Safer Health System” and improve patient safety. After all, patient-centered care is why we are in health care to begin with!
Sambasiva Rao Gangineni
Graduate Research Assistant, Boston University
What is your background, what program are you enrolled in and why did you choose to enroll in this program?
I graduated in 2017 with a bachelor’s degree in civil engineering, and currently I am enrolled in the Master of Science in Computer Information Systems with a concentration in Data Analytics.
Data analysis erases the boundaries between various disciplines. My case is a good example of this: Even though I hold a degree in civil engineering, I am currently able to work as a graduate research assistant under Professor Guanglan Zhang in Boston University Metropolitan College’s Health Informatics Lab. This is all possible because of the data analysis. If you can learn how to analyze data, you can analyze the data of any area, be it finance, health care, geo-spatial, traffic data…the list goes on. This is one of the main reasons for enrolling in this program.
What are some of the biggest challenges that health care professionals face in terms of technology?
Health care data growth is exponential, and its collection, processing, storage, security and analysis are some of the challenges that are involved. Health care professionals have less exposure to these stages of data management and analysis, and not knowing how the infrastructure works in these stages hinders them from adding value to health care by using the data they have. Also, health care professionals have less exposure to programming, which is an important tool to manage the data.
What are the three most important skills that professionals and students will emerge with after participating in one of these programs?
- Programming: which is a way to communicate with the machines.
- Analytical thinking:which yields valuable insights from the data.
- Data management: which is important in efficiently storing, processing and retrieving the data.
What do you think the future of health informatics/health information management looks like?
Health informatics will reach a stage in the future when each and every individual will be able to track the status of their health from a mobile app or a website. This is possible by personalizing the health data of an individual and running automated analysis on the data with the help of machine learning and artificial intelligence. The individual — as well as health care professionals — will be alerted about an imminent precarious situation, and care will come on time.