Johns Hopkins' CIO On Making IT Serve Health Care

By Esther Shein

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Stephanie L. Reel is CIO and vice provost for Information Technology for the Johns Hopkins University and vice president for Information Services for Johns Hopkins Medicine.

She received a B.S. in Information Systems Management from the University of Maryland, and an MBA in Business Administration from Loyola College of Baltimore. Reel has more than 15 years of experience in information systems, working with health care providers and payers. Under her direction, the Johns Hopkins Health System is enhancing and advancing the use of the Johns Hopkins Electronic Patient Record, utilizing Web-based and client/server technologies.

The Johns Hopkins Hospital also has implemented state-of-the-art patient-centric clinical systems in support of a new comprehensive cancer center. These same solutions are now being more broadly deployed across the enterprise. Clinical decision support, and executive decision support systems have also been implemented, to improve the care delivery processes, and to address many of the fiscal pressures realized by academic medical centers.

Q: Most of your professional career has been spent in health care as a technology professional. What led you to this industry per se?

The honest answer is my mother was very, very sick most of my childhood and I spent lot of time with her appreciating her illness. My older sister became a radiology technician, my younger brother became a cardiologist and I became a technologist in health care. I'm not sure if that was serendipitous or due to my mother's illness. I speculate some of it may be my respect for health care community while watching my mother deal with a serious illness...I felt that it was something I would enjoy doing. How I got into information technology, I don't have a clue. I thought I wanted to be a math teacher and then I decided I didn't want to be...and I wound up getting degree in information technology. I thought it would be more intriguing and a way to make a difference.

Q: Hospitals are generally behind the curve in terms of applying technology to improve business processes. What have you done to turn the tide, so to speak?

At a place like Johns Hopkins the real challenge is not how do you motivate people to use technology, it's how do you best leverage technology to do what the faculty or physicians already know is the right thing. When you're surrounded by this insatiable appetite for excellence and perfection and sort of a relentless pursuit for excellence in science, excellence in teaching, excellence in health care and everyone sort of marches to that excellence pursuit drummer...that never comes up. It's the opposite. It's how do you provide the correct technology and how do you provide what you already know needs to be done? The people I serve are clearly among the brightest and most demanding and probably have a very clear sense of what they need technology to do. My job is to find a way to make sure technology does it for them. So it's a bit unique. I suspect my CIO colleagues in academic medical centers probably feel similarly about the deployment challenges -- how do you bring technology to bear on the challenges they have defined? The need is well defined; it's a matter of pulling it together and providing the appropriate solution.

Q: What is The Johns Hopkins Electronic Patient Record?

A small group of physicians at Hopkins started to meet over dinner in 1994. They felt they needed to do something to make it easier to work here...figure out a way to use information technology to make it easier to practice medicine here; make it the best place to be a patient, a doctor, a medical student, whatever. They talked about this very topic once a month at dinner. Then they decided to invite some of us who worked in information technology to join them. I was among the invitees. It's important to note we were already using technology in information systems but wanted to kick it up a notch. They quickly came to a few conclusions: we could take advantage of the clinical system we were already using and do some not very expensive things to make it more user friendly and helpful to them. By the end of the summer of '95 we were actually successful in implementing what they wanted us to do. It was a relatively rudimentary improvement to what was already in the environment. Some of it was how information was presented to them. Thinking back to the early '90s it had been very character-based, mainframe, green screen, an older technology and it needed to be spruced up partially from a presentation perspective. We needed to present information in a more appealing way. I think also included in that was to get some additional documentation, like clinical notes or discharge statements, more readily available on our workstations.

So we took what was only available in a paper record to make it available in an electronic record. That's important because it gave us credibility and earned their confidence in us. As more and more doctors started to use it, we enlarged that evening group and started meeting every two weeks on a Tuesday night and...continue to further enhance the electronic patient record.

We had our meeting last night, as a matter of fact, so we still meet on Tuesday nights and we still talk about the same kinds of things. Last night we talked about taking advantage of the electronic patient record to create a comprehensive integrated problem list and are working now on how do you parse the information that's in dictated and transcribed medical records to cull out of that document a meaningful problem list to the next doctor you're going to see? So the important message is, there is a group over the past eight years that has evolved...chaired by very bright and very senior members of our medical faculty and we make tough decisions and prioritize our work and use their input to decide precisely what to do. That does differentiate us from many organizations like us. We use consultants very little and our own faculty to decide what's important and what to do next and they participate in the pilot and tell us how to improve the product.

Q: How many people participate in these Tuesday night meetings?

The total number of people invited to the meeting varies; it is about 50 -- probably 35 physicians or nurses and 15 IT professionals. Who comes is all over the map. It usually ends up being about 40 people who come -- usually about 20 to 25 care providers and 15 IT people. We meet once a month now the first Tuesday night of the month from about 5-7:30. We always have dinner and a good dessert, too.

Q: What sort of challenges do you face in serving as CIO of disparate entities like a hospital and a university?

I don't think it's typical to have a [single] CIO of both. The decision here at Hopkins to integrate all of IT under a single CIO was also evolutionary...I was in a role where I was doing a lot of [the work] and the rest of the university didn't have a CIO, and we stared talking about whether it made sense to bring it all together and honestly decided to give it a shot. There are challenges, but the advantages far outweigh the challenges. We do benefit from one another. In spite of the fact that there are two different cultures the problems we are trying to address and needs we are trying to meet -- high speed networking, a secure environment -- it's not so different. When it was two separate IT organizations we tripped over each other a little bit and did not use our collective resources as well as we could have. The first thing I did in '98 [when Reel became vice provost for the university] was bring together the help desk, data center, networking, and telecommunications [infrastructure] and it gave people growth opportunities and an opportunity to better serve our customers as well, because there wasn't as much confusion about where to go; it was sort of one stop shopping.

I also think a university like Johns Hopkins that has a school of engineering with a computer science department and an institute for security...it's a wealth of talent that is embedded within the school of engineering. Had we not consolidated the organization under a single CIO it's possible we wouldn't have leveraged all that talent in some of our actionable items -- we get to experience some of the benefits of the faculty's work. By having that wonderful resource and the relationship with school of engineering, it really makes it easier to do our job. I have about 30 students that work very part time with us...we are able to recruit students who by the very nature of their programs, are interested in information technology or computer science, and they work in our group and we hire them to do very specific projects.

Hopkins is largely grant funded so if Intel or Microsoft is funding a faculty member to do research in certain area, we can learn from that faculty's research and can apply it in a particular area. It's a learning opportunity for my staff and it promotes staff development and makes it a more exciting place to work. Q: How have you leveraged the Web to provide information to your constituents?

Probably like everyone else on the planet we are trying to empower the people we serve more and more by giving them the tools they need and most of them are browser based...I think health care is absolutely behind the curve and we've been late adopters of some of the Web-based technologies we are now using more and more to give access to technology and faculty and students so they can access systems using a browser. We've been a late adopter primarily because of our focus on security and privacy and we want to make certain as we deploy technology they are appropriately protecting an asset and intellectual property.

Q: What is occupying the bulk of your attention right now?

Probably two things that are almost equally consuming: one is our focus on patient safety so I have a number of projects that are funded initiatives related to patient safety. If you think of clinical decision support and making sure the physician has all the information he or she needs at their fingertips when ordering medicine, making sure they know of an allergy or are already on another medication -- so clinical systems to support patient safety is very, very high on the list. I already mentioned security and patient confidentiality. That's probably right beside patient safety. That consumes a lot of my time and energy. The second thing is our student information system. As a university we have not done a great deal over past five to 10 years in this area and we are in the process of deploying a comprehensive student information system. It's a big deal and it's very comprehensive. It's really the empowering stuff -- letting the student apply, register, schedule, get grades online, get their curriculum online. They will have full and complete access to improve their life at Hopkins. It's like a student portal; understanding what people expect, how to get it to work, all that. The administration and faculty component are equally important components. They need to be able to enter grades online, that's the other half of the student view.

Q: What's your view on implementation of new technologies and bleeding edge versus a more conservative approach?

One of our core values in IT at Johns Hopkins is science and innovation. I think that's probably the toughest core value for us to attain or achieve or sustain because in the real world we all live in budgets that are not unlimited or infinite so we don't have slack resources to explore emerging technology, yet it's a critical piece of what we owe to the institution. We need to explore emerging technologies. I'm a bit more conservative than my colleagues. Our challenge is to be incredibly fiscally responsible. So I try to make sure our staff stays in touch with all of the newest and greatest emerging technologies but we don't broadly deploy bleeding edge solutions until they are proven. I encourage staff to learn what they can; we have every tangible commitment to innovation, but we don't deploy less than proven technology broadly. We may pilot [new technology] with a small subset of the population. I think that's part of our fiscal accountability and fiscal responsibility.

Q: How large is your IT department and what skills are you in most need of right now?

If you look at the entire shop it's about 400 people across the university and health system. The skills I need most right now are project management skills. With the dotcom bust a few years ago there are lot of bright programmers and engineers and we have been successful in recruiting talent in the technology areas but project management and all the skills associated with that -- leadership, motivating, providing direction and good discipline project management--have not been as successful. It's not as easy to find the discipline you need in managing a department where there is insatiable demand, when the faculty is as driven as they are and as demanding as they are. It is easy to quickly sit down and write some code and satisfy a demand. That's gratifying. So there's a temptation to do that in an environment like this that's very fast moving and embracing change. But to do it in the context of a plan or in support of a strategy takes more time. It's not necessarily sustainable so we're making sure there's somewhat of a disciplined approached to the deployment of mission-critical applications.

Q: Which of your skills has served you best in managing IT?


Q: What advice would you give someone in IT who is looking to advance the same way you have?

My advice would be spend every bit of energy you have trying to understand the business needs of your organization and the business strategies, where your organization really wants to be and then work with the best of the best to design the right technological solutions to meet those needs.

Q: What keeps you awake at night?

It probably varies from night to night...it's a little bit of that fiscal responsible how do I make sure I'm demonstrating value to the institution, and my staff. What do we need to do next and communicating to our customers we're doing the right thing. How do we make sure we're listening and responding appropriately? I also lay awake wondering about staff development and how to keep them energized, informed and aware of what's important.

Q: What do you do in your spare time?

Hike. It's my escape. My husband and I love to do it and we hope that before we die we hike the entire Appalachian trial. That's what we do for fun.

If you know of a CIO or CTO who would like to be profiled, please contact Esther Shein at eshein@rcn.com.