Current Affiliation: Chief Health Information Officer, HCA
Education: Oklahoma State University, Boarded in Internal Medicine, Fellow American College of Osteopathic Internists
How I describe my work to those outside the field …
I am responsible for the deployment of the advanced clinical functionality of the electronic health record across HCA. My team informs configuration, knowledge management, workflow solutions, and adoption strategies. That sounds very technical and the tech is the draw, but as you know most of our time and energy involves working with clinicians, leaders and IT colleagues to align the technology with people. We are still very much engaged in implementation and optimization, but we will finish hospital 128 in April and complete the enterprise this fall.
Years of experience
I have always been a frustrated that we were capturing all of this structured/semi-structured information as billing codes, and dictated problem-oriented records. My transcriptionist was creating searchable text documents by editing macros she had created, but we printed them out and filed them in paper chart. It seemed insane. In the early 90’s I was practicing in a large teaching hospital that was advanced relative to clinician facing HIT, but I saw a number of gaps in clinical workflow and information availability. Many reports were still delivered by courier and we had decisions that needed to be made without the right information. I was able to work with our local IT team to shave hours to days off the time between clinical results and information access. Shortly thereafter we started making secondary use of real-time information by running some simple algorithms to identify for our case managers patients at risk of delayed discharge. Each of those simple projects gave us all greater insight into the power behind information used effectively to improve care.
What are your ambitions? At the end of your career, what do you hope to have accomplished?
I would like to see us accelerate our use of informatics to improve the experience and outcomes for our patients and reduce the burden of the system interface for our clinicians. We have the tools with biometrics, predictive analytics, and incredibly powerful processers connected to massive data stores in our pockets. The barriers that must be addressed include the alignment of incentives, organizational structures, interoperability and an adaptive medical community.
Who or what are your “key sources” in the informatics field?
From the beginning, AMIA has been one of my primary sources through tutorial and the annual meetings. I did a brief fellowship through the National Library of Medicine I have taken a few courses at OHSU under Bill Hersh’s program and the The American College of Physician Executives. I track the literature through several topical PubMed searches that email me periodically. I also have to mention the AMDIS list serve which is populated by a great group practicing informaticists that are incredibly helpful, informative as well as entertaining.
What are your hobbies? What do you do for “fun”?
I love photography and flyfishing. I take a different approach to photography. I have several old large-format film cameras 4x5 and 6x7 as well as digital. I process my own black and white film then I scan the negatives through high-resolution scanners to create digital files to print. Living in the West for 20 years I am a big fan of Ansel Adams so I like blending the old and the new world. I build all my own computers, and I have my Grandad’s vintage pickup in the process of restoration. Our entire family likes water sports and outdoor activities. All four of our kids were competitive swimmers. My wife and I swam Masters for several years in Scottsdale, but we run more since we moved to Nashville. We all love to get together, usually close to the ocean or on the beach.
AMIA is important to me because ...
AMIA has broken the ground for healthcare informatics. It’s vision has inspired many of us. Being a part of AMIA allows you to meet those amazing leaders and build your own version of their vision. The research and publications that AMIA is responsible for, and its leadership, are why we are where we are today. We are truly standing the shoulders of giants to be able to do what we do.
I am involved with AMIA ...
I have been involved peripherally on the clinical decision support committee, the syntax committee, and the genomics group. I hope to become more involved.
It may surprise people to know ...
I actually wanted to be an astronaut as a kid, but I was too tall and too blind. I grew up in the 60s fascinated by the space program, especially the Apollo moon missions. I have several volumes on the design and engineering of the spacecraft and the computers and navigations systems designed at MIT for the Command and Lunar Module. That program accelerated the microchip and PC development dramatically. We have several fighter pilots in the family, Vietnam to Desert Storm era, of whom I am very envious. They did let me crash F15 simulators on a couple of occasions. I came away thinking that if we applied the information engineering that exists in the those cockpits of even 10 years ago to prioritize and present information in the EHR we would have to be in a much better place than we are today (although I did crash the simulator). So yes, I probably over use the aviation – medicine metaphor to make a case for patient safety and human factors issues in the EHR. But I do have this great idea for “fly-by-wire CPOE” I could tell you about over a drink sometime.