From the outside in: Boston Medical Center CIO Meg Aranow discusses the enterprise art of cultivating new IT initiatives

Health Management Technology,  Jan, 2005  by Robin Blair

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e commonly herald the implementation of new info tech systems at healthcare organizations, and trade publications routinely run articles about such deployments. But behind the scenes, what does it take for those systems to first get on the radar screens of executives who make decisions and spend money? How does a forward-thinking organization weigh new IT initiatives in the wake of changing needs and sparse budgets?

At Boston Medical Center (BMC), Vice President and Chief Information Officer Meg Aranow says the driving force behind her organization's consideration of new IT initiatives can come from almost anywhere, but "almost never comes from an IT discussion." Come again?

Trickle Down, Bubble Up

According to Aranow, BMC management is in a constant monitoring mode, and at her urging, the world at large is their inspiration. Directions for future IT implementations "may come from a concept that trickled down from a senior management forum, or from a CFO wondering about our progress in improving patient safety," she says, or from a contingent of clinicians lobbying for new tech tools to streamline their jobs. "It comes from forums, conversations and musing, but it doesn't come through formalized channels.

"This may make us look chaotic at times," Aranow admits, but looks are deceiving. BMC is a private, nonprofit academic medical center, a 547-bed hospital and the primary affiliate for the Boston University School of Medicine that has mastered the art of IT implementation and utilization, from wireless to CPOE to deploying an enterprisewide EHR for its physician affiliates (see "Record Rollout for Physicians," HMT, August 2004), serving 60 ambulatory sites in 79 locations. At Boston Medical Center, there's a definite method, but no madness.

What Matters, What Doesn't

With an IT staff that numbers about 80, including about 30 business and clinical analysts, Aranow admits that the organization has only one CIO, and she's it. "It's up to IT leadership to put together two concentric circles and find the fits. One circle represents the organization's goals and priorities; the other represents solutions. It's our job to find the perfect fit." The process is never a static one, and, of course, elements inside those concentric circles are dynamic. Input comes from everywhere, and it's the CIO's job to lead an enterprisewide assessment of institutional goals and priorities, costs, community needs and available technology.

It doesn't matter, she says, to whom the CIO reports. What matters is "that the CIO has a seat at the executive table, and that he or she listens. Leading this effort is an organic process. It requires wondering what's up in the CFO's office, what does the IT staff hear from nursing, what's trickling over from physicians and how do patients respond to our efforts--and then, blending those answers into our existing knowledge of the institution's priorities and our assessment of where the trouble spots are. Only then do we turn our attention to probable technology solutions."

She says it is critical to look outside and beyond healthcare IT. "I encourage everyone in the organization to think beyond the organization and look for solutions before we encounter problems. Is there a smart way that supply chain folks track crates on freighters that we can adapt at the hospital? What technologies are used in retail operations that we can modify?" Government, manufacturing and even the gaming industry constitute sectors worth investigating, she says.

Answers Are Everywhere

As an example, Aranow cites lunching at a local restaurant several years ago, when restaurants had just started equipping managers and hosts with wireless headsets, and giving vibrating disks to guests to speed information about ready tables. This use of technology to dramatically reduce empty table time impressed her so much that she asked BMC's admissions director to visit the restaurant, check out the technology and see if there was an adaptation of it that BMC could develop for bed management.

Standardization is a process with great potential to help drive info tech deployments and still save money, according to Aranow, but it's a tough nut for healthcare to crack. "Healthcare remains a deeply cultural arena, one of personalization. Physicians who deliver care at a hospital usually are not hospital employees. They maintain individual practice styles, so top-down edicts won't work."

Similarly, patients want and expect a personalized approach, and to add value to the healthcare delivery equation, it behooves providers to make them feel they received it. "Unlike in manufacturing, our inputs vary," says Aranow, and present a challenge to standardization efforts. "Each patient's medical problems are different than on his last visit, so the interventions and expected outcomes are also different. There isn't a Hertz of healthcare, where you get the same outcome every time you use the service."