A chat with Infor's CMIO (that's Chief Medical Information Officer)

Profile picture for user ddpreez By Derek du Preez October 1, 2014
Dr. Barry P Chaiken has 20 years worth of experience in the medical field, both in the US and in Europe, and he has some interesting plans for Infor's health apps.

Earlier this month at its annual user conference in New Orleans,  Infor announced an upgrade to its core suite of applications – dubbed Infor Xi – which

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aim to further push the company's customers into the cloud with mobile-first applications that are beautifully designed and have business intelligence built into the processes and workflows.

Infor's go-to-market strategy has always been to focus on micro-verticals, with its applications tailored to specific industries. And at this year's Inforum, one of the industries that was frequently dubbed by the Infor exec team to be a leader in Xi adoption, was healthcare and medicine.

Although this may come as a surprise, given that healthcare hasn't got the best reputation for being a leader in technology innovation, much has changed recently in the US thanks to Obama's Affordable Care Act. Whilst there has been some high profile glitches (let's not mention the Obamacare portal, shall we?), the policy underpinning the Act could potentially drive a wave of change across the profession in the years to come.

This is certainly the opinion of Infor's Chief Medical Information Officer, Dr. Barry P Chaiken. I was keen to talk to Dr. Chaiken, given that he is far from just another corporate exec that is trying to flog some software. He's a trained medical professional with more than 20 years worth of experience in his field, where he not only has a masters degree in public health from Harvard, but is a Fellow of the Health Information Management and Systems Society, is on the board of the Journal of Patient Safety and Quality Healthcare and is a member of the Royal Society of Medicine in London.

Basically, he knows his stuff. And I thought it would be a good opportunity to not only get some insight into his plans for Infor's Healthcare apps, but also get his views on how the Affordable Care Act is impacting hospitals across the United States.

Dr. Chaiken's take on Obama's changes to Medicare and Medicaid centres on the idea that hospitals and doctors, in previous years, have been incentivised to 'do more' in order to get larger reimbursements. He believes that this unintentionally took the onus off of quality provision of healthcare and instead put it on carrying out more processes and procedures, to get larger reimbursements. Dr. Chaiken said:

The reality is that American healthcare, irrespective of the payer, was really very different than other healthcare systems around the world. That's because for over 50 years we had a system that incentivised people to do more stuff. That's why we are spending 18% above GDP on healthcare in the US and yet we lag in a couple of key factors in terms of the quality of the healthcare we are getting.

If you look at some of the OECD reports, you will see we are pretty much at the bottom in terms of what we do - in terms of infant mortality, pre-natal care, lifespan etc. Additionally, if you look at one key metric around our country's ability to prevent pre-mature death before the age of 75, we do worse than a lot of other OECD countries. That was driven by 50 years of us having incentives in the wrong place.

Incentives to do more testing, more procedures. I'm not suggesting people had bad intent, but when you incentivise people, it's a natural thing. It should not be unexpected, it's not crazy, it's perfectly rational – you should see the overspending, because we encouraged people to do more. We even encouraged people not to share information with each other, because if you don't share information, you have got to order the test, you've got to do the procedure.

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However, one of the key requirements introduced as part of the Affordable Care Act, is value-based purchasing for Medicare reimbursements, which is filtering down into the private players too. What this means is that reimbursements will not longer just be dependent on what you do and how much you do, but rather the quality and efficiency of the service that is provided to patients.

Dr. Chaiken said;

Things have dramatically changed in the past couple of years. Now we are in an environment where we will pay you, but we won't pay you for things that are unnecessary, we won't pay you for mistakes that you make, we will incentivise you to do better.

One perfect example, CMS, or our Medicaid and Medicare services – they do not pay for readmission to the hospital, if that readmission occurs within 30 days of discharge, if the condition is the same. If you have pneumonia, got paid on a fixed rate, were discharged, but then that patient comes back to the hospital with the same disease – shame on you hospital, you don't get reimbursed. Whereas, before you did.

Within the first six months of this programme, they saw a 17% decrease in readmissions under Medicare.

Infor's approach

Dr. Chaiken's point is that these changes are forcing hospitals and doctors to be more efficient with their care, in turn providing an opportunity for vendors to sell them systems that do exactly that. Until recently, Infor's main clinical offering centred around a system called Cloverleaf, which is essentially an electronic health information exchange.

However, in April Infor acquired a company called GRASP that specialises in automated patient acuity, workload management, patient assignment systems and consulting services. Essentially, what GRASP allows hospitals to do is assign nurses based upon the clinical workload of the patient. So, for example, a diabetic patient in a hospital is likely to need less care than someone on a ventilator, so GRASP can take that information about the patient and know from evidence based data how much care he or she will require over the course of a day, or a shift. Dr. Chaiken said:

We are also soon going to release something that allows you to assign the patients using a graphical interface, so we know what the needs are and we can assign those patients and keep track of clinical workloads and clinical assignments.

Wouldn't it also be great to take an inventory of the skills of the nurse? They're all different, they have different skills sets and experiences. If you can inventory that and compare it to what the patients need for the shift, all of a sudden you've got a really smart assignment tool that assigns the right patients to the right nurses with the right skills. You maximise the care for the patient, you optimise your resources.

This level of automation could also be extended to supply chain, according to Dr. Chaiken. He added that Infor's recently created data science lab will initially be focusing on how it can build intelligence into Infor's health apps, as he believes that there is a strong opportunity in this field for the application of business intelligence built directly into processes. He said:

You could also link the ordering of goods and services to best practice for treating specific ailments. For example, knee replacement surgery requires a

certain set of treatments based on best practice - so hospitals could organise and plan supply chain deliveries based on that best practice. It can be incredibly efficient, you even deploy just in time delivery.

Combine this with financial data, supply chain data, clinical care documents – all of a sudden you have a really interesting platform that you can understand what's happening in the organisation and how to deliver it.

The science labs is really great, because in healthcare we have done a lot of research in clinical trials, but we haven't done a lot of big data research. Additionally, we believe that how you lay out processes and workflows, and how you get information to people is important – we believe that they will begin to understand what information is needed, in what format, for those people who are taking care of patients and we can embed that intelligence into our software to make sure information is delivered in the right way.

My Take

One thing that Infor does particularly well is hiring people out of industry that know the field and know what needs fixings – it did this with its design agency Hook & Loop and it is now trying to replicate this success with its big data labs. When speaking to Dr. Chaiken, you get the impression Infor really gets the importance of industry expertise at the highest level.

Disclosure: at time of writing, Infor is a premier partner of diginomica.