Johns Hopkins’ CIO On Making IT Serve Health Care

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.