Originally Published: Mar 24, 2023
YouTube Video: https://youtu.be/DDjiIkmsofQ
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IOs must implement and optimize technology to improve the efficiency and effectiveness of healthcare delivery. Remote patients, remote workers, scarce resources, and increasing security threats keep CIOs awake at night. The job of the CIO is becoming more complex as technology evolves, healthcare organizations face growing cybersecurity threats, and the need to address the inadequacies of existing EHRs. In this session, hear from leading CIOs on shifting priorities in 2023.
Jitendra Barmecha, MD, MPH SVP - CIO, SBH Health System
Janae Sharp, Founder, The Sharp Index
Thriving in a Human Centered Data Driven Hybrid Healthcare System
Janae Sharp: Good afternoon. I am so looking forward to talking to you today. We got to sit down in January and talk about staffing and some of those real world issues for CIOs. And we just heard from Mickey Tro Pathi and talk a lot about the national interoperability level. And I really wanted to sit down with you both to revisit our January discussion and to kind of get that like boots on the ground really.
You know, real life picture of what it's like to be a CIO in healthcare and then what it's like to make those decisions. So thank you for joining us. Tell me how is it going since January? We talked a lot about staffing and, making long-term plans.
Jitendra Barmecha,: Sure. So, thank you for having me again. Let me.
By dissecting your questions from interoperability to the staffing and what is currently going on. Last weekend we lost one hour, so we had to make up for that. So that is the most recent. And in terms of interoperability and Teka this is a much awaited interoperability standards in terms of National Healthcare Information Network in terms of interoperability in terms of portability of phi or personal health records.
And more importantly is when we are trying to do care coordination or care management I, think these are building blocks and several of the building blocks have already been laid. Starting from the meaningful use now coming into the, what we used to call it meaningful
stage three is now called promoting interoperability, where structured data, whether they are clinical or quality, they're all coming together, and how we can share those data elements in a meaningful information way at the point of care that is very important, meaningful information at the point of care.
And the other use cases are obviously for the population, health management, identifying care gaps making sure that medication reconciliations are taking place. Making sure that the community at large is benefiting from any type of quality measures, whether they are medication adherence or even if they change their providers or physicians or clinicians.
There is a continuity of care. There is a longitudinal care, sort of seamless. Yeah. So, in our area we are, we have been contributing data to our regional health information exchange called Bronx Rio. Mm-hmm. And which for last 12 plus years. And we were always ahead of the game in terms of not only data contributions or data exchange but also in terms of analytics. So, we created under the innovation grant called Bronx Regional Informatics Center, where more meaningful information was were giving back to the providers. For impactful care gaps or overall population health manage.
Janae Sharp: Oh, that's important to be able to see it. You wanna know where your patients go and when you know.
Jitendra Barmecha,: Exactly. Exactly. And I think we have a good leadership at O Y C. There were good lessons learned from Massi Health and New York has been the forefront of health information exchange.
We look forward to not only complying, but making sure that our providers, whether they are community based or health system based or office based, they have access to meaningful information. Not only data, but meaningful information.
Janae Sharp: I think that's really important because there's a difference. Like you can have data and it's outdated or it doesn't have that continuity and, that's a big data project.
So you're the head of digital strategy, correct. Can you tell me. What projects do you have a big project you're doing right now, or tell me more about digital strategy.
Jitendra Barmecha,: Yeah, so I would say that we are getting an overhaul of our technology infrastructure.
What I mean,
Janae Sharp: no big deal, right?
Jitendra Barmecha,: Yeah.
Janae Sharp: Small project, just overhaul.
Jitendra Barmecha,: This is very unusual for a mid-size health system especially serving the underserved population in the Bronx to be implementing or migrating to epic electronic health record for both clinical and revenue cycle infrastructure. We are also implementing Oracle which is our enterprise resource planning whether it is financials, plannings, supply chain.
So these two projects are going at a parallel pace. And we hope that in the early fourth quarter we will go live with both projects. So when that's a big deal. Yeah, when we met in January. We just met after the holidays and although our last fall was very busy negotiating and scope of work and contracting but, now the rubber is meeting the road.
We have already crossed about ...
Janae Sharp: now you have thousands of tickets open.
Jitendra Barmecha,: Yes. Plus don't forget, we still have to do the existing business, which needs to continue or go on. Going from digital to digital is a very, very different project than we went from paper to digital. There are obviously advantage and disadvantage and to compound this project as you know, COVID Pandemic, there were several projects which took a sort of backseat because clinical requirements or clinical service was, were very, very important and took the priority. So we do still have the backlog from our Covid pandemic in terms of software upgrades.
Oh, wow. Managing the software now that if you compound these two major projects, I would say, I mean, the last project I remember which I was involved was I three 10, um. mm-hmm. But again, we had mostly testing and making sure the coding is correct. This is at a very different scale. You are talking about both ERP backlog of work and also the migration to Epic.
Janae Sharp: So maybe you can kind of level set with me a little bit there because I mean, I've talked to people during Go Live and there were two CIOs. This is like one of my major memories in healthcare, right? They're in a room and he's like, we have 2000 open tickets, and the other guy who is older and about to retire, he's like, that's okay.
That's not a big. Right. And, and then during Covid and during the pandemic, you had to scale an entire project. I was actually doing some work with the VA at the time that they took their entire workforce remote. Right? And I don't think those guys slept so, So we have, I wanna understand kinda like, how do you, how do you balance that?
Like how do you decide?
Jitendra Barmecha,: Yeah, again, healthcare we use software. We don't develop software. We are not typical tech companies. So, and yes, there are certain areas we can do hybrid work and maybe to some extent remote work. But we are providing very important service to our community. And yes, we can do telehealth, we can do virtual care.
But again, there are majority of the services, what we provide is in-person. Right. So during the pandemic, yeah, it was a huge undertaking for us in terms of providing hardware, providing e-learning, providing network access. So, I would say it was a huge acceleration of our digital capabilities and it was a really test.
Of our resiliency that we could actually we wrote a book I, I will share the book with you. So...
Janae Sharp: While you were doing that, all, you wrote a book too?
Jitendra Barmecha,: Yes. So, majority of our leaders we got a invitation from Springer. How to manage the acute crisis in a health system. The name of the book is, it's available everywhere, and that was the testament of what actually we did.
We created a template so that we can replicate. God willing, it should not happen, but again. Mm-hmm. These pandemics or epidemics are inevitable. Or business continuity is very important. So we can always take notes from that those pages. And then we can continue our, our clinical services for which are very, very important for our community.
Janae Sharp: Yeah. So yes, and the skills you develop too, like the skills you develop, keeping business going during a crisis can apply to all sorts of situations. They just make you more effective.
Jitendra Barmecha,: It was cross-training. I mean, there were several departments who had to cross-train because this was something very unique which we were faced with.
Our ambulatory care sites were closed, so people they got into inpatient setting. We did every kind of work which was necessary to improve the through. But as the pandemic kind of, went down and we are getting into what we call it is a next normal or new normal mm-hmm. Uh, We are adapting. But some of the technology in place or the workflow in place we are going to accelerate and continue, especially in the virtual care space. Right. What we are calling it as a virtual first care. And but again, those are for very unique individuals or unique cases, but they still need to come in for diagnostics or procedures yeah.
Or maybe certain care coordination activities. Yeah. Yeah.
Janae Sharp: I'd love to, dig deeper in that a little bit, because they have a lot of, you mentioned care gaps and you mentioned, you know, we've, talked a lot telehealth. I'd love to think about like, there are so many engagement tools. A lot of 'em are integrated or you have all these different options and moving parts and different, you know, different people with different preferences.
How do you balance that? Like where do you see the balance there? I feel like that's the main question I've been asking you.
Jitendra Barmecha,: Yeah. Again, you must have heard book from many individuals and again, I did not coin these words, but for us, very important is the process which is followed by people and then technology not the other way around.
Mm-hmm. If your processes are kind of rock solid and you have people to back those processes, technology, just an enabler. You know, yes, there are digital tools we can engage individuals more. But again, you need to have good processes and people in place. And, and obviously if you have digital tools to compliment or support them, then you have icing on the cake.
And that has been the mantra for us for ever since we started our digital journey.
Janae Sharp: I love that. That's very quotable. Yeah. Process people, technology. Mm-hmm. As you are bringing in all these different systems, we're going to hear later from experts in cybersecurity as you're managing the different priorities, is that something that's evolving?
With your job or,
Jitendra Barmecha,: yes. Yes. So it has been evolving for last maybe 10 or 12 years, I would say. It's nothing new, but it has become more rampant in recent years. Well, if you had dial ups internet services, obviously the intrusion were very slow. Now you are talking about two gigabyte on residents
or five Gs or wifi six. So obviously the intrusions are much faster and the velocity and the volume is very high and I relate. Information security is similar to your two things. One is infection control, like you wash your hands, make sure you don't get infection as much as possible, or you wear mask, same thing, those appliances or good solutions in place.
So that. You can reduce or minimize the intrusion within your network. The second one is the immunity. You know, so in the, during the covid, what we learned that not everybody suffered from covid the same way. People, those who were young, those who were, healthy, those who had good immune system, they had less,
I would say impact of covid infection. Mm-hmm. So similarly, if your network is immune, if your end user devices are immune, if your processes are somewhat immune, then probably the attacks from intrusion will be much less. Again, I'm not simplifying I have a Well, that's true.
Janae Sharp: Everyone's experiencing that experience that like if you have too many things running on on your computer, Or even, you know, if you have a virus, it doesn't work.
Jitendra Barmecha,: But we, over the years, we have developed a small division. I do have a, a chief information security Officer mm-hmm. Whose day in and day out job is to make sure that our assets are protected whether it's intrusion or maybe end user education. If you recall, majority of the data breaches are internal actors most of the time, and then the
a new wave of going into cloud has opened up doors for a lot of data breaches or cybersecurity issues. Yeah, but you have to have a balance of, if you are implementing full cloud strategies, you have to make sure that your immune your protection is well around the cloud or within the cloud.
And if you are hybrid, you have a separate processes managing those. Intrusions or data breaches or patches which are coming from the vendors. As I said, majority of the healthcare space, we don't develop software. We are utilizers or we use softwares. Right.
Which is good. I wanna.
Medical device.
Medical device is a separate that's a separate security topic. Yeah. Yes.
So majority of them are proprietary medical devices. All we can do is a sort of a wraparound, uh mm-hmm. If they're accessing to our network. But over the years, some of the medical devices they are sort of. Having inbuilt software where the immune system is enhanced for those right devices.
Janae Sharp: Yeah. And I've seen that, that people want certain compliance. Let's talk a little bit more about community data, like and. Like we talked some, you know, a while ago people were talking a lot about social determinants of health and the data that we're, we're getting to people, the data we're servicing. I really like that.
You've talked a lot about like education, like the end user matters. Mm-hmm. Are we getting patients and physicians and even hospital, you know, users, clinicians, you know, the billing department are. Both taking care of the business side and giving physicians and patients the data they need to live the health their healthiest lives right now.
Jitendra Barmecha,: Yeah, so I think you are touching upon a very important so I've been in the Bronx for over 25 years and social determinants of health we, didn't use these terminologies when I started my residency and early on when I was an attending. But yes, we, used to ask, we used to capture, but not in a meaningful way as an ecosystem.
Yes, we used to help them providing shelters or housing, maybe meals on wheels for areas where people were residing in food desert. But over the years things have changed. There are more housing units what we used to have in the past, and we need more because the demographics have changed.
We have increased the population. It is becoming more dense the population. So in terms of social determinants of health? Yeah. I think we have just started to scratch the surface because health is not the only issue facing our community where we serve. There are other issues, you know, clean water, clean air.
Mm-hmm. Open grounds for exercise. We have more bodegas and fast food chain than anywhere else in the country in a single zip code in the Bronx. I didn't know that. South Bronx? Yes. So there are access to fresh fruits, vegetables. Those are challenges, but again we collaborate with community-based organizations.
We have lot of interventions at homes making sure that people who have conditions they have clean air. And broadband is another one which I would call it as a social determinant of health. Now with the digital , tools no matter how much we want to accelerate in our digital journey.
But if we cannot connect the dots, for example, if there is no roads, but you have two beautiful cars with apps, it's meaningless. Right? So we have to make sure that the individuals take advantage of the FCC program, whether they are federal program or state programs, they have access to broadband.
And last but not the least I usually. Commingle both social determinants of health and political determinants of health because, oh, that's interesting. Again, we have to ensure that the constituents where our political leaders or legislators are serving, understands the needs of not only the health systems or the healthcare providers, but also the communities and the mm-hmm.
Surrounding the communities. So a lot of misinformation. We saw during the public health crisis. Mm-hmm. So again I think we need to slowly bring into those political determinants of health, whether this is climate change or whatever those are gun violence into those ecosystem. And looking at a holistic way of approaching to healthcare because health equity or digital equity in our patient population is huge
and I think not only looking at social determinants, but we need to look at the political determinants of health so that we can tackle all these whether it is equitable or digital divide right in our community.
Janae Sharp: Yeah, there are a lot of different Yeah. Barriers. So overcoming a with a plan is super important and I'm glad that health systems look at that and you know, you have that strong community.
We need more connections. Not fewer.
Jitendra Barmecha,: And I just wanna add one more thing on the wellness. Mm-hmm. So, historically, if you look at our me medical education worldwide, or specifically to US, I mean, these were more geared towards acute care. What we call it is reactive care, and that's how the hospitals were built or the system was designed, but last maybe a decade or two or maybe a little bit longer.
Slowly, we are marching towards wellness prevention and. Applying certain digital tools. So it changes the behavior and making sure that the individuals are participating more in their care. And they get a feedback. So, for example, if you have any wearable watches, you get a quick feedback that, you know, I have one, I,
I I walked, walked uh, 10 step, 10,000 steps today.
So maybe I burn so much calories and what I'm eating. So people are using the app, what they eat, how many calories? So I think these are called building blocks. And slowly I, think we are going towards more proactive care or the wellness care, if I may say. But again, we do have some challenges on the, as I mentioned, on the social leader determinants of health side open space for exercise.
But from our health system perspective we marched on about prior to Covid, and we have a beautiful wellness center with culinary medicine. We have kitchen where we teach healthy diet. We have...
Janae Sharp: oh, that's, that's a big deal. Not everybody knows that.
Jitendra Barmecha,: No, we, have our own rooftop garden where we also culture bees.
We create our own honey. Again, just to give a community a sense that you know, how we are involving evolving our healthcare. We, partnered with a housing community for 350 low-cost housing units. So again, a very small endeavor into the huge issues outside of typical healthcare.
But again, it gives example to not only the community, but also the elected officials or the politicians that, you know what these, are very important maybe all health system, maybe all healthcare provider, maybe all CBOs related to healthcare need to pay back or give some time.
Mm-hmm. Or give towards the community where we serve.
Janae Sharp: Exactly. And I feel like especially in the health equity realm, like that's, yep. Nobody can afford, health inequity. I have one last question. Sure. And that is, what is your favorite project right now? To share about.
What are you most passionate about?
What brings you joy?
Jitendra Barmecha,: So serving our community in a more meaningful way, digitally enabled safer is the optimal ultimate goal not only for me but for our entire leadership team at our health system. And I think we are in the right direction. We are going to accelerate digital, tools before we say that we are transforming.
I think we are accelerating right now. Or we have been accelerating in past few years. Hopefully we'll optimize and then we transform the healthcare so that we have more healthy communities where we serve.
Janae Sharp: I like that. No, it's good to accelerate that. And you've been part of some really fast paced work.
Yes. And we wanna wish you luck. I'm glad I got an update on the community efforts that you've been putting in and I'm even more impressed.
Thank with just the, the depth of work. Yes. Because I understand that all those things are giant project.
We have a good team and that's what keeps me going. So yeah, to be part of the team, you know,.
Having a good team is the best. Yeah.