More patients with complex diseases, added pressure to take care of them after discharge and greater expectations to demonstrate quality of care. Together, these cardiovascular service line (CVSL) realities translate into much more data to manage, and the need for someone to do it.

We have so much data in healthcare, but how are we applying it so that the data provides information and knowledge that can be used to transform the patient experience and lead to outcomes that patients feel are as good as they could be?” asks Mike Mytych, principal of Health Information Consulting in Menomonee Falls, Wis. “Are we giving providers the integrated tools to choose the best course of therapy?”               

Not yet, Mytych says, but there are solutions. One is for CVSLs to identify a dedicated clinical informaticist who will focus, at least part-time, on the service line. “At first, it’s a bitter pill to swallow financially, but it will pay off in spades,” he  told Cardiovascular Business, sharing why the informaticist role is important, whom to recruit and the results that signal success.  

Approximately how many U.S. CVSLs have created a position for a dedicated clinical informaticist?

Based on audience responses at educational meetings and talking to people in the industry, fewer than 25 percent have a specific, identified role. And for most of those organizations, it’s a split position. Often it’s a physician who has taken on the job one-half or one-third time.

Is that the ideal scenario, where a physician focuses on informatics part of the time?

Yes, because the physician is positioned to be a change agent. It can be difficult for non-physicians to be in that role, which needs to include governance of data and provisioning of it for quality metrics, population health, disease management and so on. When you consider the pressure on cardiologists to stay current in a challenging specialty, comply with evidence-based guidelines and now move to value-based care, you can see why it takes strong physician leadership to get commitment and buy-in across all of the providers within the service line. It’s difficult to succeed without that shared ownership of the data and how it is used. Other options include recruiting physician assistants or nurses. A nurse may already be responsible for, and have a keen understanding of, data sources for the cardiovascular registries and could take on the informaticist role, with the support of a physician.

What are the main reasons that CVSLs should hire a dedicated clinical informaticist?

First and foremost, it works best when the clinical informaticist is identified from within the service line and groomed for the position and has the inherent respect of his or her colleagues. I’ve never seen it done successfully when the person is pulled in from the outside. He or she won’t have insider knowledge of the provider groups, understand the specific data flow and model of data and know how to integrate it. And he or she won’t be in a position to work shoulder to shoulder to affect change—whether it’s for creating standards of care or for producing and using quality metrics or actionable data around specific patients.

Mytych says there are essentially three reasons to bring on a clinical informaticist:

1. CVSL Complexity

“The CVSL represents tremendous value from the revenue and cost sides. A dedicated informaticist can produce the metrics for quality reporting in value-based care and understands how data flows from various provider venues—the cath lab, diagnostic labs, surgical, ambulatory, everywhere—throughout the organization to eventually be used on the quality side as well as the patient-centric side.”

2. Volume of Data

“There’s so much data flying around, and it’s coming from a lot of different sources and providers. It’s not unusual for a service line to have 10, or even 20, different data systems, especially if it’s multi-campus plus dozens of ambulatory locations. It gets even more complicated when there are mergers or acquisitions of other CVSL venues of care.”

3. Lack of Centralization

“There’s no one centralized person who is responsible for the quality of the data or process. Somebody must be tasked with paying attention to the governance of how data is being produced, working with providers to make sure it is being produced as structured documentation and ensuring integrated data flow into analytical repositories to be used for population health, disease management and evidence-based medicine.”

Could chief medical information officers (CMIOs) fill these roles?

They could, but it's unrealistic to expect that CMIOs could understand all of the nuances within every service line, plus they are potentially not from the CVSL. You need someone who understands the flows that all of the different types of patients in that service line go through. That’s one more reason you want a clinician as the health informaticist. 

What characteristics should CVSL leaders look for when recruiting an informaticist?

The first thing is a clinician who sees the long-term value of using technology that produces data, information and transformation to create more efficient, more effective outcomes for patients. It’s someone who has an innate passion for taking on quality information that supports improvements in care and outcomes and reduces cost; in other words, the Triple Aim. By the way, that passion doesn’t have to be for the use of systems because, frankly, a lot of providers are frustrated with systems that aren’t living up to their performance expectations, and that’s fair. But given that, how is the informaticist going to affect change?

The second quality is great communication skills—he or she knows how to socialize information to other providers to drive toward the Triple Aim. It takes a little bit of salesmanship, cajoling and charm. It’s the ability to present information so it doesn’t feel insulting, but rather that you’re sharing data that support good outcomes and coming together as a team.

Another thing to consider when zeroing in on candidates is the work they’ll be taken away from and where they are in their careers. You can’t assign this to a high-volume proceduralist. The leadership has to be convinced that this will pay off in a reasonable timeline and meet measurable goals. The service lines that are in the more advanced stages of development are starting to understand why the investment is worth it.

What steps can you take to help new CVSL clinical informaticists succeed?

I’m a big believer in collective wisdom, so I’d encourage them to spend some quality time with another organization that has done this successfully, and make a commitment to pay it forward down the road. 

Informaticists will need to work closely with the CMIOs of their organizations and the CVSL analysts who work with the systems—all of the systems that produce data. They need to understand how the systems are set up and used so they can ensure consistency.

Also, make sure you have a solid information technology foundation in place. If you don’t have the structured documentation tools and a strong analytics service area in the IT department, it won’t take long before the informaticist gets frustrated by the lack of ability. The interoperability and the tools have to be there, and the physicians have to be using them and using them correctly. If you have poor interoperability, lack of integrated data and other system-related deficiencies, it makes it tough for the informaticist to succeed. The organizations that have been successful have this solid foundation. It doesn’t have to be perfect, but they have to have the basics in place. It’s not just hiring someone. You have to solve the other parts, too.

How do you know if your informaticist is succeeding?

You see that the service line is able to take information and apply it toward various care environments, such as TAVR, electrophysiology or heart failure, to impact quality metrics, drive efficiency and reduce cost. You might see improvements with readmissions, reduced complications (such as bleeding) or improved outcomes. Or you might see physicians using dashboards to monitor themselves, which leads to greater commitment, and that impacts variance. You should start to see performance enhancements like greater use of radial PCI. These are things that can drive dollars and better metrics. The results can be stunning.