There are no e-health strategies. There are business strategies enabled by the e-age."
With Internet technology figuring so prominently in everyone's data-management plans, the credo of David B. Pryor, M.D., sounds odd considering he's the chief information officer of an 18-hospital healthcare system that spans Minnesota and inches into Wisconsin.
But in Pryor's mind, the unwavering emphasis on business strategies is what ultimately advances Allina Health System's technology and enhances its capacity to deliver patient care effectively and efficiently. And that, after all, is the ultimate business mission for providers.
"Business units need to have ownership over the information systems projects and processes," Pryor says. Though information professionals are important to a project's success and ongoing support, "you create value with the unit interacting with the patient."
Pryor, a board-certified cardiologist, has plenty of experience interacting with or on behalf of patients. Besides practicing medicine since the early 1980s, he spent more than a decade managing medical research and clinical database development, then took a turn as president of a Boston teaching hospital before settling in as CIO at Allina nearly five years ago.
Though he's made the transition to information systems, Pryor says he still sees a few patients at Allina's Minneapolis Heart Institute. And he continues to serve in such clinical capacities as chairing the performance-measurement task force of the Joint Commission on Accreditation of Healthcare Organizations.
With such a heavy-duty track record outside the technology mainstream, Pryor says it was crucial that he reach out to Allina's information professionals when he arrived there to underscore how essential they were to his percolating IT priorities. "It's important to have the necessary skills and competencies represented," he says.
But the IT department's skills have been channeled into activities selected by clinical and administrative leaders, who control project committees and are accountable for the success of information technology initiatives.
Physician focus. Pryor says his background enables him to focus on the impact a project will have on physicians, which helps him win their support. In order to get doctors to play along, he says, you have to "nail the big three": demonstrate improved patient care; decrease the hassles that prolong the day and encroach on family life; and avoid hurting physicians' bottom line (and maybe even help it).
Sometimes that means making some nontraditional decisions during the rollout of complex information initiatives.
For example, activating an electronic medical record at Allina took into account the need to "minimize productivity hits" on physicians' practices as well as keep a project on schedule.
An interface with the laboratory information system wasn't going smoothly, but the rest of the system was ready to activate on schedule. That lab-data problem might not seem big enough to delay the whole project. However, Pryor says that from a physician's perspective, it's not practical to have to go somewhere other than the designated medical record for lab results.
So it was either delay or find another way. The decision, he says, was "driven by what the clinician needs": Allina employees hand-entered lab results into the electronic medical record for a few months until the lab system interface was ready and could take over.
The same focus on clinicians led to construction of a technologically superior communications network that actually can "heal" problems itself. For example, it resolved the problem of unreliable laboratory data exchange.
Doctors in emergency departments complained about recurring unavailability of lab results because the computer connection failed too often. After an investigation, Pryor found that lab results had to run a relay race from source to destination involving 11 electronic "handoffs." Each of the connections failed only about once a year, but the cumulative impact was serious for the hospitals depending on the cobbled-together network.
Fixing the problem meant undertaking a project to revise the entire IT infrastructure. The technology solution was available: Pryor asked for and received "a terrific plan" from his information technology staff to eradicate the reliability problem. But as an administrator, he ruled that Allina could not afford it.
Instead, he asked his information pros to break the project into three years and give him the first year. That was doable, and so was the rest of the network project when handled in stages.
Not only did that solve the original problem, but it put Allina in great shape for other business and clinical advances because of the network's great speed and reliability.
"Every year it costs less and less to do the same thing, and the productivity of each employee keeps going up," he says. Allina is even making plans to transfer its telephone traffic to the same lines that carry data and images throughout the provider network.
The great acceleration of advances in computer applications and information transmission can be seriously impeded if healthcare organizations don't look at their ability to distribute data by modern means, Pryor says. "If the road is only dirt, it's not going to get you there as effectively as if it were paved," he says.
Pryor draws from past administrative experience and the mind-set of a researcher to understand how to initiate information technology within an organization. "Research is a process of conducting studies or controlled trials in which you use data to test a particular hypothesis," he says, calling Allina's results "the ultimate data-driven decision."
A clinical background. The technology and practice of mining data for valuable findings were in their infancy when Pryor began a long stint at Duke University Medical Center, Durham, N.C. Upon completing a cardiology fellowship at Duke in 1981, he joined the faculty of the medical school and operated the medical center's cardiology consulting service. At the same time, he went to work for Duke's section of clinical epidemiology and biostatistics.
One of his achievements as the section's director was instituting a computerized cardiology database. The software creation produced 50 types of reports, including routine online diagnostic and prognostic profiling, generating more than 70,000 cardiology reports a year. The database, which followed more than 25,000 Duke patients on 17 protocols, was used for clinical practice, research and strategic planning.
Pryor served as principal investigator for several research grants, including work for HCFA and its Agency for Health Care Policy and Research. He also oversaw the development of the medical center unit, which grew to 400 full-time-equivalent employees and a $30 million budget in 1994 from 16 FTEs when he became director in 1984.
Twelve years after joining Duke, Pryor entered the senior administrative ranks as director of clinical program development, where he honed both clinical and information management skills. He worked with administrative, physician and nursing leadership to develop clinical pathways and algorithms. Meanwhile, he reorganized information systems management for the medical center in conjunction with senior medical center leadership.
Pryor says he faced the choice in 1994 of becoming chief medical officer at Duke or taking an offer to be president of New England Medical Center in Boston, which needed someone to reorganize inpatient and outpatient services into "care programs." He chose to go to Boston.
It turned out to be a short stay. The reorganization was intended to bring together staff from a number of specialties and departments to organize care around patients' needs and medical conditions. But it also was intended to get a handle on a money-losing operation at a time when managed-care pressures on hospitals were just beginning to be felt.
Pryor did the thankless work. He restructured physician compensation and began revising incentive programs, eliminated 575 positions, instituted patient satisfaction and quality-of-care assessments, and trimmed $32 million from operations.
In the highly charged climate of the time, with world-class doctors and departments getting their first taste of fiscal reality, the changes were immensely unpopular. "I was not a loved guy," Pryor says.
New England Medical eventually had to get fiscally responsible; it agreed to be purchased by Rhode Island-based Lifespan in January 1997, partly to stem its annual operating losses and face an accumulated debt of $240 million. But Pryor already had left in mid-1995 for the Allina job.
Well-funded. He's now responsible for an annual operating budget of $60 million, an annual capital budget of $20 million to $30 million, and another $60 million in jointly managed subcontracts.
In 1999 he also assumed senior clinical leadership, giving him the latitude to mesh companywide information needs with recognized care-management opportunities.
"The physician perspective is extremely helpful in crafting the overall vision," Pryor says. The challenge now is to get all clinical, administrative and payer interests to understand the great variability in how patients are treated and to find a way of managing care delivery so everyone benefits.
"Much of the healthcare (business) activity the people are pursuing are zero-sum-game survival strategies," where the goal is to grab an edge at the expense of another, he says. For example, insurers try to ratchet down payments at the expense of providers, or doctors band together to dictate terms to payers or hospitals.
Such internecine skirmishing works in the short term but doesn't increase value for anyone. The trick, says Pryor, is to attack the root causes of waste, inefficiency and impaired effectiveness, make clinicians and technical pros accountable for producing a higher level of care delivery, and give all partners a share of the payoff.