"You can read it with a $20 USB reader," he explains.
The exceedingly modest and tech-savvy Aviles notes that the smart card is part of an initiative of a state-funded regional health information organization led by 976-bed Mount Sinai Hospital. "I'd love to take credit for this other than to say that Elmhurst has been one of the innovators in the system," says Aviles, HHC's president and CEO since 2005. "They've really paved the way on a number of initiatives." That is the way it goes with so many information technology initiatives at HHC, the nation's largest public hospital system. Working on a limited budget to provide the crucial safety net for 1.3 million patients annually, HHC under Aviles' stewardship has blazed a trail of IT innovation that rivals or bests any private hospital in the country. Using IT as the enabling tool, HHC is daring to venture into new frontiers on the clinical side of the equation—particularly the patient-safety front, where many hospitals fear to tread. In recognition of his accomplishments, Aviles, 56, is one of the three winners of the fifth annual CEO IT Achievement Award, co-sponsored by Modern Healthcare and the Healthcare Information and Management Systems Society.
"First of all he is obviously responsible for a huge operation—the safety net health system in New York City—so it was pretty impressive that he was able to accomplish a tremendous amount" building an information technology infrastructure, says Glenn Steele Jr., president and CEO of Geisinger Health System, Danville, Pa., last year's award winner and a judge in this year's competition. "That was amazing to us. The other thing was he really focused on patients with chronic diseases and getting the metrics in setting aims that would benefit the care of those patients as part of his and his senior leadership's goals."
With $172 million of the system's annual budget devoted to IT, HHC under Aviles' direction is harnessing the power of its huge clinical database to establish an electronic registry to track 50,000 diabetic patients, conduct deep-vein thrombosis risk assessments, reduce drug errors through electronic prescriptions and reduce pediatric asthma hospitalizations. In addition, as part of a quality transparency initiative, HHC recently posted on its public Web site the system's performance on four quality indicators: heart attack, heart failure, community-acquired pneumonia and surgical site infections.
This summer, Aviles vows that HHC will begin publicly reporting facility-specific nosocomial infection rates as well as quality data from its electronic disease registry. HHC also has committed to conduct depression screening online, reaching 80% of the system's 225,000 primary-care patients by the end of next year. Aviles says he has made it abundantly clear to the HHC staff that "as we develop a greater ability to mine data that is reliable and accurate, we will not only use it to drive improvements but also to reduce variability in our system. It allows us to compare facilities."
The innovation seems almost counterintuitive to HHC's reputation, Aviles admits. Responsible for one-fifth of the hospital discharges and providing more than 40% of all inpatient behavioral health services and 33% of all inpatient chemical detox services in New York, HHC is thought of as the provider of last resort. The system treats about 453,000 uninsured patients and accounts for one-third of the city's emergency room and hospital-based clinic visits.
"A lot has changed over the last decade," Aviles says. "I'm most proud of the fact that this public system has shown such capacity to be innovative in the use of IT. It runs against the grain of the stereotypical public hospital system."
Louis Capponi, an internist who serves as HHC's chief medical informatics officer, says Aviles has a deep understanding of technology and has been extremely supportive of all the IT efforts. He recognized, Capponi says, the power that IT has "to drive patient care and a safer health environment."
Aviles has been involved with the building of an IT infrastructure at HHC from the beginning, standing on the front line at Elmhurst as the electronic medical record was rolled out. In the early days when building functionality in the system was a major issue, there was some physician resistance, he recalls. "From the beginning it was clear to me that we would be able to leverage technology to drive compliance in care and evidence-based medicine," Aviles says.
Physicians' attitudes quickly changed as they saw the technology's power and soon began working to customize the IT system for their particular needs, he says. Computerized physician order entry is now old hat, a staple of the system since 2000 when less than 5% of the hospitals in the country probably had it. The introduction of CPOE alone reduced the need to clarify medication errors by 85% among the 100 million prescriptions generated by the health system each year, but "We're so far beyond CPOE," he says.
Since arriving as CEO, Aviles has ramped up the pace, especially in developing a chronic-disease data registry, setting an ambitious goal to enter the data for 50,000 adult diabetics over a 10-month period ended in June 2006. "It's a very powerful tool that allows us to feed data back to all clinicians caring for diabetics" for comparative purposes, he says.
Typically, internists will underestimate by half the number of diabetics under their care and overestimate by a factor of two the number of well-controlled diabetics under their care, Aviles says. At the end of last year, Aviles says they ran the data and found a 20% improvement in the blood sugar levels of 13,000 adult diabetics. "It was, I think, a very telling example of the power of the data if it can be collected and reported back to physicians in a useful way," Aviles says.
Aviles is one of three recipients of Modern Healthcare's fifth annual CEO IT Achievement Award program, co-sponsored by the Healthcare Information and Management Systems Society. The other recipients will be featured in upcoming editions of Health IT Strategist.
This story initially appeared in this week's edition of Modern Healthcare magazine.
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