You can count Michael Marino, DO, MBA, chief of information security (IS) operations and clinical systems at St. Joseph Health, among the critics on what health IT vendors are offering to hospitals and health systems, comparing them to using old flip phones that debuted in the late 1990s.
Marino, who has also served as both CIO and CMIO for St. Joseph, spoke with Clinical Innovation & Technology about the issues he sees with stagnant electronic health records (EHRs), why healthcare leaders can’t see EHRs as one-time investments and how to move to better platforms for patient engagement.
Clinical Innovation & Technology: You've said before that ‘patient portals are dead.’ What brought you to that conclusion?
Michael Marino, DO, MBA: I think basic patient portals are dead, when you talk about what people did to hit MU (meaningful use).
The initial MU requirement was that you could transmit patient records, discharge summaries to patients, basic CCDAs (Consolidated Clinical Document Architecture) to patients at discharge. The difficulty is—and I think you can look at the consumer healthcare space to understand—that unless you’re doing ongoing engagement, people will sign up and then not use them.
So what we’ve done is we’ve partnered with a startup company to say, “I need to deliver those basic constructs, but that isn’t sticky enough to keep people engaged with a portal.” So how do you marry more wellness applications [and] more social applications with “I need to send you your discharge summary"?
If you’re only going to interact with the portal once, you’re liable not to even worry about it next time. What we’ve seen with a more engagement-based platform is people not only use it for those transactional parts of their healthcare, but they use it for their wellness, they use it more socially, like to challenge friends with steps, more like you’d see in a wellness platform versus a healthcare portal. If you put the two together, I think it’s the best of both worlds.
What is the state of technology investment in healthcare—and are the investments paying off?
I think that hospitals and health systems have certainly got the message that it’s important and have invested a significant amount in core systems, EHRs (electronic health records) and PACS. I think the part that’s been missing, and I think St. Joe’s may be different, is that it’s going to require an ongoing investment. It’s not one-and-done.
That is both in the software space and in the hardware space. So in order to roll out an EHR for any hospital to hit MU, hospitals had to make the big investment and had to have servers or come up with a partner to host it. You had to roll out multiple PCs, but anybody who works on a PC knows they’re good for, what, two years, three years?
It’s just like the phone we have in our pocket. Does anybody got a phone older than three years?
So I think when you’re going back to leadership and saying it requires an ongoing investment, a lot of systems are struggling. We don’t necessarily struggle with the innovation part of this bend, but some of the core infrastructure—it’s hard to convince CFOs you’ve got to buy PCs every three years.
At HIMSS 2017, there was plenty of criticism being leveled at health IT vendors for the quality of products that health systems are investing so much money into. Former CMS Administrator Andy Slavitt actually called health IT a "somewhat failing industry" because of customer dissatisfaction. Do you feel IT products are where they need to be to make effective use of all the data now available to clinicians and health systems?
Not even remotely.
When you think about any other part of your life when technology’s been brought to bear, it sped up the process. I always use paying bills as an example. If you sat down and paid all your bills—paper and pen and checkbook—it probably took an hour to 90 minutes. If I use an online bill pay service, I sit down and pay my bills, the same bills I paid before, in less than five minutes, and I can actually do two things at once because it doesn’t require that much attention.
So when I first started practicing medicine, it was still paper. The amount of time it took to write a reasonable note and capture the key things for the patient (was) three, four minutes with a pen and a piece of paper. The same time to click through anybody’s EHR is at least twice that long, if not three times that long.
We need to deliver efficiency, analytics and suggestions, not ask people to click boxes and most EHRs today are still clicking boxes. People are starting to make inroads. If you walked around HIMSS, there are many bolt-ons trying to make inroads, but I think it’s run its course.
The first time I put in a CPOE (computerized physician order entry) was as a resident over 20 years ago now, and it hasn’t gotten a lot simpler in 20 years. You know, I had a flip phone 20 years ago. That was markedly different in computing power. EHR is not a lot different than it was in the late '90s.