Matthew Anderson is vice-president and CIO, University Health Network, Canada’s largest acute-care teaching hospital. In this role, Matt is responsible for leading the organization’s IM strategy, which aims to improve the patient experience, achieve the best clinical outcomes and ensure accountability through IT. Matt is also charged with managing the organization’s complement of information services, including telecommunications, health records, performance measurement, risk management, medical engineering and medical imaging – an annual expenditure of more than $100 million. Matt spoke to CGR senior writer Brian Eaton recently about how this English major leveraged his university electives all the way to the VP’s office. Excerpts from their conversation follow:
Q. How did you find yourself pursuing opportunities in the IT field that ultimately led to your current position?
A. It all started with a Bachelor of English from the University of New Brunswick (UNB) and then a Masters Degree in Health Administration from the University of Toronto. Not exactly your typical background for a chief information officer. I got into information management in health care when I graduated from UNB – I am from Toronto but I went to New Brunswick for school. When I got back to Toronto I got a job at St. Michaels Hospital (St. Mikes) in the planning department, helping to pull together their strategic plan. While I was working there the vice-president at the time, discovered my secret. I actually went to UNB to study math and computer science but had taken an English class and fallen in love with it, so I ended up using my Math and Computer Science credits as electives. It sounds cooler, though, when I tell people I just have an English degree.
Q. Was it just a case of being in the right place at the right time that jumpstarted your IT career?
A. While I was at St. Mikes, the vice-president in the planning department also had IT responsibilities and realized I had a related background. I started doing some work (in his office) and then I moved over to what at the time was the Toronto Hospital.
I started there as an IT analyst. The hospital sponsored me to do my Master’s degree and shortly after that was completed I left for Johnson & Johnson Medical Products, but only stayed there for a short period of time. I found myself at a company called HealthLink, which was a small networking company owned by public and private sector organizations, and after being there for about a year I had the opportunity to become the CIO at the University Health Network (UHN).
It’s all had a very rapid pace, and I have been very opportunistic. When the opportunities came, for tremendous positions, I took them.
Q. When were you at St. Mikes and what was the nature of information management initiatives at that time?
A. It would have been 1993. At the time, and even still today, St. Mikes did not have an electronic health record (EHR). We first looked at what information we had available to us, and often it was information that we got out of the paper chart or from the coding system and from various one-off databases that we had around the hospital. We spent most of our time with the collection and distribution of information through a hodgepodge of systems. We also looked at moving St. Mikes towards an EHR.
Q. Who was championing what would have been a relatively groundbreaking effort in the early 90s?
A. It was that same vice-president I mentioned earlier who had the IT responsibilities. But we didn’t call it an electronic health record at the time. I think we referred to it by its components. We would have said, “you have to get admitting electronic, you have to be able to view results electronically.”
When I went over to the Toronto Hospital in the late 90s they were sorting the components of an EHR they had begun to implement as far back as 1986. They were among the few organizations starting down the EHR path, but at best they would have called it the electronic patient record. The paper chart was still the main record, and we engaged in projects right off the bat that mostly looked at moving away from the mainframe system, with limited terminals connected to a pretty crappy network, and redirected to main servers. Our priority was to improve the reliability of the infrastructure. It took about two years to convert to a newer environment but the paper chart was still dominant. We did have some good information available electronically, including laboratory results, radiology results and patient admission and discharge systems.
Q. Was there resistance to IT projects at that time?
A. You get into physician resistance when you get into issues around order entry. In the early stages of these projects we were not immediately contemplating the physicians doing order entry, nor were we talking about significantly eliminating the paper chart. From a physician workflow perspective, in the early stages, we weren’t having a big impact on them so they didn’t know to be resistant to it. It’s hard to argue against the value of having this information – laboratory results for example – available in a computer to be looked up. There are not a lot of people who would resist that.
The resistance did come more in the form of trying to create the value proposition, because it was a substantial financial investment, and in health care, as everybody knows, the dollars are pretty scarce. In the early stages of the implementations it was more about the battle to demonstrate the value of a robust infrastructure, and the value of having information online. When you show them the price tag, you want them to agree.
Q. When did attitudes start to change, allowing for greater IT adoption?
A. It was later in the ‘90s and in early 2000 that we got more sophisticated projects like computerized physician order entry. We changed our policy in ‘98 to state that any information that is available electronically will not be included in the patient paper chart.
It was when we got to this stage that we truly changed the workflows of the clinicians – not just the doctors, but also the nurses and the pharmacists. That’s when you start to get into (another kind of) resistance. Now you are changing the way clinicians have been operating and the biggest challenge, although there are a bunch of them, is speed. The physicians and nurses are extraordinarily busy. At the UHN we see more than 900,000 outpatient visits per year, and some of our physicians are seeing their patients for less than two minutes. In the paper world, physicians had spent a lot of time optimizing their paper process so that it supported that workflow. When you translate those practices into a computer setting, that becomes the biggest challenge for a physician.
Q. Can you detail one example where speed and paper-to-digital processes clashed?
A. If you look at ordering a medication, in a paper environment a doctor can just scribble out something on a piece of paper. There are four different components to a drug order (the drug to be given, the route of the drug to be given, the frequency and the dosage), but the physician in a paper environment does not necessarily always cover all four. It is left for a nurse or pharmacist to follow up; they sometimes just leave it to be somebody else’s problem. In a computer environment doctors are forced to fill out all four components. That’s just a very simple example to demonstrate that on paper you can jot down Tylenol 3 and walk away. Now you have to go to a computer, call up the patient, put in Tylenol 3, oral, every four hours, and these are the new restrictions on physicians – it’s a big challenge.
Q. If the physician thinks it takes longer, forgetting for now that they are not doing their complete job, how do you get them to embrace change?
A. Fortunately, as we have asked more and more from our clinicians, including physicians, the value proposition that we are able to give back to them is getting better. With our computer system, using the same example of medication order entry, the value back is that we have built the hospital formulary right in, so clinicians don’t have to look things up, it’s all on the computer. We also have automatic allergy checking so that we can flag that to the physician when they are ordering a drug. We also flag patients’ medications for adverse interactions, as well as laboratory checking if the physician does not realize the patient’s condition has changed. Now there’s value coming back to the physician and they have reason to put information into the computer.
Q. What will your position look like five years from now?
A. I think that what we are seeing is that CIOs in health care are becoming less and less about the technology. The technology is becoming a lot more standardized and robust, and IT related issues don’t crop up nearly as much as they did two or three years ago.
Being a CIO in health care will be more about understanding the health care business, and then understanding the relationships between the different types of health care providers and working with them to establish a way of taking advantage of the IT tools.
Brian Eaton (firstname.lastname@example.org) is senior writer with CIO Government Review.