Third Annual Informatics Conference: Business Transformation through Informatics

Transcription

1 Presented by: The Fuqua School of Business / Master of Management in Clinical Informatics Program and The Duke Center for Health Informatics Wednesday, April 18, 2012 at The Fuqua School of Business Third Annual Informatics Conference: Business Transformation through Informatics April 18, 2012 For additional information, please contact: Ana Quinn, MBA Manager, Business Strategy Duke Clinical Research Institute The Fuqua School of Business Health Sector Management Program Master of Management in Clinical Informatics ana.quinn@duke.edu Phone:

2 Meeting Organizers Jeffrey M. Ferranti, MD, MS Kevin A. Schulman, MD, MBA Ana Quinn, MBA Chief Medical Informatics Officer, Vice President for Clinical Informatics, Associate Director, Duke Center for Health Informatics (DCHI); Assistant Professor, Newborn Critical Care, Duke Medicine Professor of Medicine and Gregory Mario and Jeremy Mario Professor of Business Administration, Associate Director, Duke Clinical Research Institute (DCRI), Director, Fuqua Health Sector Management Program, Duke University Manager, Business Strategy, DCRI Meeting Participants Mia Camp Business Optimization and Resiliency Strategist, Verizon Jason Cooper, MS Vice President, Clinical Analytics, CIGNA HealthCare Randy A. Delgado, MBA Health Industry and Healthcare IT Advisory Executive, PricewaterhouseCoopers LLP John Edwards, MA Director, Healthcare Strategy and Healthcare Business Intelligence Practice, PricewaterhouseCoopers LLP Jeffrey M. Ferranti, MD, MS Chief Medical Informatics Officer, Vice President for Clinical Informatics; Associate Director, DCHI; Assistant Professor, Newborn Critical Care, Duke Medicine Michael Gallagher, MPH, MBA Health Informatics Leader, GE Healthcare Performance Solutions Ahmed F. Ghouri, MD Cofounder and Chief Executive Officer, Anvita Health Art Glasgow Chief Information Officer and Vice President, Duke Medicine Denise Hatzidakis Chief Technology Officer, Premier Healthcare Alliance Kristina N. Kermanshahche Chief Architect, Digital Health Group, Intel Corporation Brent Lamm, MBA Director of Information Technology, University of North Carolina Translational and Clinical Sciences (NC TraCS) Institute Terrence Macaleer Senior Vice President, Enterprise Sales, Allscripts Rahul Mahadevan, MA, MBA Director, Electronic Health Records Services, Stanford Hospital & Clinics Jeffrey D. Miller, MBA Chief Executive Officer, North Carolina Health Information Exchange Maureen K. O Connor, JD Executive Vice President and Chief Strategy Officer, Blue Cross and Blue Shield of North Carolina (BCBSNC) Steve Savas, MBA Principal, Business Technology Office, McKinsey & Company

3 Kevin A. Schulman, MD, MBA Professor of Medicine and Gregory Mario and Jeremy Mario Professor of Business Administration, Associate Director, DCRI, Director, Fuqua Health Sector Management Program, Duke University Benjamin Smith Principal Consultant, Quintiles Transnational Corporation David A. Watson Chief Operating Officer, MedeAnalytics, Inc. David Wiggin, MBA Program Director, Healthcare and Life Sciences, Teradata Corporation Meeting summary written by Patricia A. French, Left Lane Communications Deluxe Scholarship Sponsors Gold Sponsors Silver Sponsors Bronze Sponsors

4 Participant Snapshots Who are they? From where did they travel from?

5 Third Annual Informatics Conference: Business Transformation through Informatics On April 18, 2012, Dr. Kevin Schulman, Dr. Jeffrey Ferranti and Ana Quinn hosted the Third Annual Informatics Conference, Business Transformation through Informatics, at Duke University s Fuqua School of Business. The meeting offered its 250 attendees a vision of how to get from Point A to Point B with regard to transforming healthcare costs, quality, and access through the use of informatics. Point A is the current state of healthcare in the U.S., in which 6 categories of waste overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse represent a minimum of 20% of total health care expenditures. Technology can play a role in addressing all of these aspects, but it will require evolution and transformation in business cultures and processes, not in the mechanics of software systems. At a minimum, organizations will need to have a clear strategy, proactive business (not just clinical) leadership, business ownership, actionable knowledge (not just data), and courage to transform. Several other sectors have accomplished such change, particularly in the retail and financial sectors. Now it is healthcare s turn. With input, leadership, support, and coordination from all areas of an organization, businesses can be transformed to deliver better value to the healthcare system and, ultimately, to improve health. Keynote Addresses Topic: Speaker: Topic: Speaker: Shared Services and the Healthcare Cloud: A Strategy for Adoption Kristina N. Kermanshahche, Chief Architect, Digital Health Group, Intel Corporation Analytics: No Adoption, No Value (aka, The Hard Part) David A. Watson, Chief Operating Officer, MedeAnalytics Inc. Presentations and Panel Discussions Topic: Moderator: Topic: Moderator: Panel Discussion: Business Transformation Through Analytics: Competing David Wiggin, MBA, Program Director, Healthcare and Life Sciences, Teradata Corporation Randy A. Delgado, MBA, Health Industry and Healthcare IT Advisory Executive, PricewaterhouseCoopers LLP Ahmed F. Ghouri, MD, Cofounder and Chief Executive Officer, Anvita Health Brent Lamm, MBA, Director of Information Technology, NC TraCS Institute Terrence Macaleer, Senior Vice President, Enterprise Sales, Allscripts Maureen K. O Connor, JD, Executive Vice President and Chief Strategy Officer, BCBSNC Panel Discussion: Service Transformation: Business Ownership of Health IT Steve Savas, MBA, Principal, Business Technology Office, McKinsey & Company John Edwards, MA, Director, Healthcare Strategy and Healthcare Business Intelligence Practice, PricewaterhouseCoopers Rahul Mahadevan, MA, MBA, Director, Electronic Health Records Services, Stanford Hospital & Clinics Jeffrey D. Miller, MBA, Chief Executive Officer, North Carolina Health Information Exchange

6 Benjamin Smith, Principal Consultant, Quintiles Transnational Corporation Topic: Presenter: Topic: Moderator: Topic: Presentation: Health Research Institute Informatics Study: "The Critical Role of Data Informatics in Driving Business Decisions" Randy A. Delgado, MBA, Health Industry and Healthcare IT Advisory Executive, PricewaterhouseCoopers LLP Panel Discussion: Organizational Governance Art Glasgow, Chief Information Officer and Vice President, Duke Medicine Mia Camp, Business Optimization and Resiliency Strategist, Verizon Jason Cooper, MS, Vice President, Clinical Analytics, CIGNA HealthCare Michael Gallagher, MPH, MBA, Health Informatics Leader, GE Healthcare Performance Solutions Denise Hatzidakis, Chief Technology Officer, Premier Healthcare Alliance Panel Discussion: Moving Forward and Next Steps Jeffrey M. Ferranti, MD, MS, Chief Medical Informatics Officer, Vice President for Clinical Informatics, Associate Director, DCHI; Assistant Professor, Newborn Critical Care, Duke Medicine Art Glasgow, Chief Information Officer and Vice President, Duke Medicine Kevin A. Schulman, MD, MBA, Professor of Medicine and Gregory Mario and Jeremy Mario Professor of Business Administration, Associate Director, DCRI, Director, Fuqua Health Sector Management Program, Duke University

7 Keynote I: Shared Services and Healthcare Cloud: A Strategy for Adoption Speaker: Kristina N. Kermanshahche, Chief Architect, Digital Health Group, Intel Corporation Shared services are a means to share needed infrastructure for health information exchange (HIE) in a cost effective manner. Countries and regions are struggling to establish models for shared services while also creating collaborative economic models that drive local innovation and accelerate adoption of advanced healthcare usage models. The goals of coordinating care and sharing data are to provide the highest quality of life at the lowest possible cost. Initial components of such a system might include proactive wellness programs, home or community care, and appropriate acute care. Later aspects might include a shift in focus from acute care to preventive care. For systems to share data and services, data centers must evolve from discrete sites and networks to a consolidated, cloud based infrastructure. This will require development of open architecture that is efficient and secure, yet flexible to networking, along with being scalable and cost effective. The financial sector offers an excellent example of overcoming these challenges. Whatever the architecture, healthcare systems will need to be able to handle increasingly massive amounts of data. The average hospital now requires 175 TB of storage for imaging and clinical records, and the primary data storage is expected to reach 100 PB by 2014 (1 PB = 1024 TB). For genomic data alone, Baylor College of Medicine required 125 TB, with a 25 fold increase expected over the next 2 years. Data storage needs overall are projected to reach 35 ZB (35 sextillion bytes) by 2020, a 44 fold increase from There are numerous business drivers for cloud computing: Efficiency: enormous economies of scale; efficiencies in size, buying power, infrastructure, power consumption; unparalleled resource utilization Agility: reduce provisioning time from days to hours; automate workflows to enable consistency, agility and elasticity; payment for resources actually used Availability: high availability for all workloads, regardless of location; protect intellectual property, data, and differentiated business processes; provide secure, broad network access on authenticated devices Services: on demand, self service portals to streamline business processes; establish measured services for virtual machine utilization, health, usage; apply actual application consumption for information technology (IT) capacity management Healthcare utility and value added services: address scarcity by effective allocation of resources, expertise; leverage ecosystem for non core competencies, achieve economies of scale; accelerate standards adoption through lower barriers to entry, build the network value model of exchange In a common healthcare usage model for care coordination, the local HIE would need to connect with the national HIE or Ministry of Health, physicians, hospitals, pharmacies, disease management programs, the family, the patient, other caregivers, payers, laboratories, and other stakeholders. The question becomes how best to interconnect and incorporate workflows into this model while balancing the 4 primary aspects of a mature model: business drivers, governance, and metrics; policy and standards; investment and revenue models; and architecture It can be most effective to address the HIE capability maturity model in phases. Phase 1 might include scheduling and triage, longitudinal health records, care coordination, and

8 medication, laboratory, and imaging records. Phase 2 might expand to include disease registries, clinical guidelines and protocols, chronic disease management, remote patient monitoring, and transitions of care (discharges, referrals). Phase 3 could encompass data services and secondary use, clinical decision support, public health and population management, quality metrics and reporting, and rural health and telemedicine. All of these are predicated on organizations having an end strategy in mind and using a normalized set of information to share. In an HIE collaborative economic model, revenue is shifted, delivering incentives to each functional group according to the value derived. The HIE contributes value, and various stakeholders derive value. The goal, as always, is to deliver improved outcomes at reduced cost. Data liquidity across regions can be handled in 3 models: centralized, federated, or a hybrid scheme. Each offers advantages and disadvantages in terms of sustainability as a business model, semantic normalization, standards adoption, and issues of privacy and security. The centralized liquidity option is best for a sustainable business model, but the federated option is best for local control. A hybrid might represent the best compromise among competing aims. Secure healthcare clouds such as Intel s include a strategy for adoption with phased implementation using best practices, standards and technologies. Through collaboration with key ecosystem partners around the world, cloud companies can offer a comprehensive set of the latest security technologies and solutions covering end to end cloud deployment models. Fully realizing the benefits of cloud based healthcare IT (HIT) will require gathering, sharing, mobilizing, and empowering healthcare delivery. The path forward must include highly secure solutions based on open standards, best practices, worldwide models, and key learning. The result will be the best possible care for the largest population at the lowest possible cost.

9 Keynote II: Analytics: No Adoption, No Value (aka, The Hard Part) Speaker: David A. Watson, Chief Operating Officer, MedeAnalytics, Inc. Culture eats strategy for breakfast. Healthcare systems are awash in data. In the past, data have been primarily administrative, but clinical and unstructured information have now been added, and social and other types of data are likely to be added in the future. The growing complexity of increasingly massive amounts of data only increases organizational performance pressure. Unfortunately, many companies underestimate the effort required to migrate to fact based management. It is much harder to predict where an organization is going than where it has been. The goals of healthcare analytics are to improve the experience of care, improve the health of populations, and to reduce the per capita costs of healthcare. These goals must be accomplished in the context of payment reform; heightened performance measurement; provider, payer, and patient incentives; and demands for increased transparency in quality and cost information. But organizations must have a strategy and end goals in mind, to identify the best path forward. One example illustrates some of the difficulties encountered in applying analytics to healthcare. Accountable care organizations (ACOs) aim to enable care coordination, quality improvement, population health management, cost reductions, and program administration. To achieve these aims, ACOs must develop methods for handling numerous aspects of care delivery and management: Care management: includes operational and analytic components, enables ACOs to provide better care for patients with chronic disease. Evidence based medicine (EBM): measures adherence to care guidelines based on comparative effectiveness research and scientific literature Clinical pathways: provides guidance for patient care based on the latest research and best practices, resource for physicians to provide the appropriate care at the appropriate time to the appropriate patient Quality reporting: calculates and analyzes provider performance on quality of care metrics used in ACO contracts Physician scorecarding: enables cultural change and performance improvement, resulting in reduced resource costs, increased service line margins, and improved quality outcomes; physicians can compare themselves to their peers and understand their relative performance Comparative program analytics: key to overall evaluation of ACO stakeholders, enables ACOs to compare the performance of both its component organizations and the ACO as a whole against other ACOs Cost and utilization: enables ACOs and providers to understand root causes of cost and utilization variances Shared savings administration It is not sufficient to create a data warehouse and expect organizational change through analytics analytics without leadership is an expensive hobby. Organizations must be clear on the goal to be achieved, the intensity of the change required, the culture and how it will need to be managed, and what level of sponsorship will be needed. Lacking any one of these criteria will doom transformation. Success can be facilitated by tethering management to project success and by integrating cultural change measures into project deliverables. In the end, transformation is more about the people than it is about the technology.

10 Panel Discussion: Business Transformation Through Analytics: Competing Moderator: David Wiggin, MBA, Program Director, Healthcare and Life Sciences, Teradata Corporation Randy A. Delgado, MBA, Health Industry and Healthcare IT Advisory Executive, PricewaterhouseCoopers LLP Ahmed F. Ghouri, MD, Cofounder and Chief Executive Officer, Anvita Health Brent Lamm, MBA, Director of Information Technology, NC TraCS Institute Terrence Macaleer, Senior Vice President, Enterprise Sales, Allscripts Maureen K. O Connor, JD, Executive Vice President and Chief Strategy Officer, BCBSNC Overview Fostering business competition can accelerate advancements in healthcare delivery and improved health outcomes. Analytics can inform organizations about the transformations needed to improve performance and competitive ability. Discussion topics As in other industries, the basis of competition in healthcare includes factors such as brand loyalty, cost, quality, and innovation. Drivers of competition include personal and corporate financial gain, business viability (survival), and qualitative measures such as social good. For employers, analytics can cut costs and increase the quality of healthcare. An example is identifying top tier providers for major cost driving areas (orthopedics, cardiology), increasing their reimbursements, and incentivizing employees to visit only these providers. Providing quality data to all providers also motivates them to improve and move into the top tier. Analytics can inform value based models for insurers to contract with providers. Instead of analyzing claims data, payments can be tied to quality measures readmissions, mortality, optimal care scores allowing strategic decision making and opportunity to effect change. Creating a platform for enterprise wide analytics can support research, quality metrics, operations, and satisfying regulatory requirements. It can also be used to create care teams for high risk, chronically ill patients, integrating data from multiple sources claims, pharmacy, patient surveys, electronic medical records (EMRs) to drive risk stratification, previsit planning, prompts, online educational, decision aids, and case management reminders. Finally, it can be used to identify and reduce unneeded tests and treatments, reducing costs to the system and risks to patients. IT can accelerate healthcare transformation through competition. In one case, a for profit health system entering a new market decided to build a value based system from scratch, to compete with an existing health system. Because a hospital was not the primary driver, the criteria for selecting a HIT vendor differed: HIE normalized/aggregated data were to feed business analytics. Data were then used to manage health, not just care for the sick. In one case, 2000 clients showed evidence (but not a diagnosis) of diabetes. Of these, 540 were evaluated, generating $250,000 of additional revenue. Understanding internal efficiencies can be aided through analytics. When legacy trend reporting and forecasting capabilities left gaps in understanding of historical trend drivers, one company developed its overall business intelligence capabilities to create historical and future trend models with a framework that could be leveraged across its insurance products. Senior leadership gained clarity about past and emerging trend drivers by segment and for the company overall.

11 Panel Discussion: Service Transformation: Business Ownership of Health IT Moderator: Steve Savas, MBA, Principal, Business Technology Office, McKinsey & Company John Edwards, MA, Director, Healthcare Strategy and Healthcare Business Intelligence Practice, PricewaterhouseCoopers Rahul Mahadevan, MA, MBA, Director, Electronic Health Records Services, Stanford Hospital & Clinics Jeffrey D. Miller, MBA, Chief Executive Officer, North Carolina Health Information Exchange Benjamin Smith, Principal Consultant, Quintiles Transnational Corporation Overview The challenge in HIT is not the technology; it is the policy, the business change management around deployment of HIT. Simply mandating compliance will not ensure its achievement. The Law of Unintended Consequences is always a concern as well. Discussion topics The ARRA stimulus proposals spurred the deployment of EMRs, perhaps prematurely, given the low levels of uptake. Methods for improving the situation and gaining business ownership of HIT vary by constituency. For providers, the primary goal is to provide quality care. For hospitals, they are now aiming to become service providers for their communities and their physicians, not just care providers for inpatients. All stakeholders will require demonstration of the practical value of HIT systems in achieving their goals, but this will not be sufficient. Also required is top down support and sponsorship of HIT initiatives, perhaps coupled with ties to incentives for improved utilization. Driving a sustainable business model remains a major challenge of HIE development. If businesses do not buy in to HIE development, efforts won t achieve critical mass (and value), but if no critical mass is not achieved, businesses will not buy in to the HIE concept. However, if an HIE can be tied to actionable knowledge, then businesses might see its value, moving to ownership, secondary uses, and monetization. As another example, a standalone hospital might use an HIE to expand its network of care, even if it is temporarily a loss leader. HIEs must provide business with models to capture new types of data within their systems, not just reimbursement variables. This could include scientific research data or operational aspects to improve efficiency. Consumers present a formidable cultural issue with regard to HIEs. They have fully embraced technology and are comfortable sharing health information on medical community and social networking sites without security. They also are active seekers of health information online. In contrast, most health systems and providers have been extremely slow to incorporate an online presence into their care models. Portals are insufficient in this regard people need accurate, tailored information about disease management, tools, and community resources, so that they can take ownership of managing their care to the extent possible. Recent regulatory rulings are also spurring a focus on engaging with patients. Healthcare will not go the way of consumerism with the retail industry; it is still based on relationships. HIT should focus on providing tools and support for fostering relationships. As long as business cases are focused on the patient, they should represent a win win scenario. Repeat business might go down as people become healthier, but satisfied clients will refer new patients to providers, resulting in no net change in volume. And if care is value based, costs of care will decrease, resulting in no net change to the bottom line. Either way, this will be good for healthcare and HIT companies.

12 Presentation: Health Research Institute Informatics Study: "The Critical Role of Data Informatics in Driving Business Decisions" Presenter: Randy A. Delgado, MBA, Health Industry and Healthcare IT Advisory Executive, PricewaterhouseCoopers LLP Overview Three main factors are pushing the health sector to rethink their business strategies: 1) the changing landscape of reimbursement, 2) convergence regarding information exchange, and 3) stakeholder engagement. Incorporating clinical informatics across a healthcare organization will be essential as the reimbursement landscape evolves to a more outcomes based approach To assess the state of clinical informatics, Health Research Institute (HRI) surveyed more than 600 provider, insurer, and pharmaceutical/ life science professionals about their clinical informatics perspectives. They also interviewed 30 top executives across those sectors and 1000 consumers. Key points Demands for clinical informatics are converging, and organizations are starting to engage with each other to expand their capabilities. With regard to governance, 56% of companies reported having no formal clinical informatics program. For staffing, 50% of companies stated that they will hire technical, nonclinical informatics talent in the next 2 years; 35% reported that they would hire clinical informatics resources. Technology: 85% of companies reported that integrating and standardizing data from multiple sources, integrating clinical evidence and measures would be challenging. In all, 70% of providers, 47% of insurers, and 49% of pharmaceutical/life sciences companies reported not exchanging data externally at present. 87% of pharmaceutical companies reported concern about the quality of EMR data. Research goals: 83% of pharma/life sciences companies listed health economics and outcomes research, whereas 75% of insurers listed outcome based research. Quality goals: 61% of providers want to improve population health by managing disease, whereas 85% of insurers want to improve management of complex cases. Drug adherence: all 3 sectors listed improved compliance with treatment as a goal. Nonadherence represents $200 billion in wasteful healthcare spending. All sectors reported that patient engagement is a way to drive profit, but they struggle with how to use informatics to help. Organizations were concerned about integrating social media data and measuring effectiveness, but consumers are concerned about security and privacy, especially for pharma. 54% of the consumers were comfortable with their physician consulting an online community of physicians with regard to their treatment. Social media participation is evolving for health industry companies. They are using it to listen (for company brand sentiment, new discoveries, and patient outcomes), participate (sponsor education, corporate messaging), and engage (providing customer service, fundraising, championing a healthrelated event or condition). Even within one organization, there are multiple, 1 dimenstional views of a patient. Having a single view of a person encompassing medical information, insurer data, medications, clinical trials, lifestyle, behaviors will create opportunities for improved care.

13 Panel Discussion: Organizational Governance Moderator: Art Glasgow, Chief Information Officer and Vice President, Duke Medicine Mia Camp, Business Optimization and Resiliency Strategist, Verizon Jason Cooper, MS, Vice President, Clinical Analytics, CIGNA HealthCare Michael Gallagher, MPH, MBA, Health Informatics Leader, GE Healthcare Performance Solutions Denise Hatzidakis, Chief Technology Officer, Premier Healthcare Alliance Overview The goal of data governance is to have faith in the data, so that it can be transformed into actionable business intelligence. Governance can be thought of as a wrapper for business practices, within which analytics and informatics work. This overarching philosophy guides governance at small, local companies to global healthcare organizations. Discussion topics Organizational governance can apply not only to data and analytics but also to operations, clinical, and financial aspects. Governance policies can follow logically if organizations determine what metrics will be collected, how they will be used, what the elements will look like, and what predictive capabilities are desired. One trap that some companies fall into is simply building a data warehouse, thinking that this is equivalent to gathering business intelligence. On the contrary, it is only one step in the process. Another way to define governance is Make it easy to do things the right way and hard to do things the wrong way. Governance does not include policing, however. Governance covers the data portfolio (sources, difficulty in extracting from warehouse), implementation (definitions), operationalization (data cleaning), and compliance (legality, privacy). When developing governance policies, organizations should take into account their mission/vision as well as the culture and history of the group(s). In addition, governance should be aligned tightly to business interests at all levels of the organization. Initial and continued collaborations among all stakeholders (analytics, business, IT, information management) will result in a workable, living system of governance. A steering committee can be helpful when prioritizing among competing organizational needs. Members should include decision makers from pertinent stakeholder groups, including product development, clinical operations, finance, employer reporting, sales, and marketing. The group should also reflect both inward facing functions such as IT, operations, and finance and outward facing functions such as client reporting and marketing, to reflect two aspects of better efficiency. Relative numerical values might be assigned to competing areas for prioritization, but organizations should remain open to overriding these when appropriate. Filling a market niche and expanding the organization s capabilities are examples of values that cannot be assigned numbers. Coordination of IT, data, compliance, and organizational governance can take many forms. Some groups use a board type structure, representing different levels from the company up to the CEO. Others have layers strategic (executive), operational (implementation), and tactical (planning) for both the business and IT sides. Still others have IT/analytics governance piggybacked on the clinical side when present. For all scenarios, it is important to have cross fertilization (a healthy tension ) to foster understanding and community across groups. Governance can inform and validate the business use of analytics. If proper governance is in place, then the business side can give input as to the use of the data. In fact, the data warehouse can be opened to all uses, if the platform robust, open, and appropriately governed.

14 Panel Discussion: Moving Forward: Next Steps Jeffrey M. Ferranti, MD, MS, Chief Medical Informatics Officer, Vice President for Clinical Informatics, Associate Director, Duke Center for Health Informatics (DCHI); Assistant Professor, Newborn Critical Care, Duke Medicine Art Glasgow, Chief Information Officer and Vice President, Duke Medicine Kevin A. Schulman, MD, MBA, Professor of Medicine and Gregory Mario and Jeremy Mario Professor of Business Administration, Associate Director, DCRI, Director, Fuqua Health Sector Management Program, Duke University Overview The presentations and discussions of the day provided several avenues for pursuit. Strategies for moving forward should include investments in formal educational programs, cross training within organizations, and community, regional, national, and international outreach. Discussion topics The annual Informatics Conference has been a valuable addition to the efforts geared toward improving care for patients through better use of informatics. Thought leadership in academia, industry, and government must face the challenges to healthcare and the country through leveraging intelligence and operationalizing innovations. The Duke organization might offer service to the community through conducting community based research into best analytics practice, perhaps tied to the MMCi program. Businesses continue to need both people who can frame business cases for investing in analytics and/or informatics and those who can develop business around analytics/informatics. Degree and practicum programs in this space should be kept as pragmatic as possible, helping students learn how to solve real problems using real data. Examples could include having students help deploy and use EMRs for informatics activities. Former MMCI students who are now working around the world also should provide feedback on this topic. Cross pollination between business and informatics also applies to the global community as they begin to implement EMRs and analytics. Best practices remain to be developed for identifying and fostering appropriate candidates within both global business and informatics degree programs. At present, students in the Global MBA program in Fuqua do have access to MMCi classes, but efforts should be expanded and formalized. The education of physicians also requires change. The traditional, closed model of information contained within a solo practitioner no longer applies, but current medical school programs generally do not include training about the principles and value of HIT and information sharing. There appears to be a new willingness within academic medicine to consider data sharing; for example, the Duke School of Medicine is now including training on the EpicCare EMR in their curriculum. In addition, medical informatics is now a recognized medical specialty, representing a step in the right direction. Still, it might take additional encouragement from the American Association of Medical Colleges, national medical board entities, and specialty societies for widespread change to occur.

15 About the HSM Industry Conferences The HSM Industry Conferences were initiated to address the healthcare information technology (HIT) provisions of the American Recovery and Reinvestment Act of The inaugural conference, held in April 2009, focused its discussions on HIT related connectivity and industry strategies, with three aims: to provide forums where top minds from top healthcare organizations meet to discuss the most relevant topics of the day facing the health sector, to facilitate and strengthen relationships between Fuqua's HSM and MMCi programs and leading healthcare organizations, and to enhance the HSM and MMCi extracurricular opportunities for students by allowing for a broader, deeper exposure to health sector issues beyond the classroom environment. That first conference brought together 50 senior executives representing more than 20 healthcare firms. Since then, the MMCi program has seen its first class graduate (2011), and HSM has hosted a total of nine Industry Conferences, each with an average attendance of 200 guests representing more than 90 organizations from US and international markets. The meetings alternate their focus every six months, with the Informatics Conference taking the spring, and the Medical Innovation and Strategies (Wireless) Conference taking the fall. Collectively, these conferences continue to achieve all of the three original aims, with the addition to strengthening cross collaboration at Duke and cocreation of new organizational partnerships.