CMIO profile: Dr Robert Wah

Dr Robert Wah, the former head of the US military’s health IT programme and president-elect of the American Medical Association, says the digitisation of healthcare is an opportunity that must be shaped and led by clinicians.

The ex-navy veteran clinician says that physicians are often already leaders – “the captain of the ship” – but to become effective clinical information leaders they need to add management skills.

EMRs just the first step

Dr Wah argues that clinical information leaders – chief medical information officers in the US and chief clinical information officers in the UK – are essential to lead the workflow and business change that the introduction of electronic health records enables.

CSC’s chief medical officer also stresses that introducing electronic medical records is a vital first step, but it is how they are used to transform patient care that remains the real prize to focus on.

Dr Wah spoke and took part in the first CCIO Summer School in July and will be returning as a keynote speaker at the CCIO Leaders Network Annual Conference, which takes place alongside EHI Live 2013 at the NEC in Birmingham in November (10.00am on Wednesday 6 November in Theatre C).

“I’ve always just seen information technology as just another tool to allow me take better care of my patients,” he tells EHI. But where Dr Wah differs from most other clinical information leaders is the sheer scale of the projects he has led.

An illustrious career

His career includes 20 years as a serving US navy endocrinologist, which progressed to him leading the health IT programme for the US military.

“I was leading a $900m health IT programme for US military healthcare, a healthcare system that covers 450-clinics, 65 hospitals and that cares for 10m patients.”

He says that the US military has a proud record of successfully using clinical IT: “In the military it’s been 20 years since I wrote a prescription on a piece of paper.”

Dr Wah went on to become the deputy chief information officer of the US military and helped David Brailer set up the Office of the National Coordinator – the government body charged with ensuring every US citizen has an electronic medical record by 2015.

From 2009, he led the $30 billion HITECH EHR investment programme. Dr Wah jokes that his friends tell him he left the ONC too early, just before the $30 billion of HITECH money arrived in 2009, and recalls how one visitor used to tease them about how little money the ONC had.

“Richard Granger from the UK used to regularly visit us and he’d often boast about how his budget was bigger than ours,” says Dr Wah. He joined CSC in 2006 as its chief medical officer.

Leadership the key to success

Whatever the scale of project, Dr Wah says that the absolute key to being an effective CMIO is leadership.

“Leadership is often part and parcel of what we do as clinicians,” he tells EHI. “Physicians are often said to be captains of the ship. We are often leaders of the healthcare team.”

He stresses that to be an effective leader on information and IT a CCIO needs to first be a clinical leader.

“I always say to people don’t hire the person with a pocket protector and every gizmo ever made. You want the clinician working in the hospital that every other clinician in the place would send his family member to.”

“The person you really need is the person who has the clinical credibility. So when he or she says this is the way to go, others will follow. If the guy with all the gadgets hanging off his belt says this is the way to go, he won’t be nearly as well listened to.”

Dr Wah says the role of the CMIO is fast evolving in the US, moving beyond EMR implementations.

“Many organizations use the CMIO as a role to facilitate the adoption of electronic medical records in their organisation. The smarter ones are using that same person to extract value from moving from paper to digital.”

He adds: “it starts with the ease of implementing EMRs, but most are expanding past that to reaping value from the digital information they now have.”

Stay focused on workflow

Dr Wah is also clear about the benefits of working customers who have a CMIO.

“If you don’t take the technology and look at how to improve your business flow you will miss most of the benefits. Organisations that recognise that often charge the CMIO with focusing on the workflow.”

He adds: “a paper-based process is extremely sequential, but electronic is very different. You can have multiple simultaneous access and it allows us to work very differently.”

“But if you’ve never taken care or a patient or worked through that workflow it will be very difficult for you to see the opportunities an EHR provides.”

Health IT, cyber-security and cloud meet

In his CSC capacity, Dr Wah says that as healthcare achieves new levels of automation and digitisation there are new opportunities and challenges.

“I think there is a coming intersection between health information technology, cloud computing and cyber-security. And at the centre of that intersection is the patient.”

Dr Wah explains: “Today as we move off paper onto a digital platform and as we network that platform and digital information together, the natural next step is that we are going to want to analyse that information in new and innovative ways that we never could do on paper.”

He says the convergence of cloud computing and analytics offers the opportunity to be much more flexible in analysing clinical data and gaining insight from it.

“As we move into digital world and you ask patients what they are most concerned about with their electronic health record, I would say their biggest concern is privacy and security of their information.

“They are very concerned that their health information will show up on the Internet one day. They are seeing it with their financial information and are very concerned their health information could go the same way.”

Ask for whom the bell tolls

Once patients’ confidential data is in the open, the genie is out of the bottle.

“If your diabetes diagnosis, psychiatric diagnosis or HIV diagnosis show up on the Internet that is a bell you cannot un-ring, and patients recognise that.”

Dr Wah suggests that an emerging role as a custodian of patients’ confidential data needs to become a future area of focus for clinical information leaders

Dr Robert Wah will be speaking at the second CCIO Leaders Network Annual Conference, which is co-located with EHI Live 2013. This year’s conference is free for all visitors to attend.