Careers: Interviews
Dr. Danny Sands: Director of Medical Informatics, Cisco Systems; Assistant Clinical Professor of Medicine Harvard Medical School

This week, Stephen Ibaraki, FCIPS, I.S.P., DF/NPA, MVP, CNP has an exclusive interview with Dr. Danny Sands.

Dr. Danny SandsDanny is an internationally recognized lecturer, consultant, and thought leader in the area of clinical computing and patient and clinician empowerment through the use of computer technology. Prior to joining Cisco, he served as the Chief Medical Officer and VP for Clinical Strategies for Zix Corporation, where he provided clinical leadership that helped the company become a leader in e-prescribing. Prior to that, he was the Clinical Systems Integration Architect at Beth Israel Deaconess Medical Center in Boston, where he had worked since 1991.

He earned his baccalaureate at Brown University, medical degree at Ohio State University, and a master's degree at Harvard School of Public Health. He did residency training at Boston City Hospital and an informatics fellowship at Beth Israel Deaconess Medical Center. He is an Assistant Clinical Professor of Medicine at Harvard Medical School and maintains a primary care practice in which he makes extensive use of health information technology.

Danny is the recipient of numerous health IT awards, sits on the board of the American Medical Informatics Association, and has been elected to fellowship in both the American College of Physicians and the American College of Medical Informatics.

The latest blog on the interview can be found in the IT Managers Connection (IMC) forum where you can provide your comments in an interactive dialogue.
http://blogs.technet.com/cdnitmanagers/

Index and links to Questions
Q1   Can you describe your current roles with Harvard Medical School and as Cisco System's new Director of Medical Informatics? How will you shape these organizations strategies and objectives into the future?
Q2   Can you provide specific examples how the clinical environment can be transformed by technology?
Q3   From an overall perspective, what are the steps required to implement these IT solutions for clinicians, patients, and provider organizations?
Q4   What are your perspectives on the future direction of technology in the clinical environment?
Q5   What specific challenges/barriers did you experience and the resulting lessons and useful tips from your work as: Chief Medical officer and VP for Clinical Strategies at Zix Corporation, Clinical Systems Integration Architect at Beth Israel Deaconess Medical Center in Boston?
Q6   Overall, what are the top opportunities and threats for the medical ecosystem and how they can be managed using people, process, and technology?
Q7   Looking back over your career, what three stories and resulting lessons can you share that were most pivotal?

DISCUSSION:

Opening Comment: Dr. Sands, with your impressive background in the Medical Informatics field, we are fortunate to have you doing this interview. Thank you for taking the time to share with our audience.

A: It's a pleasure, Stephen.

Q1: Can you describe your current roles with Harvard Medical School and as Cisco System's new Director of Medical Informatics? How will you shape these organizations strategies and objectives into the future?

A: I have been on the faculty of Harvard Medical School for many years, where I continue to teach residents and students about medicine and health information technology and collaborate on some research projects. The job at Cisco is new. In this role, I provide both internal and external health IT leadership, build relationships with customers and other organizations, and help partners transform their clinical and business practices using IT. I also maintain a part-time internal medicine practice at Beth Israel Deaconess Medical Center in Boston.

Q2: Can you provide specific examples how the clinical environment can be transformed by technology?

A: Electronic medical records, computerized physician order entry, electronic communication, clinical decision support, patient access to their records, just to name a few.

Q3: From an overall perspective, what are the steps required to implement these IT solutions for clinicians, patients, and provider organizations?

A: Not a simple answer. In general, this requires an organization (or practice) that is committed to transforming clinical care processes. Key members of the organization must be committed to the project, including administration and key clinical leaders. Organizations must pursue a careful analysis of current workflow and pain points. Then they must select a system with adequate attention to the company itself, site visits including user interviews, demonstrations, and attention to system stability, performance, expandability, and usability.

Q4: What are your perspectives on the future direction of technology in the clinical environment?

A: Currently, we have an unsafe environment for patients (medical errors are common and costly), and both patient and physician satisfaction is flagging. Ultimately, physicians should be rewarded based on quality of care delivered and patient satisfaction, and not just quantity. We should get continuous feedback on how we're doing and we will strive to improve. Technology such as electronic health records with integrated clinical decision support can help us improve the safety and quality of care we deliver. Ordering tests and medications through intelligent computer systems will be compulsory. These systems will inform clinical decisions by incorporating information about patient health problems, medications, allergies, and increasingly genomic data. Through e-communication with colleagues and patients we will improve the therapeutic relationships we have with our patients and provide comfort to them. Patients will have continuous access to their health records and health care teams whenever and wherever they need them. As we age and become infirm, home monitoring will help us maintain our health and prevent illness. Technology will enable these transformations and many more.

Q5: What specific challenges/barriers did you experience and the resulting lessons and useful tips from your work as: Chief Medical officer and VP for Clinical Strategies at Zix Corporation, Clinical Systems Integration Architect at Beth Israel Deaconess Medical Center in Boston?

A:

  1. Chief Medical Officer and VP for Clinical Strategies at Zix Corporation:

    When implementing office systems, it's crucial to get a commitment from all members of a practice (not just a single project champion). In addition, providing an application, even at no charge, does not produce success. Implementing clinical systems is a high-touch, hands-on process. Finally, quality of service in clinical applications or systems is crucial.

  2. Clinical Systems Integration Architect at Beth Israel Deaconess Medical Center in Boston:

    I worked in several capacities at Beth Israel Deaconess over my 14 years there. I learned many lessons there, some taught by my mentors who are pioneers in clinical computing, Warner Slack and Howard Bleich. I will mention a few.

    • The adoption of health IT systems is facilitated by an organizational culture of health IT use. In fact, the more functionality you provide for users, the more they will want.
    • Clinical applications must be engineered around clinician workflow.
    • Applications must be reliable, response time must be rapid, and clinical information must never be lost. A user's behavior when interacting with a computer program is shaped by the consequences of his behavior. In other words, if the user interacts with a system and good things result (useful information, minimizing of workload, etc.), that user will want to use the system again. If, on the other hand, use of the systems results in pain (for example, waiting for system response, lost data, bad information displayed) that user is not likely to want to use the system again.
    • For physicians, offer training, but do not require it; offer plenty of support (or just-in-time training).
    • Make support a one-stop-shopping and multi-channel experience, accessible through phone, page, e-mail, and any other channels you have available to your users.
    • Utilize clinicians who have expertise in health IT to help design and implement clinical system. Ideally, these should also be users of the system you are implementing.
    • Don't go live with a clinical application unless IT staff will be available to take it offline or deal with resultant problems (so avoid weekends).
    • Set goals for system use and monitor progress against your goals.
    • Communication skill is the most important skill a clinical IT director can possess.
    • It's better to beg forgiveness than to ask permission.

Q6: Overall, what are the top opportunities and threats for the medical ecosystem and how they can be managed using people, process, and technology?

A: I will limit this to US and Canada:

  1. Reimbursement system based on quantity rather than quality of care.
  2. Reimbursement that focuses only on visit-based care-should also reimburse for phone-based and online interactions.
  3. Not enough investment in health IT to improve efficiency, cost-effectiveness, and quality of care.
  4. Inadequate human resources to help physician practices and hospitals select, design, and implement health IT systems.
  5. Poor education of public and clinicians about benefits of health IT.

Q7: Looking back over your career, what three stories and resulting lessons can you share that were most pivotal?

A: When I started my training in health IT, one of my mentors made me spend time with personnel in all parts of our hospital. This included nurses, physicians, pharmacists, ward secretaries, radiology technicians, laboratory technologists, and others. I was angry, because I didn't understand why I had to do this. I met with dozens of people and learned how they did their jobs, how they interact with the hospital computing system, what needs were being met, and which weren't. In retrospect, this was an extremely valuable experience.

Another experience involved e-mail. I was doing a project in computer-assisted discharge planning. I realized that communication, often via e-mail, was a crucial part of this. I hypothesized that e-mail was important for clinical work in the medical center. My teacher disagreed and felt that most of it was social. This prompted me to study the use of e-mail in our institution, and I found that at the time most was clinically oriented.

Finally, when I took over leadership of our electronic medical record project I established a committee with roles and responsibilities, established a culture of customer service, set goals for system utilization, and monitored data every quarter and how well we were achieving these goals. This turned out to be valuable because it made us more focused and directed. We developed esprit de corps and pride of ownership. It resulted in excellent results as we were able to track our progress.

Closing Comment: Danny, again, thank you for sharing your deep insights, talent and experiences with our audience.

A: My pleasure, Stephen.

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