Bob Brown is the co-author of “The Health Information Exchange Formation Guide: The Authoritative Guide for Planning and Forming an HIE in Your State, Region or Community.” The book was published in February 2011 and was recently named HIMSS Book of the Year. Along with co-author, Laura Kolkman, RN, MS, FHIMSS, he also writes the monthly HIE Formation column in HIMSS monthly e-newsletter, HIMSS HIELights.
Brown is the vice president of professional services of Mosaica Partners, a health information consulting and advisory firm. The firm’s clients include: the federal government, states, regions, communities, HIE/health IT vendors and numerous organizations that collect, manage and share health information.
He led the team that developed both Mosaica’s HIE Maturity Framework and its HIE Formation Methodology. Brown oversees the development and delivery of all of Mosaica’s consulting and advisory services.
Brown has over 30 years of management and executive-level consulting experience and is an internationally recognized authority on consulting and the consulting process. His well-rounded background includes accomplishments in developing consulting methods and tools, developing and delivering consulting and advisory services and product management of technology products and electronic financial services. He also has additional management and technical level experience in banking, publishing, telecommunications and information systems.
HIMSS: How did you become involved with HIMSS?
Brown: In 2007, I was the managing director of Consulting Intelligence, LLC, a specialized consultancy. We advised our clients on the use of external consultants, resolved troubled consulting projects and helped them locate, negotiate with and engage the right consulting firms. When contemplating the expansion of her HIE consulting organization, Laura Kolkman, founder of Mosaica Partners, sought my advice in the areas of consulting best practices and consulting practice development. It was a very interesting engagement, and I got my first glimpse into the world of health information management and the need to share health data. Subsequently, I joined Mosaica Partners as an external advisor. I joined HIMSS and attended my first HIMSS conference in Orlando in 2008. I’ve been a member, and attended every annual conference, since then.
HIMSS: What has been the most rewarding aspect of your involvement with HIMSS?
Brown: Without question, it’s been the opportunity to meet and work with some extraordinarily talented people who, regardless of their social, economic or educational backgrounds or their political persuasions, share a common vision that the way we provision healthcare can be greatly improved through the use of information technology. I believe most HIMSS members—whatever their role in their respective organizations – are completely dedicated to that idea.
Of course, having HIMSS publish the book I co-authored with Laura, seeing it become a HIMSS top seller, and then, having it receive the Book of the Year award were also especially rewarding.
HIMSS: Can you list key points made in your book, “The Health Information Exchange Guide: The Authoritative Guide for Planning and Forming an HIE in Your State, Region or Community”?
Brown: The main point is that forming a health information exchange (HIE) organization is not a technology project. In consulting parlance, it’s viewed as a large scale change management project, albeit one with an important technology component. But the project, at its heart, is about bringing people together to a stand-up organization that’s dedicated to the greater good.
The next point is that experience has shown us there are right and wrong ways to form an HIE. There is not just one right way, but there are leading practices that should be incorporated into any HIE formation effort, regardless of whether the HIE will be public, private or tied to an ACO. There are some things you should always do and some things you should never do. We have a custom designed methodology we use with our HIE formation clients to insure essential activities are always included. We believe every HIE formation effort should seek some form of experienced outside counsel, either experienced volunteers or paid advisors, to ensure they’re on the right path and doing the right things, in the right order and in the right way.
Finally, like any business, an HIE is an organization that must operate in a business-like manner. It’s important to understand and engage your various customers and stakeholders, learn what they want and need, and how to satisfy those wants and needs. That all sounds very simple, and it actually is, but it’s not necessarily an easy thing to do.
HIMSS: What was one of the greatest challenges in composing the book?
Brown: If only there was just one that came to mind! Actually, there were a couple of major challenges. The first was how to organize the construct and flow of the book so that it would make sense to the reader. There’s a lot involved in planning and forming an HIE. We had to develop a structure that would accommodate a normal front to back reading as well as provide easy access to specific information for someone who wanted to use the book as a reference source; to learn about a specific subject like governance, privacy, or sustainability.
Another challenge was integrating Laura’s extensive experience and expertise in health IT and HIE with the consulting methods and approaches and project management best practices I was responsible for contributing. Our expertise and work styles are very different. Fortunately, Fran Rubino, Laura’s longtime assistant, was able to keep us both on track and focused on the job at hand. Some 19 months after we started the effort, the book was published.
HIMSS: Please describe some of the milestone events in your career.
Brown: Very early in my professional career I was introduced to IT when I was hired as a junior systems analyst at BOSE Corporation. There I learned about business systems and processes and was part of the team that brought information technology systems in house. I picked up the basics of manual and automated systems, integrated workflow, business process design, systems development methodologies, telecommunications and managing complex IT projects. What I learned at BOSE served as the foundation for my subsequent professional career. I learned how IT was an enabler and how to harness it for that purpose.
Many years later, while specifying the IT infrastructure required to support a new customer service strategy for Bank of Hawaii, I was approached by IBM. They were starting a national consulting practice that specialized in improving customer service and customer relationship management. They approached me because of the work I was doing at the bank, including presentations I was making at banking and customer service conferences. IBM hired me and provided me with world-class training and education in the consulting arts and sciences. Just as I had done with IT, I took to consulting like a duck to water.
In addition to consulting with IBM’s clients on customer service and CRM issues, I developed new consulting methods and several enhancements to IBM’s customer-centric consulting offerings. I was subsequently tapped to expand IBM’s consulting curriculum and to train consultants at IBM’s education centers in Europe, North America and Asia.
HIMSS: What are the most notable changes you’ve seen in the field of health IT over the course of your career?
Brown: The biggest change is one that has not yet happened, but I think it’s about to. That change is about improving the usability and usefulness of our health IT systems and the need for a more engineering-like approach to our nation’s overall health IT infrastructure.
So many clinicians and staff members are unsatisfied with the usability and usefulness of the health IT applications with which they’re working. This isn’t news; you hear the complaints everywhere. Those systems simply aren’t satisfying their wants and needs. The systems themselves might be effective, but they’re often painful to work with. That’s a huge problem.
What’s generally missing in these systems is an accommodation of the practitioners’ and staff member’s perspective and of established protocols. Instead of proactively assisting the clinicians and their staffs, the systems are often getting in the way. Many don’t integrate well with existing process and workflows; sometimes they even impede those processes and workflows. That’s very frustrating, but it’s almost impossible for a single clinician or staff member to affect the necessary changes.
Until now, we’ve relied mostly on the federal government and health IT vendors to specify the functionality and user interfaces of our health IT systems. I think we’re all slowly coming to the realization that another perspective is needed. I believe we’ll be seeing a more proactive approach by the members of the healthcare community – probably through the involvement of their professional organizations and associations – to provide that new and much-needed perspective. Those organizations have the clout to ensure that the changes needed to improve health IT systems’ functionality, usefulness and usability are defined and implemented. I think their involvement is essential, if we want to realize the true potential of health IT.
We won’t realize that potential until the underlying health information infrastructure and applications we use are more accommodating to the continually evolving world of IT, wants and needs of clinicians, their staff members, the organizations they work for and of course, their patients.
HIMSS: What advice would you give professionals just entering the healthcare or IT field?
Brown: Climb aboard and hang on! Seriously, the intersection of healthcare and IT is really still in its infancy. Healthcare still lags many other industries in the effective use of IT. I believe great strides will be made in the next decade. Possibly more than in any other field, there is an opportunity to do great and important work with talented people who are on a noble mission.
If you’re just starting out, your hours may be long and your pay may not be what you could earn elsewhere, but the rewards, both personally and professionally, can be great. Welcome!