The Mount Sinai Hospital

Kumar Chatani

The Mount Sinai Health System has become a leader in shifting to a value-based health care model from a fee-for-service model. It is one of the largest not-for-profit health systems in the country, consisting of seven hospital campuses and the Icahn School of Medicine at Mount Sinai, plus ambulatory and other facilities located throughout the metropolitan New York region. Our mission is to improve the quality and efficiency of care and the patient experience for our diverse set of patients, while advancing medicine through our unrivaled education and research. Our value-based service strategy is centered on providing compassionate patient care that is continuous and coordinated both across our hospitals and when patients are at home, leading to fewer hospitalizations, and ultimately lowering costs for our patients and our Health System. Consequently, the Mount Sinai Information Technology department must aggressively transform our technology products and services in order to support our Health System's vision and direction.

Our population health manage­ment program is a major strategic component for facilitating this shift to a value-based health model. An im­portant population health initiative for the next few years will be to enhance our technologies to support New York State’s Delivery System Reform Incen­tive Payment Program (DSRIP), which is a main driver for the Medicaid Rede­sign Team (MRT) Waiver Amendment. To meet this mandate and receive the expected incentives, Mount Sinai formed the Mount Sinai Performing Provider System, which entails numer­ous initiatives such as a home-based primary and palliative care program and an advanced multi-disciplinary ad­olescent health program, all requiring extensive technology capabilities.

"Our patient information, as well as our organizational data, must be safeguarded from growing and ever-evolving cyber threats"

A major component of our popu­lation health strategy is our unique Health Information Exchange (HIE) platform, which provides secure, time­ly, and flexible patient information to our physicians, clinicians, affiliate or­ganizations, and insurance payers. This HIE platform will be extended to work with our Performing Provider System partners and services developed by New York State in order to enable inte­grated patient information exchange. In addition, our HIE platform will be en­hanced to support physician outreach initiatives, marketing strategies, and competitions for research grants/con­tracts. Equally important, our HIE plat­form will support new initiatives to en­courage and improve communications with patients with the goal of empowering patients to take ownership of their own health.

In concert with our HIE’s data warehouse, data mining of Electronic Health Record (EHR) and claims data will be­come an even greater focus as we advance our analytical abilities to monitor and improve clinical quality and provider performance, and to identify and leverage leading practices. Our data warehouse and associated analytic platforms will be enhanced to include important functions such as clinical decision support, population health metrics, predictive analytics reporting, registries for care management, and utilization management.

Digital medicine is the convergence of tech­nology and health, and is a major driver of change in how we manage health care. By establishing key vendor partnerships, we will increase our efforts to develop inno­vative digital technology platforms. These digital medicine products will enhance our doctors’ ability to collaborate in novel ways with our patients, enrich scientific research opportunities, and empower patients to govern their health care. Below are exam­ples of our digital medicine focus areas:
• Smart therapeutic interventions
• Enhanced algorithms for disease detection and interventions
• Establishment of digital biomarkers of diseases
• Platforms to connect care teams, patients, and providers
• New methods of analyzing and visualizing data
• Applications for personalized medicine
• Tools to foster engagement between patients and consumers/patients

Telehealth and wearables are two other emerging tech­nologies that will deliver high-quality care regardless of ven­ue and with greater convenience for both our patients and providers. Our focus in these technologies includes remote patient monitoring and care, health educational programs, two-way interaction between the health provider and the pa­tient/consumer, and mobile health, all with the goal of pro­viding and promoting healthy behavior.

Our patient information, as well as our organizational data, must be safeguarded from growing and ever-evolving cyber threats. As attacks continue to increase and become ever more sophisticated, our diligence in protecting our as­sets also needs to be enhanced. The Mount Sinai environ­ment poses a unique challenge given that we need to protect this information, while at the same time promote the open exchange of information for our academic and research func­tions to enable the free flow of ideas and information nec­essary for our School of Medicine. Consequently, we have established a comprehensive and multi-layered IT security program that protects data both at rest and in transit, our computing resources, and networks from various threats.

Given the sensitive nature of the data we manage, we are making selected use of cloud technologies. When evaluating cloud solutions, we must balance cost reduction and opera­tional efficiencies with our ability to manage and access our data in secure fashion. Since we operate in a hybrid environ­ment, we utilize both on-premises and off-site cloud ser­vices, and we expect this approach will continue within our organization.

Another key technology driver for sup­porting our forward-thinking health system is consolidating onto a single EHR system across our inpatient and ambulatory set­tings. Our EHR is a key enabler behind the Mount Sinai Ac­countable Care Organization; has profound impact on safety, quality, and efficiency; and pro­vides a data and research plat­form for the National Institutes of Health and other grants. As more and more health systems con­solidate across the country, this type of EHR technology integration will continue to grow in importance.

Of course, meeting our regulatory requirements, which continually evolve and expand, is a high priority for any health care organization. Our HIE platform combined with our data warehouse and analytics enables us to meet these regulatory challenges in a timely, accurate, and flexible manner.

The Mount Sinai information technology landscape is a complex ecosystem that is constantly changing and evolv­ing. We must balance flexibility and innovation to support our health system’s shift to a value-based health care model, while being diligent in protecting our assets and meeting our regulatory requirements, all while also being cost-effective in providing our products and services. We must also perform to the highest level of professionalism with few errors in or­der to protect the health of our patients.

Our responsibilities as health care information technolo­gists can often be challenging, can seem daunting at times, and are constantly changing and advancing. And yet being an information technologist in the health care industry, which is exploding with change and growth, is exciting and exhilarat­ing. What an exciting time to be a health care information technologist in a progressive organization such as Mount Si­nai. We are helping to save lives and move an industry into the future.

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