NaviNet Admin on March 27, 2012

2012 NaviNet Expert Interview Series: Dr. Geeta Nayyar, CMIO of AT&T


We recently sat down with Dr. Geeta Nayyar, the first-ever Chief Medical Information Officer at AT&T and a practicing physician. Her work touches multiple healthcare stakeholders and organizations. Geeta’s clinical background is in Internal Medicine and Rheumatology. She is a member of the Public Policy Committee for the Health Information and Management Systems Society (HIMSS) and serves on the Committee on Government Affairs for the American College of Rheumatology. Dr. Nayyar believes that technology can enable effective and efficient healthcare.

What do you predict as the biggest game-changers in HIT in 2012?
Healthcare stakeholders are increasingly looking for technologies that will better allow clinically integrated care. Technology can help us analyze the vast amount of data that continues to grow at an astounding rate. All of us need the opportunity to put it all together and use analytics to make more informed decisions regarding patients and see patterns in healthcare on a larger scale. Bringing evidence-based medicine to the point of care can help clinicians manage chronic, complex patient conditions for individual patients and across entire patient populations.

This ultimately will be the foundation for a successful provider organization and the building block for a successful accountable care organization. Along these lines, technologies that better enable the shift of care from an acute care setting to a nonacute or home setting will be increasingly important. Patient-centric care remains the cornerstone of this shift, along with better patient engagement and education tools that technology has the opportunity to provide.

Accountable care organizations: Are you a supporter?
Yes. Today’s healthcare system provides incentives for expensive interventions rather than prevention. Now, policy and reimbursement models are shifting to a more “accountable care” model, with incentives being based on value versus volume and preventions versus interventions.

What factors will shape care collaboration in the coming year?
Information exchange isn’t a one-way street. If caregivers are not connected, they cannot collaborate effectively as a team. We need to focus on providing better clinically integrated care—improving collaboration among providers, patients, and the entire care team. I believe an integrated care model with fewer opportunities for gaps in coordination will improve outcomes.

Do you believe that care collaboration can lower the cost of care?
Yes. Solutions need to address the entire healthcare continuum of care—from the home setting to the acute care setting, with a focus on preventing patients from being hospitalized again and again.

Consider this example: In today’s healthcare system, the typical patient is John Doe, a 72-year-old white male with multiple diseases from hypertension to diabetes and heart disease. He sees multiple physicians who have difficulty coordinating his care and communicating effectively among his care team.

John may or may not have a primary care physician (PCP), and if he does, he likely only spends about 10-15 minutes with his primary doctor every month or so. That doctor may advise him to see one of the multiple specialists that he sees for his various disease states. Those specialists typically do not communicate effectively with each other—and do not do so in real time. Often, time lapses between communications, and John is largely left to manage a great number of medications and treatment regimens on his own.

It’s no wonder that he is hospitalized 10-12 times a year and is treated for acute flare-ups, with poor follow-up and little to no communication with his varying physician specialists and PCP. There likely has been little to no communication to his care team as to why he was even hospitalized in the first place or what treatments were adjusted in the hospital that might impact another medical condition or treatment he is taking. John may or may not have the intellectual ability or resources to manage and coordinate large parts of his care on his own.

It’s easy to see that the hardest part is often not making the diagnosis, but the coordination of care and effective communication needed among the various providers and institutions.

What changes do you foresee in physician office dynamics as more providers move to a collaborative value-based model?
The aim of a collaborative value-based model is to create more of a team approach to the patient. No longer will there be silos of care delivered from various care team members, be that from specialists, nurses, or pharmacists. This will result in a more streamlined and collaborative approach to patient care.

What value do you believe HIT creates in the healthcare industry?
In today’s healthcare environment, we rely almost exclusively on multiple individual practitioners—doctors, nurses, pharmacists, and others—who operate separately. This results in disconnected clinicians, not more efficient and effective care teams. We can help change that by applying to healthcare the same technology and innovation that have made mobile technology and smart phones an integral part of our lives. The value that technology can bring is the enablement of a new, integrated approach to healthcare, where providers work together as an efficient and effective team—while also empowering patients to take a more active role in their own care.

At AT&T, our solutions help solve challenges in the healthcare system along the entire continuum of care—from acute care settings to home care settings. We’ve built solutions to address the various gaps in healthcare. The AT&T ForHealth portfolio includes services that are focused on providing better clinically integrated care and improving collaboration among providers, patients, and the whole healthcare team. Our solutions are focused around four pillars: improve outcomes, reduce costs, increase access to care, and deliver personalized care.

What are the most valuable changes mobile devices can bring to practices?
Healthcare is an industry well-suited to take advantage of mobile technologies because they can enable caregivers to have real-time information about a patient’s condition and response to treatment. Ubiquitous mobility has laid the foundation for mHealth adoption. People are increasingly thinking about their own health and wellness. Most—88%—doctors would like to see patients track their vital data at home. Home-based remote patient monitoring services can reduce the amount of time patients spend in hospitals and allow caregivers to continuously track their status. This could bring a variety of important benefits: better health outcomes and greater patient satisfaction because less time is spent in the hospital or traveling to appointments. Providers can use their time more efficiently, helping more patients. And this efficiency can result in significant cost savings, as well.

What is the one tool or application you wish existed?

It’s not the tool or application that is important, but what it’s able to accomplish. I would love to be able to sit down and talk with a patient and easily have a holistic view of who they are, their medical history, their medications, and allergies. What are their baseline labs/values? It would be ideal to have that kind of data available at my fingertips. The clinical part of my job is where we need to focus. What are my patient’s symptoms? What condition do I think they have? Providers shouldn’t have to divide their attention between the clinical aspects of care and also dealing with back-end data-gathering and coordination of care issues.

Thank you, Geeta, for sharing your insights on HIT and its role in improving healthcare. What goals does your practice have for 2012? How will HIT and mHealth tools help your practice to reach desired outcomes? Join the discussion on our blog or by connecting with us on LinkedIn, Facebook, and Twitter. Learn more about what HIT experts and physicians are thinking about in 2012, including Bryan Vartabedian of 33 Charts,Janice McCallum of Health Content Advisors, and Jennifer Dennard of Billian’s HealthData and Porter Research.

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