Inside CACI's health care IT strategy

Army Col. Keith Salzman, a surgeon, joined CACI International Inc. as chief medical information officer in the company’s Transformation Solutions Group two weeks after his military retirement last month. It’s a position Salzman seemed to be training for ever since he was commissioned as a reserve Medical Service Corps Officer through the Health Professional Scholarship Program in 1987. He was the first surgeon for the Stryker Brigade combat team, and he served in Heidelberg, Germany, as deputy commander for outlying clinics and as interim deputy commander for clinical services in Kosovo. His last post was as chief of regional informatics for the Western Regional Medical Command at Madigan Army Medical Center in Tacoma, Wash. Salzman recently spoke with Associate Editor David Hubler about his new career. They were joined by Michael Grabfelder, CACI senior manager for health care IT. Here are excerpts from that conversation.

Q: How did you and CACI get together, and what attracted you to the company?

Salzman: Last October, after I got back from Iraq and Germany, I gave a talk about theater medical information flow at an electronic health records conference. I had run the program to implement and use IT tools in Iraq to document patient care and get it back to the states. Executives from CACI were present and because those are things CACI is interested in, we exchanged cards. There were a few companies that were interested, but CACI was the most interested and committed. We ended up talking and that’s what got me here.

Grabfelder: We’ve had our eye on Dr. Salzman for quite a while. We’ve known about his abilities and his stature. We’ve been strategically building the business, and part of our strategy was, as we were able to bring in more IT work of a clinical nature, we needed a chief medical information officer. At that conference he announced his retirement and we took advantage of approaching him at that time.

Q: How does the satisfaction of being a medical professional compare with the work of building an IT health care infrastructure as a CMIO?

Salzman: I’ve done both most of my career, not as a CMIO but medical work as well as administrative leadership roles to improve the delivery of medical care. The technical solutions that have been developed are good, but they fall short because they’re not informed by a clinical and functional perspective. That’s just the nature of the industry; they haven’t had that skill. So it’s satisfying to me to be able to bring about enabling technology so that patients and providers have a better experience. Think of the iPhone. We really want to bring the same capabilities of communication and efficiency and effectiveness that IT has to offer to the health care arena.

Q: But with so many large contractors vying for a piece of the lucrative health care pie, can a system be created that will serve, say, the entire military community, or will health care IT solutions continue to be competed for?

Salzman: Hopefully it will be a friendly competition. But the cat’s out of the bag, transformation has started, and you can’t put it back in the bag. Every industry has gone through it. In the health care industry, though, there are so many players that trying to align them is very difficult. But people are realizing that we have to do it in some way. That leads to business process re-engineering and clinical workflow so that you’re not just digitizing these processes, you’re also transforming them and changing them to realize the benefits of the digital process as well as the workflow process.

Q: What are the biggest problems today in the military health care system?

Salzman: You have a lot of stovepipes in the agencies so they each have what they perceive as their [health care] business that is special and unique. But when you look behind the scenes anywhere from about 60 percent to 90 percent of that business is the same. There needs to be a way to standardize and get everybody on the same or a similar sheet of music to make this process easier. We did this work between [the Defense and Veterans Affairs departments] at Madigan, sharing electronic information and health records.

Also when I was in Iraq I could type a note about a soldier and that clinical care note would be in the VA system within an hour. The promise of exchanging information is being realized. I’ve testified before Congress a couple of times about this process. They get impatient about things, but the reality is nobody else is doing this kind of interoperable work. The VA and DOD are pioneering this work, doing discovery on how this is done. I think that’s leading to solutions that the nation can benefit from.

Q: It sounds like the military is an ideal controlled population to create a cradle-to-grave medical records system.

Salzman: That’s what the Virtual Lifetime Electronic Record project is all about with President Obama and the two agency secretaries, Robert Gates at DOD and VA’s Eric Shinseki agreeing over a year ago to create a health record that tracked not only the new recruit but his eventual children’s health care records including when they grow up and maybe join the service. So their health care records are built over time and shared with the providers over the continuum. If we have the DOD and VA on a common platform and you start feeding information from outside the agencies, including public and private hospitals, you have a pretty good core for the nation to look to as a guide on how to handle the information. It’s also a great opportunity for the federal sector – because the government pays for about 50 percent of the health care in America – to take the lead and say, here’s how we’re going to do this. Others will have a target to shoot at instead of everybody struggling with a proprietary solution that doesn’t integrate.

Q: What is your biggest challenge now that you’re in the civilian sector?

Salzman: Breaching the trust issues is the biggest challenge. Trust between the services, trust between the DOD and the VA and their partners, and how we are all going to come to agreement on what it is that we’re going to do. There has to be some agreement and trust that we’re going to solve this problem together and put aside our agency differences so we can perform this service that the nation needs. Part of it is leadership on the government side, but part of it is improving the working relationship between the public and private sectors.

Q: As you sit down in your new office, what precisely will you be doing?