Life at the Intersection of IT and Clinical Care; Stephanie Lahr, MD, Chief Information Officer at Monument Health

The COVID-19 pandemic presented challenges to every industry - but none more than healthcare. Within just a few months, care delivery approaches that had worked for decades were no longer adequate to meet the needs of medical facilities or the communities they served. 

That's where people like Stephanie Lahr, MD, Chief Information Officer and Chief Medical Information Officer at Monument Health come in. Board certified in both internal medicine and clinical informatics, Dr. Lahr walks the crucial line between medicine and technology to help her colleagues on both sides of that line navigate the largely uncharted waters of medicine in the digital age. 

"My interest in clinical informatics really grew out of a belief that technology was going to be central to the evolution of patient care delivery over time," says Dr. Lahr. "If I wanted that to go well, I felt like I should be a part of making that happen and not standing on the sidelines."

Early Exposure to EHR 

Dr. Lahr's first exposure to the challenges of health information management came while she was still a resident at The University of Texas Medical Branch at Galveston in the early 2000s. The health system was in the midst of implementing its first Electronic Health Records system and she saw first hand how hard - and also how valuable - EHR could be. 

"As a resident, you just do what you're told, so implementing the EHR system was just one more painful part of residency," says muses. "But over time, it started to become apparent that, while it was painful at first, there were also many good things about it."

That fact really hit home when a devastating hurricane hit the region about a year after the EHR implementation. Lahr's house, along with those of many of her neighbors, was filled with water. At work, thousands of paper records were destroyed within hours. But thanks to the EHR system, Dr. Lahr was back at work in a makeshift office within two weeks, armed with a computer and a telephone.

"Many people could not come home for weeks or months," recalls Lahr. "It was extremely powerful for me as a clinician to know that, even though the paper records were unusable, I was still able to send prescriptions, give them information, and help relieve some of the stress in what was already a stressful situation."

The Shift Toward Healthcare Informatics

By 2008, managing healthcare information digitally had become a way of life for Dr. Lahr. But that was not the case everywhere, a fact that became very apparent when Lahr interviewed for a hospitalist position at Kootenai Medical Center in Coeur d'Alene, Idaho that same year.

"I was meeting with the CEO and I asked about their EHR system and his eyes kind of got big and he said 'Gosh, we have never had a doctor ask us about that before,'" says Lahr. 

Lahr got the hospitalist job and was also invited to help the hospital shift how it managed information. "I was providing expertise to the informatics and IT people, and they said, 'Would you talk to the surgeons? Would you talk to the cardiologists?'" says Lahr. "So I started brokering some of those conversations."

After doing course work in information management through various physician leadership programs, Lahr decided to pursue board certification in clinical informatics. 

For a while, she continued to wear both a clinical and an IT hat, practicing as a hospitalist one week and doing information management work the next. Right around the time that she decided to cut back on her clinical hours and focus on informatics, Monument Health came calling. 

"They were looking to do a system-wide changeover to a single EHR system and they needed someone who could speak both languages to be a liaison between the IT and the clinical side," says Lahr. She became Monument Health's Chief Medical Information Officer in 2016. 

Information Management in the Age of COVID

Dr. Lahr spent her first year-and-a-half at Monument Health leading a team whose job it was to visit Monument clinics, observe workflows, analyze the current state of information management, and assess the needs. In October 2017, the entire health system went live with the EPIC EHR platform. A year later, Dr. Lahr took on the additional role of CIO and is now a Certified Healthcare CIO through the College of Healthcare Information Management Executives. 

"The funny part is that people might have briefly thought we were done after we went live with EPIC," says Lahr. "But the reality is that was just the beginning. That is the foundation we needed to be able to move to the next level."

When COVID-19 hit the region in 2020, it only reinforced the importance of the technology - and the auspicious timing of the implementation. 

"Everyone suddenly realized that there is an absolute need for us to look at different ways of delivering care - either because patients are too far away, or it is not safe, or we don't have the staff," says Dr. Lahr. 

Early in the pandemic, Lahr helped set up a Nurse Triage Line to help manage the onslaught of patients needing information, tests, and support. Originally established with a handful of IT nurses, Lahr, and another doctor, the Nurse Triage Line is now a permanent fixture with 9 full time nurses and plans to expand its navigation services. 

Restoring the Joy of Practicing Medicine

But Lahr says technology is not just about efficiency; it's also about better relationships. Some Monument clinics are already using exam room technology that "listens" to doctor/patient conversations and converts them into natural language notes in a medical chart, so doctors and patients can simply chat. 

Virtual assistants (think an Alexa-type device for exam rooms) will soon enable doctors to answer questions such as "When was the patient's last MRI?" without having to dive for the chart. Another new system will provide smart telemonitoring of hospitalized patients and even document their care in the EHR, freeing nurses up to focus on patient care. 

By reducing friction and streamlining processes, Lahr believes this kind of technology can help restore the joy of practicing medicine. 

"As a clinician at heart, this is an imperative for me," says Dr. Lahr, a 2021 winner of the Healthcare Information and Management Systems Society’s Changemaker in Health Award. 

"We have never seen a time when we were potentially further away from that joy. But we have an opportunity to help fix that if we do it right. We have to keep asking, 'What are the challenges that our clinical teams are facing and what tools are out there that could help?' These are the things that excite me every day."