Tell us a little bit about yourself and your organization.
I’ve been the CIO at MemorialCare for about 16 years and with the organization for some 33 years. My training as a pharmacist has allowed me to bring a clinical background into my work as CIO. A subsequent MBA allows me to approach today’s challenges from both a clinical and business perspective.
MemorialCare, based in California, is a private, not-for-profit integrated delivery system that includes 1,500 beds across six hospitals, and a medical foundation with 400 physicians in an IPA model and 150 physicians in a staffing model. MemorialCare is listed among the top 20 percent of health systems nationwide by Thomson Reuters and in 2011 the organization was identified as one of the top 100 integrated healthcare networks nationwide.
What have been the benefits and challenges associated with EHR adoption to date?
Today, we live with Epic across five of six hospitals and 175 physicians. In addition, approximately 300 physicians use the NextGen EHR. Epic replaced an early-generation EHR (TDS, now Allscripts) installed in 1991. The experience with that system – CPOE, alerts, order sets, best practices, etc. – was immensely helpful as we configured, installed and supported the rollout of the Epic system. We know from that experience, for example, the critical role of physicians and nurses as the key leaders and champions of change, patient safety, and system design cannot be overemphasized. Apart from that experience, we also benefited from all that had been learned by other organizations that had gone before us with EHR rollouts, both successes and failures. We went live with Epic at our first hospital six years ago. We completed implementation of Epic’s clinical and revenue cycle systems over the ensuing four years.
We’ve learned that rather than being done with our EHR journey, we are actually just beginning. We are currently live with high levels of physician adoption and have largely eliminated paper-based records in our care for patients. Nevertheless, we find ourselves expanding the Epic system and exploiting its power in an environment where care process and healthcare financing are undergoing a revolution as a result of healthcare reform. Challenges included keeping pace with advances in the features and functions of Epic, increasing cost pressures, the anticipated organizational changes associated with accountable care, a transition from fee-for-service out outcomes focused financing, and the basic operational needs of accountable care.
Other challenges we faced were developing a system that would work well for everyone – from specialist to internist to hospitalist and beyond. Many different but interrelated workflows are involved, some that emphasize content while others are built for procedural speed. Another challenge is ensuring system reliability, speed, and near-constant availability. While we have “downtime” procedures, we are not terribly productive reverting to paper when the system is not available. We simply must take steps to minimize and protect against system failure.
What role has voice recognition played as it relates to your organization’s EHR adoption?
Today, we’re moving from an era of dictation and transcription to an era of voice recognition. As a result, the role of the transcriptionist is shifting from one focused on transcribing to one focused on editing the text captured by voice recognition.
Our EMR captures data in two forms – structured and narrative data. Increasingly, EMRs are incorporating functions and tools that help streamline the capture of both types of data. Voice recognition, specifically Dragon Medical 360 | Network Edition and Dragon Medical 360 | eScription, play a large and growing role in the capture of the patient narrative. Voice recognition helps make our physicians more productive, as the capture of narrative is integrated with structured data gathering tools such as forms and discrete data fields. This will be especially important and helpful as we shift to more elaborate coding under ICD-10.
How has meaningful use influenced your development roadmap? Have you found meaningful use to be very “meaningful”?
We invested in the Epic EHR well before the HITECH Act and Meaningful Use incentives and embraced MU along the way as part of our adoption and use of Epic. We have already attested for Stage 1 for MediCal (Medicaid in California). We believe in Meaningful Use and think it represents the best interests of patients, providers and payers. Currently, we’re in the process of digesting Stage 2. While we find it daunting as it relates to the breadth of the information provided, we’re confident that we’ll be able to tackle these new requirements over time. So yes, we do find Meaningful Use “meaningful” and generally the right thing to do.
What type of involvement do you see your organization having in Accountable Care Organizations (ACOs) and what role will technology play in it?
EMRs are a foundation of ACOs and increasingly taken for granted – table stakes for participation in an ACO. While we’re still ironing out the details of what an ACO means for our organization, the reality is we’re living in a post-EMR world. ACOs are the next frontier and, clearly, EMRs will play a major role in the making the ACO model a reality. Other technologies, such as analytics, interoperability and data warehousing will play an equally big part in this shift toward the focus on population health and outcomes-based care.
What’s are your thoughts on HIE? What will it take to have a truly successful HIE?
New policies and regulations need to be put in place at the Federal level for HIE to truly work. Today, providers are reluctant to consider or embrace HIE because of the financial and reputational risks associated with the idea of sharing patient information. Issues of patient consent management, opt-in vs. opt-out, and privacy create both real and imagined barriers. We need to create a legal and regulatory environment that is receptive and supportive of HIE rather than potentially risky and punitive. As an organization, we participate in local, public HIE efforts while we endeavor connect our systems to affiliated providers to safely and securely make available patient information as our physicians and patients currently demand and expect in the current environment. We’re encouraged by the progress and ongoing regional and national dialog with regard to HIE though we do think it will evolve slowly and unpredictably.
What’s the most beneficial IT program that your organization has implemented? What benefits were achieved?
Our EMR. It’s had the most dramatic impact on the patient care we provide and how we run our “business” efficiently with substantially higher levels of patient safety. It is a vital go-forward “platform” on which to build new tools and capabilities to survive and thrive in a rapidly-changing healthcare environment.
What are your biggest challenges as CIO?
Figuring out what it really means to be an ACO and what it means to manage the health of a population. I find myself constantly thinking about these questions:
- What do we really mean by population health?
- How do we restructure our business to provide population health services, and with which organizations will we need to affiliate to carry out population health initiatives?
- What tools and technologies will we need beyond the EHR to make population health a reality?
Which IT project doesn’t get enough attention and why?
Establishing social media tools and technologies that can help facilitate internal collaboration – beyond email and our intranet.
Effectively engaging patients in their health care, likely using social media, apps, etc. I’m constantly wondering what patients really need from us in order to manage their health and wondering what role apps or other technology might play in making an effective connection between provider and patient.