Chuck Podesta’s stance on Stage 1 Meaningful Use criteria probably won’t win him any toasts at the next CIO event. That’s because, despite the position of organizations like CHIME (and this journalist), Podesta thinks the criteria aren’t overly onerous. Though he acknowledges the incentive payout structure isn’t perfect, little else about the program disquiets the Vermont-based CIO. One reason Podesta is feeling pretty good about meeting Stage 1 requirements is he’s in the process of becoming an Epic shop and, more interestingly, he’s embarked on a path to help neighboring community hospitals become Epic shops as well. It’s all part of a nascent program from the vendor called Epic Community Connect. And while Podesta says it works for his neck of the woods, it may not fit into all healthcare markets. To learn more about these issues and many others, healthsystemCIO.com editor Anthony Guerra recently chatted with the Fletcher Allen SVP & CIO.
… if you’re in an area that has that type of unemployed workforce, I think you have a huge opportunity to set up a Vermont High-Tech-type organization linked up with your vendor …
The thing to remember is that Stark goes away in 2013. Two years ago it was a great model, but it’s not so much anymore.
So you’ve got to go into this with your eyes wide open knowing that if it’s a failure, you’re talking about the reputation of your organization.
PODESTA: To augment our workforce, we’re working with a company called Vermont High-Tech. We’ve got some Department of Labor grants where we’re actually taking some unemployed and underemployed Vermonters and working with Epic to get these people certified, and then putting them on the PRISM regional project. In my mind, that’s a huge win-win. I get excited about that one.
GUERRA: Recently, HHS gave out $84 million for workforce development. Do you think that will produce the workers you need in the timeframe you need them?
PODESTA: The program that we’ve started requires a few things. First off, you need to be in an area like Vermont. We have GE here and we have IBM — two high-tech companies that have had some layoffs just like everybody else. We’ve been able to take advantage of that because these workers are out with all these skills, and they just need to be retrained on different products. We’ve had skilled IT people that have been laid off at the state level.
So if you’re in an area that has that type of unemployed workforce, I think you have a huge opportunity to set up a Vermont High-Tech-type organization linked up with your vendor — whether it’s a Cerner, an Epic or McKesson — to create some sort of workforce institute. To me, that has a lot more promise than — and I don’t want to sound negative here — a four-year college program or even a two-year community college program. Those are great for the long term and are needed to get qualified people into the healthcare IT workforce going forward, but with the timeframes we have here, I think we need something a lot more focused. That’s what we’re doing — focusing on a skilled group of individuals that are either underemployed or unemployed and retraining them quickly. When I say quickly, we’re talking about two to three months, then getting them back into the workforce at a decent wage.
GUERRA: Where are you with PRISM Regional? Have you started your first hospital?
PODESTA: We’re actually in contract negotiations. Within the next weeks we’ll be finalizing the hospitals that will be part of our pilot group and then our practices. We have a get-together set up where we’re inviting them in, then we’ll have a series of demo days. We also have a health information exchange called VITL — Vermont Information and Technology Leaders. There are also regional extension centers which just received $6.8 million, so we’ll be linking that into some of the offerings that we have to these practices for the different types of implementation support services. So I would say, by the end of May, we will have a pretty solid list of practices that are interested, and then we’ll get started with them in the June/July timeframe.
GUERRA: Is PRISM Regional different from your Stark-related work?
PODESTA: Not really. They’re linked in a way because they’re all under PRISM Regional. The financing models are different. There’s no way to work with the hospitals using Stark, so they have to come up with the money.
The thing to remember is that Stark goes away in 2013. Two years ago it was a great model, but it’s not so much anymore. What do you do in 2012 if that doesn’t get extended? So what we’re trying to do is come up with some other options using the Meaningful Use dollars as collateral. We’ve got a local bank here that’s actually working out a program where they’ll do a small percent interest loan — potentially you can use the Meaningful Use dollars as collateral and hold all payments until you get those monies. So there’s other types of models that I think you can do rather than the Stark road to get this done. And again, if you have a regional extension center in your area, that will certainly help from an implementation standpoint.
GUERRA: You mentioned that you’ve got a dinner set up with some of these independent physicians, are you going to present the concept to them?
PODESTA: Yes. Actually, we have a brochure, we have a product, we have the KLAS report, we still have some of the financing options, so we have to present all that at the beginning. I’m sure we’re going to get a lot of interest. Actually, we already have. Even before doing our presentation, I get emails every week asking. “When can I get PRISM in my office?” so I know there’ll be a large turnout for that, and then we’ll sign them up for demos. We’ll probably also invite them in to show them the entire system. A lot of these practices, however, use the inpatient system now, so they’re familiar with the product from an inpatient perspective.
GUERRA: Any idea what kind of resistance you might encounter? I hear physicians are very wary about having hospitals house their data.
PODESTA: I think we’ll hear some of that as well, and we’re prepared to answer those questions. The Epic system is very powerful from a security standpoint in segregating patient data, while keeping it accessible for those who need it. So I think we’ll get a pass on that part. It’s not their number one concern. Actually, on the billing side we’ve got a lot of interests in taking over their billing. We’re actually hearing things like that because what we’re finding is a lot of these practices have these old DOS systems that were built by someone’s nephew 20 years ago. Those systems are very hard to support with all the changes in billing. So they’re actually thinking that if they have to focus on the EMR, they’ve got to get out of the back office side of it. So there may be an opportunity for hospitals there as well. If you already have a group practice and you’re doing billing, maybe extend that service. You could also extend transcription services — things like that actually are an added value to some of these practices.
GUERRA: There’s so much money swirling around in different arrangements with licensing and Stark and all these kinds of things, it just makes me think that hospitals must be careful not to take on more than they can financially handle. Does that make for some interesting conversations with your CEO and CFO?
PODESTA: Sure. I mean there’s risk in this, and I would tell any CIO that they definitely must have great relations with the rest of the C-suite and be open and honest about the risks. When we look at this venture, we’ve created pro formas and a business plan around it. We’re looking at this business like any new venture a hospital would be looking to get into. I’ve had a lot of help from many parts of our organization — midlevel all the way up to senior level — and it’s been a great collaboration. You just can’t do it by yourself, and you have to be open and honest about those risks.
You might build a business plan and do the pro forma and then decide it will just be too much of a distraction. I think a lot of organizations will find themselves in that role. We talk about how we have to make sure that PRISM Regional doesn’t divert us from PRISM. We don’t want resources that are needed to execute on PRISM to be pulled onto PRISM Regional issues — we can’t have that. So the organization has to be set up in a way that accommodates it.
The other one I would urge CIOs to look at would be the risk of failure and what that means. At first look, they may say, “Well, if for some reason it doesn’t work, we’ll just shut it down.” Well, I don’t care if you point the finger all day long at that small hospital; it’s a big paintbrush and you’re going to be painted with it. So you’ve got to go into this with your eyes wide open knowing that if it’s a failure, you’re talking about the reputation of your organization. So when you’re talking about risking the reputation of your organization, you can imagine the frank discussions that we’re having at high levels, because we truly feel that this absolutely has to go well. But we also think that the benefits on the other end are so great that we can look two or three years down the road and hopefully be able to look back and say, “You know, this is the biggest thing that we could have done for healthcare in Vermont,” but those risks are there, and you need to be open and honest and not sugarcoat them at all.