When John Glaser left his position as CIO at Partners HealthCare, he also left a vacancy in the weekly CHIME SmartBrief, where he was the voice of the CIO. It was a void that CHIME’s leaders felt could only be filled by someone who had both years of industry experience and a firm grasp on legislative issues. They chose Bill Spooner, a 25-year veteran who has earned recognition from HIMSS and other organizations for the IT initiatives that have helped transformed San Diego-based Sharp Healthcare into one of the most advanced systems in the country. In this interview, Spooner talks about the work his team is doing at Sharp, how health reform presents both challenges and opportunities for CIOs, and why it is so critical for the provider community to serve as the voice of reason in the Meaningful Use debate.
- Does MU stifle innovation?
- Would the world be better without Meaningful Use?
- Sharp’s MU road
- ICD-10 — “We have 55 applications that will have to be modified … so it does have me a little bit nervous”
- Advice to overworked CIOs
There were some really clever ideas in terms of medication management in clinical pharmacy that can really add value. It’s things like that that some organizations have maybe pushed to the backburner because there’s such an emphasis on a Meaningful Use.
In the long run, it’s going to be better for patient care, no question. But at the same time, straightforward regulations that make sense and are consistent from stage to stage are far preferable to indecisive and changing requirements that would be difficult—if not impossible—to achieve.
The message that we’re hearing from our clinicians loudly and clearly is, ‘Don’t tell us that we’ve got to learn two different kinds of coding. We’re going to do one.’ And in speaking with most of them, that one is SNOMED, not ICD-10.
The times that we’re in right now are incredibly demanding. And it’s going to be important that we all learn to take a deep breath from time to time; that we not take ourselves so seriously as though the world is going to stop if we’re not on top of every one of these new ideas that comes out the door.
Guerra: You wrote recently about how Meaningful Use dollars and requirements may be crowding out the ability of some organizations to innovate, and you were commenting on some innovation that had been done at an organization and you said, “This is great and, I fear that we’re not getting as much of this as we could be because of Meaningful Use.” Do you want to expand on that? And if I’ve mischaracterized it, please set me straight.
Spooner: You are right on, Anthony. From a financial standpoint and just from an organizational bandwidth standpoint, we are committed to achieving Meaningful Use. The incentive dollars are worth attaining and we don’t want to be subject to the penalties in 2015 if we don’t become Meaningful Users. At the same time, we have so many hours in a day—so many other things that we would like to do that truly advance patient care in some cases being put on the backburner in the face of Meaningful Use. Even if we had all the money in the world, we can only hire so many staff, and we’re seeing staffing charges pop up in many places around the country. Anecdotally, I hear that we’re getting a lot more phone calls these days looking for help than offering consulting help, for example. Even the consulting organizations are trying to gear up their resources to support their client bases.
So clearly we can’t do everything, and some of the things that organizations are trying to do are really directed specifically at items of patient safety or quality. In the article that I was commenting on, there were some really clever ideas in terms of medication management in clinical pharmacy that can really add value. It’s things like that that some organizations have maybe pushed to the backburner because there’s such an emphasis on a Meaningful Use. We all want to be meaningful users, but a straightforward framework that we can march to without a lot of delay and without changing requirements as we move along would be much to our benefit.
Guerra: Interestingly in my survey, which has 125 CIOs now, I asked the question a few months ago, ‘Do you sort of wish the Meaningful Use program would go away, and you could essentially go back to your own strategic plan as supposed to having the government’s forced that upon you.’ But very, very few respondents wished the whole thing would go away. My gut feeling is that no matter how frustrating this program is, some CIOs who’ve had some longevity in their careers still see this as the greatest catalyst to progress that they’ve encountered in their careers. What do you think about that?
Spooner: Oh that’s unquestionably true, and looking at it specifically from a self-interest viewpoint, nobody wants to turn down the money. But at the same time, we need it to be money that makes sense. If it a facility that already has an EMR product that will meet Meaningful Use has to spend more money to get it than they’re going to receive from Meaningful Use payments, then they certainly would question whether they should go after it or not. It has given attention to IT; in many cases, it has forced organizations to move ahead with things that they knew they should do all along, CPOE being a perfect example. And clearly in the long run, it’s going to be better for patient care, no question. But at the same time, straightforward regulations that make sense and are consistent from stage to stage are far preferable to indecisive and changing requirements that would be difficult—if not impossible—to achieve.
Guerra: Where do you stand on your road to Meaningful Use? Attestation just opened up, but are you going to wait until 2012?
Spooner: Let me just go back a little bit before I answer that question. We have, in both in our hospital and our ambulatory world, installed the meaningful releases—the certified versions of our vendor software. In both cases, we are nearly complete in terms of any workflow changes that we have to make in terms of collecting the data properly, and we are testing out the reporting capabilities of the vendor software. And so we see ourselves as being prepared to attest to meaningful use by mid-summer. At the same time, we don’t plan to apply until the new fiscal year. On the hospital side, we haven’t made the decision for our medical group as yet. We’re going to wait until fiscal 2012 to attest to give us that extra year to prepare for Stage 2.
Guerra: What can you tell me about your ICD-10 preparation and how that’s going?
Spooner: We are doing a lot of work on ICD-10, and I think we have appreciated the complexity. I could be a little bit off on my numbers, but we’ve identified that we have 55 different applications that carry an ICD-9 code that will have to be modified to ICD-10. We have somewhere around 120 or 125 payer transaction combinations that will have to be tested. So we see this tremendous, integrated testing process that will simply overshadow anything we’ve ever done before in terms of our preparation for ICD-10. So it does make me a little bit nervous.
We are trying to use this opportunity, though, to advance our clinical documentation. We spent a lot of time about a year ago thinking through suggestions by HIM coding experts that SNOMED should come before ICD-10, which creates a little bit of a contradiction in terms of Federal requirements, because for October 2012, for Stage 2, you can have SNOMED or ICD-10. You don’t have to have SNOMED until Stage 3, which is kind of the reverse order from where you want to go.
We are looking at putting SNOMED in place now so that can drive the ICD-10 code. We think that makes a lot more sense and that’s the direction as an organization that we want to take. We’re also looking at some of the intelligent coding tools that can be used to augment our documentation products so that we can make it easier for our clinicians to do the documentation and thus, perhaps drive more online documentation.
The message that we’re hearing from our clinicians loudly and clearly is, ‘Don’t tell us that we’ve got to learn two different kinds of coding. We’re going to do one.’ And in speaking with most of them, that one is SNOMED, not ICD-10, unless they have to do it. So, it’s going to be a big challenge and we’ve been in the analysis stage and planning stage for about a year and a half. We will implement the 5012 transaction that’s required for EDI in January of 2012, and by next year, we’ll be testing as quickly as we get vendor’s offer to test with.
Guerra: And just ask a final question now and then I’ll give you a chance to add anything that we haven’t touched on. Not to date you, but you’ve been in the business for a little while. You’re former CHIME CIO of the Year. Never has there been such a confluence of requirements on hospital and health care CIOs, and never have you had to do so much mandates and so many projects of such scope and complexity while reading the tea leaves of the government meetings. It’s pretty unbelievable, the requirements these days. I wonder if you have any advice to your younger or your less experienced colleagues on how not to get overwhelmed; how to stay on top of everything and stay in the good graces of your CEO and your board. It’s tough times, especially if you weren’t set up in good shape to make this sprint in these few years, and you may have your managers looking at you saying, ‘What’s the problem? Why can’t you just make this happen?’
Spooner: I think that you’ve been pushing us recently, and in your column which came out a couple days ago, your survey asks how many hours a week that we work and how often do we take vacations without taking our e-mail with us and things like that. I think that the times that we’re in right now are incredibly demanding. And it’s going to be important that we all learn to take a deep breath from time to time; that we not take ourselves so seriously as though the world is going to stop if we’re not on top of every one of these new ideas that comes out the door.
And I think it’s important that we take the time out to think, and it’s important that we take the time out to plan. I’ll use the example of the ACO regulation that just came out. If we go back to a year ago when the health reform law was passed, everybody was looking at being an ACO. The thinking was, you have to be an ACO. As the regulations have been released, we’re hearing about a lot of people stopping and rethinking this process and saying, ‘I’m not sure that with the complexity of it, it really makes sense for our organization.’ And I think it’s those kinds of things we have to do. We need to take a deep breath and really think through our options rather than reacting to every opportunity that comes along before we recognize whether there truly is an opportunity or not.
Guerra: That’s great advice. Is there anything else you wanted to touch on?
Spooner: I would just say it is an exciting time, there’s just no question about it. I’m sure that you’re hearing a lot of us complaining about the delay in getting regulations, the incredible workload, and that the Feds don’t realize what they’re doing in terms of pushing three or four initiatives upon us at once—they probably do realize what they’re doing.
But still, it’s an exciting time to be in the industry. I think that we clearly are at the focus on national attention. We clearly have to find a way to ‘bend the cost curve,’ and IT really is a part of that. It’s just a case of us all collaborating as best we can and putting the best ideas on the table. I heard a speaker several years ago who wrote a book, and he was talking about how to take your job seriously and but not yourself, or something like that. And we all do have to learn to relax and to just dig in and do the best we can. But it is a very exciting time.
Guerra: Well, thank you so much for you time today, Bill. It’s always great to speak to you, and I hope to talk to you again soon.
Spooner: Great to talk with you too, Anthony. Thank you very much.