For Scott MacLean, CIO of Newton-Wellesley Hospital, the expectations are high. Not only is the 200-bed community hospital located just outside of Boston, an area that has been known for years as a hotbed for IT innovation, but it is also a member of Partners HealthCare, one of the most advanced systems in the country. So what did MacLean and his team do to meet those expectations? Create an enterprise repository that enables allergies collected throughout the organization’s affiliated physician practices to be viewed in its inpatient Meditech system. In this interview, MacLean discusses how the allergy repository was set up, the key role played by Meditech in the process, and how he is dealing with the combination of Meaningful Use, ACOs, and ICD-10 requirements.
- Ambulatory/acute integration
- Bringing over the allergies
- Meditech’s flexibility
- Newton-Wellesley’s Meaningful Use roadmap
- Certification challenges
- Partners ACO route
- Noga takes the helm
We talked about this service-oriented architecture model where we have a number of Partners’ centralized data bases and services that we’ve built to native applications. And of course the next logical step, especially if you have a central allergy repository, is that you’d want those allergies to display natively in your vendor systems, and be able to accept allergies from the vendor systems.
Each institution also has responsibilities for building their Meaningful Use roadmap on the hospital side, and making sure that we manage to it, and then we report into that central person on the hospital side. So because all of our configurations are purely different in our acute care hospitals, we’ve made our own Meaningful Use road map.
There’s no doubt that the payment model is changing. It’s changing with the federal programs, but also locally here in Massachusetts. And while I don’t think we classify ourselves as an accountable care organization right now, we certainly are thinking strategically about how we will compete in our market.
There are new regulations and practices around information security that we want to make sure we’re at the top end of, and we’ve looked repeatedly at where we can consolidate and where we can standardize on various systems without compromising.
Guerra: Good morning Scott, thanks for being with me today. I look forward to chatting with you about some of the things going on at Newton-Wellesley, which is part of Partners HealthCare.
MacLean: Sounds great. I look forward to it, Anthony.
Guerra: This conversation is almost a follow-up on a piece you wrote for our site last year, when you told us about your work with Meditech and Siemens, and your home grown EMR—Partners’ longitudinal record, and some of the integration there. I think one of your points in the article was that Meditech had done good work for your organization and had been flexible. Would you say that’s accurate?
MacLean: Absolutely. I think that they’ve bent over backwards to help us out. We’ve been a long-time Meditech customer, and we’ve really asked them to do some things that are not in the norm as we’ve taken on enterprise applications like PeopleSoft and Soarian, and of course the LMR you mentioned. But I think it’s also been a time for them to be able to demonstrate how they can interoperate with other systems, and so the situation that we have with Soarian is that they essentially accept an ADT feed from Soarian into a submerge model, which they have done with other vendors. And then we have custom charge interfaces that come out of Meditech and go back to Soarian, which works pretty well for us.
Guerra: I want to read the last paragraph in your column that you wrote last year, because essentially this is what you completed, and what we’re going to talk about today. You write at the end, ‘Finally, the most challenging test of interoperability involves integrating Meditech allergies with our enterprise allergy repository, which is called PEAR. In this model, an allergy recorded in Meditech is filed into PEAR, which can be viewed immediately in the native systems at other hospitals in our network, as well as our ambulatory record. Likewise, allergies filed in those systems are synched with the Meditech allergy record and displayed real time. This initiative is scheduled to be live early next year.’ We are in May of the year you were referring to when you emailed me. I believe you have completed this work. Is that correct?
MacLean: Yes, and if I remember correctly, it was live on March 1 of this year. Maybe I’ll go back a little bit. As I think people in the market place know, when John Glaser was with us, we talked about this service-oriented architecture model where we have a number of Partners’ centralized data bases and services that we’ve built to native applications. And of course the next logical step, especially if you have a central allergy repository, is that you’d want those allergies to display natively in your vendor systems, and be able to accept allergies from the vendor systems. So quite some time ago, we began discussions with Meditech about doing this with them because we have a number of Meditech hospitals within the Partners network, and they were intrigued and worked really hard. Their software is not constructed to accept services from other systems, so they really took it upon themselves to engineer a way that this could happen for us. And I have to say that the collaboration, the cooperation, and the fees—we had to pay them to do this—were very reasonable.
What happened is we now have all of our ambulatory physicians on the Partners’ LMR, whether they are PCPs or specialists, and so they’re recording allergies in that record. When a patient is admitted into the hospital, the Meditech system goes out and grabs those allergies and updates the file within Meditech. And then, as described in the note that I wrote for you, if a person is in a hospital and hasn’t been seen elsewhere in Partners, the allergy that is recorded in Meditech would then be sent back to this common repository, which then shows up in the LMR, and also in the other hospital inpatient systems downtown, like at Mass General and Brigham and Women’s Hospital.
So it’s quite a patient safety feat and it was a pay-for-performance goal for us and really worked out well.
Guerra: How does that dovetail with your overall Meaningful Use roadmap?
MacLean: I think that it’s just another piece that doesn’t necessarily get us to Meaningful Use at Newton-Wellesley—we have a timeline for doing all those different projects. But it’s a real patient safety effort for the continuum of care within Partners. So for all of our affiliated physicians that are on the ambulatory record, we’re just another hospital within Partners where any activity that happens in the hospital is also focused on keeping the allergies reconciled. So I think in this case, it’s really emphasizing medication safety and allergic interactions. And of course that’s a major element in what you want to have for Meaningful Use, so I guess where it works really well is, when you record an allergy in the ambulatory space and the patient is admitted, we know that it’s going to be there in the in-patient system as well.
Guerra: You have a pretty unique environment. Do you think there are many other organizations around the country that might be able to mimic or make use of the methodology you’ve put in place here, and the data flow?
MacLean: Well I think that was certainly part of Meditech’s motivation; they wanted to see if they could do it successfully, and we’re pretty proud of their engineering efforts. I think there are other development systems around the country that do their own development, and certainly could to do this with Meditech or with other vendors. And now that we are mandated under Meaningful Use, of course there is the interoperable mandate with the CCD which would contain allergies, and you’d want to file those in whatever records. So I think that will be more of the model that will take place through state and regional HIEs as we go forward.
Guerra: You mentioned the cost of this customization; you thought they were reasonable. I wonder how you think of that as a CIO. You could take the position of ‘Listen, as the vendor, if you want to keep this account, this is what we need.’ And then you could say, ‘Of course I understand there’s work involved, and we’re willing to pay something reasonable, but we’re not willing to pay an unreasonable amount.’ I just wonder how you think about that, as a CIO.
MacLean: Well I think that, like for everyone, there is a resource trade-off. We proposed this idea because within our own internal system, we had developed this methodology and the central repository for allergies, and I think there had to be interests and benefits for both parties. For us, obviously, it was the workflow and patient safety upside. Before, we had to put the allergies in the ambulatory side and then make sure that they were updated upon admission to the hospital. So we’ve automated that process. We still do the check-up to see if there is an allergy record there already. So I think that ifMeditech had not wanted to do it, or any vendor didn’t want to do it, they might price it out of reach. We found that Meditech’s interest in doing it put pricing within something that we felt like we could handle, particularly when you put that up against the savings and workflow and the patient safety benefits that we got from it.
Guerra: At your organization, are Meaningful Use attestation and these types of things being handled at the hospital level or at the corporate level?
MacLean: We have a person who is overseeing Meaningful Use both on the ambulatory side and the inpatient side, and each institution also has responsibilities for building their Meaningful Use roadmap on the hospital side, and making sure that we manage to it, and then we report into that central person on the hospital side. So because all of our configurations are purely different in our acute care hospitals, we’ve made our own Meaningful Use road map. I have a project specialist who does all things Meaningful Use in terms of coordination, and I have a clinical informatics physician who has done a very good job of interpreting the rules and seeing how things would work for a physician. We have a project plan for the items we have to do, and we’ve coordinated with any central Partners resources that we need for our attestation date, which is expected to be October of 2012.
Guerra: I’m wondering about certification, especially with your hybrid environment, with different vendors and a home-grown product. How are you handling that?
MacLean: Sure. I think it’s complicated to discern how all these things work, and I think that’s true for many people—we’ve seen some of that in the press. Our plan is that we’re going to have a number of vendor-certified systems. Also, Partners reached CCHIT certification for LMR a couple of weeks ago. So what we’ll do is go to the CMS website and be able to pick from a menu of certified systems—those will be Soarian, Meditech, and the Partners systems that we’re using—and we’ll be able to come up with CMS certification number for Newton-Wellesley Hospital that’s unique to our site. We’ll be able to use that number to register and then attest when we complete Stage 1 of Meaningful Use.
Guerra: What about issues that have come up around ACOs? Partners HealthCare essentially is an integrated system right—are you an ACO, and how do you have to reconstitute yourself? CHIME has recently put a statement where they take issue with a number of aspects of the ACO rules, one of them is quality reporting, and one of them is how it dovetails with Meaningful Use. Do you have any thoughts on what’s come out so far about ACO and how you might handle that?
MacLean: Sure. We are an increasingly an integrated delivery system; we have managed our owned physicians and our hospitals to have optimum operations and quality of delivery of care, and we have some fairly sophisticated information system that support those. But there’s no doubt that the payment model is changing. It’s changing with the federal programs but also locally here in Massachusetts, and while I don’t think we classify ourselves as an accountable care organization right now, we certainly are thinking strategically about how we will compete in our market. And we’re looking at various strategic initiatives under our relatively new CEO Gary Gottlieb, and we know that there will need to be information system support for all of that—on the fiscal, administrative, and clinical side. Jim Noga, our newly appointed CIO, is on top of that. He’s getting input from various professional organizations about how we’ll position ourselves, and then he’s driving that so we’re working hand-in-glove with strategic business initiatives to respond to how our overall organization of Partners wants to position itself in the eastern Massachusetts market.
We know we have a lot of work to do. Right now we’re focused on completing the items we need for Meaningful Use. We’re focused on 5010/ICD-10 like everyone else, and we’re also putting a fair amount of energy into optimal IT operations, because we want that to run as efficiently as possible so we can spend time and money making our systems more useable and efficient for our care providers.
Guerra: You mentioned Jim Noga, the new CIO at partners replacing John Glaser who went to Siemens. So far, have you been able to discern any specific priorities that Jim is bringing to the table that maybe different or unique to the position?
MacLean: I think one of the things that we need to focus on, and this is changed quite a bit in the time since John left, is we really want to shore up and make sure that we have the best practices around our infrastructure. Our storage is growing exponentially as we do more and more research in the general mix area, so we have those issues. There are new regulations and practices around information security that we want to make sure we’re at the top end of, and we’ve looked repeatedly at where we can consolidate and where we can standardize on various systems without compromising the specific differentiators that might be for one of our institutions or one of our physician practices.
So I think we’re being a little bit more rigorous about that than we have in the past. Because in the past, I think we had managed things fairly ahead heterogeneously, and I think when you talk about accountable care, we’re seeing recommendations from various professional organizations about more standardization and being able to deliver quality reports or whatever you might need to support that.