Like many rural systems, Centra Health serves a large geographic area — which requires supporting physician practices with different needs and expectations. It’s a challenge that Ben Clark, VP/CIO, welcomes with open arms. Now in his ninth year as the head of IT, Clark has spent a total of 23 years at Centra, a nonprofit system that includes three hospitals, as well as health and rehabilitation centers, a regional cancer center, and physician practices. In this interview, he talks about being a McKesson shop surrounded by Epic organizations, the importance of staying ahead in terms of Meaningful Use, balancing the needs of different specialties, and the challenges that both his team and physicians face in connecting the continuum of care.
- About Centra
- A McKesson shop surrounded by Epic installs
- Working with independent vs employed docs
- Integrating the practices
- The pressure to produce — specialty vs primary care
- Specialty physicians, niche EMRs & the health system CIO
- First mover advantage
The affiliated or non-employed physicians are certainly looking for what best serves their practice, but at the same time, we have an aligned medical staff that has open communication. And so there is no contention in the non-employed group compared to the employed group.
For the primary care groups, whether they are employed or not, it’s all about productivity. Some of the specialty groups have the luxury of a little less throughput needs, because they have procedures and other things that supplement their money trail.
We are trying to deploy a system that can be customized for each specialty. With anything like that, there is a compromise. It’s not as good as a niche product, and the question becomes, can we make it good enough?
We are looking for a longitudinal record, and we know that whether it’s bundled payments, medical home, or whatever is coming down the pike today, we’ve got to incorporate the whole community into that.
As the CIO, I’ve been lucky to inherit an IT group that has been forward-thinking with physicians. We have been connecting to offices for 15 years or more, and we have been providing information to these offices in an integrated format for the last seven years.
Guerra: Good morning, Ben. Thanks for joining me today to talk about your work at Centra.
Clark: Thank you, it’s good to be here.
Guerra: All right, let’s talk a little bit about Centra. You have three hospitals and a whole bunch of other stuff—why don’t you give the listeners some more information.
Clark: Centra has three hospitals, as you said. They are a multi-specialty system with two hospitals in Lynchburg, Virginia, with split duties between mother, baby, and critical care. We have a smaller hospital in Farmville, which is about 70 miles to our east. It’s a feeder hospital and 80-bed system. So overall, we have about 575 beds total. We also have a fourth specialty hospital—a long-term acute care (LTAC) that has another 30 beds, but it’s a hospital within a hospital. And then like every other health system around, we have about 190 physicians who are employed, 40-something locations supported by the IT group, and joint ventures, surgery centers, imaging centers, and a rather large mental health presence, as well as critical care. So there’s not a lot of close competition. We do have large systems all around us, but our immediate service area is about 65 miles. Centra enjoys a pretty strong market share.
Guerra: Do you expect that to continue? You kind of probe the edges, like countries looking for a little more territory.
Clark: We are certainly trying to shore up the fringe areas and the areas that touch in the different health systems, but Centra’s primary goal is to support the Lynchburg-Farmville-Central Virginia area, so we’re not in an acquisition mode. Many of the people around us are hunkering down and installing large IT systems, which we have completed already, and so their focus is not on Centra. Will that be so in the near future? Possibly, but right now, it’s not.
Guerra: Do you have some big Epic shops in your neighborhood that are competing with you?
Clark: That’s exactly where I was going. Just a little to our west, Carilion Clinic just recently completed their major Epic installation, University of Virginia Health System has just started Epic, and then to our east in the Richmond area, Bon Secours is installing Epic. So it’s all around us.
Guerra: And you are a McKesson shop, correct?
Clark: We are. We have McKesson Horizon, Clinicals, and Star Financials.
Guerra: Let’s talk a little bit about your physicians. You said you have 190 employed, and I would imagine a couple of thousand independents that refer in?
Clark: No, not quite that many. More like 450 non-employed.
Guerra: Have you found a big difference in working with those two populations of doctors, in terms of their priorities and in how you engage with them?
Clark: Yes, I would say there is a big difference. I do believe that Centra has enjoyed a very good working relationship with the physicians in our market. The affiliated or non-employed physicians are certainly looking for what best serves their practice, but at the same time, we have an aligned medical staff that has open communication. And so there is no contention in the non-employed group compared to the employed group. It’s just basically focused on what their needs are. For instance, at Centra, we’ve provided a high-speed connectivity to any and all physicians. I put in a 100-megabyte circuit to just about every physician in our local area. They are connected to our portal for images and just about any kind of information that we are storing. We do that for the employed as well as the non-employed groups.
Guerra: Do you find that you just need a different approach in terms of sensitivity to their time—that when you’re trying to engage with them, you have to use different tactics or you have to be a lot faster in your presentation? Although I did get an e-mail from one physician who told me that I had it wrong—that even employed physicians have a workload that they have to produce, so it’s not like the hospital is okay with them just sitting around and getting all kinds of training. So it may not be as cut and dry as I had thought about in terms of the needs of those two different populations.
Clark: I think the pressure for productivity is equal.
Clark: I would say the differences hold true more for specialty versus primary care. For the primary care groups, whether they are employed or not, it’s all about productivity. Some of the specialty groups have the luxury of a little less throughput needs, because they have procedures and other things that supplement their money trail, so they can do a little bit better and not have to have the productivity. It wouldn’t be surprising to me today if an employed family practice physician’s productivity numbers were significantly less than in a non-employed.
Guerra: That’s very good to know, and I appreciate you telling me that. So it’s not so much employed versus non-employed, but primary versus specialty?
Clark: That would be my look at what I see on my end, yes.
Guerra: But when it comes to these specialty docs, the debate or the discussion I’d been hearing was that the difficulty was in trying to get specialty docs to embrace systems that were primarily designed for primary care. Is that another point of contention?
Clark: Many of the electronic health record vendors have done a very good job of trying to build out niche systems for, say, orthopedics or urology or gastroenterology. OB in particular has some very niche systems. And so the individual non-aligned physician may go after this niche system because it fits very well within their workflow and what they’re doing. I think where you’re coming from is an enterprise like Centra can’t afford to do that. I can’t support that many different systems, so we are trying to deploy a system that can be customized for each specialty. With anything like that, there is a compromise. It’s not as good as a niche product, and the question becomes, can we make it good enough? I would be surprised, if you survey it across the country, if there weren’t several of the larger EHR vendors out there that are successful in the specialty areas.
Guerra: Let me give you a little scenario and you tell me if this has come up or how you think it might be handled. We talked about 450 independent physicians in your area that refer patients. Since a number of those are specialty physicians, which are often high-value physicians. They bring a lot of money into the hospital, so they’re very desirable. Let’s say you have a situation where a specialty physician or physician group has gone ahead and purchased a niche EMR that is obviously for their specialty. They love it. They want to refer in patients, or they do refer in patients, and they want integration with your McKesson system. They did not consult you before they purchased that system, nor did they think they should have to, and they just want you to go ahead and make this work. We want to see stuff that we do in the hospital, and in the hospital, we want to access our practice system. Is that a realistic scenario these days?
Clark: Yes, it’s a realistic scenario. It’s happened in Centra’s environment several times, but the answer is, we are going to try and help make them work, and in, we fact are. An example in that area is an orthopedic group that went with an EHR vendor—and they’re the only ones in town with that vendor. We are working with them. We are integrated with them. They can get into our system, and we are building out integration into theirs.
The way you phrased that, it could be perceived as adversarial, but in reality, I think maybe these practices felt that they came to us and we weren’t ready, or it wasn’t a solution that they were interested in. Or, as in the case of this orthopedic group, they were way ahead of us. They put theirs in before we were ready. We asked them to slow down, and they felt like they couldn’t. We are looking for a longitudinal record, and we know that whether it’s bundled payments, medical home, or whatever is coming down the pike today, we’ve got to incorporate the whole community into that. So we’re working at it, and I am in a good environment in that I only have about five different EHR’s that I’m trying to integrate with.
Guerra: You mean on the ambulatory side?
Clark: On the ambulatory side, yes.
Guerra: That’s fascinating what you just said. I was thinking as you were talking about trying to get ahead of this by doing a preemptive educational tour of the practices in the area. Interestingly, you said you asked them to slow down and they said, ‘I can’t do it.’ So I guess as far as your colleagues are concerned, speed is important, because if you don’t get going as a health system, a lot of those practices are going to get ahead of you, and then you’re going to have to deal with the integration after the fact.
Clark: That’s exactly right. For instance, we at Centra attested for Meaningful Use yesterday. We completed our attestation. We are staying way ahead of the industry in that, because our technology was deployed. We are out there. We are ready to go in our integration with the physicians. As the CIO, I’ve been lucky to inherit an IT group that has been forward-thinking with physicians. We have been connecting to offices for 15 years or more, and we have been providing information to these offices in an integrated format for the last seven years. So it was just naturally part of our workflow to work with physicians, to integrate with them, pull their referral information, share our demographic information, things like that.