Christopher Scanzera hasn’t been a CIO for very long — in fact, the former consultant has only been on the hospital side for a year. But that’s been enough time to develop a solid understanding of the key priorities for hospital-side IT leaders. As CIO of AtlantiCare, a two-hospital system located in southeastern New Jersey, Scanzera is focused a number of key issues, from ensuring that his organization has the technology required to support accountable care, to establishing internal and external health information exchanges. In this interview, he talks about the challenges involved with having multiple vendors, what he expects will happen with personal health records, the advantages of have a consulting background, and why he prefers the term “integrated delivery” to “ACO”.
- About AtlantiCare
- Cerner inpatient, McKesson Star patient financials
- eClinicalWorks in the physician practices
- WellLogic for HIE, physician portal, patient portal
- Moving from best of breed to best of cluster
- Attesting to Stage 1, thoughts on MU
- HIE & ACO
- Thoughts on PHRs
- Reading the tea leaves
- The tricky transition from fee for service to pay for performance
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I wish we had the ability to have a fully-integrated solution. But based on where we are with our investments in the vendors and our maturity with the vendors, I’m going to need to stay the course, at least in the near term, with the separate clinical system and patient financial system.
I believe that folks that aired on the side of caution and said, ‘You know what, we’re going to wait unit the fourth quarter of the calendar year to pick up the additional time for attestation’—that made a lot of sense, especially given the fact that we don’t know what Stage 2 is going to look like yet.
What we’re going to do is continue to go down the path of deploying what we’re calling the hospital-centric HIE, where it’s basically our inpatient information being pushed out to the community-based providers.
I think over time what we’ll see is that, like the proliferation of any other Web-based technology, folks are going to embrace it more on the Web and basically reach in and use the Web as a tool to access their information and perhaps add some of their own.
We liken it to operating with a foot in two boats, if you will. And maintaining the balance is actually going to be absolutely key because we can’t exit and fully escape the fee-for-service space too rapidly for obvious reasons, and at the same time, we don’t want to under-prepare or get too far behind the curve in what the new accountable care or integrated delivery model is going to look like.
Guerra: Good morning, Christopher. Thanks for joining me today. Let’s talk about your work at AtlantiCare.
Scanzera: Good morning.
Guerra: I think a good place to start would be with an overview of the health system—what it includes, the moving parts, and we’ll go from there.
Scanzera: Sure. We are AtlantiCare. We are a two-hospital, multisite healthcare delivery network here in the southeast corner of New Jersey. We serve basically Ocean County, Atlantic County, and parts of Cape May County, and we’re actually moving in-land a little bit.
Guerra: Okay. You said two acute care facilities, correct?
Guerra: And how many beds approximately in those combined?
Scanzera: I believe it’s just under 600 beds in its entirety.
Guerra: Okay, great. Why don’t you give us a little bit information about your core clinical application environment, in the hospitals first—are they on the same platform, are they on different platforms? Let’s start there.
Scanzera: We have a couple of different core clinical—or what we call strategic—vendors. We are a Cerner shop for our clinical applications on the inpatient side. We are a McKesson shop for our patient financials on the inpatient side—we’re a Star shop. For some of our ambulatories, we are an eClinicalWorks shop. For our physician practices and wiring it all together, we are a Wellogic health information exchange shop. We’re also using the Wellogic platform for physician portal, patient portal, and basically integrating personal health records. We also use some Premier products for our analytics as well as some advisory board applications for our analytics.
Guerra: All right. So, a lot of organizations have different clinical and financial inpatient systems, is it something that is okay with you? Do you have some integration there, or is it something that long-term you don’t like as a CIO?
Scanzera: I’m okay where we are right now. I wish we had the ability to have a fully-integrated solution. But based on where we are with our investments in the particular vendors and our maturity with the vendors, I’m going to need to stay the course, at least in the near term, with the separate clinical system and patient financial system.
Guerra: Okay. So have you done much integration between eClinical works and Cerner?
Scanzera: We have. Through the information exchange, we basically have orders and results coming out of our hospital-based information systems. And we’re in the process of basically pushing those orders and results to the ordering physicians vis-a-vis the health information exchange—the Wellogic platform into the eClinicalWorks office-based applications.
Guerra: And I believe I saw that you already attested to Stage 1?
Scanzera: We are in the process of that.
Guerra: In the process. So what were your thoughts around what they put together for Stage 1? Did you think it was reasonable?
Scanzera: In terms of Stage 1, I believe the answer is yes. I also believe that folks that aired on the side of caution and said, ‘You know what, we’re going to wait unit the fourth quarter of the calendar year to pick up the additional time for attestation’—that made a lot of sense, especially given the fact that we don’t know what Stage 2 is going to look like yet. And I believe going through that attestation process in the fourth quarter of the calendar year and waiting until the new year on the fiscal year for attestation made sense.
Guerra: You mentioned that we know a little bit about Stage 2. Most people don’t really have time to listen to the policy committee meetings and see what’s happening. How how closely do you keep an eye on what they’re putting together?
Scanzera: On a periphery—actually, in terms of what some of the requirements are, we, through one of our Cerner vendor work groups, are watching that fairly closely. I’m not enmeshed in the details because it really does change on a week-to-week basis. We are going to be very interested in seeing what ultimately happens with the dates. I know there’s been a separate work committee set up nationally to provide some advice recommendations about possibly moving and pushing the second-stage requirements out a little bit. I don’t know that that was met with open arms yet, but I suspect that there will be more on that, and we’ll hear more regarding that in the near-term.
Guerra: You mentioned Wellogic. You’ve done some HIE work and you’ve also spoken at a conference—and we’ll get into that a little bit—about ACOs. I guess those two kind of go hand-in-glove. Does that make sense?
Scanzera: Yeah. ACO as a future delivery model and using health information exchange as a technology underpinning to support that—yeah, they are related in terms of what some of the accountable care requirements will be going forward and how we might be able to leverage some of the information exchange to support those requirements.
Guerra: So, what can you tell us about what you’ve done in the HIE front using Wellogic? And you mentioned a portal, what’s the overview there?
Scanzera: In terms of where we see us going as an organization, I think what we’re going to do is continue to go down the path of deploying what we’re calling the hospital-centric HIE, where it’s basically our inpatient information being pushed out to the community-based providers. That’s really the phase one. The next phase that we’re working on is going to be an HIE-to-HIE connection with another one of the major providers here in the south so we can actually exchange information among and between two of the larger health systems down here. I expect to see that in the near term. I don’t know if it’s going to be fourth quarter or first quarter next year but that’s a work in progress.
And then building out additional capabilities and standing up physician and patient portal capabilities, we’re looking at that right now as a fourth quarter initiative that may end up moving out to the first quarter of next year. Again, it’s really going to be driven by, what’s the other strategic priorities might be around where we need to go from the integrated delivery network.
Guerra: What are your thoughts around the PHR field? In your vision, are patients all going to have their own PHR? We know Google Health is shutting down, and Microsoft HealthVault is a platform but not a PHR. What are your overall thoughts on the PHR field and how that might play out?
Scanzera: My take right now is that it’s going to be Web-enabled view-in for patients to access their information. There are legislative requirements that we produce it and make it available and other formats in terms of media, and we’re going to go down that path. But I think over time what we’ll see is that, like the proliferation of any other Web-based technology, folks are going to embrace it more on the Web and basically reach in and use the Web as a tool to access their information and perhaps add some of their own, and ideally, when you take a look at accountability and taking accountability for managing your own health, using that as a tool to do so.
Guerra: When we talk about a portal with AtlantiCare, we talk about a Web view for patients to see into their hospital record, correct? So that doesn’t really involve the third-party PHR vendor, does it?
Scanzera: Well, it depends on the source system of the information. The information that could end up in the portal could come from the hospital-based system. It could come from a third party or external laboratory or radiology or some other testing-type system. When you take a look at the overall construct of the portal, if there’s some particular content or content management component that we would want as part of it, that would also come from the outside potentially as well.
Guerra: So as a lot of this is in progress, as you keep an eye on how things are evolving and legislation and even these PHR companies like Google Health going out of business, you have to kind of move forward and keep an eye on things, correct?
Scanzera: Absolutely. I mean, if you take a look at what’s going on with some of the requirements around integrated delivery networks, the notion of managing the health of the population, and the notion of continuums of care and access to information to support continuums of care, this is going to be one of the key components moving forward that we’re going to have to incorporate into the model.
Guerra: One of the dynamics that we talk about a lot when I speak with CIOs is the idea of positioning the health system for the accountable care world and paying for value and performance versus the current state of getting paid for doing things for transactions. We say that if you move too quickly to be in the future world, you’re not going to bring in the revenue you need today. Does any of that dynamic make sense to you about positioning yourself to be ready for the next world while living in today’s reimbursement world?
Scanzera: There’s no question about it. I mean, clearly, shifting from a fee-for-service model to a pay-for-value model as opposed to pay-for-volume model, it lends itself to some very interesting dynamics in terms of where you focus your efforts and your energies. I think we’re taking a fair and wise approach in terms of how we’re doing it. We liken it to operating with a foot in two boats, if you will. And maintaining the balance is actually going to be absolutely key because we can’t exit and fully escape the fee-for-service space too rapidly for obvious reasons, and at the same time, we don’t want to under-prepare or get too far behind the curve in what the new accountable care or integrated delivery model is going to look like. So again, it’s maintaining that balance of, continuing down the path in the current model and preparing for the future.
Guerra: A lot of people didn’t like the ACO notice of proposed rule-making. A lot of people didn’t like the way that was structured—they thought it was too complicated and there wasn’t enough upside. Did you have any thoughts on that proposal?
Scanzera: We took a look at that and in terms of the upside potential, we didn’t see enough value in going down the path. And again, that’s why I’m moving away from the whole notion of calling it accountable care to calling it integrated delivery.