For Robert Slepin, health information technology has never been an end in its own right, but rather a tool that can be used to improve individual and population health. In this interview, Slepin discusses his organization’s goal of getting its hospitals and physician network on Epic in 2012, best practices for disengaging with vendors, how disease management can help improve patient outcomes, and why ICD-10 should be postponed. He also talks about the importance of transparency within an organization, how to effectively delegate tasks, and why it’s okay to say, ‘I don’t know.’
Chapter 1
- About JCLHN
- Running Meditech/ChartLogic, Going Epic (go-live 2012)
- Cost/benefit of going with Epic
- Integrating the independents/HIE
- Managing resources, project prioritization
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Bold Statements
It’s a tremendous amount of work, but I wanted to have an opportunity to come in as CIO of a delivery system that was starting this project and be able to take it from start to finish and optimize it over a period of time.
You’ve got two groups on two separate systems, so you’ve got two teams in IT that are working on the care and feeding of the systems and making it all work together.
The organization went through a disciplined process to think that through and determined that while we may be spending more on Epic compared to the other two alternatives, the value was greater, and it was overall a better decision for our organization given our strategic direction.
There were a number of priorities that were considered in the decision: coordinated care across the continuum with patient-centered care; a focus on primary care and medical home development; integrating the hospital and the physicians both within the network and within the community at large; and improving outcomes and reducing costs.
The main argument for not doing the community physician rollout in full force next year is that it’s really a lot to do. It’s a lot of risk and it doesn’t seem to be in our best interest or in the physicians’ best interest for us to take on that much more.
Guerra: Good morning, Robert. Thanks for joining me today to talk about your work at John C. Lincoln Health Network in Phoenix.
Slepin: Good morning, Anthony. It’s good to be here.
Guerra: I appreciate that. Let’s talk a little bit about John C. Lincoln. Tell us about the health network. I understand you have two hospitals and some other things mixed in there, so please just give us an overview.
Slepin: Sure. John C. Lincoln Health Network is an integrated healthcare delivery system that includes two hospitals with about 470 beds total serving the Phoenix area, as well as about 79 primary care physicians and advanced practitioners. We also have community outreach programs and a health foundation. We have been here serving the market for about 80 years.
Guerra: You said 79 primary care doctors—are they spread out into lower number of offices because you have some with multiple doctors?
Slepin: We do. We distribute our physicians and our practitioners currently in about 20 locations primarily in the north and central area of Phoenix, and that number is rapidly growing. We’re up from a count of 45 from 2010, so we are enjoying tremendous growth in our physician network.
Guerra: And that’s about 20 physician offices that you’re supporting, is that correct?
Slepin: Correct.
Guerra: Okay, let’s talk a little bit about your application environment. What are you working with on the inpatient clinical side and then what do you have in the practices?
Slepin: Today we are primarily relying on Meditech magic as our core hospital information system serving both hospitals. And in our physician network, we’re primarily using ChartLogic in most of the practices. There are some of the newer practices we’ve acquired that have other systems and some that are on paper. But we are actively working on a project to implement Epic as our electronic health record to serve the entire John C. Lincoln Health Network, and we’re on track to go live with Epic to replace most of the Meditech functions, except for lab and blood bank, in 2012. We’ll also be replacing ChartLogic. So at the culmination of our project by the end of 2012, we’ll have our entire physician network and both our hospitals on a one medical record for the system.
Guerra: So, you’ve been at the organization for about ten months, is that correct?
Slepin: Right. Nine months now.
Guerra: Was the Epic decision made before you got there or after?
Slepin: The selection process was orchestrated prior to my arrival by the interim CIO and the management team. When I came on board, the vendor of choice had been named as Epic and I was given the task to work with our team to finish the contract negotiation, and go to our board for funding and begin the project implementation, which was what we did during the spring.
Guerra: So that’s not a bad situation to walk into. It’s pretty popular vendor. So walking into an organization that’s going live on it, you’re going to have one system for all. Is that a pleasant situation to walk into or is it still a big install and a lot of work and kind of stressful?
Slepin: Yes, yes, and yes—all of the above. I was delighted that John C. Lincoln had selected Epic. It’s clearly the leader in the market and I think it’s a good fit for the goals that this organization has to become a clinically integrated healthcare delivery system that’s the provider of choice in our market. So it’s a good fit. For a number of reasons, including integration along the continuum of care, care coordination, having a single database for our community, and all of the various functionality that Epic offers, I feel that it was a good decision. It’s also a tremendous amount of work, but I wanted to have an opportunity to come in as CIO of a delivery system that was starting this project and be able to take it from start to finish and optimize it over a period of time. So I’m really excited to be part of the team.
Guerra: Would your life be much different if you were walking into the environment that had been there where you have one system in the inpatient environment and then another system in the physician practices and had to then tie that altogether? It’s a much different scenario to deal with this, isn’t it?
Slepin: There are differences in that, and that’s been typically what many organizations have done in the past with best-of-breed. In that particular case, you’ve got two groups on two separate systems, so you’ve got two teams in IT that are working on the care and feeding of the systems and making it all work together. There certainly are viable strategies and alternatives to make that work, but a lot of the challenges are very much the same, and then there are some unique challenges to the integration that organizations need to deal with. We decided that we didn’t want to deal with the challenges and the complexity of that integration. Why not keep it simple and have one database?
Guerra: A lot of people are making that decision and it’s not an inexpensive one. So the advantages must outweigh the cost.
Slepin: Correct. In fact, one of the first questions I asked when I started was about the process the organization had used to compare not just the features and benefits but the other aspects of the decision, including the total cost of ownership and the value. The organization went through a disciplined process to think that through and determined that while we may be spending more on Epic compared to the other two alternatives, the value was greater, and it was overall a better decision for our organization given our strategic direction.
Guerra: So as you said, the decision to go the Epic predated you. Are you able to speak to the selection process and who was considered, that type of thing?
Slepin: Sure, I can speak to it. I didn’t participate in it but certainly I’m aware that the finalists other than Epic were McKesson and Meditech. The organization put together other cross-functional team representative of the overall network and brought in an outside consultant to assist with a rapid evaluation and selection. There were a number of priorities that were considered in the decision: coordinated care across the continuum with patient-centered care; a focus on primary care and medical home development; integrating the hospital and the physicians both within the network and within the community at large, because we also work with many outstanding community-based physicians; and improving outcomes and reducing costs. These are some of the requirements that we looked at.
Guerra: When you looked at McKesson, did you look at Horizon or Paragon—do you know?
Slepin: I believe we looked at Horizon.
Guerra: Okay, I’m just curious because Paragon is supposed to be an integrated system. What about Cerner?
Slepin: I apologize—it was Paragon. We looked at version 6.0 Client Server for Meditech and Paragon for McKesson.
Guerra: Why didn’t Cerner make the short list? They’re supposed to be functioning off of one database for ambulatory and acute care.
Slepin: John C. Lincoln had Cerner installed some years ago and so there was experience with Cerner, and a decision was made that Cerner would not be one of the finalists. It’s probably best to put it that way.
Guerra: Well said, so we’ll leave it at that. What is your strategy for the independents—are you going to offer them Epic under a Stark program with some discounting? I spoke to one CIO who is kind of in your position, and he or she said, ‘We’ve got Epic and we’re going to underwrite Epic, but it’s still a little more expensive. So we’re also going to offer the Allscripts product to give physicians something a little more affordable. What’s your strategy around the independents?
Slepin: Initially our strategy for independent physicians will be to offer a physician portal from Epic which will replace our existing portal that we use to access our legacy systems. We have the ability for hundreds of community physicians today in their offices to access a rich database of information with that portal. So that will be on day one next year that we’ll offer that. We also are planning to provide Epic ambulatory for selected subspecialist physicians beginning in late 2012, and we’re still working on the details of that strategy.
We surveyed our entire medical staff over the summer to take a look at what they’re doing now. Do they have an EMR today? Do they have plans to install one or are they installing? What is out there? What is their interest? What would their interest be in being in Epic and integrating with John C. Lincoln? And so we’ve gotten good intelligence there. We have a number of community physicians who have reached out to us and expressed interest in working with us. So we’re still thinking through all the details of a community physician strategy and we’re going to look to probably start that in 2012 and then expand that to 2013 and beyond.
Guerra: A lot of people are in that stage of figuring out a way to go with the independents. You have to get your house in order first, right?
Slepin: Yeah, that’s the point. We have a huge challenge, which we’re up to, but it’s going to take everything we’ve got in 2012 to put Epic in for both our hospitals and our physician network, and to begin implementation with subspecialty areas. The main argument for not doing the community physician rollout in full force next year is that it’s really a lot to do. It’s a lot of risk and it doesn’t seem to be in our best interest or in the physicians’ best interest for us to take on that much more. We already have a more aggressive timeline and so we want to make sure we do an outstanding job in laying a very solid foundation that we can build on for the long term.
But we are very committed to working collaboratively with our community physicians. They are critical to our success now and in the future, and we’re exploring a variety of alternatives for integrating with them. And one of them also is looking at health information exchange and what’s going on in the state of Arizona and the Phoenix market and considering where that plays into this as well.
Guerra: And that’s certainly a dynamic many of your peers are facing, which is we have 15 things that we need to do but we only have the resources to do four or five of them well. So of the things that we really would like to do, what do we have to put off just to be responsible?
Slepin: Exactly. It’s overwhelming, the amount of work that we have on our plate now and that’s coming. Health information exchange is terribly important, and it’s part of what we’re all striving for under the Meaningful Use strategy. We have some hospitals in Phoenix that have chosen to participate in the initial stages of the Arizona Health Information Network beginning next year in a pilot. We’re not ready for that. We’ve got to focus on putting Epic in first and then we’re going to evaluate whether or not or how we would participate in that particular exchange.
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