There are few things that can rock a CIO’s world as much as learning that the clinical information system you’ve been using for years—and have even upgraded to the latest version—is being phased out. But like any CIO, Atlantic Health’s Linda Reed has learned how to move past the bumps in the road, even those that will hugely impact her organization’s IT strategy. In this interview, Reed talks about the challenges in getting physicians to adopt EMRs, the work she and her colleagues are doing to facilitate data exchange in New Jersey, and how she is working to prevent staff burnout. Reed also discusses the most challenging aspects of Meaningful Use attestation, the value of advocacy groups like CHIME, and how difficult it is for CIOs to take time off.
Chapter 1
- About Atlantic Health
- Lack of interest in EMR subsidy programs
- Dealing with McKesson’s revamped Horizon/Paragon strategy
- The need for 1-on-1 attention from vendors
- Most challenging part of attestation: meds reconciliation
- When it’s a process issue — not a technology issue
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Bold Statements
A lot of physicians are still either intimidated about the complexity of the EMR, or they just don’t want to incur that kind of effort at this point in their careers, and a lot of them are just trying to hold on and get out a couple of years without having to join an ACO or one of the new reimbursement methodologies.
Meaningful Use is one thing, but I’m not quite sure how intriguing that is to people right now anymore, especially now that they’ve seen that there’s really more to it.
Even though they said they’re not going to change anything and they didn’t technically sunset it, I’m concerned, and a lot of other McKesson CIOs are concerned about the what that product and the support of it is going to look like over the next number of years.
We’re all still kind of waiting. What I was expecting or what I would have liked to receive was, ‘here’s your McKesson product portfolio today. Here’s where it will match with where we’re going in the future, and here’s how we keep your investment whole.’
When you look at your score cards, you’re saying, ‘why aren’t we hitting the mark here?’ And then you go back and it’s a process problem. So I think it’s understanding what you’re collecting, how you’re collecting it, and how it’s coming back into a system, and then tracking that problem back into how are they doing this from an operations perspective.
Gamble: We’ve spoken before, Linda, but why don’t you give our readers and listeners an overview of your organization — number of hospitals, total beds and what you have in the way of clinics.
Reed: Since we’ve spoken, Atlantic Health has acquired another hospital. So at this point in time, we are three acute care hospitals: Morristown Medical Center in Morristown, Overlook Hospital in Summit, and Newton Medical Center up near Sparta, N.J., in the northwest corner. We also have a state-designated children’s hospital. So when you put us all together, along with all the other services we offer — we do have a cardiovascular institute and we have a neurosciences institute — we’re somewhere around 1,100 beds. We have just about 10,000 employees. And we’re really proud to say that we’ve been selected for the fourth year in a row as one of Fortune Magazine’s 100 best places to work. We have a physician practice with mostly subspecialists that, now that we acquired a huge group of cardiologists and some primary care physicians, is probably closer to about 300 and 310. And then we have different clinics and facilities out in the community, including some primary care offices.
Gamble: You guys are always growing, aren’t you?
Reed: We are. Our revenues are about $1.3 billion.
Gamble: Okay. I know that you have a large number of affiliated physicians, and I wanted to talk about how that works in terms of integration with the hospital EMR.
Reed: Well it’s interesting, because we started offering a subsidy package for physicians that wanted to get an EMR, and I we were a little disappointed. I think we felt we would have gotten more interest. But we have noticed, and I’ve talked some of my peers around the country, and it seems that there isn’t a lot of interest in hospital-based subsidies. Everybody who’s offered something has had a very similar experience where the uptick isn’t much as I thought it would be. We had someone come in a few weeks ago and they were talking a little bit about some of the generational changes and some of the things that are happening with physicians out there. A lot of physicians are still either intimidated about the complexity of the EMR, or they just don’t want to incur that kind of effort at this point in their careers, and a lot of them are just trying to hold on and get out a couple of years without having to join an ACO or one of the new reimbursement methodologies, and not having to use some kind of electronic medical record. For the ones that we work with that do have out there that have electronic medical record, we have kind of like a private health information exchange and we use that to deliver results into their EMRs.
Gamble: It is surprising that you said because I looked on your website and I see that there are almost a dozen EMRs that you’re willing to work with.
Reed: We do. It’s interesting, some of them already have EMRs, I think some of them just don’t want to work with the hospital in some ways, and some of them are still maybe skeptical or concerned about what it means for them to work with the hospital. So it’s very interesting. But like I said, I’ve talked to a lot of my peers and a lot of people who’ve offered subsidy packages similar to ours, and they’ve been disappointed too with the utilization.
Gamble: What can you do about it? I guess just kind of wait and see how things pan out with them, or as you said, work toward the private HIEs, things like that?
Reed: I think the HIEs are going to be important. We’re working with the New Jersey RED Center also, so we brought them in. We signed up physicians; they can participate with the REC through us, and hopefully that will also elevate the interest. I think the people who really want one and want to use one might have already gotten there. And so now what you really have are the people who will do this probably kicking and screaming.
Gamble: It’s an interesting dynamic.
Reed: It is, and a lot of CIOs that I’ve spoken to have been kind of surprised by the lack of the interest. But at the same time you see that EMR adoption is growing. So I think Meaningful Use is one thing, but I’m not quite sure how intriguing that is to people right now anymore, especially now that they’ve seen that there’s really more to it. But going forward, if you’re going to participate in any kind of new reimbursement methodology, you probably need to have something in place to be able to manage those patients and manage quality data.
Gamble: Absolutely. So in the hospitals, you have McKesson — would you consider yourself a McKesson shop?
Reed: Pretty much. We’re probably about 80 percent McKesson, but we are definitely still considered best-of-breed.
Gamble: Okay, so along those lines, I wanted to talk a little bit about the recent announcement from McKesson that they’re shifting away from Horizon and focusing more on Paragon. As a long time McKesson customer, how is this going to affect your organization’s strategy?
Reed: Very much so. I think the first thing I said to McKesson was, ‘in a lot of ways, you impacted our strategy a lot.’ There are a couple of things. We already thought that that piece of our strategy was set so we could move on to other things. Well, now it’s not. Even though they said they’re not going to change anything and they didn’t technically sunset it, I’m concerned, and a lot of other McKesson CIOs are concerned about the what that product and the support of it is going to look like over the next number of years. McKesson has already said — and we understand—that they have to get us through Meaningful Use, which takes us through 2015, but what does it do to your strategy going forward? And that, in a lot of ways, might be the lynchpin to some of the strategies that you were putting out there. So it truly was a blow, I think, to all of us. The other thing is, you already said to yourself, ‘That work is already done. I can move on to the next thing.’ And now you cannot move on to the next thing. So there’s an opportunity cost there.
Gamble: What version were you working on?
Reed: We’re on 10.03. We’re on the very latest version. We were actually their first 10.3 customer; we were their pilot site for that.
Gamble: Did they do a decent job of communicating the strategies to the customers and offering assistance, things like that?
Reed: Not really. We’re all still waiting for that. I think it is one thing that disappointed quite a few of us — they made the announcement but didn’t have a lot of information to give us to make us confident in what was being announced. So we’re all still kind of waiting. What I was expecting or what I would have liked to receive was, ‘here’s your McKesson product portfolio today. Here’s where it will match with where we’re going in the future, and here’s how we keep your investment whole.’
Gamble: Right, absolutely. So it is going to be a matter of just sitting down and trying to figure out where you’ll be several years from now?
Reed: Yes, and there are a lot of things out there. There are a lot of caveats and a lot of things that we don’t know. If you are going to need to purchase new licenses, if you’re going to need to convert data, do you stay there? Or is this an opportunity to look for something else? What’s McKesson going to do to both engage their current customers and find a way to keep them?
Gamble: Hopefully you’ll start to hear more going forward.
Reed: Yes, and they’ve said that. So they’ve already set up individual meetings with the people from Paragon. So they’re trying to work with all of us. It really is very personal because we all look different, so it really is very much an individualized, one-on-one, sit-down meeting. The questions that I think everybody has are: Paragon is considered one of the Best in KLAS products, but where it is today? And how soon does it work for somebody that looks like me?
Gamble: Yeah, that definitely does put a wrench in things for you.
Reed: Very much. But the thing is, we’re all working toward Meaningful Use anyway, and we’re all close, and so it doesn’t change things tomorrow. But I think McKesson really did think that people wouldn’t be thinking about doing anything for maybe, five, six, or seven years and I think that’s not going to happen. I think people are going to do whatever they need to do before then.
Gamble: You don’t want to wait when you have something that big hanging over your head. You don’t just want to wait on that.
Reed: And there is more kind of merger and acquisition activity out there too.
Gamble: Something you always have to keep your eye on. Now you mentioned that they said that they would get you through Meaningful Use. How are you guys positioned right now for Meaningful Use? Have you attested to Stage 1?
Reed: We’re going to do the reporting period in February and then we’ll attest nine days after that.
Gamble: What do you think is the most challenging aspect of the attestation for Stage 1?
Reed: There are a few, I think. Medication reconciliation is challenging for us. It’s interesting because even though your systems can do certain things, when you look at your score cards, you’re saying, ‘why aren’t we hitting the mark here?’ And then you go back and it’s a process problem. So I think it’s understanding what you’re collecting, how you’re collecting it, and how it’s coming back into a system, and then tracking that problem back into how are they doing this from an operations perspective. And I think it is also figuring out what you have to change in operations. Early on we had an issue with, ‘do you collect advance directives?’ Of course we do. We asked that question but it wasn’t coming across, and I think it had to do with how it was asked, when it was asked, and how it was documented.
Gamble: There really are so many pieces to this.
Reed: That’s right. And it’s funny because there are all these things you thought would be a no-brainer, and then you have to just kind of track them back and follow them along.
Gamble: It’s a matter of just keeping all these pieces together and keeping track of all the moving parts.
Reed: Right, because you might think it’s technology issue, but it’s not. It could be very much how are they doing this.
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