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.
- Putting the finishing touches on 5010
- A piecemeal approach to the ICD-10 conversion
- Being in “constant upgrade mode”
- The cost of replacing top staff
- Getting CIOs to work together on HIE
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I think the problem with it is that it’s kind of piecemeal because now you’re going to do ICD-10 for Medicaid but you’re still going to need to do ICD-9 for other things. So it really is disruptive from a workbook perspective.
I had a board member one time say, ‘If I gave you more money, could you do more?’ and the answer was ‘no, because there is only so much change an organization can absorb at one time, and we’re there.’
We’ve been in constant upgrade mode. That’s just the business of healthcare. Then you add on the real, true IT. You bring in mobility, and bring-your-own-device, and add on the privacy and security, and then you have to manage things like virtualization and data loss prevention.
It probably costs anywhere between $12,000 and $20,000 just to put somebody in a seat, so that’s not something you want to lose. And then if you have somebody who is a seasoned person, that could cost you hundreds of thousands of dollars to rebuild those skill sets.
At the end of the day, all of our hospitals are going to have to do this because when you start looking at reimbursement for readmissions or redundant testing, if we don’t work together, how are we going to do that? So I think we all just see the writing on the wall and know that doing something like this takes time, and we have to start now.
Gamble: Where do you stand on ICD-10? That’s just an interesting topic right now too because there’s a lot of talk about possibly delaying it.
Reed: I was on the CMS website the other day and they have a bunch of FAQs out there and one of the FAQ is, ‘will this be delayed?’ And I think the answer just said, ‘no.’ But I think it’s interesting where the American Medical Association is going with this, with their protest.
We’re ready for 5010. We’ve done a lot of the upgrades, especially from the McKesson perspective. We’ve done the preliminary upgrades, but everything needs kind of a last-patch type of thing. I think we’re okay there; I think the biggest issue for us though is doing the coder assessment — what’s that going to look like. I think we’re going to do some modeling from a financial exposure standpoint. Most people will tell you that it’s very much like Y2K because you have to contact the vendors and you have to contact the payers and see when they’re ready and when you’re going to attest. So it’s just putting that whole plan together.
Gamble: What’s interesting as far as the push to delay it is that although there are some people who say, ‘It would be great to get a little more time,’ I think there are also people who will say, ‘We’re on this track now. So maybe we should just move toward this and get it done and have one more thing out of the way.’
Reed: It’s funny, we were talking to somebody last week because I did a presentation and they said, ‘It’s kind of like the metric system. Everybody else in the world has done it, and we just put it off and put it off and put it off.’ And maybe we’ll never get there, because right now we are the only industrialized country that isn’t on it. I think the problem with it is that it’s kind of piecemeal because now you’re going to do ICD-10 for Medicaid but you’re still going to need to do ICD-9 for other things. So it really is disruptive from a workbook perspective. You’re going to have to put mapping software in place or something, because you’re still going to have to code in two different versions.
Gamble: I can imagine that gets really complex.
Reed: Yeah. It’s interesting; what’s out there also is that with ICD-10, there’s two pieces. There’s the initial coding and there’s the procedural stuff. So physicians use the ICD-10 and then they use CPT codes, and the CPT codes all stay the same, but the 9 goes to 10. The hospitals, I think, have the bigger change, because we got the ICD-9 to 10 for the initial coding and then we also have the ICD-9 to 10 in the procedural coding. So it is probably a little more convoluted for doctors, but I think our biggest issue too is physician notes and documentation. We’ve already brought in numerous ways to have documentation improve so that the coding could get better, because coders can’t code what’s not in the documentation, and now we’re going to have to bring that in again, because what do the physicians have to document differently? What do they need to do? How do they need to document for the granularity that’s not going to have to be coded in the ICD-10?
Gamble: Sometimes I think there’s only so much change people can cope with.
Reed: And that’s kind of where we are. I had a board member one time say, ‘If I gave you more money, could you do more?’ and the answer was ‘no, because there is only so much change an organization can absorb at one time, and we’re there.’ We’re so there. And I think everybody’s there. So again, just take a look at so many of these things — Meaningful Use, 5010, ICD-10, and now you’ve got ACOs out there; you’ve got the bundling that’s coming out; physician alignment is huge — everybody is out there buying physicians, and you just put those altogether and everybody is just exhausted and just damned.
Gamble: From the point of view as a CIO, you’re dealing with so many different things — how are you able to prioritize, because it seems like your priorities must be constantly changing?
Reed: They do. They change almost every day. And I think the thing that concerns a lot of us is that you’re moving from day-to-day, and it’s almost just-in-time support in that you have to take care of the things that are coming up from day-to-day. So we know the long-term goals and we know where those are heading, but we almost react on a daily basis.
Gamble: I would think that you have to.
Reed: You have to.
Gamble: And maybe it’s just because we’re in this time, but it seems to me that now more than ever, you’re constantly having to reshuffle priorities and put things on the backburner that really can’t go on the backburner.
Reed: It can’t. But it’s interesting because if you think about what people have been doing for the last year, also for Meaningful Use, is we’ve been in constant upgrade mode. That’s just the business of healthcare. Then you add on the real, true IT. You bring in mobility, and bring-your-own-device, and add on the privacy and security, and then you have to manage things like virtualization and data loss prevention. So you’re just trying to run the business of healthcare and then you add on the true IT components, and it’s a daunting challenge.
Gamble: And now as far as your staff, is burnout something that you’re extra cognizant of right now?
Reed: It’s huge. In 2011, we did all of the Meaningful Use, we upgraded all of those systems, and we did a lot of our virtualization because we were getting ready to move to a new data center. We hadn’t moved in ten years; we had been in one place for ten years, and we moved our entire data center in six months. We upgraded all of our systems for Meaningful Use. We brought on a new hospital and put all of the Atlantic Health System applications in there. We had some major upgrades. We totally redid our radiology information system — just some very large initiatives. Nobody slept; there were no weekends. You do all of these things at night. And then we had to support that live for about a month; actually some of it is still going on.
So staff burnout is huge. If they don’t quit, they’re just exhausted. So from that perspective, we provide flexible work hours. We also do let people work from home. We let our analysts work from home twice a month; our managers can work from home once a week, so we try to do the best we can, but there’s so just so much.
Gamble: And you don’t want to be dealing with low morale, because that of course affects productivity.
Reed: That’s right, and we generally have pretty good staff engagement scores. They did go down some from last year, but I think it’s just from being overwhelmed.
Gamble: Sure. And as a leader, you have good people who work for you, and you don’t want to lose them, but it’s got to be so hard.
Reed: Absolutely. It probably costs anywhere between, I’d say, $12,000 and $20,000 just to get somebody to the point where they can function; just to put them in a seat, and so that’s not something you want to lose. And then if you have somebody who is a seasoned person, that could cost you hundreds of thousands of dollars to rebuild those skill sets.
Gamble: You just mentioned the acquisition of Newton Memorial. How much was required on your part from an IT standpoint — where they on a different system?
Reed: They were on a very old Cerner platform. They hadn’t upgraded. They would’ve had to incur a huge expense to upgrade that. They needed to upgrade their network; they needed to update their data center. So they had a lot of upgrade costs, plus they have their own IT department, so this decentralized IT as part of the Atlantic IS department. And then we just put up them on all the latest versions of everything that we had.
Gamble: And was a longer or more difficult process than you had anticipated or was it about what you expected?
Reed: No, we did it in six months. Actually, we would have loved to spend more time, but we had a time constraint, and so basically what we did is, they had to take a configuration that was already created for one of our hospitals, so they really had to start taking a look at changing how they did things in terms of their workflow to match how the system already worked because of the time constraint. So we actually did that conversion in six months.
Gamble: Okay, and like you said, I’m sure you probably would have liked to spend more time on it.
Reed: Absolutely, that was probably a two-year conversion that we consolidated into six months.
Gamble: That’s amazing. But I guess that’s what you have to do right now.
Gamble: Okay, so I want to kind of switch gears a little bit and talk about HIEs. You’re a part of Jersey Health Connect, right?
Reed: That’s right.
Gamble: I know that in terms of the HIE picture in New Jersey, there’s quite a few of them but Jersey Health connect is one of the bigger ones, and I just want to ask you a little bit about your role in that, and what was involved in getting some of these hospitals to work together.
Reed: You’re right; Jersey Health Connect is the largest. So the state has four that were funded form the ONC grant that came out. So Jersey Health Connect was one; there’s Camden HIE; there is Health-e-cITi-NJ in Newark; and there was one in Atlantic City, but that one is defunct, so they’re looking at reallocating that money to getting another submission in there to reallocate that money to something else in South Jersey. And when you put them all together, it would give us a statewide network.
At this point in time, I am president of Jersey Health Connect; it started a little over two years ago. There were a number of us that already were on RelayHealth, and so we started having a conversation about, ‘Since we’re already on this platform, can we start talking about sharing data?’ And the platform actually then hooked into others; it is an HIE technology. And here in New Jersey, a lot of the CIOs have known each other for a long time, especially up in this area. So we just asked a couple more of our long-term time friends, ‘Does anybody want to have a conversation?’ And the next thing you know, there were probably six of us that said, ‘Let’s do something,’ and that grew. It’s up to 19 now.
We also have a long-term care facility and now we’re looking at bringing on other things like maybe a radiology company and any other providers that want to come on. Where we are right now is that we’ve done all the governance, we’ve got our membership agreement signed, we have all of our by-laws, and now we’re just working on the data exchange component.
Gamble: So it wasn’t an issue where it was tough to get hospitals that might be competing to work together.
Reed: No, and I think that’s the thing that fascinates most people. You’ve got people that compete, and we just came together so easily, but I think it had to do with the fact that we were always very transparent. Everybody gets a say, we have a board that everybody sits on. I think inherently, we trust each other. I think everybody understands that the agenda really is to make this a benefit for our patients. At the end of the day, all of our hospitals are going to have to do this because when you start looking at the laws of reimbursement for readmissions or redundant testing, if we don’t work together, how are we going to do that? So I think we all just see the writing on the wall and know that doing something like this takes time, and we have to start now or when that lever is pulled, we won’t have an infrastructure in place to be able to do it.