Montefiore Medical Center prides itself on being a forward-thinking organization. The Bronx, N.Y.-based system began implementing an EMR in the mid-90s, and was closing in on full CPOE just a few years later. But although the organization has always embraced innovation, CIO Jack Wolf believes what is just as important is maintaining a sound strategic plan. In this interview, Wolf talks about the weighted decision of whether to transition to a fully-integrated system, the need to be able to seamlessly connect the acute and ambulatory worlds, and how he dealt with being blindsided by a vendor decision. He also discusses Montefiore’s participation in an ACO program, the health IT workforce shortage, and his thoughts on MU Stage 2.
Chapter 3
- The ICD-10 postponement — “I’m very happy with the delay”
- The overall value proposition of converting
- Thoughts on MU stage 2
- “CIOs should be more incorporated into the process”
LISTEN NOW USING THE PLAYER BELOW OR CLICK HERE TO DOWNLOAD THIS PODCAST AND SUBSCRIBE TO OUR FEED AT iTUNES
Podcast: Play in new window | Download (9.3MB)
Subscribe: Apple Podcasts | Spotify | Android | Pandora | iHeartRadio | Podchaser | Podcast Index | Email | TuneIn | RSS
Bold Statements
I’ve spoken to a lot of my peers who are trying to educate themselves on ICD-10 — what it means and what the changes are going to be and what they’re going to have to do. And I’m thinking to myself, ‘oh my god, you’re a year behind if you just starting to think like that today.’
I don’t think anybody really sat down and thought about what this is going to mean. Every physician has to go through a process of training and understanding what the codes are going to be and what the requirements going to be. It’s an enormous amount of work.
There are certain things that are out of the control of the provider organizations. No matter how easy we make it for patients to get to their results, no matter how easy we make it easy for them to communicate interactively with their providers, it is not something that the hospitals should be at risk for in terms of Meaningful Use dollars.
Any one of the pieces of Meaningful Use stage 2 that you look at, it would be nice if we could get there; if we could have those things happening; if we could attain those levels. But then I think they’re open to hearing what the reality of trying to get there would be, and they rely on us to provide that feedback.
I have to answer the questions when stage 2 comes out and it’s publicized, and then some of our doctors start reading about it. And they call me and say, ‘Where did this come from? Why would we do this?’
Guerra: I want to touch on the ICD-10 postponement. It seems to be taken one of two ways. If you were far along on it, you’re kind of frustrated that the government pulled the rug from under you in a sense, maybe taking away some of the stick that you were able to bring to the rest of the organization to say, ‘we have to do this. This is the deadline. The government is not moving it.’ All of a sudden the government moves it, and the impetus may be gone. On the other side of the coin would be organizations that were nowhere near far along and probably weren’t going to make it, that were quite happy. Your thoughts on that — first from your organization’s point of view, and then if you think it was the right thing overall for the industry.
Wolf: We’ve done a lot to prepare ourselves for ICD-10. We’ve used some external consultants; we’ve built a program; we have a plan; and we started to execute on that plan. We’ve identified all the systems that need to be upgraded. We’ve started our notification and education project process across Montefiore for educating physicians and other providers on what’s going to be coming. We’ve started to beef up our coders and get them trained. So a lot of activity is going on, but even with all of that, I think a lot of people are underestimating the work involved in migrating to ICD-10. I’m very happy with the delay, because I think we had a very tight timeline — even for us, who are very focused on it and started early, it’s still a very tight timeline to meet the requirements. I’ve spoken to a lot of my peers who are trying to educate themselves on ICD-10 — what it means and what the changes are going to be and what they’re going to have to do. And I’m thinking to myself, ‘oh my god, you’re a year behind if you just starting to think like that today.’ So I’m not upset by a delay. I think it’s warranted; I think it’s needed.
Guerra: If you take away the timeline, do you see an underlying value of ICD-10? I know one of your colleagues, John Halamka, consistently wrote in his blog that he just didn’t see the value, pure and simple, especially not before other steps were taken. It sounded like overall he’s just wasn’t sure if this was worthwhile.
Wolf: That’s a tough question. I do see value in a better identification of procedures, but I think we’ll get there in other ways, certainly as we get more documentation and our electronic medical records advance further. I don’t know, I guess my thought is I don’t really see that great an advantage in migrating to ICD-10.
Guerra: Right, especially when you compare it to the work involved.
Wolf: The work involved is enormous. I don’t think anybody really sat down and thought about what this is going to mean. Every physician has to go through a process of training and understanding what the codes are going to be and what the requirements going to be. It’s an enormous amount of work, and cottage industries for consultants. A lot of organizations are seeing consulting companies springing up around ICD-10 and hiring coders that they’re going to then sell back to the provider organizations at probably a 100 percent mark-up. I mean, it’s crazy the way it’s happening.
Guerra: I bet you those folks weren’t too happy with the delay. That was about the same way you felt when GE told you they were sunsetting their lab system.
Wolf: Yes, I’m sure.
Guerra: I always say that the government seems to play a little fast and loose with the kinds of things that have such ripple effects throughout the entire country and throughout the industry. And it just seems a little light in sense of, ‘alright, here’s the date,’ and then we get close and there’s a pushback and it’s like ‘okay, let’s delay.’ But there are big ramifications from these things.
Wolf: Yes, the impact is pretty wide and pretty dramatic.
Guerra: Going back to Meaningful Use, did you take much of a look at Stage 2? Does anything there concern you? I haven’t examined it in-depth but I’ve read some discussions about it which seemed to indicate it was a pretty big step up.
Wolf: There are some pieces of Stage 2 that concern me, and specific areas are the requirement for the number of patients that are actually utilizing things that you put in place for patients. I don’t know how we’re going to gauge that. I don’t know we’re going to enforce that or push that with our patient base. So 10 percent of patients have to access their results online — I don’t know how we would facilitate making that happen. So there are certain things that are out of the control of the provider organizations. No matter how easy we make it for patients to get to their results, no matter how easy we make it easy for them to communicate interactively with their providers, it is not something that the hospitals should be at risk for in terms of Meaningful Use dollars.
Guerra: Right, I was just thinking that you can incentivize a physician to make sure they tell a patient to lose weight, but to actually hold them financially accountable for weight loss?
Wolf: Right.
Guerra: A lot of people say, and it seems to be the case, that they come in high on these things. They know they’re going to get knocked down. It’s almost like putting your house up for sale — you list at about 20 percent higher than you hope to get, because you know everybody wants to feel like they’re getting a deal. I wonder if it’s a deliberate government strategy — we’ll come in a little high, we’ll get clobbered with some comments, and then everybody will talk about how responsive we were.
Wolf: I think that what’s happening is, when you sit around the table and think about the things that we’d really like to see happen that would really improve patient care; that would really improve quality — these are all things that would help that happen. And so I don’t know that they’re saying, “let’s just put everything in and then we’ll back out some of it.’ I think they’re saying, ‘let’s put everything in and then let’s get it out there so people can comment on it.’ Because any one of the pieces of Meaningful Use stage 2 that you look at, it would be nice if we could get there; if we could have those things happening; if we could attain those levels. But then I think they’re open to hearing what the reality of trying to get there would be, and they rely on us to provide that feedback. So I think the concept of the comment period is really to say, ‘okay, here are all the things we’d like to have happen, now you tell us what’s real.’ I think it’s more that way than it is, ‘let’s just add some things on that we can then back out.’
Guerra: I think you might be right, but I personally don’t know if that’s the most efficient way to go about these things, because you pretty much put the whole industry in a frenzy to get comments and to make these things realistic, when maybe you could have some more reality checks on the frontend. But that’s just me.
Wolf: Sometimes you ask yourself, ‘who thought this through?’
Guerra: Right, but I’ve heard other CIOs say that about this stuff.
Wolf: And I have to answer the questions when stage 2 comes out and it’s publicized, and then some of our doctors start reading about it. And they call me and say, ‘Where did this come from? Why would we do this?’
Guerra: Well, and I’ve written about this before, you look up the makeup of the HIT Policy Committee, and some of those members have never worked in hospital or physician practice. They’re really kind of special interest representatives for patient care and patient rights and privacy advocates and things like that, so operationalizing some of these things is not maybe their best skill or top concern.
Wolf: I think there should be more input from the CIOs out there. We should all be more engaged — not more engaged, we are engaged, but more incorporated into the process.
Share Your Thoughts
You must be logged in to post a comment.