As if CIO Chris Van Pelt didn’t have his hands full with the hospitals and physician practices already in his health system, IUH keeps building and acquiring new ones for him to automate and integrate. To bind them all together, Van Pelt and his team are using Cerner, rolling it out one facility and practice at a time, after a thorough readiness review has been conducted by a team formed specifically for that purpose. But getting to a basic level of automation isn’t enough, as Meaningful Use Stages 1 & 2 call the organization to further action, including the use of PHRs as a basis for patient engagement. To learn more about Van Pelt’s wins and challenges, healthsystemCIO.com recently caught up with the Indiana-based executive.
- About IUH
- Managing a “Massive research and education component”
- Running a Cerner shop (in 9 hospitals) going down the line with the rest of the hospitals
- Opening hospitals at a rapid-fire pace
- Evaluating a practice’s readiness to go electronic
- Going down the PHR road
- Stage 2 concerns
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There are some practices we were acquiring in the last two years that were still on paper, if you could imagine that. So I think those are the quick ones where we say, “Okay we have to get you automated,” so they jump to the top of the list.
But there again, if you read the press and even the latest reports on PHRs within the last couple of months, it still is a challenge. We’re going to be pushing a rock up a hill, I think, with the patient populations to get them to help us meet those draft Stage 2 requirements.
CMS, state reporting and specific quality initiatives, either at the state or federal level, they all seem to be on divergent paths with respect to what those quality metrics are.
Gamble: Hi Chris, thanks so much for taking the time to speak with us today.
Van Pelt: Good morning Kate.
Gamble: To start off, why don’t you tell us a little about Indiana University Health, number of hospitals, what you have in the way of physician groups, things like that?
Van Pelt: We’ve got 19 hospitals across the state of Indiana, several thousand owned and affiliated physicians, a dozen ambulatory surgery centers, and a number of subacute facilities all over the state.
Gamble: I’m sure that will help because you’re a pretty large organization and like you said, you’re spread out pretty…
Van Pelt: We’re a $6 billion health system, so yeah we’re a pretty good size.
Gamble: IU Health was formerly known as Clarian Health, right?
Van Pelt: That’s correct.
Gamble: When did that happen, the changing of the name?
Van Pelt: The name changed a year and a half ago, January.
Gamble: Was there a specific reason for that, to reflect growth or anything like that?
Van Pelt: I think the association between Clarian and Indiana University has always been there. IU is one of the parents formerly in the system, so we just wanted to call out and recognize that association more discreetly to give the public a better sense of the connection between the hospital systems and Indiana University. As I looked around the country, it looks like a lot of other health systems have done the exact same thing in about the last 24 months. I don’t know if there was a marketing company that was going around saying, “Call yourself the university plus health.” Somebody has made a lot of money on that.
Gamble: Right. Sure. So just to give us a little bit of a lay of the land, you have the 19 hospitals, and then as far as the physicians, you have one large physician group, IU Health physicians?
Van Pelt: That’s correct. That’s the aggregating point.
Gamble: About how many docs are in that?
Van Pelt: Probably a thousand providers proper, but then again we’ve got several thousand that are actually connected through IUHP, but employed physicians probably in a thousand range today. Obviously we have massive research and education components. We have a number of residents and fellows that also number in a 1,100 to 1,200 category.
Gamble: That’s part of the partnership with the IU School of Medicine?
Van Pelt: That’s correct. Between our downtown hospitals and our facility up at Muncie, we have most of the residency programs in the state.
Gamble: Alright. Just to give us an idea, when did you start as CIO at IU Health?
Van Pelt: I’ve been in the role three years, October.
Gamble: So let’s talk about the clinical application environment. First off, what are you using in the hospitals as far as EHR?
Van Pelt: Cerner is our primary EHR.
Gamble: And is that all in the hospitals?
Van Pelt: It’s in 9 of our hospitals, the downtown core hospitals, our Northeast and Northwest hospital systems. As we’ve been acquiring our building – we’ve built 7 hospitals in the last 8 years. So we’ve been on a pretty vicious pace of opening new hospitals. That’s consumed most of our capacity to put Cerner into any of the others. As we’ve continued to affiliate with existing hospitals, we prioritize them for later integration with the EMR.
Gamble: Is it going on a one-by-one basis or do you have hospitals that are in different stages of implementation?
Van Pelt: It’s a one-by-one. Again we prioritize the facilities based on either patient flow or economic justifications, as far as when we will get to them, but we’re doing them one at a time based on ROI and need to do so. We have a number of critical access hospitals across the state and, so far, that’s been a lower priority item, to get to the critical access hospitals. They typically don’t need the level of clinical automation and functionality that would be afforded by the same system that we’re offering to our Methodist hospital, for example, which is a trauma facility. There’s not a huge need and demand to get that level of automation and functionality into a CAH.
Gamble: I would imagine that this whole process of implementing Cerner in hospitals is taking up a pretty good chunk of your time.
Van Pelt: Oh, sure. Opening hospitals takes up a good chunk of our time. I don’t know if any other health systems have opened that many facilities in that amount of time. We’re getting quite good at opening hospitals.
Gamble: Right. Now as far as the physician group, what are they using in terms of the EHR?
Van Pelt: There again, the primary EHR they use is Cerner. We do have an interface to IDX billing on the back end, for the pro fee billing, but Cerner is the predominant EMR that the physicians use. We’ve been acquiring physicians, as I think everybody has in the country at this point, at a very rapid pace. We can’t flip them as quickly as we’d like to onto the common EMR because a lot of those practices that we acquire come with existing EMRs, so we work to integrate that data with our IHIE and INPC partners here in the state of Indiana.
Gamble: But you try to get them onto Cerner.
Van Pelt: Oh sure. The strategic direction obviously is to bring them onto Cerner. It’s a question of resources and timing. You couldn’t convert 100,000 practices if you wished to. It’s just too consuming. So we’re prioritizing them, again, based on the need. There are some practices we were acquiring in the last two years that were still on paper, if you could imagine that. So I think those are the quick ones where we say, “Okay we have to get you automated,” so they jump to the top of the list.
We have a set of criteria, about 10 criteria, that we use to evaluate a practice’s readiness to come onto Cerner. We have an ambulatory governance committee that’s constructed of many of the product line leaders, the CMOs and ambulatory governance leadership specifically that helps govern that process about who and when gets converted, from an ambulatory standpoint, onto Cerner.
Gamble: Speaking of the practices that you are acquiring, are the adoption rates of getting onto Cerner pretty good?
Van Pelt: I can answer agnostically and just say good. As we’re acquiring practices, they typically have an EMR. It’s atypical at this point that they don’t, but their level of automation is where their gradient is. And there, again, it depends on what type of practice it is.
If it’s a heavy procedure area like a urology practice, it may be less automated than, say, a GP and a family medicine practice who’s trying to look across a continuum of a patient’s record. So we’ve got three very large primary care medical homes established, three disparate practices, family medicine and two generalist/internal med practices, and two of those three are now on Cerner, and the third is on Allscripts, and has been for a significant amount of time, but they’re going to be moving over to Cerner here in the next, probably, 12 to 18 months.
Gamble: Let’s switch gears a little bit and talk about some of the other IT projects on your plate. One of the things I wanted to just talk about was personal health records, as this is something that we’re hearing more of now with the Meaningful Use Proposed Stage 2 rules. What’s your strategy with PHRs at this point?
Van Pelt: We initiated the strategy about two years ago. We didn’t want to have all of our eggs in one basket because it was too ill-defined a couple of years ago, but we forayed into a couple of spaces. I have an Epic PHR up in our Lafayette area. One of the practices that we acquired is our Arnett Clinic, and they had been running Epic prior to that event. We’ve continued with a lot of them to stay on Epic for the time being. So they’re piloting the PHR out of Epic, MyChart, but our predominant push has been with the Cerner PHR. It’s been labeled a number of things — IQ Health is synonymous with it — but we’ve got our own internal branding that we’ve put on.
But we’ve had really good success with a very large primary care practice. Our adoption numbers are a little higher than what gets published nationally, as far as patients picking it up and using it in and interacting with it. I have several lead physicians who are pretty big sponsors of it and are finding some good outcomes with respect to communicating back and forth with patients. But there again, if you read the press and even the latest reports on PHRs within the last couple of months, it still is a challenge. We’re going to be pushing a rock up a hill, I think, with the patient populations to get them to help us meet those draft Stage 2 requirements.
Gamble: Many are concerned with that. Does it help to have some docs leading the PHR charge?
Van Pelt: Yeah, sure. I mean you have to have passionate physicians about any topic, let alone PHRs. The more I found that a physician is advocating a given thing, especially a PHR, if they’re very engaged with their patients, then the patients at least have enough interest to follow through a couple of steps. If they can log on one time, that’s great, but are they going to start to interact with it? I’ve been quoted previously as saying I think patients are more desirous of logging on to Facebook and Tweeting than they are about their health status through a PHR.
Gamble: Yeah, unfortunately that seems to be true, and it brings up an issue of how much physicians and other healthcare professionals can really influence this.
Van Pelt: It’s human psychology, right? I don’t know the answer to that. I don’t know that anybody does. The patients who have chronic diseases, obviously seem to be very engaged. Diabetics, asthmatics, and specific, like oncology types of treatments, those patients are very much out seeking information themselves and very engaged. But the layperson who may only see a physician once a year, twice a year or never, which is the majority of the population, that’s a tough group to try to get at and try to get them interested and interacting with that.
Gamble: Right. I think anybody who can get those numbers up, there’s going to be a lot of people asking what your secret is.
Van Pelt: Yeah, exactly.
Gamble: As far as the other proposed rules for Meaningful Use, Stage 2, what were your thoughts on those? Were they pretty much what you expected?
Van Pelt: Yeah by and large, they are what we expected. We’re obviously anxious to see what the Supreme Court does with their ruling in June and what that downstream impact could be. But we’ll wait with baited breath for the June decision from the Supreme Court and then the Stage 2 Final Regs in July, and have to put both of those data points together to see what we do with it.
I think we’re pretty well-positioned. We’ve still got some challenges, specific items like we just talked about, with the PHR threshold, we’re going to have to take some different tactics to make sure that we hit that metric if it doesn’t change. I’m not sure if you need to go to tactical moves like incentivizing financially a patient to have to log in that one time or do a specific set of actions; I’m not certain what levers you’ll have to pull to get that, but I’m certain we’re going to have to do something different to make that happen.
The rest of the metrics, CPOE adoption and all those types of matters – here again, I think they look fine. We’re not too concerned about it. There will still be some work. Then the ongoing, continuing thing I think everybody’s struggling with it, are the quality indicators and quality reporting guidelines, since they’re still not well-coordinated. CMS, state reporting and specific quality initiatives, either at the state or federal level, they all seem to be on divergent paths with respect to what those quality metrics are. They were promised to be coordinated by Stage 2, but it doesn’t appear that they have been.
Gamble: Right. That’s another topic we’re hearing a lot about. Actually I should ask, how are you positioned as far as Stage 1? Have you attested yet?
Van Pelt: Yes, we attested all of our facilities. I think I might have one or two of the non-Cerner hospitals that are yet to attest. They ran into a couple of hiccups in Q1 that lagged their data collection process, but we’ve got a line of sight on the remaining couple that need to do that. We’ve taken down monies from the Fed and the state, both on Medicaid and the CMS Medicare program.
Gamble: So you’re in a pretty good position. What you brought up with quality reporting is interesting because I just spoke to a CIO who said that if she could do Meaningful Usage Stage 1 all over again, she would have taken care of that first, that it proved to be more of a challenge than she anticipated.
Van Pelt: Yes, definitely. Definitely it was. We didn’t do it last or first. We kind of took it all at once, but that became operationally one of the harder matters to have to solve for, because the quality reporting touched so many things. Some of that requested reporting is either not automated or they’ve messed with too many of the numerators and denominators of reporting that we are already doing, and that ended up causing us to, in some cases, create 3 or 4 different versions of a report we are already doing, if that makes sense. We had to extract specific populations. If we were surveying all of our patients, they only wanted 65 and over, so there’s a duplicate there. The quality departments in a lot of the hospitals are really going to struggle. They struggled in Stage 1, probably some are still struggling with Stage 1. But then Stage 2 becomes even that much more difficult.
Each physician specialty has their own registry reporting requirements, which seem to be on steroids right now with respect to growth. I’ve got a couple of specialists that are maybe up to 10 or 12 registries just for one specialty that they want to participate in. So there again, it’s a data capture and quality reporting initiative which is all ‘mom and apple pie, let’s do that’ but that is definitely an overwhelming topic, I would think, for any CIO in any health system at this point.