For some people, being the new CIO means making a splash by setting big goals and implementing sweeping changes. But when Tressa Springmann assumed the CIO role at LifeBridge in the fall of 2012, it was more of a ripple. Although she was a seasoned veteran, having served the role for 13 years at Greater Baltimore Medical Center, Springmann opted for a “listen and learn” approach at her new organization, and it has served her well. In this interview, she talks about the change management hurdles she had to overcome at LifeBridge, the deliberate strategy her team is employing to get physician practices on one EHR system, and what she does to stay energized.
- Bringing practices into the fold — “It’s a mutual win or loss.”
- Starting the 90-day MU reporting period
- Portal challenges — “We haven’t come up with the sweet sauce.”
- “The real new frontier” with data exchange
- Tracking readmissions across the state
- The burden of federal mandates
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When things don’t make sense, they’re very hard to implement. And to many people who only come to a hospital for an acute episode or a surgery or something that’s once and done, it just doesn’t make sense. It’s not worth establishing the whole account.
It’s exciting stuff, don’t get me wrong, but it’s very concerning that there are some of these things that are totally out of our hands that might impede or affect our ability to continue the course.
They have created a real relevance for themselves. Instead of each of us having to struggle with our own readmission reports, they’re developing some that will be available to all of us.
With a global budget you’ve got to manage under the margins, so cost containment is a big deal. And yet, with MU and PQRS and ICD-10, there’s just a plethora of work and investment going into place merely to remain compliant.
Gamble: I’ve heard people say that it might be easier going from system to system than it was from paper to an electronic system, but that still doesn’t take into account everything that people at a practice are going through. Especially if they’re just getting used to it, and like you said, they’re just starting to see some value, I can’t imagine that being an easy discussion.
Springmann: It’s a change, especially for the practices that we’ve acquired that have become really tight partners of ours. It’s a mutual win or loss. Once they’re in the fold, if the transition is problematic, it’s a lose-lose. And everyone is only one acquisition away from needing data exchange. Specialists are able to participate in multiple ACOs. Even if we were outside of the state of Maryland, if I had a gap in my physician profile and I needed a cardiologist or a neurosurgeon, unless they’re employed, you are not going to them on your EMR, so you better have some forethought in how you’re going to plug them in effectively over time.
Gamble: As far as Meaningful Use, where do you stand with the hospitals?
Springmann: Our hospitals are just beginning the reporting period. We’re hoping for the next 90 days, starting April 1, for Stage 2. There are a couple of measures that we don’t have the same control over as we did in Stage 1, and so if this next 90-day reporting period doesn’t bare out, we’ll do the subsequent reporting period. But both of our hospitals are Stage 2, year 1, so we went through Stage 1 for three years. We very early adopters — not to my credit, I wasn’t here.
Gamble: As far as the 90-day reporting period, what are some of the factors that are a little bit more challenging this time around with Stage 2?
Springmann: We’re offering our portal to every single patient that walks in the door, but we have not come up with the sweet sauce on how to get them to go out and enroll. We aren’t hitting our enrollment numbers, and I can’t make them. We’ve tried incentives. We’re doing everything that I can think of that we can, and we’ve certainly been evaluating quite a bit of best practices, but it’s the old ‘you can lead a horse to water’ adage. Our hospitals aren’t in extremely affluent demographics.
Not to generalize, but nowadays, folks are very weary about getting spammed by marketing if they give you their email address. I think in the practice setting — and I’ve had great success in the physician practice setting in other organizations — a portal makes huge sense. You’re running there with your kids. You’re going there all the time. You forgot what your labs were last time. You can go and look. But I have to tell you, for the hospitals, I know we’ll get there, but I think of that little community hospital that competes with other community hospitals, and they’re going to really struggle to get people to enroll in their portals. So that’s one of the measures.
And I’m confident we’ll get there. It’s just like a lot of other technologies. When things don’t make sense, they’re very hard to implement. And to many people who only come to a hospital for an acute episode or a surgery or something that’s once and done, it just doesn’t make sense. It’s not worth establishing the whole account.
The other measure that’s a bit of a challenge — and I think it’s just because of our early adoption status — is the ability to share patient information upon transitions of care. We’re one of the first hospitals in Maryland that’s begun Stage 2, year 1, and we all know nursing homes are still struggling with their EMRs. So who am I going to share my data electronically with in the state using the direct protocol? We’re having to go out and educate people on what it is. It’s just an extremely heavy lift.
Gamble: I can imagine. That’s one the time where sometimes it’s not so easy to be the early adopter.
Springmann: No, not at all. Certainly, they’ve benefited to the maximum from an incentive payment perspective and they’ve done a beautiful job — and I say ‘they’ because as I said I’ve only been here this last year. But as these requirements get tougher, it’s very hard when you’re out in front and you’re talking about data exchange with the rest of the industry and how to do it effectively instead of just teaching to the test, so to speak.
Gamble: Yeah, absolutely.
Springmann: It’s exciting stuff, don’t get me wrong, but it’s very concerning that there are some of these things that are totally out of our hands that might impede or affect our ability to continue the course.
Gamble: Right. You mentioned CRISP before — is that an HIE?
Springmann: Yeah. Maryland is very fortunate; it only has one healthcare information exchange in the state, and it’s got a great deal of state support. And in fact, a handful of years ago, the governor asked all the hospitals to participate, so all the hospitals in the state of Maryland are exchanging ADT and clinical data already. We’re all contributing.The real new frontier is going to be the ambulatory setting — post-acute, etc. There are some really neat use cases that we’re able to do now because all the hospitals are connected.
Gamble: What do some of those cases involve?
Springmann: I’ll give two examples. One is their ENS, the event notification system. If one of my primary care practices or my homecare company gives a patient profile to CRISP, CRISP will establish a mailbox and anytime any one of those patients presents in any ER or inpatient facility across the state, the organization who provided the profile gets a notification. And in some cases, as it is in ours, we’re actually working on an interface so it goes right into our Cerner inbox when that occurs for our practices.
Let’s say I am a patient-centered medical home and I’ve given my patient list to of folks, I can know in real-time if any of my patients have shown up at any one of the hospitals in Maryland. That’s pretty powerful.
Gamble: Yeah, it is.
Springmann: And because we’re all providing ADT data, and again, it’s real-time, we not only can easily identify what our readmission right is inter or intra-hospital or intra-system — which many of us can run reports for, and we’re still struggling with that — but with CRISP, we’re also able to see where else are these patients going. So we know our inter-hospital readmissions — people who came here, and we also know which patients were admitted elsewhere.
It’s a very effective tool to see our high utilizers, because we may think they are really high utilizers here at our facility, only to find out that compared to other hospitals that’s nothing, because we can see them across the whole state. It’s helped quite a bit and CRISP has also gotten the state funding to be the prescription drug monitoring program for the state. So it’s also an easy way for clinicians — and obviously only physicians and pharmacists can access this — to quickly determine if there’s prescription drug problem.
Gamble: That’s something that we’re starting to hear more about. It’s something where it seems like there should be an easy enough fix, but you’re talking about all these different systems of information that don’t necessarily speak to each other. That’s a huge need that could be addressed.
Springmann: CRISP is also looking at being a provider of direct. In Maryland, you can get a free direct email address and use them for data exchange as your HISP. Actually, I take that back. I don’t know if they’ve been approved as a HISP yet, but they’re working on it.
Gamble: That’s one of the HIEs that’s ahead of the game and doing well. I guess if you can be the only HIE in the state, that already gives you a pretty good advantage.
Springmann: They’ve created that and partnered with the state and with the cost review commission that I mentioned. So they have created a real relevance for themselves. Instead of each of us having to struggle with our own readmission reports, they’re developing some that will be available to all of us. Now obviously the hospitals do pay a subscription and we are a large part of financing CRISP, but there are many other sustainability projects between grants and state contributions, etc.
So you’re right, we have been very, very fortunate, because the HIE has been extremely well-led, and they have really worked hard on financial sustainability. They’ve identified use cases that are highly relevant and worth it, and they’re the only one in town, so that made it much easier than in some of the states that have three or four, or more.
Gamble: It’s hard to get everyone to work together when you have different regional HIEs that aren’t necessarily in communication.
Gamble: Okay, so you have lot going on there. Are there any other big priorities on your plate? And I feel funny saying that because you obviously already have quite a bit.
Springmann: I do think right now, ironically, a lot of us feel we work for the federal government, because gone are the days when we as organizations could, with discretion, identify what was the most important set of systems to implement or to do or to get ROI on. Because keeping in mind that with a global budget you’ve got to manage under the margins, so cost containment is a big deal. And yet, with Meaningful Use and PQRS and ICD-10, there’s just a plethora of work and investment going into place merely to remain compliant.
And these federal regulations are extremely complex. We’ve got the benefit of a number of resources that are connected to folks in DC and their own associations that can help us with interpretation and compliance. But again, I think of those small physician practices or those smaller FQHCs (Federally Qualified Health Centers) — we have relationships with those as well — or the small community hospitals, and it’s just overwhelming how they can stay on top of what the requirements are.
I think now that Meaningful Use is turning the corner and moving into an era of negative incentives, if you will, you’re going to hear a real outcry of folks who did not understand or who didn’t fully appreciate what was being said, even though CMS has I think done a pretty good job continually communicating.