One-on-One w/Fletcher Allen CIO Chuck Podesta, Part I

Chuck Podesta’s stance on Stage 1 Meaningful Use criteria probably won’t win him any toasts at the next CIO event. That’s because, despite the position of organizations like CHIME (and this journalist), Podesta thinks the criteria aren’t overly onerous. Though he acknowledges the incentive payout structure isn’t perfect, little else about the program disquiets the Vermont-based CIO. One reason Podesta is feeling pretty good about meeting Stage 1 requirements is he’s in the process of becoming an Epic shop and, more interestingly, he’s embarked on a path to help neighboring community hospitals become Epic shops as well. It’s all part of a nascent program from the vendor called Epic Community Connect. And while Podesta says it works for his neck of the woods, it may not fit into all healthcare markets. To learn more about these issues and many others, healthsystemCIO.com editor Anthony Guerra recently chatted with the Fletcher Allen SVP & CIO.

BOLD STATEMENTS

Epic has allowed us to extend the license and the database out to Vermont and northern New York practices and hospitals as well.

… we need a lot of different options and different swim lanes of implementation to get us there, and the vendors aren’t going to be able to do it alone, the consulting companies aren’t going to be able to do it alone.

… let’s keep the bar where it is, let’s keep the 23, let’s keep the dates as much as we can to force that sense of urgency but let’s give these hospitals and practices some money upfront if they’re showing good faith and trying to get this thing off the ground.

GUERRA: I thought an interesting way to start would be to let you dictate our path by talking about a few initiatives you’re working on right now.

PODESTA: There are two major ones right now. One is our electronic health record implementation, which we’re probably about three-quarters of the way through. We have the Epic product, which we affectionately call PRISM: Patient Record Information System Management. We had an internal raffle for the name and an employee came up it.

Fletcher Allen Healthcare is about a 550-bed tertiary care academic medical center in Burlington, Vermont. We’re actually surrounded by 13 other community hospitals but Fletcher Allen is the only academic medical center in Vermont. And we went live with our inpatient system last June, and that’s going quite well. Our CPOE stats are hovering around 95%, 96%. So we feel very good about that. We feel very good, from a hospital perspective, on meaningful use. We’ve got a benefits realization team lead by our quality group who’s actually managing that effort, and we understand the 23 criteria. We’re working on the data collection aspect of that to be able to prove that we’re compliant in all 23 categories of meaningful use, at least with how they’ve defined today. We’re not sure what will happen in the future.

On our ambulatory side, we have a large faculty practice made up of almost 500 physicians. We also have residents and medical students. We are affiliated with the University of Vermont medical school. They’re connected to us. But as part of that faculty practice, I believe we have almost 200 primary care physicians and specialists that we’re implementing the Epic ambulatory product for, and we’ve just completed our primary care physician rollout — I think we’re going live with our third specialty clinic today. Actually, today it’s the cardiology clinic. So we’re moving along there. We will be finish with that by December of this year, and we’ll also include a product called MyChart, which we’re rolling out in conjunction with the ambulatory care sites that will make available personal health records for the patients. We’re very excited about that, and we’ll be starting a marketing campaign in the community with that.

So internally, that’s Fletcher Allen. That’s our biggest IT project, and I think it’s timely from a meaningful use perspective, but what’s really exciting is we’ve also got another project called PRISM Regional. As you know, Epic markets to the larger health systems and hospitals in the United States. And in Vermont, since we’re unique with being the only academic medical center surrounded by these smaller community hospitals and smaller practices, Epic has allowed us to extend the license and the database out to Vermont and northern New York practices and hospitals as well. So over the last year we’ve been planning the PRISM Regional effort. We have a lot of interest from hospitals and from non-employed practices. We actually have a dinner coming up soon to announce the ambulatory offering, since we’re now far enough along with our implementation on the ambulatory care side. We’ve been working with a variety of hospitals to extend the electronic health record out to them as well, and that’s moving along.

We are looking at what we call PRISM Regional LLC — a separate nonprofit corporation wholly owned by Fletcher Allen — to be set up as a “software as a service” organization to supply the services on a centrally hosted model. We’ll be able to leverage some of the resources we have internally, but since it is a SaaS model, we want to make sure that our customers will get the level of service outlined in the SLAs we’ve been working through with them. So it’s going to be unique program.

When I first got into this, probably a year and a half ago — I’ve been in Fletcher Allen since June of 2008 — it was really right at the beginning of our inpatient implementation that we started talking to Epic about this. They weren’t really too interested, you know. There were some models throughout the United States where some of their Epic clients had rolled the ambulatory product into the non-employed practices, but no one has done it with non-affiliated hospitals. So that was kind of unique, but Epic’s come a long way. They’ve really been very supportive. I think ARRA and meaningful use has driven this model a little bit faster than it normally have developed because a lot of these community hospitals and small practices really don’t have options out there. Some of the vendors that market to them may or may not make meaningful use, may struggle to make it. So a lot of these small hospitals are coming to the Fletcher Allen’s of the world and asking for help. So it started out as me working with a small band of brothers and sisters, and all of us working with Epic.

Epic hosts conference calls usually attended by at least 15 CIOs from across the country who are either beginning to implement this model or planning to implement this model, and I think you’ll see this as a way for some of these smaller community hospitals and practices to get to meaningful use, which is exciting because everybody knows all the work that we need to do for all these practices and hospitals to get there. And we need a lot of different options and different swim lanes of implementation to get us there, and the vendors aren’t going to be able to do it alone, the consulting companies aren’t going to be able to do it alone. So having a PRISM Regional and Epic Regional — or it could be Siemens Regional or McKesson Regional or Cerner Regional, it really doesn’t matter — I think is going to be important. And it also works well when you look at some of these states that are struggling to get a hospital information exchange up and running sustainably, and the goal of that is to link those disparate electronic medical records together. So if you can have an Epic database with three or four or five community hospitals on that among hospitals that share patient populations — whether it’s primary care, secondary care or tertiary care — that goes a long way, from a patient safety, quality and satisfaction standpoint. But it also helps with the HIE or the exchange of healthcare information because, in Epic’s case at least, it’s all in that single database.

For example, at Fletcher Allen, one out of every five patients that we see is transferred in from one of those 13 community hospitals because they need tertiary care, and so by having Epic at Fletcher Allen and at those community hospitals — and possibly within their community practices as well — those clinicians can get a single view of everything that happens to that patient at Fletcher Allen and also at their home hospital and in their home practices without relying on a health information exchange. It’s not the end all because you’re not going to implement an entire state with a PRISM Regional type of approach, so there’s still is a role for an HIE, but at least it can be a large node and take some of the burden off of a health information exchange in a particular state.

So for all those kinds of reasons I think you’ll start to see this model moving forward, and I’m going to keep talking until you interrupt me (laughing), but one of the things a little bit of a renegade about is this meaningful use stuff. I’ve answered the CHIME surveys and the HIMSS surveys and the AHA surveys and I think I’ve been a bit of a lone wolf on this because I feel we shouldn’t relax meaningful use at all. And again, some of that may be a little bit selfish because we look good at Fletcher Allen, I don’t think we’ll have any issues here, but I also think we should be rewarded for doing the right thing as well.

And the other part is when you look at ARRA and meaningful use, it’s all about patient safety and quality of care. Implementing these technologies, like CPOE, are supposed to limit errors and increase the level of patient safety and quality of care. As CIOs, we’re asking the government to back off of that and it doesn’t feel right with me somehow. Instead of creating a sense of urgency and getting this stuff done, we’re spending our time trying to get it relaxed. In healthcare IT and in healthcare in general, we tend to do that. Every time something tough comes along — whether it’s ICD-9 or now ICD-10 coming out, or even HIPAA — we keep pushing back because we say we don’t have the resources at the time to get it done. Let’s take a look at why we should be doing it and get started, rather than complaining that it’s too stringent and the bar’s too high and that sort of thing.

Now with that said — and I’m probably going to get a million emails because I’ve said this — I think the incentives are a little bit one sided. I like the idea, the carrot and stick approach with incentives and penalties, but everything’s on the backend, there’s nothing on the front end. Especially for these smaller hospitals, they don’t have the resources to even get started on this stuff. So I do feel for them, and what I would be proposing — and what I’ve even sent into the CHIME organization —is to say let’s tell the government that rather than relax meaningful use, give some credit on the frontend. So, for example, if a hospital signs a contract with an electronic medical records vendor that’s certified, they get 25% of their ARRA money right then and there on that particular signing. So now they have some funds and can move forward. Then maybe when they go live, they get another 25% and then when they show meaningful use, they get the rest of it.

If that was the program, imagine how many hospitals would be cranking out RFPs getting this stuff done. The vendors would be hiring people because there would be a rush of implementations, consulting companies would be hiring people. I don’t know how it would impact the unemployment rate, but at least in healthcare it would be a boon. Now, I think the boon is still coming, and it looks like it’s gearing up. We can certainly accelerate that with a different carrot and stick approach, and I haven’t seen that anywhere. What I see is everybody wants to relax to get 15 out of the 23 categories, you get something for that. Well, that’s okay. I’m fine with that but let’s keep the bar where it is, let’s keep the 23, let’s keep the dates as much as we can to force that sense of urgency but let’s give these hospitals and practices some money upfront if they’re showing good faith and trying to get this thing off the ground. If you do that, you get everybody focused on implementing electronic health record instead of complaining about how stringent the deadlines and the criteria are.

So I don’t know. That’s kind of my 2 cents. I know I’m probably crying into the wind on some of this stuff, and I know some people will think, well, that’s easy for you to say, Chuck, because Fletcher Allen is positioned well. That’s true, but we’re also trying to help our fellow brother and sister hospitals and practices by extending the Epic system out. It’s not only about being able to share that patient information, but it’s also about helping get them to meaningful use. I really think that’s part of my role as CIO of the largest Vermont healthcare organization. I feel I have some responsibility to these smaller hospitals and practices to use my influence and knowledge to help them in any way that we can. It’s exciting to be able to do that.

So I think CIOs of academic medical centers can certainly make an impact in the community by coming up with these types of models to help these smaller organizations out.

So with that, I’m going to take a breath, Anthony. Any questions?

Part II