Bill Spooner, SVP & CIO, Sharp HealthCare
When John Glaser left his position as CIO at Partners HealthCare, he also left a vacancy in the weekly CHIME SmartBrief, where he was the voice of the CIO. It was a void that CHIME’s leaders felt could only be filled by someone who had both years of industry experience and a firm grasp on legislative issues. They chose Bill Spooner, a 25-year veteran who has earned recognition from HIMSS and other organizations for the IT initiatives that have helped transformed San Diego-based Sharp Healthcare into one of the most advanced systems in the country. In this interview, Spooner talks about the work his team is doing at Sharp, how health reform presents both challenges and opportunities for CIOs, and why it is so critical for the provider community to serve as the voice of reason in the Meaningful Use debate.
Chapter 2
- Thoughts on PCAST — “Without a doubt, it could not be implemented in the timeframe that was suggested in the original report”
- Other ways than MU to foster progress
- The quality measures conundrum
- Are CIOs influencing policy? “I’d be thrilled to see a mainstream, community healthcare system CIO on the Policy Committee itself”
- “We need a long-term plan”
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Bold Statements
Physicians are busy people, and they don’t need to be forced into seeing fewer patients every day in order to satisfy these needs.
I think that we can gain more improvement in quality, cost, and access to healthcare by looking at the framework that was created two years ago, and outlining an aggressive plan for implementing that—faster adoption of CPOE, true adoption and expansion of clinical decision support.
Where this is going to challenge us in the long run is that we truly do want to get those analytics into our own warehouse capabilities. Should the number of clinical indicators and quality indicators be expanded significantly, we could find ourselves either having to move to the vendor analytics engine, or having a very major, almost duplicate form of analytics that we have to support.
One of the very frequently discussed items of late has been a recommendation that we delay applying for Stage 1, attesting to Stage 1, to give us an extra year to get ready for Stage 2. And a lot of organizations are doing that now because of frustration over the indecisiveness and apparent lack of clear direction from the policy committee and CMS.
Guerra: Any more thoughts on the PCAST report overall? There’s a lot of pushback from the work group they created. Some of the members are saying that it may not even be desirable overall. But, even beyond that, they were questioning how implementable it is within the next few years. What are your thoughts around the overall PCAST report?
Spooner: I think that without a doubt, it could not be implemented in the time frame that was suggested in the original report, where they were actually suggesting components should be rolled into Stage 2 of Meaningful Use. Especially when you consider the development time for vendors, the cost to vendors and providers to make these modifications, and then the change process of implementing an organization and just some of the practicalities. Take the example I just cited around granular definitions; building them into the software as well as getting the clinicians trained and willing to gather the information if a primary care visit is extended by two or three minutes while the physician is having to gather more information to satisfy Meaningful Use. That really has an adverse effect in patient care. Physicians are busy people, and they don’t need to be forced into seeing fewer patients every day in order to satisfy these needs. So while there were some interesting ideas presented, it would be better to pilot something like that than to suddenly, by fiat, tell the whole nation to adopt this totally untested concept. If anything, it could create a crisis in health care rather than making the improvements that it’s intended to do.
Guerra: The odd thing about it is that the report came out, and I believe President Obama said, “Run with this. I want this to move forward,” to ONC, probably through HHS. But it was actually put in there that it needed to be acted on boldly and aggressively. So it wasn’t casual; it wasn’t put out there as food for thought. This was sort of marching orders in a way.
Spooner: And I would speculate, and this is just my speculation, that Meaningful Use, with some of the thresholds being finalized at fairly local client levels, was not viewed by the White House as bold or aggressive. And this may have been the response. I think that we can gain more improvement in quality, cost, and access to healthcare by looking at the framework that was created two years ago, and outlining an aggressive plan for implementing that—faster adoption of CPOE, true adoption and expansion of clinical decision support, all things that were provided in the original report. And those are things that don’t require vendors to write more software because their software already has clinical decision support capabilities; it’s just a question of providers implementing them. And so the true work could be happening around changing the care processes, rather than in these major IT drills installing and paying for new software.
I would make the same argument around health information exchange. Health information exchange is a large hurdle for us but we’re going to do it someday, and we could be more aggressive in moving that forward using the frameworks that have been developed already.
Guerra: CHIME put out a survey recently that showed that now the number one concern around Meaningful Use is reporting quality measures. I’ll just read to you a little bit from a webinar John did with Pam McNutt. McNutt said, ‘Quality measures are the sticky wicket for everyone. These measures have to be created directly from your EHR versus having them abstracted and entered into the CMS website as we do today. So this is going to be very challenging. I think people were surprised (at how difficult this is going to be) because many of us are already reporting some of the same quality measures to CMS through various programs such as Core Measures and Pay-for-Performance. We have the data, but the thing is, a lot of this data is captured through abstractions, where someone is reading through the chart or notes and pulling the data out and keeping tips on who had what. But the thing here is that it has to be generated from the EHR.’ So do you echo those concerns, and are you able to expand on that a little from your own point of view?
Spooner: When I talked with our quality leaders, they tell me the data abstraction is an awful way to have to collect the data and we should be able to get it directly from EHR. So from that perspective, I’ll differ with Pam a little bit. But where I will totally agree with her is the challenge in automating those; some of the majors are very, very detailed and complex. Many of us in our organizations have very sophisticated analytics capabilities with data warehouse environments that we have developed over the years, and to produce those in a manner that would be better compliant is a big challenge. It would require us to have our data warehouse certified using the site certification through one of the certification agencies, in order to have those accepted by CMS. So it’s a pretty large burden. In my organization, we decided to subscribe to our EHR vendor’s reporting engine, because we just judged that it was sufficiently complex, and that it was a high-risk proposition for me to produce those in a very short period of time. We may come back to it later and decide to build them in-house. But for now, we felt that it was a safer bet to subscribe to the vendor’s service.
Where this is going to challenge us in the long run is that we truly do want to get those analytics into our own warehouse capabilities. Should the number of clinical indicators and quality indicators be expanded significantly, we could find ourselves either having to move to the vendor analytics engine, or having a very major, almost duplicate form of analytics that we have to support.
My other comment is around what I would view as a need to do consistent reporting of quality indicators. Each organization, in my view, doesn’t need to invent new ones. Let’s find the ones that are most relevant to patient care, and then aim for quality improvements in all of them. I’m not sure that I’m adding to either the quality of care or the quality of life by just adding another indicator to achieve this kind of incentive versus another one. A uniform set of quality indicators for all means would be much more efficient for us, and, I think, a lot more beneficial to patient care as well.
Guerra: Do you feel that the voices of CIOs are being heard to the extent they need to be? There are some members on the committees—Marc Probst is up there. But do you think that CIOs are influencing policy or reacting to it?
Spooner: I think a little of both. I’ve really been pleased that Marc has represented many of us on the policy committee, and I’ve been thrilled that we’ve been able to have as much engagement with ONC as we’ve had through our CHIME groups. I know that when I compare today with five years ago, we are so much more engaged and so much more viewed as an expert resource, and for that, we’re all thrilled. But again, it’s never enough. We would like to be able to have more forums like that; more ways of getting input. My own personal bias coming from sort of a mainstream community hospital without employed physicians is that I’d love to see more people at the policy committee level who represent that type of an organization. And Marc is not the only one; we have some people who are not CIOs but still represent our view. For example, we have Judy Murphy from Aurora Health Care and Liz Johnson from Tenet Health Care on the Standards Committee—both are very astute clinicians, clinical leaders, and IT leaders. Both of them are nurses with fantastic input. But I’d still be thrilled to see a mainstream community, healthcare system CIO on the policy committee itself.
Guerra: You wrote to me about the ambiguity in the program and that’s part of the frustration—not necessarily because the bar is so high, but it’s just the lack of clarity around some of the measures and the ability for providers us to then move forward with conviction about what’s coming out. And I wrote last week that at the most recent policy committee meeting, it seemed to me everything was still on the table. The stages, the requirements, menu—everything was up for discussion which, to me, if I was at a hospital like you are, I would be getting very frustrated saying, ‘Come on. Let’s take some options off the table. Let’s start narrowing this thing down’. We’re already getting ready for Stage 2 of a three-stage program. Can you explain a little more about your personal frustrations with the ambiguity and complexity that the program has.
Spooner: We need a long term plan, not a six-month plan of items that we can implement. We just can’t react that well, and that fast enough. We all intend to help our organizations drive an overall organizational strategy, and that doesn’t mean knee jerk reactions every time that a federal agency gets a new, great idea. One of the very frequently discussed items of late has been a recommendation that we delay applying for Stage 1, attesting to Stage 1, to give us an extra year to get ready for Stage 2. And a lot of organizations are doing that now because of frustration over the indecisiveness and apparent lack of clear direction from the policy committee and CMS.
From now until Stage 2, we have less than 18 months remaining until October 1, 2012, and we don’t even have clear regulations. There are many items being bantered about. It’s pretty unrealistic that we can confidently say that we can meet Stage 2. So why not wait six months complying with Stage 1 and give ourselves another year to get ready for Stage 2. It doesn’t mean that we slow down any work, but it means that we simply very smartly buy ourselves an extra year of compliance to Stage 2 to achieve compliance. And I think that’s an area that may have surprised some of the policymakers who are trying to demonstrate that their paying out the stimulus and having the impact on the economy that they expected to have by the very nature of the regulatory process actually slowing down our application for the money.
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