One of the biggest pain points for CIOs—at large health systems, community hospitals, and everywhere in between—has been positioning themselves as Accountable Care Organizations. The ultimate goal of aligning the patient, provider, and insurance carrier to provide quality care at a low cost is not an easy one, especially when factoring in Meaningful Use, ICD-10, and other top priorities. To help provide some guidance, a number of leaders—including Steven Riney, CIO of Methodist Medical Center of Illinois—collaborated with Premier to develop a multi-phased ACO roadmap. In this interview, Riney talks about what it takes to make the ACO transformation, how Meaningful Use has challenged vendors as well as healthcare organizations, and how Methodist worked with their vendor to tailor a system that accommodates the needs of different specialties.
- About Methodist Medical Center
- The application mix (McKesson Horizon inpatient & ambulatory care)
- Going from 7.6 to 10.3.1
- “As we look to 10.3, there is much improved integration”
- Specialist pushback: “Cardiology is probably the key area”
- RelayHealth for HIE
It’s been the vision of our CEO Michael Bryant for 10 for ten years—to be able to use technology and leverage technology to be able to deliver care more efficiently with a lower cost and a higher level of satisfaction.
There’s a lot of detailed data that a traditional ambulatory practice would not care about and would not be able to collect, and we are feeling a little tight on those types of things. So we’re evaluating how we get that additional information without losing the integration that we’ve had.
They’re able to see everything that’s happened to that patient across the continuum, and we’re able to see what happened within their practice and be able to provide better care. There is good reason to do that; we relaxed the Stark Laws to be able to deliver that kind of thing.
As a customer, it’s never fast enough or soon enough, but they’re moving in the right direction. One of the things that I’ve been really pleasantly surprised with is the relationship and the service orientation of McKesson. Dealing with them three and four years ago, I didn’t see that as much. But I’m seeing a significant change, and that was a breath of fresh air when I stepped in the organization.
Guerra: Tell me about Methodist Medical Center. I’d like to talk a little bit about your work there, but give us an overview of the organization?
Riney: We are an integrated delivery network. We have 339 beds, and we have more than 160 providers across multiple counties. There are four main counties, 16 total counties across the service area. We provide phenomenal quality; we consistently hit quality indicators at the 95th percentile. But there are few that we’re a little lower on, which means we’re probably around the 90th percentile. And to us, that’s not really delivering what we want. We want to hit that 95th percentile on quality. From a cost prospective, we operate at the 25th percentile of the cost curve. So we’re a very efficient, quality organization that, by the way, has a very high level of patient satisfaction. We’ve achieved the 95th percentile in patient satisfaction through Press Ganey—95th percentile overall, and our physician practice hit 97th percentile last month.
It’s a tremendous organization. The triple aim measures of quality, cost, and satisfaction are a natural for us because we are able to achieve high levels of quality, low cost, and patient satisfaction. We do that today, so that the triple aim measure of the ACOs is right down our strike zone.
From an automation prospective, we have a full EMR across acute care and ambulatory care, and we have an effective system within our home health system. It’s not as integrated as the previous two, but we’re making it more integrated. We have CPOE up and running and have had that for three to four years. The close loop medication process has been around for two to three years, and the clinical documentation and charting from a nurse prospective is there. We have the full EMR, full ED system, and full patient portal. Those are just the highlights, but you can appreciate that there’s a lot there. It’s been the vision of our CEO Michael Bryant for 10 for ten years—to be able to get to this place, to be able to use technology and leverage technology to be able to deliver care more efficiently with a lower cost and a higher level of satisfaction. And he’s been able to do that through technology, which it’s been a tremendous thing.
I’ve only been here about a year and a half now, I was here earlier in my career, but on my return trip it was just amazing to see what had happened to this organization in the past 10 or 11 years. On the ambulatory care side, we have a full EMR; all of the physicians are doing documentation and we have templates to drive the documentation. It’s a very effective solution—we actually have one private practice using our EMR as part of an effort to do some integration with an ACO. We’ve tried that model and we’re evaluating it now, but we haven’t implemented that. And then we have a personal health record and e-visit process, so that’s a pretty high level within the organization, but it’s a really well done, very effective implementation across an integrated delivery network.
Guerra: What’s your physician mix—is it a closed system or do you have community doctors referring in?
Riney: We have two medical staffs. One is MMG (Methodist Medical Group), which is a closed staff. Those are employed physicians. The specialists provide care at the hospital, but most of the primary care of physicians do not—we use a hospitalist model there. Within the community, have an open staff; we have those two models, and they work really well together.
Guerra: But how many independents refer in?
Riney: I don’t have an accurate number for that. It’s at least two or three hundred, and it’s probably closer to five or six hundred.
Guerra: Now let’s talk about vendors. What you are using for inpatient, and then if you have any of those physician groups on any ambulatory EMR—the ones that are employed.
Riney: Sure, we’ll start with the ambulatory every practice. We have 38 practices across multiple counties and every physician is on the same ambulatory record, and that data is shared among that entire ambulatory group, including the private practice group that we just implemented not long ago. So there’s a full continuum of data, and that data is available to each practitioner. It’s primary care-heavy in its makeup, but we also have a good group of specialists—cardiology, surgery, etc. We have a lot of folks on the specialist side also, but each one of those practices is automated and automated consistently within all of those practices.
Guerra: Which vendor do you use?
Riney: We use McKesson’s Horizon Ambulatory Care. And it’s been a very effective solution for us. As with every solution, we also want to push it a little harder though.
Guerra: With specialists, you’ve got some cardiology practices and other practices that are also on Horizon Ambulatory? I’m asking because I wonder if the systems that are designed for primary care are working out well in specialty practices, or if you find that in some of the specialty practices, there is some pushback because it wasn’t really design for them.
Riney: There is that issue, and that’s an issue we’re looking at and evaluating as we speak. In cardiology it’s probably the key area. There’s a lot of detailed data that a traditional ambulatory practice would not care about and would not be able to collect, and we are feeling a little tight on those types of things. So we’re evaluating how we get that additional information without losing the integration that we’ve had. And that is a key thing as we go forward. It is absolutely a key issue for us.
Guerra: That’s going to be a very interesting issue because many CIOs are trying to get that integration rolling out a consistent system. And we would like to have the same system inpatient and outpatient—one database if possible, to really have the integration. Nobody has been talking much about pushback from the specialists, but I assume we’re going to see that as the systems get rolled out into specialty practices.
Riney: That is absolutely the case, and I think it’s not a replacement of core elements; it’s an augmentation of core elements for that specialty practice. And we’re putting together an HIE. We have our own hospital-based HIE that we’ve been working with through Relay Health, but our community is also putting together an HIE, and I’m on the board. We think that we’ll be able to use CCDs and some of those HITECH initiatives as they mature. We’ll be able to use some of that and leverage some of that broadly to really help us deliver some ACO functionality.
Guerra: So it sounds like you’re inclined to say what can we do to our McKesson Horizon Ambulatory product to make it more suitable to these specialty practices, rather than let’s find a specialty EMR that will work for them.
Riney: I don’t know that we have a complete answer on that yet. That is part of the conversation, but no matter how it works, there will be a bases of what’s being automated and how it’s being accessed that will be consistent among all of our practices.
Guerra: Right, so you don’t lose the integration.
Riney: Exactly. That is key as we look forward, and that’s why we did one of the private practices; so we can determine whether we can do an integration at that level. Because at that point in time, they’re able to see everything that’s happened to that patient across the continuum, and we’re able to see what happened within their practice and be able to provide better care. There is good reason to do that; we relaxed the Stark Laws to be able to deliver that kind of thing.
Guerra: And you’re on McKesson Horizon Inpatient?
Riney: We are. We have a very strong implementation. We’re full CPOE, we’ve got full closed loop, and we’ve got clinical documentation. It’s there and it’s working well for us.
Guerra: What version are you on?
Riney: We’re just around the corner from getting the Meaningful Use upgrade and so in the middle of August—I think August is our target date—we’ll be swapping out our current 7.6 and going to 10.3.1.
Guerra: And 10.3.1 is the most recent version?
Riney: That’s the most recent and it’s also the certified version.
Guerra: How long have you been a McKesson customer?
Riney: I’ve been a McKesson customer for close to 18 months now. I’ve done consulting with McKesson customers so I have some familiarity with them, but it’s been about 18 months.
Guerra: And how do you feel about the integration between the products within the McKesson family?
Riney: I’d like it to be stronger. But as we looked at 10.3, we found that there is much improved integration. We looked at the Horizon Health, and in terms of being able to pull the drugs together, to be able to pull the problem list together, and to be able to pull a lot of things together—allergies, in a consistent way, they’re moving in the right direction.
As a customer, it’s never fast enough or soon enough, but they’re moving in the right direction, and it’s a good direction. One of the things that I’ve been really pleasantly surprised with is the relationship and the service orientation of McKesson. Dealing with them three and four years ago, I didn’t see that as much. But I’m seeing a significant change, and that was a breath of fresh air when I stepped in the organization. The relationship we have, the support we get—the broad sharing of direction has been very, very positive.
Guerra: Give me some examples of how that actually manifests itself. Does it have to do with you not having to reach out, with them reaching out to you, or with them being more responsive?
Riney: All of those things. We’ve talked to them about things we want to be able to do; we want to be able to have our systems fully integrated so that there is a unified database. Now they’re not there but they understand that that’s what we need, and it’s something they want to deliver and 10.3 is the bridge. So we’d like to think that over the past 10 years, we’ve had a strong influence on their pulling things together. I know that we’ve had a strong influence on their hack implementation and their user group. We’ve had five or six leaders within the user group that have come from Methodist over that period of time. So we’re working at the executive level. We had Rod O’Reilly in two weeks ago to share with our executive team, and we’ll go down there and we’ll share with them. So we have that interaction at that level.
I have a very strong McKesson executive that I work with on a service who is now completely responsible for my customer SAP; he’s the one throat to choke within the entire organization, and it’s all his. They’ve gone away from this developer model where they’ve had these silos and funded the development based upon sales within that, and they’ve gone to a model that really is taking a look at it across the organization, putting the resource and the development where it’s needed. And we think that will be much more responsive to our needs.
Guerra: Dave had a few changes at the helm over the last few years—they’ve had Pam Pure, Sunny Sanyal, and Dave Souerwine is there now. Any thoughts on that? I guess you think things are improving. If you could ask Dave a question, what would it be?
Riney: I don’t know that I have a question off the top of my head for him. Rod has been able to answer our question when he was here. I think the one question is that ultimately will want to be able to get someone we can continue to work with over the long haul. I mean there have been some changes, and I don’t think that’s a challenge that is specifically related to McKesson. That’s a challenge across the industry, on the CIO side and on the automation side, and for the people who provide the automation services. So I think that’s consistent challenge for all of us.