Ben Clark, VP/CIO, Centra Health
Like many rural systems, Centra Health serves a large geographic area — which requires supporting physician practices with different needs and expectations. It’s a challenge that Ben Clark, VP/CIO, welcomes with open arms. Now in his ninth year as the head of IT, Clark has spent a total of 23 years at Centra, a nonprofit system that includes three hospitals, as well as health and rehabilitation centers, a regional cancer center, and physician practices. In this interview, he talks about being a McKesson shop surrounded by Epic organizations, the importance of staying ahead in terms of Meaningful Use, balancing the needs of different specialties, and the challenges that both his team and physicians face in connecting the continuum of care.
Chapter 3
- Leveraging Stark, underwriting McKesson & Allscripts
- Running McKesson Horizon 10.3.1
- Integrating the clinical and financial sides of the house
Podcast: Play in new window | Download (10.6MB)
Subscribe: Apple Podcasts | Spotify | Android | Pandora | iHeartRadio | Podchaser | Podcast Index | Email | TuneIn | RSS
Bold Statements
At one point, I had nine practices with electronic health records running nine different EHRs. We actually pulled all the physicians together one evening—as many as we could gather in a room, and we sat down and told them that wasn’t sustainable.
The Stark Laws allow health systems to pay up to 85 percent, and some systems out there are doing that. So when we’re saying we’re going to pay 75 percent and then we want half of that back, we are being asked, ‘Why aren’t you paying the full 85 percent?’
Organizationally, I think you have to decide whether you want to be at the very front and get a lot of development support when you’re going live with something like that, or if you want to be in the middle of the pack, where it’s stable and it’s steady and they’ve got a process figured out that’s reproducible.
I think the integration between the clinicals and the financial side is critical to the function of the hospital. And so the fact that the Star solutions and the Horizon solutions were built together and played together and share information… that very much has contributed to the success of McKesson as a whole in our organization.
Guerra: I found a document online where you put it out to the independent physicians that you are willing to underwrite Allscripts and McKesson. McKesson makes sense, and with Allscripts, I’m guessing you said that because it is very prevalent in the community?
Clark: That’s correct. We found that—I think before we even knew it—over seven of our practices were already running Allscripts.
Guerra: So what made you stop there? Why not do one more? Obviously, you don’t want to do more than you have to—that’s the dynamic there, right? Keep it as little as possible.
Clark: Correct. At one point, I had nine practices with electronic health records running nine different EHRs. We actually pulled all the physicians together one evening—as many as we could gather in a room, and we sat down and told them that wasn’t sustainable; that we need to work with them to organize this a little bit better. And they are the ones that said, ‘You know, we like Allscripts. Let’s settle on that.’ Once the two or three of the largest groups went with Allscripts, it became an easy decision for Centra to support it.
Guerra: Are you doing point-to-point or are you doing some kind of cloud-HIE type of thing?
Clark: We have a metro Ethernet ring that we created around the city, almost eight or nine years ago, and we allow any physician practice to connect to that ring. What actually happened was I was paying for all these point-to-points and the cost was pretty exponentially going up. And about eight years ago, we worked with a local vendor and put in this metro Ethernet ring where we pay one price for that ring, and we negotiated basically an unlimited number of connections to it. So this allowed every physician office in town to connect to this private ring, so that it’s only our medical traffic on it and it ends at my data center. So we were able to give as much as one gigabyte of bandwidth, which nobody needs yet, to each physician office on that ring or within the footprint of the ring. So if you’re two, three, four, or five miles away, we are still mapping people back to the ring and then into us.
Guerra: Right. And I noticed another interesting point in your arrangement. It says, ‘physicians will agree to reimburse Centra one-half of the costs subsidized by Centra from the Meaningful Use funds, if and when they receive them.’ I had asked someone about that before and they said no, they weren’t doing that, but I thought it made sense: we’re helping you underwrite this investment, so we should share in some of the benefit. But is that a tricky point that comes up?
Clark: It’s tricky in that the Stark Laws allow health systems to pay up to 85 percent, and some systems out there are doing that. So when we’re saying we’re going to pay 75 percent and then we want half of that back, we are being asked, ‘Why aren’t you paying the full 85 percent?’ But I do believe that people understand that. I’m not getting any push back. We have about 50 physicians to date that have taken advantage of this process or this program, and none of them have attested for a Meaningful Use yet, so I haven’t gone collecting.
Guerra: You have to check in with them once in a while to get the check?
Clark: Yes, we’re talking with them, and of course we would know because by us hosting it, we are running the Meaningful Use attestation reports coming out. And I know that a couple of them are close, but none of them are ready to attest yet, because they haven’t met the requirements.
Guerra: They’re not sending you out there personally to collect, are they?
Clark: No, not yet.
Guerra: That’s good. Let’s talk a little bit about McKesson. How long have you been with them?
Clark: We went live with the Star and Horizon products in October 2005.
Guerra: What version of Horizon did you go on then, and have you upgraded since?
Clark: We did. We actually came up on version 7.6 and we’ve had several iterations of that. Today on the clinical side we’re on 10.3.1, which is their Meaningful Use patch. And we were a beta site for that so we got in front of the curve on their clinical upgrade path for Meaningful Use.
Guerra: So that’s the latest version?
Clark: Correct. I believe there is now a 10.3.5 about to hit; it’s just patches to the 10.3.1.
Guerra: Do you move on an upgrade like that as soon as it becomes available?
Clark: We had not. Organizationally, I think you have to decide whether you want to be at the very front and get a lot of development support when you’re going live with something like that, or if you want to be in the middle of the pack, where it’s stable and it’s steady and they’ve got a process figured out that’s reproducible. I would say up until the 10.3 beta we did last year, we were more of a ‘middle of the pack’ type of organization. But we felt like this 10.3 upgrade was pretty big. It was good to be in the front and the development team from McKesson would help us with that, and I think that proved to be a pretty wise choice.
Guerra: And how do you feel they’re doing with the integration between the modules?
Clark: I think McKesson is continually working on it, and I think they’ve got a ways to go. But if you ask me if it is better than it was a year ago, I’d have to say, absolutely. They are working diligently. The new product that rolled in—it’s called CAF, a common application framework—starts really bringing a lot of information together. They have another module that’s called Horizon Health Summary (HHS) that shares its one common database that many of the applications are sharing now. They are building that integration, and you can start to see it very clearly now.
Guerra: I came across a white paper online by McKesson in which you were quoted, and you talked about being excited bringing together the clinical and financial processes within one IT environment, one application environment. Tell me about that. Is that a big focus? Was that a focus?
Clark: This was back in 2005, I believe.
Guerra: I think the data on the paper was 2008.
Clark: Okay, and that’s when we probably received an award from McKesson for the way we rolled out all the products that we were doing. I think the integration between the clinicals and the financial side is critical to the function of the hospital. And so the fact that the Star solutions and the Horizon solutions were built together and played together and share information is appropriate. I think that that very much has contributed to the success of McKesson as a whole in our organization because they were built to work well from the time the patient walked in the building until the time they were discharged. With several of the vendors we were looking at in 2005, you’d buy the clinical system from, say, Cerner, and the financial system from someone else. We just looked at that very carefully and saw that we could make it work. The integration would be there. It’s only dollars you’re talking about. But we just felt like that having a single solution made sense.
Share Your Thoughts
You must be logged in to post a comment.