After nearly two decades as a health system CIO, Gary Barnes has seen his fair share of change, and learned a thing or two about how to manage it. He believes that when it comes to initiatives like Meaningful Use, sometimes it’s better to just rip off the band-aid than waste time dwelling on how much it might hurt. In this interview, Barnes talks about why, even though he’s still got concerns about the program, Meaningful Use is long overdue. Barnes also discusses how his organization is preparing for Stage 2, why EMR upgrades involve more change than people expect, the shortage of quality health IT people in the industry, and how satisfying it can be to help physicians.
- About MCHS
- About the CHIME Meaningful Use Survey
- Tackling the quality measures
- The consequences of an industry in haste
- “The key is having a group working with the clinician”
- On MU: “It’s going to all work out, but not without some pain”
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One of the most difficult things is meeting quality indicators, and to do that, it’s going to change a lot of processes for the physicians. And so you really have to have a good group that coordinates these activities with physicians.
The difficulty is that it’s all about people, process, and technology, and the people and the processes are definitely the most difficult things to change.
The vendors are trying to build the application and they’re on such a short timeframe of making the requirements within the software, and then they deliver it to the health care providers, and we’re looking at it saying, ‘Oh man. It’s going to be difficult to get the end users to use this,’ because it’s so much more complicated.
It’s kind of like pulling off a band-aid. Sometimes it’s easier just to rip it off and move on then to sit there and rehash the pain. But I think the key to all of it is having a group that works with the nursing and the physicians and your IT staff, reviewing these processes and trying to ease the pain on some of these things.
I think it’s panning out. It’s going to take time and commitment from all the organizations, but as we all know, this is something that’s needed to be done for a long time. It’s going to all work out, but not without some pain.
Guerra: Good morning, Gary. Thanks for joining me to talk about the recent CHIME survey on Meaningful Use, some of the other projects that you’re working on, and how things are going at your organization. First off, thank you for being here.
Barnes: Thank you.
Guerra: Why don’t we get a little context first to help frame some of your opinions and points of view? Tell us a little bit about Medical Center Health System.
Barnes: Okay, we’re 362-bed acute care hospital and we’re the regional trauma center of West Texas. We have one hospital; I can’t keep up with all of the different clinics we have these days—five or six, and then we have a physician group.
Guerra: How long have you been at Medical Center?
Barnes: I’ve been here for 26 years.
Guerra: Okay so you’ve been there 26 years. Go ahead and tell me about your engagement and involvement with CHIME. I think it’s pretty substantial.
Barnes: I’ve been a member of CHIME since 1992. I was a foundation member when we first started the organization, and now I’m with the Board of Directors. I’m in my second year of a three-year term.
Guerra: All right, let’s talk a little bit about the survey. I’ll mention a few facts from the survey and you can just expand and give me your thoughts or maybe you interpretation. We could look at any of these things and say the glass is half-full or half-empty. It all depends on where you think the numbers should be. So first off, 66% still have concerns related to meeting Meaningful Use requirements. In terms of the positives and negatives, what do you think of that 66% number?
Barnes: I agree with it. There are a lot of organizations that are still trying to figure out how they’re going to do some of these things. One of the most difficult things is meeting quality indicators, and to do that, it’s going to change a lot of processes for the physicians. And so you really have to have a good group that coordinates these activities with physicians, and hopefully they’ll help you out by doing these automated processes.
Guerra: Because the last thing, I guess, you want to do is take care of these things manually after the fact, right?
Barnes: Absolutely. That’s the whole requirement of Meaningful Use—to automate those processes. For example, with quality indicators, hospitals have been doing that manually in the past. They’ve been going out there and gathering all that data, and that’s what the federal government is trying to do—to make it so it’s automatically extracted from the electronic medical record instead of manual collection.
Guerra: So you have to work backwards. You have to look at the quality measures and figure out how to get those on the front end—one the user end—electronically, and there’s where the workflow change comes in. And I guess that’s the hardest part of this. Anything that you can handle in the IT shop is not that big a deal, but once you have to go to the clinicians, that’s a whole different ballgame, right?
Barnes: Absolutely. The difficulty is that it’s all about people, process, and technology and the people and the processes are definitely the most difficult things to change.
Guerra: Right. I spoke to one CIO the other day who had some problems sneak up on him. He took delivery of an upgrade on his EMR and was surprised to see the level of change that was involved in the upgrade. And he knew once he saw that, he was going to have trouble with the physicians getting them to learn the new interface. Do you think there’s a lot of that type of thing going on? Does that resonate with you?
Barnes: Absolutely. The vendors are trying to build the application and they’re on such a short timeframe of making the requirements within the software, and then they deliver it to the health care providers, and we’re looking at it saying, ‘Oh man. It’s going to be difficult to get the end users to use this,’ because it’s so much more complicated. It’s just a complex process for the physicians or any other user to use sometimes.
Guerra: He also said he had vendors firing off of versions to him where they would rush it out the door and then a week later you’re getting a few bugs fixed and another update and another update. Do you see that happening too?
Barnes: Absolutely. That’s definitely happened to us where we were going to get the Meaningful Use product and once we get that, we had to go back and load three or four different versions of fixes on those.
Guerra: Practically speaking is that just a burden on IT deployment or have you already rolled out the version and people are seeing those bugs and getting irritated?
Barnes: A little bit of both. Sometimes we notice it first and some of them get out there for the end users and it creates a lot of frustration for them because they’re saying, ‘Why didn’t you tell us about these changes?’ And sometimes they are undocumented changes because they went in there and fixed them, but it wasn’t documented in their change process.
Guerra: So when we picture policymakers listening to this, is there any advice you can give them? What do they need to know about the speed that things are happening out there? As we said, the vendors are rushing the software out there. Is this just the way it had to be—as some people put it, you have to break a few eggs to make a cake?
Barnes: Sometimes, it’s kind of like pulling off a band-aid. Sometimes it’s easier just to rip it off and move on then to sit there and rehash the pain that you go through. But I think the key to all of it is really having a group that works with the nursing and the physicians and your IT staff, reviewing these processes and trying to ease the pain on some of these things. Because it is not easy by any stretch.
Guerra: Let’s talk a little bit about the time delays. That seemed to be an interesting point in the survey. People got kind of irritated waiting for their checks. Is that a real problem out there?
Barnes: Are we talking about the delays in receiving the stimulus?
Barnes: It’s all based on your organization. Once, for an example, we were able to get our Texas Medicaid Money, and basically it took about eight weeks to go through that process. I didn’t think that was a big problem. Now to get the Medicare funding, we haven’t completed our attestation yet because we’re still refining our processes to make sure we can meet the requirements.
Guerra: So maybe it’s a better question for Joanne Sunquist from Hennepin County Medical Center, who’s also quoted in the release. She said that even though she attested on August 18, they’re still waiting for payment. And here are a couple of interesting facts: of all respondents, 13% said their organizations have actually received funding and that’s under Medicaid. Only 4% have gotten it under Medicare. That’s pretty low.
Barnes: Well there’s a big difference in those two. Number one is that with Medicaid and the state funding, most of the states are only requiring that you’ve purchased a complete EMR that meets requirements. In some sense, that’s fairly easy to get. You fill out all the forms, which weren’t too complicated. Once you do that, you’re there. On the Medicare side, you have to meet those 23 criteria. And so with that, you have to make sure you’re meeting those different levels. It’s a lot more difficult to reach that.
Guerra: Yeah. Like I said, Joan Sunquist, it looks like she’s been waiting about 2 months and I’m not sure if that’s an extreme amount of time to get your money on a federal program. Sixty-eight percent say they expect to qualify for Stage 1, but not until fiscal year 2012. So I guess that in 2011, a lot of people are waiting. We’ve got people talking about a delay in Stage 2 to give people more time. How do you feel about the whole program overall? Do you feel that it’s panning out or is it just pretty problematic?
Barnes: I think it’s panning out. It’s going to take time and commitment from all the organizations, but as we all know, this is something that’s needed to be done for a long time. It’s going to all work out, but not without some pain.