For Robert Slepin, health information technology has never been an end in its own right, but rather a tool that can be used to improve individual and population health. In this interview, Slepin discusses his organization’s goal of getting its hospitals and physician network on Epic in 2012, best practices for disengaging with vendors, how disease management can help improve patient outcomes, and why ICD-10 should be postponed. He also talks about the importance of transparency within an organization, how to effectively delegate tasks, and why it’s okay to say, ‘I don’t know.’
Chapter 2
- The art of vendor disengagement
- Disease management/business intelligence
- “What’s the risk of this patient getting what kind of disease?”
- The importance of analytics
- Homecare/mobile technologies
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Bold Statements
Show respect and understanding for the vendor. Be candid in your communication and expectations and talk upfront about what your plan is and what your milestones are. Once a decision is made and the timing is right, inform the vendor.
Think about your different vendor relationships. Look at the contracts. Understand the terms and conditions, what are the notice dates for termination, how do you provide the notice, what are your rights and what are the vendor’s rights, and just manage the contract. And more importantly, manage the relationship in a very professional way.
Like most integrated delivery networks, we’re certainly moving in the direction of looking at total population health and looking at the individuals more holistically, and constructing a delivery network that not only takes care of you when you’re sick but also works hard to keep you well and optimize your health status.
Analytics is key in this area to really focusing on a deeper understanding of a patient situation in terms of their health status and understanding what their risks are from a health perspective.
Delivery systems like Kaiser and Group Health and others have inserted Epic’s MyChart or other personal health records in the process of care and are getting very meaningful adoption, and I think that holds a lot of promise.
Guerra: Let’s talk a little bit about vendor disengagement. You’ve been in the business in different roles for over 20 years, correct?
Slepin: Yes. I’ve been in the business of IT for over 28 years, and most of that’s been in healthcare IT.
Guerra: Disengaging from a vendor is probably not something that is new to you. So maybe you can offer some best practices for your colleagues. Let’s say you’re disengaging from Short Logic or Meditech—how do you do that well and gracefully and also so that you get the cooperation you need in order to disengage? You can’t just pull the plug and walk away. I’m sure you need their cooperation to do it well.
Slepin: Yes, it is important. We will be disengaging with a number of vendors over the next year or so. As we consolidate on Epic, we’ll be able to decommission a number of other systems. So it is terribly important, and if there’s one thing I would say, it’s to follow the golden rule, and that is to treat others as you would want to be treated and show respect and understanding for the vendor. Be candid in your communication and expectations and talk upfront about what your plan is and what your milestones are. Once a decision is made and the timing is right, inform the vendor. Do it and don’t be secret. And also, be respectful. They are probably going to want to ask you questions. For example, I got a call from Meditech and they asked why we chose not to upgrade with them. And I was happy to share that candid input to their management that hopefully would help them improve their process going forward.
Guerra: Without naming any specific vendors, have you had anyone in this particular process respond in a way that you didn’t think was appropriate?
Slepin: Most of the vendors have been very understanding and cooperative and have recognized it’s a business decision and these things happen. The more enlightened ones, of course, are hoping to get back in the door later for other business. In fact, I have one infrastructure vendor who we’re replacing and they’ve lost millions of dollars of revenue for the years to come, and their VP for the area has asked to come to see me to talk about the future. We still have that vendor here in-house, too. So we want to cooperate as much as possible. But most of them are great. There’s been one vendor I can think of that has not been cooperative in terms of providing us access to their database layout—their database dictionary to be able to retrieve data to convert it into Epic and it’s been very disappointing; but on the other hand, I think they treat all of their customers that way.
Guerra: That’s why you’re no longer a customer.
Slepin: It would be one more reason not to be, right?
Guerra: Right. I guess the thing I would fear the most is people figuring, ‘Hey, they’re leaving us; let’s get them with every charge that we can possibly conceive of—disengagement charges and charge them for data and charge them for whatever else. We’re losing them, so why not?
Slepin: I suppose that certainly could happen. Hopefully you’re protected by a contract, right? So that gives you some protection in terms of avoiding gauging, and hopefully you’re managing the vendor relationship effectively. That certainly is a risk and it’s one that you need to be mindful of, and I think the risk will vary based on the vendor. So what you want to do is think about your different vendor relationships. Look at the contracts. Understand the terms and conditions, what are the notice dates for termination, how do you provide the notice, what are your rights and what are the vendor’s rights, and just manage the contract. And more importantly, manage the relationship in a very professional way. I think most of the time, if you do that, you’re going to be fine. There probably will be some cases where you’re going to struggle and someone’s not going to do the right thing, you’ll be prepared to deal with that.
Guerra: Yeah, and I would imagine is it’s a little easier for you being there nine months as opposed to if you’ve been there 10 years and had been the person that brought them on.
Slepin: Perhaps. I don’t have the history, I don’t have this longstanding relationship, so I can be the guy to say ‘no’ and feel comfortable doing that. And I feel sorry for the negative impact that our decisions have made on individuals and companies where people have lost revenue streams. How can you feel happy about that? But we have to make the right, tough decisions for John C. Lincoln Health Network, stick with them, and move forward. And I think that by being transparent about that internally with our staff and management as well as externally with our vendors, everyone appreciates the face that you’re being honest, candid, straightforward, and direct. And you have to do what you have to do, and we move on. So most people understand that and recognize that it’s business.
Guerra: Let’s talk about disease management and business intelligence. I’m just looking over your Linkedln profile—you have those down as specialties. You were with a company called LifeMasters, and I believe that relates to these fields. It sounds to me like something that should be important for everybody. It sounds like it’s right in your radar and right on your organization’s radar—health information exchange but really managing and promoting wellness. Is that correct?
Slepin: Yes, it’s critically important to our industry. LifeMasters was a pioneer in the disease management field. It started up about 17 years ago and early on, wrote its own electronic medical record that had a single database for its providers, its patients, and its clients and employees. It’s pretty remarkable. They did an amazing job providing health coaching services for people suffering from the most debilitating chronic diseases: congestive heart failure, chronic obstructive pulmonary disease, coronary artery disease, diabetes, and asthma are the top five. I had an opportunity to work with them for several years as their CIO, and it was really an eye-opener for me to see a different angle of our industry and see what was possible when you’re focusing on the patient’s health and finding ways to understand what the risk factors are for the patient and to plan a strategy for care and intervention. It was about finding ways to engage with the patient and get them activated to take responsibility to manage their own health and to work collaboratively—not only with them but also with their primary care physician and other care providers to help optimize their health status to avoid readmission or some sort of exacerbation of their disease that would land them in the emergency room or back in the hospital.
It’s a very cool company. And I learned a lot about health and wellness and managing chronic disease, and I plan to leverage that experience and knowledge at Lincoln, because like most integrated delivery networks, we’re certainly moving in the direction of looking at total population health and looking at the individuals more holistically, and constructing a delivery network that not only takes care of you when you’re sick but also works hard to keep you well and optimize your health status.
Guerra: And what does a health system like yours need from an IT point of view in order to do disease management the way the world seems to want it done going forward—the way the government wants it to be done, CMS, and even your organization. We talked about you going on an Epic single database. I imagine that makes everything a lot easier but from a vendor-agnostic point of view, what would you need to do disease management well?
Slepin: Sure, that’s a great question. I think that while I learned a lot at LifeMasters, and over the last couple of decades we as an industry have learned a lot about disease management, I would say that we don’t know everything yet. There’s a lot more to learn. And frankly, it seems like the biggest challenge for disease management is not about technology or clinical process. It’s really more about what goes on inside the human head because about 60% or more of chronic disease costs are driven by human choice and human behavior. But putting that aside for a moment, there’s a lot obviously that we can and must do to better manage disease and help people be proactive about their health and wellness.
From an IT perspective, there are a number of things that we can do to enable the implementation of capabilities that are going to support health and wellness and disease management, which is all about increasing the accountability of healthcare delivery network for the outcomes of health and disease prevention.
So the first step is to put in the infrastructure. You need the electronic medical record—that is the core foundation. So all the things that we’re doing today to put in the EMR, in Lincoln and just about everybody else that’s working on this, that’s foundational and you need to do that. And you need to connect it together, whether you choose to go with Epic or some other integrated system, or get a best-of-breed and interface them yourself. Either way, you want to be able to allow cross-site exchange of data sharing so that you have all the benefits of that data.
Analytics is key in this area to really focusing on a deeper understanding of a patient situation in terms of their health status and understanding what their risks are from a health perspective. It can be something as simple as being able to do an online health risk assessment and comb through mounds of healthcare insurance claims and EMR data to be able to analyze the patient from the data and the facts. To be able to figure out proactively what’s the risk of this patient getting what kind of disease; how quickly do I need to respond; do I need to talk to this patient about quitting smoking; is there a weight issue that I worry about; what’s their blood pressure; if they’re diabetic, what’s their blood sugar level—looking at all of this data, correlating it, and figuring out in a proactive way what to do about that.
So looking at it from a population perspective is something that healthcare networks have not done before. There are systems you can buy or invest in that give the ability to pull all of this information into a database and comb through with algorithms and stratify the risk of the population to identify gaps in care, compare it to the best medical evidence, and organize the information and provide workflow capabilities so that various nurses, physicians, and health educators in your organization can have reminders and alerts and dashboards. They can have information to drive workflows that are designed around interventions that are designed to reach the patient, to be able to engage them, get them in for whatever procedures or exams they need, and do all of this in a proactive way.
Analytics is also helpful on a real-time basis when patients are in hospital; for example, I know there is a pretty exciting application that came out in the last year and there’s been a lot of press about. And there are others that do real-time analysis of data in your electronic medical record to predict mortality in the ICU, for example, with a pretty high degree of reliability. So having algorithms and analytics software that you can use to run against your EMR can bring on enormous power of information to be able to take action to improve someone’s status while they’re in the hospital as well as when they’re out.
I think there are a lot of other capabilities with disease management; one of the most exciting areas is what’s going on with mobile technology and technology in the home. There are a number of big companies that I hear about like Cisco and Philips, and Epic and other EMR vendors probably also are investing in devices, whether they’re mobile or in-home devices that provide automated monitoring and allow for communication on a real-time basis of vital signs and information that a patient might provide about how they’re feeling and their health status to be able to trigger. Again, we’re talking about timely interventions by the right person, along with continued care, to effect an improvement in that patient’s health status.
Personal health records are a promising opportunity for engaging patients in managing their conditions as well as their overall health status. We’re seeing examples of delivery systems like Kaiser and Group Health and others that have inserted Epic’s MyChart or other personal health records in the process of care between the care provider and the patient and are getting very meaningful adoption and I think that holds a lot of promise as well to help with this.
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