Chuck Christian, the longtime CIO at Good Samaritan Hospital, believes that health information exchanges have been getting a bad rap. Christian has been involved in HIE work for more than a decade — long before Meaningful Use was even on the radar, and he wants CIOs to realize that getting connected with data exchange can yield benefits that go beyond just qualifying for funds. In this interview, Christian talks about the state of HIE in Indiana, how his organization is leveraging HIEs to improve patient care, and the optimal role for CIOs when it comes to HIE initiatives. He also discusses negotiation points, the importance of knowing the costs involved, and why he thinks the industry is just beginning to scratch the surface on how information can be most effectively used.
- Moving into an ACO world
- From sickcare to healthcare
- Razor-thin margins and CAHs
- Making it easy to do the right thing
- The role of the CIO in HIE
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It’s kind of like process improvement or implementing software. If you want to be ensured of a failure, have IT do the whole thing. If you want to ensure success, partner with them. Let’s do this together so we can incorporate your ideas and we can understand. I think that’s what we’ve got to do from an ACO standpoint.
Some of these smaller facilities in the rural areas, the critical access hospitals, are operating on an absolutely razor thin margin right now. If you’re going to ask them to do more and get paid less for it, I’m not sure they’re going to survive.
With our size, we can be a little bit more flexible and entrepreneurial. It’s not that we don’t plan and we don’t execute on the plan; we do. But we’re also looking very carefully at the things in the environment that will have an impact on us possibly in the future, and how can we react today.
I’m not in the business of dropping PCs on desktops and writing HL7 interfaces. I have people on my team that do that. My job is to help figure out how do we use that technology to make what we do better; to provide higher quality, safer healthcare for our patients.
Guerra: It sounds like the world that you’re talking about is the ACO world. Is that what people are envisioning as an ACO — where we’re lining up the incentives with the behavior we want to bring about?
Christian: Well, the world that I’m talking about, I’m not sure you could read the ACO legislation and picture that.
Christian: I think the concepts are the same. How do we appropriately reimburse for quality? I don’t have a clue right now. I’m still learning, and I think we’re all still learning. It’s very interesting. If you listen to some of the principles, particularly the architects of the ACO, what I heard them say was, we didn’t expect there to be about 100 in the country. And no, we don’t expect them all to be profitable. What that tells me is this is an experiment. We’re already at ACO 2.0 and we barely have a couple of them spinning out there. But some of the rules we’re putting together are to make sure that people don’t game it. It makes it really hard. If I was a CFO, I don’t know how they’d be able to put a performer together to say, ‘Are we going to break even, are we going to make a little money, or are we going to lose our shirts?’ Because if you don’t know who’s going to be in your ACO group until the end, you don’t know if they’re going to allow you to access your data because it’s up to them whether they share it or not.
I’m not sure how you do that. There are some really smart folks out there moving forward with this, and I plan on reading and listening to see what did you learn through this process. It is no different than some of the other demonstration projects that CMS has run. Some have been very, very successful; others not so much. But I also know that these private-public collaborations that have happened in some markets have been very, very successful and have lowered the total cost of healthcare when people start working together.
And they’re working together because they know it’s the right thing to do. It’s not because somebody is forcing them to do it. It’s kind of like process improvement or implementing software. If you want to be ensured of a failure, have IT do the whole thing. And you’re doing it to them. If you want to ensure success, partner with them. Let’s do this together so we can incorporate your ideas and we can understand. I think that’s what we’ve got to do from an ACO standpoint — start learning about what works and what doesn’t work. The other thing is I think it’s a change in thought process on how we go about thinking about the care that we provide.
I had an opportunity to be in the car with Dan [a physician who works with area nursing homes and home care agencies] yesterday for several hours, and the older physicians get it. They are taking care of patients from birth to death. And so they get what these folks are going through. I’m kind of ignorant of that. And so it was really great to have the time to spend with him and some of the time I’m spending with others. Let’s really talk about healthcare. And we’re not talking about sick care anymore; let’s talk about healthcare and how do we keep our population more healthy so they’re not accessing services. Well, that kind of flies in the face of what we’re doing because we’re a volume-based business. We get paid for what we do today. And for me, if we’re really truly going to get to that point of payment for quality, we’ve got to quickly change the reimbursement model or we’re going to see some organizations start to suffer financially.
Some of these smaller facilities in the rural areas, the critical access hospitals, are operating on an absolutely razor thin margin right now. If you’re going to ask them to do more and get paid less for it, I’m not sure they’re going to survive. And those facilities, even though they can’t offer the depth and breadth of services, they fulfill a definite need for healthcare in those markets. In some markets, it’s maybe okay to drive 60 to 70 miles. I’ve got a friend that lives in Montana and her husband is a superintendent of mines. For her to access health care, she has to drive 90 miles to Billings. In 90 minutes, if you’re having a heart attack or if you’re bleeding, or something like that, that’s a long time. It’s kind of that golden hour. If you’re having a stroke, that’s a long time. And although these smaller facilities may not be able to provide the quality of service, with the technology through the telestroke programs and some of the electronic ICUs, we can keep people closer to home and provide good quality healthcare at a lower dollar and not have such a negative impact upon their families.
My wife and I were talking; I had a heart attack about 14 years ago, and I’m just thinking of the inevitability of whenever I have to have open heart surgery. I’m thinking about the impact upon her if I go to Indianapolis. If I have it up there, that’s two hours from home. But it’s also about quality, or the perceived quality that the organizations that do a lot of this stuff can do. So it’s six in one, half a dozen in the other, I guess.
Guerra: Right. I was just thinking about what you were saying — the expression that you want to make it easy, especially from a policy perspective, for people to do the right thing, so to speak. You want to have those incentives line up. It seems like our realization of the right thing as an industry is ahead of the policies making it easy to make those choices.
Christian: Well, keep it in mind that the organization I have the privilege of working for may be a little different. I mean, we’re a community facility. We’re the only hospital in the county. And we service a market of about 250,000 people in the rural area of Southwest Indiana and Southeast Illinois. So it’s really easy to think about this in the realm of taking care of our friends and our family. If I was in a more competitive market like Indianapolis, Chicago, Evansville, or Terre Haute, I may think a little bit differently.
The other thing is that with our size, we can be a little bit more flexible and entrepreneurial. It’s not that we don’t plan and we don’t execute on the plan; we do. But we’re also looking very carefully at the things in the environment that will have an impact on us possibly in the future, and how can we react today in order to start working on those processes that we need to fix. We’ll always have room for improvement. With our organization, it’s not like turning the Titanic around in the Wabash. The Wabash is a river right next to us. It’s pretty shallow and it’s pretty narrow. With our organization, we can move pretty quickly around implementing change and that kind of thing. I mean, if I want to talk to the CEO, I report to him, so I can just go walk into his office. I’ll meet with him three or four times a week. If the director of radiology wants to talk to the CEO, he’s got one person that he has to go through to get to. And actually, Mark can go talk directly to Rob anytime he wants to. We don’t have that chain of command type of thing. Everybody knows everybody. I think that’s one of the advantages of working in a smaller facility. It also has its disadvantages too.
Guerra: What do you think should be the role of the CIO when it comes to health information exchange? We always say that you can’t have IT running it. But should they there be out there in front somewhat talking to the board and the rest of the C-suite as a proponent, or just responding and talking about options? What do you think the best role would be for the CIO?
Christian: Well, I’ll talk to you about this thing called CIO 2.0. I’ve been doing this for a long time and I’ve had the privilege of kind of being around as this thing called the healthcare CIO role was being defined. And I think that what we need to do is be strategic. In health information exchange, what’s the impact upon the operations? And I think my job is to translate that technology into information that senior leadership and the board can understand what is the impact upon our operation.
The other thing I think we have to be is innovative. Nothing is what it appears to be. How can we leverage that technology to have a more positive impact upon our operation? How do we become more efficient by having this technology in place? And the other thing we have to do is be realists. One of the things that Rob McLin, who’s our CEO, has given us permission to do is go try it and fail early — just don’t fail again doing the same thing. And so we have the opportunity to go out and be innovative and try new things. And if it doesn’t work, we need to find that out very quickly.
This is something new to us. And so we are kind of moving that ball out through the organization and trying to be more entrepreneurial about that kind of stuff. So I really think the CIO’s role is, one, to be that partner — not necessarily related to technology. I think it’s related to the business of the organization. We’re in the business of taking care of patients. I’m not in the business of dropping PCs on desktops and writing HL7 interfaces. I have people on my team that do that. My job is to help figure out how do we use that technology to make what we do better; to provide higher quality, safer healthcare for our patients. Of course my boss used to be the CFO, and so I also always have to add, at the most effective price point.