There are few things that can rock a CIO’s world as much as learning that the clinical information system you’ve been using for years — and have even upgraded to the latest version — is being phased out. But like any CIO, Atlantic Health’s Linda Reed has learned how to move past the bumps in the road, even those that will hugely impact her organization’s IT strategy. In this interview, Reed talks about the challenges in getting physicians to adopt EMRs, the work she and her colleagues are doing to facilitate data exchange in New Jersey, and how she is working to prevent staff burnout. Reed also discusses the most challenging aspects of Meaningful Use attestation, the value of advocacy groups like CHIME, and how difficult it is for CIOs to take time off.
Chapter 3
- Using cloud-based services
- Managing the business, not the technology
- Benefits of CHIME member-to-member surveys
- Setting up ACOs
- The PHR wars are heating up
- No vacations for CIOs
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We didn’t have to incur the cost of going out and getting data center space, bringing in servers, and creating the infrastructure — nobody has to manage that. So really for us, it’s really managing the business as opposed to managing the technology.
I think staying in touch with your industry organizations is invaluable, especially with the amount of information that’s going to be flowing in the next couple of years. You need those organizations to kind of help you stay abreast of really what’s coming down the pike.
I think that’s still a big open question, because we’re taking a look at what systems we have in place and what do we need, but not until we get into it, I think, are we going to really understand exactly where the gaps are.
Where are you going to put the data? Do you have one place to pull it all together? I don’t see that right now. I’m just concerned that we’re going to start seeing a fragmentation based on personal health records.
I’ve tried to be better, because it gets to the point where even if you look at your email, then you’re sucked in and you can’t stop. So I’ve really tried to avoid that. I’ll take a glance just to make sure that there’s nothing on fire.
Gamble: One of the big questions or barriers that always come up with HIEs is long-term sustainability. So I guess once you have that figured out, that’s another huge piece of the puzzle right there.
Reed: It is. We’ve got the grant, and for us size kind of matters because the bigger you are, the better you can charge your members. But one of the things we did is, because we’re just not sure what data exchanges are going to look like in the next three to five years, we went with RelayHealth because it was a cloud-based, software-as-a-service. We didn’t have to incur the cost of going out and getting data center space, bringing in servers, and creating the infrastructure — nobody has to manage that. So really for us, it’s really managing the business as opposed to managing the technology.
Gamble: That’s another pretty big piece right there.
Reed: It is, and in that way, we were also able to sign a three- or four-year contract. It gives us the opportunity, should the market shift, to make a decision at that point, as opposed to now having a long-term real estate lease, owning servers, and owning infrastructures that you have to do something with.
Gamble: Okay. So in terms of HIEs, is Jersey Health Connect in touch at all with leadership for the other HIEs in New Jersey as far as seeing their progress and how that’s going?
Reed: Yes we do. There’s a series of different meetings out there and we put them together, and there is one where all of the HIEs are represented. And the state does have some expectations at some point down the road after we all stand ourselves up as to how we’ll put those independent organizations together.
Gamble: One last thing I want to touch on is that you recently earned Fellow status from CHIME, and I know that you’re involved with HIMSS. I’m sure it can’t be easy to be involved with these types of initiatives right now, but how important do you think it is that CIOs put in that time?
Reed: I think it’s very important, just from the standpoint of the networking capability. It keeps you informed. CHIME with their StateNet component for Meaningful Use and advocacy and with what HIMSS is able to do when the notice for proposed rulemaking comes out — if you’re not in touch with organizations like that, how are you going to keep up? Because you can’t go out and read all these things. You can’t go out and read the whole rule. So you need organizations like that to put out information in a way for you to be able to understand what’s going on, and to have people to talk to if you have questions. The whole advocacy department for CHIME is just a huge resource.
At the same time, I’m on the Board of a nursing home in New Brunswick, and that’s important too, because you have to find ways to give back to the community. It actually helps because now with the HIE we’re looking at bringing them on as part of the continuum. But I think staying in touch with your industry organizations is invaluable, especially with the amount of information that’s going to be flowing in the next couple of years. You need those organizations to kind of help you stay abreast of really what’s coming down the pike.
Gamble: Yeah, that’s a tremendous resource. And if you are struggling with something or just have a question, do you contact people through CHIME?
Reed: Oh yeah, and that happens all the time. You might say, ‘I heard this,’ and people will try to help get you answers for that.
Gamble: And I know that some people do polls too.
Reed: Yeah, you can do member-to-member surveys and all kinds of things. Those are very helpful.
Gamble: Do you try to take the time to participate in those if you see them?
Reed: Absolutely. Every time that a member-to-member survey comes across in CHIME, I’ll always answer it, unless I don’t have anything for it. But nine times out of 10, I answer, because you get the information back too. So not only you’re helping the person that you’re answering for, but you get all the information back too, so it’s very helpful.
Gamble: Alright, before we wrap up, I know we’ve talked about a lot, but are there any other issues you wanted to address as far as anything that you’re working on right now or anything else that’s on your mind?
Reed: Yeah, ACOs. So Atlantic put in our application; we’ve got a pretty large ACO going in. And I think one of the things that’s unknown is exactly how you’re going to manage some of these things; how the data is going to flow. We’re working with a company called QualCare that’s going to help us do the data analytics. But I think that’s still a big open question, because we’re taking a look at what systems we have in place and what do we need, but not until we get into it, I think, are we going to really understand exactly where the gaps are.
Gamble: You’re in the initial phases right now?
Reed: Yes. So we have the governance put in place, we have all of the membership in place, and we submitted the applications on January 20 when it was due. We anticipate hearing something in March, and then if we’re accepted, we’ll start up on April 1. So, again, we’re in the process right now of looking at that whole data flow. And day 1 CMS has approved what kind of data goes to the company that we’re working with for analytics, they’ll scrub that data; they’ll get that back to us. We now have to find a way to distribute it to our care management team and then to physicians. We do physician match.
So what’s the workflow and the process so that we can map where the data is and then at some point determine whether there’s any kind of technology gap that has to be filled? It’s funny because I think what concerns me is everybody says, ‘We’ll just do that through a system.’ But we’re talking about Medicare beneficiaries, and they could be anywhere between 65 and up, so how many of those people don’t use technology? People are always talking about patient portals or personal health records, but what do you do about the people that will never use one of those?
Gamble: Which is a lot of the population.
Reed: Yeah, so you’re going to have to put processes in place for automation, process in place for telephone, and process in place for snail mail. You have to figure out all of those touch points, and since we are a healthcare provider and not an insurance company, that’s not something that we’ve already done or ever done.
Gamble: That’s something where there are a lot of questions. And it’s interesting what you said about the Medicare population — or even people who are middle aged or younger, they still can’t quite get a grasp of who is using PHRs and who is using portals. It’s still such a big question and such a tough thing to have to anticipate.
Reed: It truly is. What’s scaring me is the PHR wars that are starting to heat up. We’re seeing data segregation based on PHRs, because now if you have a physician that has, let’s say, eClinicalworks, that comes with a PHR patient portal. Now that data is there. Jersey Health Connect has a patient portal and your insurance company has a PHR — so how many PHRs will you have and how fragmented is your data going to get?
Gamble: And are individual patients being relied on to update all of these?
Reed: Yeah, and then where are you going to put the data? Do you have one place to pull it all together? I don’t see that right now. I’m just concerned that we’re going to start seeing a fragmentation based on personal health records.
Gamble: Right, who has ownership of the data and is the data speaking.
Reed: And if you can change insurance companies frequently, what happens to your data that stays there?
Gamble: That could be why there is some hesitation among some patients.
Reed: Right.
Gamble: So you have ACOs — that’s another pretty sizable project on your plate. With everything going on, are you ever able to take a breather or are you pretty much just plugged in all the time these days?
Reed: All the time. I’ve pretty much passed up three weeks of vacation in 2011. I just didn’t take it, and that’s not good.
Gamble: Everyone always says you’re more productive when you can take time out, but sometimes it’s just too hard.
Reed: It’s just too hard, right. But I’m going to make an effort this year. You just can’t think clearly after a while.
Gamble: Yeah. And when you go on vacation, will you shut the Blackberry off?
Reed: You know, it’s funny because even on the weekends I’ve tried to be better, because it gets to the point where even if you look at your email, then you’re sucked in and you can’t stop. So I’ve really tried to avoid that. I’ll take a glance just to make sure that there’s nothing on fire.
Gamble: Maybe that’s the key — setting up some kind of system where you say, ‘Okay, I’ll check it, but only for this amount of time.’
Reed: Right. You can’t let yourself get sucked in, or you’re done.
Gamble: Yeah. Okay, was there anything else?
Reed: No, I think that’s it.
Gamble: Well, thanks so much for your time, I appreciate it.
Reed: It’s my pleasure, anytime. I’m glad you’re back, and anytime you want to come out and have lunch, that would be great.
Gamble: I’d love to do that. Thanks so much, and I’ll talk to you soon.
Reed: Alright, great.
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