With an ever-growing number of projects on their plate, many CIOs are struggling with prioritization challenges. And what often happens, according to Rick Schooler, CIO at Orlando Health, is that tasks that are deemed urgent take precedence over projects that are essential to an organization’s growth. As his organization continues to expand, Schooler is working to balance immediate IT needs with Orlando’s long-term strategy to deliver a clinically integrated model of care, which is no simple task. In this interview, he talks about his concerns with the proposed MU stage 2 rules, why CIOs will need to put pressure on vendors, the importance of being plugged into the executive team, why enterprise analytics can’t be put on the back burner, and the skillset that today’s CIO must have.
- Being named CIO of the Year
- CHIME focus groups
- Orlando Health’s 10-year plan
- Developing a value-based purchasing model
- Physician alignment challenges
- Allscripts in the inpatient & outpatient settings
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The topics that the vendors and consultants want to walk through give us all the chance to weigh in on what’s going on in our markets and what we’re doing and learn from each other. So it’s really hard to get out of the office for that much time, but it’s very much worth it, and I highly recommend it to anyone.
We believe to survive in the future state of healthcare, we’re going to have to have a full continuum of services that are integrated through information as well as through clinical process and branding. And from a patient’s perspective, it’s a seamless, continuum of care that is one integrated delivery model.
We will get paid in future for how well we keep our patients, as well as how efficiently we treat them when they need treatment. And the quality of the outcome, along with the efficiency of keeping patients well and putting them through our continuum, will determine essentially how well we get paid.
As we acquire physician practices, if they have an EMR, they’re going to go to one of the three and we’re targeting people as we acquire them — if you’re cardiology, you go to GEMMS. If you’re other, we’re going to target moving you to Allscripts Enterprise.
We put it an HIE platform that will serve as the virtual record; it’s the continuum record, and we’ll feed that with all of our internal clinical systems as well as referring-in aligned physicians. We’ll send data to that and we’ll send CCDs out of that as well. That platform will also be our touchpoint into the statewide HIE.
Gamble: Hi Rick, thanks so much for joining me on this call.
Schooler: Okay, great.
Gamble: There are a few things I wanted to talk you about, but I want to start by congratulating you on being named CIO of the Year. Just kind of looking at the past few winners, it looks like you’re in great company, so I’m sure it means a lot to get that kind of recognition from CHIME and HIMSS.
Schooler: Oh yeah, and as I said, in my acceptance speech, if you want to call it that — my two minutes of fame, I’ve known most of the people that are on the list for years. There are just a couple of folks on that list that I don’t know fairly well or at least have had professional acquaintance with for several years. And it’s just really such an honor. It’s really humbling to be able to receive something like this because there are so very few people who make that list, and as I was telling some folks at the conference, I’ve never been one to seek to get on certain lists. I’ve been blessed by being awarded certain things over the years and different kinds of recognition and so forth, but if there’s a list that I would want to get on, this would certainly be the one for a healthcare CIO. So as I said when I spoke the other night, for a healthcare CIO, it doesn’t get any better than this.
Gamble: I’m sure it’s great having an opportunity to be out there at HIMSS talking to the people who are in this group of CIOs that I’m sure you’ve talked to a lot over the years. I’m sure it’s nice to have them in the same place for a couple of days.
Schooler: Many of us stay in touch during the year in different ways, with different kinds of groups and different kinds of mail lists, and so forth. So we’re always trying to stay connected, and as different people come and go, we always learn so much more from each other. And that’s a great value of both CHIME and HIMSS, just to be able to form these relationships over the years and retain them through informal as well as formal meetings like this. The CHIME focus groups, for example, are really good sessions where we get together with other CIOs. There are between I think eight and 11 different CIOs in the room and the topics that the vendors and consultants want to walk through give us all the chance to weigh in on what’s going on in our markets and what we’re doing and learn from each other. So it’s really hard to get out of the office for that much time, unless of course one takes a vacation, but for a series of meetings, it’s very much worth it, and I highly recommend it to anyone. But it’s like a lot of things—the more you put into it, the more you’re going to get out of it.
Gamble: Absolutely. So let’s kind of take a step back and just a little bit of information about the organization. I know people are familiar with it, but Orlando Health has eight hospitals, correct?
Schooler: Well, we wholly own six. We’re getting ready to acquire another, which would give us the seventh, and then the eighth facility is our MD Anderson Cancer Center Orlando. And that is now moving to hospital base as well, so that puts us at hospital base facilities. We’re part owners in another facility that we sold off a few years ago down at St. Cloud, and we’re half owners at another facility, so we’ve got our hands now in nine facilities total that we either wholly own or partially own. We wholly own eight. So I think we’re up right around 2,000 beds now, maybe a little over with the wholly owned facilities, and I think we’re around 14,000, maybe approaching 15,000 employees. We’re Level 1 Trauma for both pediatrics and adults and a statutory teaching facility as well. We have eight residency programs and pretty much cover the whole gamut of healthcare.
We’ve got hospital-based outpatient as well. We employ physician practices; we’re now up over 350 employed doctors. And we’re continuing to clinically integrate by acquiring more physician specialists as well as forging very important primary care contracts for our medical home partners as well as our continuum partners that do primary care and home medicine throughout the community.
Gamble: So you guys are constantly growing.
Schooler: Well, it’s growth driven out of market necessity and market opportunity, because we believe to survive in the future state of healthcare, we’re going to have to have a full continuum of services that, quite frankly, are integrated through information as well as through clinical process and branding. And from a patient’s perspective, it’s a seamless, continuum of care that is one integrated delivery model. And really our strategy as an organization is to deliver a patient-first, clinically integrated model of care through collaboration with our physician partners. And that’s really easy to say, but let me tell you, it’s hard to do. But we’re couple of years into our 10-year strategy, and we’re just chugging along, one step at a time, one year at a time, making it happen.
Gamble: Can you tell us a little bit about the strategy?
Schooler: Well the strategy, again, is founded on the notion that we’re not going to do anything that’s not first vetted through the experience or the eyes of the patient. So everything we do has to first have the patient’s interest, the patient’s expectations, and the patient’s well-being and convenience as the very first consideration. We have different pillars that are the foundation of our strategy, which include best-in-class quality, physician collaboration, and again the patient first is one of the key pillars, but also delivering extraordinary care. Just like any of the strategy, we have series of pillars that define it. But it’s really about getting us where we need to be to survive in a value-based purchasing model of healthcare payment.
And we believe, like many others do, that the money is going to keep getting less, and reimbursement is going to continue reduce, relatively speaking. We will get paid in the very near future and future for how well we keep our patients, as well as how efficiently we treat them when they need treatment. And the quality of the outcome, along with the efficiency of keeping patients well and putting them through our continuum, will determine essentially how well we get paid; how we do financially. We believe that’s going to be a very true reality and so we’re preparing for that future. Our strategy is really all about getting that clinically integrated model of care with collaboration among our physician community that we’ve never had. We have right at 2,000 credential doctors that work in Orlando Health Facilities.
Gamble: And those are employed?
Schooler: No, approximately 350 are employed; the rest are private physicians with which we hope to have a very strategic alignment with many of them, but it’s a very competitive marketplace here.
Gamble: What is the core clinical system that you’re using at the hospitals? Are you using Allscripts?
Schooler: Our hospital-based EMR is the Allscripts Sunrise product and it also is for hospital-based inpatient and outpatient. And then the EMRs we use in our physician practices at this point in time are AllScripts Enterprise. We use the GEMMS product for cardiology practices and we use the Allscripts Sunrise ambulatory manager as well for some of our employed practices. So we have three core ambulatory EMRs; the Sunrise ambulatory EMR is fully integrated with the Sunrise inpatient hospital base and hospital outpatient.
So with Sunrise, there’s the ambulatory manager, and then there’s the clinical manager. The ambulatory manager can be used for hospital-based clinics as well as free-standing physician practices. So we’ve got a total right now of four EMRs. We have a couple of others that are going away because the docs going to roll up into one of these other three, so it’s not really worth discussing that. But as we acquire physician practices, if they have an EMR, they’re going to go to one of the three and we’re targeting people as we acquire them — if you’re cardiology, you go to GEMMS. If you’re other, we’re going to target moving you to Allscripts Enterprise.
Gamble: As far as the other docs in the community that are not yet part of the system, are there any issues with integrating with the different systems or, like you said, are you just trying to get as many of them as possible onto the Allscripts platform or GEMMS?
Schooler: With the ones that we employ, that’s the case. But there are many EMRs in our community and so we’ve put in an HIE platform that will essentially be the continuity of care document, the CCD exchange point to and from for those aligned providers and us. We’re not going to have those aligned providers try to send and receive data in and out of our core systems. We put it an HIE platform that will serve as the virtual record; it’s the continuum record, if you will, and we’ll feed that with all of our internal clinical systems as well as referring-in aligned physicians. We’ll send data to that and we’ll send CCDs out of that as well. That platform will also be our touchpoint into the statewide HIE, and if we need to send discreet pieces of data to our aligned providers like a lab result only, we have another platform for that. It’s a basically a transaction broker that will be sending transactions out of our infrastructure out to the aligned providers as they need detailed or specific sets or pieces of data.
But our primary exchange point with physician practices we anticipate will be our HIE platform, both for sending and receiving data as well as viewing the patient’s full continuum. Because that will incorporate home health and outpatient therapies in addition to hospitalized services as well as our employed docs and aligned physicians. So you can begin to see how, as a health system, you begin to form that continuum record when you have everyone contributing to a common trust or vault, if you will, as the HIE platform.
We do have a community RHIO. We feed information from that in a separate way; it comes right out of our integration engine. But we do participate in a community RHIO — I was actually the co-founder and I’m the vice chair of the Board. We’ve been at that for several years and that’s proven to be very effective. It’s fully integrated with our hospital-based systems. But there’s a community RHIO and then there’s a statewide Florida HIE that we’ll be tapping into as well.