Phyllis Teater, Associate VP/CIO, Wexner Medical Center at The Ohio State University, Chapter 2

When you achieve something accomplished by less than 100 out of more than 5,000 U.S. hospitals, you’ve hit the healthcare IT big time. What’s even more impressive for Wexner Medical Center at The Ohio State University is all four of its hospitals achieved HIMSS Analytics Stage 7 designation at the same time. To learn more about the organization’s IT journey, along with the career of its CIO Phyllis Teater, healthsystemCIO.com recently caught up with the Columbus-based executive.

Chapter 1

Chapter 2

• Connecting with the community to facilitate referrals
• Is MU spurring practices to adopt?
• Measuring up to Meaningful Use
• Stage 2 concerns
• Comparing HIMSS Analytics & Meaningful Use Stages

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BOLD STATEMENTS

Certainly many of the measures are challenging, but I do think we need to be challenged.

Some small provider, be it a hospital or a practice and their ability to really do (Meaningful Use), I think, is quite a daunting task.

They do not award Stage 7 without a visit to the site. It’s much more like a JCAHO-type of thing than the Meaningful Use metrics, which are very discreet and, frankly, to be filed sort of from afar by the providers.

Guerra:  When we talk about connecting, I would imagine you have independent physicians that are referring into your hospitals?

Teater:  Actually, because we are an academic medical center – it depends what you mean by that, because I want to make sure we’re on the same page. We do have a closed medical staff because all the medical staff are faculty. To have community physicians actually admitting patients here, we have very little of that, again, because of the closed medical staff. We do serve as a referral facility for community physicians that need tertiary or quaternary or even secondary care — a primary care office in the community that would refer a patient here for heart treatment or something.

We do have lots of referring physicians. We just don’t quite have the same model that a lot of community hospitals have, and so we do have a very large group of referring all over Central Ohio and actually down towards West Virginia from Central Ohio that do refer patients here consistently, and then of course since we have almost every specialty here at Ohio State in conjunction with our medical school, we refer a lot between ourselves, a primary care physician affiliated with Ohio State would often refer to a specialist affiliated with Ohio State.

Guerra:  Let’s talk about when a community physician, now they’re not admitting and then coming to follow up because that doesn’t work that way. They’re pretty much referring them in and then that’s taken over by your facility so there would be…

Teater:  We wouldn’t take them over, we would care for them and make sure they get back to their primary caregiver.

Guerra:  {Laughing}. I get it. I get it. When they’re referred in, is there an electronic hand off of the file or some data there?

Teater:  We have a couple of things in place, and then we’re planning more. Certainly with any practice or facility that has Epic and is up on Care Everywhere, we can pull the chart electronically, and we do see that. For instance, we have a number of services that we offer our Children’s Hospital here in town. We provide radiation oncology, for instance, for some of the children that have oncological problems at our Children’s Hospital. They do happen to be an Epic client so that is a pretty easy workflow, given that Care Everywhere functionality. We sort of have that going on with anybody that’s up on Epic.

Secondly, we do have a number of facilities that refer to us that do not have Epic, of course. We do currently, and as is the case with most institutions here in Central Ohio, we do have an HIE solution for that. We do take their charts, we scan in the pieces of the chart into portions of the electronic medical record so they can be quickly found and related to tests that we would do. For instance, a CT scan from an outside hospital would be identified as such. We could upload the image. We have a way to pull those images in and then we could upload the report and scan that in, but it would still be in the radiology area so that it was easily found by our clinicians.

Guerra:  Have you noticed a significant uptick in electronic medical record use at practices, small physician practices out there as a result of Meaningful Use?

Teater:  I believe so. I am part of a small non-profit organization that is what’s called the sub-REC for the State of Ohio, one of the sub-RECs. In the state of Ohio, we were issued, as all states, a significant amount of funds to help through the regional extension centers to increase the adoption of electronic medical records for primary care providers, and so I sit on the board of the organization that administers the sub‑REC for Central Ohio. We are affiliated with between 1,300 and 1,400 physician offices around Central Ohio and the 14 contiguous counties that make up the Central Ohio area.

We are working with them so that they can receive funds to get some help on education and those kinds of things as they prepare to install a system, then to get it ready for Meaningful Use. I do feel with the practices that I’m the most familiar with, which would be these in this area, that there has been a lot of activity acquiring the systems and signing contracts, and many of them now are coming live. We are starting to see many of them file for Meaningful Use, especially at small practices because the reality is to get a few doctors at a practice up on Meaningful Use and meeting all of the criteria is somewhat easier than an institution such as my own where we’re at about 800 physicians that we need to get up on Meaningful Use and all meeting the criteria.

We’re really seeing some progress here, at least, in Central Ohio area, and I know as we participate in the regional extension center for the whole state of Ohio, they’re seeing that same thing in all of the regions in Ohio that are helping to administer this particular set of funds and helping the local physicians to get live.

Guerra:  Have you attested to Stage 1?

Teater:  We have not, neither on the hospital nor the EP side. On the EP side, we have run our first set of data for our physicians, and we see from the data that about 45% achieved Meaningful Use. We believe, based on our data in the first measurement period, that we can file and attest shortly. The rest of our physicians we’re running a rolling window and working with them on some education to get their measurements up. Some of them are very recently live on electronic medical records so we kind of expected not to get them all in one shot. On the hospital side, we have not opened our measurement period. We’re just finishing stabilization post-live that was eight months ago. We all enter into a measurement period this winter.

Guerra:  How do you feel about the timing?  I know they extended things a year for Stage 2. You’re still looking to attest to Stage 1. Do you feel the timing is reasonable?

Teater:  I think so. Certainly many of the measures are challenging, but I do think we need to be challenged. I think we will be challenged to get there but I think, as an industry, we need to continue to set the bar at a place where we can make progress for our patients. What I am probably the most concerned about with some of the challenges in Stage 2, though, would be some of the smaller practices and especially smaller hospitals that support an outpatient volume. Their capability to make the investments in systems and staff is limited — it’s a pretty significant staff investment to do all of the work required for Meaningful Use. Some small provider, be it a hospital or a practice and their ability to really do (Meaningful Use), I think, is quite a daunting task. I feel for them and want to provide them some help.

Guerra:  How would you compare the HIMSS Analytics Scale with the Meaningful Use stages?

Teater:  I think they both have strengths. I think the CMS program has to be very much driven by definable metrics, at a very detailed level, so maybe it did include some things that we wouldn’t have done otherwise. I think the HIMSS Stage 7 process is about, to a large degree, your processes that improve the care environment. Review of your scanning processes for the pieces of paper you still do have because that’s so important that information is available to every caregiver to make the best decision. Review of how you set up your policies and procedures and those kinds of things.

They do not award Stage 7 without a visit to the site. It’s much more like a JCAHO-type of thing than the Meaningful Use metrics, which are very discreet and, frankly, to be filed sort of from afar by the providers. CMS takes that in and makes a decision without interaction beyond that with the institution or with the provider. The nature of those makes them really different programs because of the way that they operate. We all in the healthcare industry have our individual opinion of the exact metrics in Meaningful Use and whether they are the right ones or not, but we had opportunities to comment and they did change, I believe, for the better through the common process. I think that we’re getting there, but I think that the discreet nature of it makes it quite challenging.

Chapter 3