Many times, it’s one key insight that allows all our future plans to be crafted with confidence. For Greg Kall, the insight was that no matter how many of his systems were based on the same platform, there would always be a foreign one to connect with. Based on that assumption, Kall rejected the rip and replace road many of his colleagues are going down, opting instead for connectivity and a march toward as much “sameness” as possible. To learn more about Kall’s health system and the challenges that come with connecting up community docs, healthsystemCIO.com recently caught up with the Ohio-based executive.
- Best of breed shops cheering standards development
- Building an in-house data management staff
- Measuring up to Meaningful Use
- MU work fueling ACO development
- Investing in infrastructure
- Stage 2 concerns
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If you would have asked me that question five years ago, I would have said, “Boy, I don’t know if we’re ever going to get there.”
I don’t think that I’m the only person who has realized that we need to engage the community in this world of healthcare reform.
I think some of the patient participation stuff might be a little onerous, and we’ll see what happens with that …
Guerra: Since your shop is best of breed, I’m assuming that advances in standards can make your life much easier. Are they moving fast enough?
Kall: You know, the change in this space has been pretty dramatic over the course of the last three years. If you would have asked me that question five years ago, I would have said, “Boy, I don’t know if we’re ever going to get there.” ARRA has pushed Meaningful Use and the incentive payments have started to push the industry a little bit faster, and I’m happy to see that. Is it done yet? Far from it, but at least we’re moving in the right direction around standards and records exchange.
I would say that the vendor community is really starting to accelerate into this space as well, which is great to see. If you take a look at the strict HIE vendors of three years ago, you see a lot of them acquiring business intelligence components to add to their capability stack, to add portal technology to their capability stack. So I think the vendor community is starting to get the message as well, and is starting to layer in the parts that we need to pull this off, because I don’t think that I’m the only person who has realized that we need to engage the community in this world of healthcare reform. I think many people have started to realize it’s more than hospitals, it’s more than employed physicians, it’s a community that needs to be engaged and, therefore, more parts need to be thrown into the mix in order to solve the equations.
Yeah, I’m betting on vendors adopting standards. I’m betting on the fact that the Feds will continue to push standards. I’m hoping that Meaningful Use will continue to help vendors interoperate to a greater extent, but I also realize that I have to build a big pile of expertise internally to help get this done. That’s been a conscious effort that we’ve had here at Summa over the last four years. I have a good crew of decision support people, data warehousing people, integration analysts, the kind of people who can get the data from point A to point B, as well as reposit it and make it available for people that do analytic work on top of it.
Guerra: Could you ever imagine a point at which, because standards had not come along, you needed to recommend an enterprise buy?
Kall: No, and I’ve got to tell you, even if I sold my board on the fact that I needed to put one system in that can do registration, billing, electronic medical records and CPOE, I still will not have solved the problem. I could get my hospitals and maybe my employed physician group practice onto a single platform, but what am I going to do about homecare, what am I going to do about post-acute care, what am I going to do about the independent community physicians who are still part of this process? So I don’t ever see myself making that recommendation to say, “Look, we need to put in one monolithic system for the wholly owned parts of our organization.” I need to solve for a bigger problem and maybe the vendor community will begin, the large monolithic vendor community, will begin to build out extensions, if you will, into the community to help that kind of stuff happen, but it’s an expensive proposition to move in that direction and, to be honest with you, we’re looking at ways of doing this that don’t cost that much but still produce a result that we want, which is moving information cleanly between different entities.
Guerra: We talked about your application environment; tell me about maybe some of the top projects. I mean, you could talk about whether or not you’ve attested yet for Stage 1 or maybe any of the other main projects that are on your plate right now.
Kall: When ARRA was passed in 2009, we quickly came to the conclusion that we wanted to get in early on aligning our organization to be able to qualify for Meaningful Use and so we took a pretty proactive approach to dealing with it and, you know, there were different schools of thought on that at the time. Some folks thought, well, this legislation is never going to stick or the timeframes will get moved out. We kind of bet on the fact that maybe it will stay, and maybe we are going to have to deal with it. And so, by the fall of 2009, we had created a plan to get all of our wholly owned entities to Meaningful Use and put the pieces in place that we needed to get there.
One of the big projects that we have currently in flight, of course, is continuing to move all of our organizations to have the functionality that they need to qualify for Meaningful Use and, to some extent, the fruits of that labor are wrapping up now.
In 2011, we qualified two of our organizations for Meaningful Use – Akron City Hospital and St. Thomas Hospital. We plan on qualifying three other organizations this year for Meaningful Use – the Crystal Clinic Orthopedic Center, which is a joint venture we have with an orthopedic group, it’s an inpatient orthopedic hospital. We’ll also qualify two of our other general med/surg hospitals – Barberton Hospital and Wadsworth Hospital – for Meaningful Use this year.
We also began the process of implementing eClinicalWorks enterprise version for our employed physician group practice. As the end of last year, we qualified about 150 physicians for Meaningful Use, and we plan on getting another 50, for a total of 200 docs, qualified this year. So we’ve had a very purposeful march through getting our organization ready for Meaningful Use, and it did two things for us. One, it provided us with an income stream from the incentive payments that’ll help us fuel future IT projects, but it is also giving our organization the tools that we need for our accountable care organization patient center medical home.
You can’t do those kinds of things without electronic medical record systems. And so, from 2009 to today, we’ve been marching through a plan to get our organization qualified for Meaningful Use and give us the tools that we need to continue to power the organization in the future around electronic medical records. That’s one thing.
On the administrative system side, as I mentioned earlier, we began the implementation of a new ERP system for the wholly owned entities last May, and that will finish up in December of this year, and we began the implementation of a new revenue cycle system, the Soarian financial system. We began that project earlier this year. We’re balancing our portfolio around the clinical systems as well as the administrative systems as we move forward with a couple of these projects over the course for the next couple of years.
On the infrastructure side, we’re always making investments in our security environment, but one of the big changes that we’re making this year is to move our core data center out from our core hospital, Akron City Hospital, to a collocation facility as a move to fortify our computing environment. We’re going to be moving to a Tier 3 collocation facility over the course of the next 12 months as well.
The other big piece of work that we’ll be doing is really around the connected community. We’re going to continue to make investments in health information exchange technologies, normalization technologies, analytics and data warehousing technologies and portal technologies over the course for the next couple of years, and that really will probably keep us busy. That will give us enough to do through 2015.
Guerra: Anything in Stage 2 stand out as a red flag to you?
Kall: You know, we’ll see as the regs get finalized. As we watched what happened with Stage 1, there was a lot of movement in terms of what ultimately became formalized. So I’m going to wait and see what happens. I think some of the patient participation stuff might be a little onerous, and we’ll see what happens with that, but we’re kind of hedging our bets there and putting in technology that allows us to get there. But there’s nothing that I’m getting overly concerned about yet, Anthony. Again, we’ll see how this plays itself out.
Guerra: I’ve heard from other CIOs about patient engagement concerns, such as having to provide a copy of a patient’s record within a certain amount of time.
Kall: Right, and making it available to them in greater depths and details. So I’m keeping my eye on that one.