Frank DiSanzo, CIO, St. Peter’s Healthcare System, Chapter 1

With all of the preparation Frank DiSanzo’s team did before rolling out an EHR, the one thing they didn’t factor in was revenue loss. It was a tough pill to swallow, and one DiSanzo hopes to help others avoid. In this interview, he talks about why organizations need to anticipate a decrease in patient volume during an implementation, the “awkward” position he was put in when McKesson announced it was sunsetting Horizon in the middle of St. Peters’ inpatient rollout, and why he believes it’s important to keep patients informed of major initiatives. DiSanzo also discusses the McKesson CIO meetings, his role as chief strategy and business development officer, and the secret to Jersey Health Connect’s success.

Chapter 1

• About St. Peter’s
• Physician alignment strategies
• Running the full gamut of Horizon
• The “awkward” timing of McKesson’s announcement
• Determining the next steps — Paragon or another product?
• The McKesson CIOs of NJ/NY
• The vendor leapfrog game

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Bold Statements

While McKesson is doing everything they can to ensure a smooth migration from Horizon to Paragon, it is, in fact, a migration, and it is a different system, so there are training requirements for clinical staff and employed and community physicians. And there are workflow considerations, so it is very much like switching an EHR vendor.

We are trying to work together as far as migration strategy and what that would look like and how we can help each other out. There’s been a great deal of collaboration among the CIOs on this topic, which is really a nice thing to see.

I think any conversation around change is difficult to have, and the result that we’ll probably be forced to make a change a lot sooner than we would have in the past makes that even harder.

There is a lot of angst about potentially how forthcoming McKesson was with that news, or when did McKesson know as opposed to when they let the hospitals that run Horizon know, particularly those that were early in the implementation.

Our board understands the issues relative to the sunsetting of the product, and they’re looking to administration and the medical staff to make recommendations as to where we go next.

Gamble:  Hi Frank. Thank you so much for taking the time to speak with us today.

DiSanzo:  My pleasure. How are you?

Gamble:  Good, thanks. Why don’t you start off by telling us a little bit about your organization just to give the readers and listeners some background?

DiSanzo:  I work for Saint Peter’s Healthcare System. We’re located in Central New Jersey, in New Brunswick specifically. We are a tertiary care hospital with roughly 475 beds. We’re also comprised of a children’s hospital, an ambulatory surgery center, and various other businesses such as a nursing home, adult day care, and urgent care. We’re one of the largest healthcare providers in Central New Jersey. We’ve been here for well over a hundred years and we are sponsored by the Diocese of Metuchen. So we’re one of the few Diocesan-sponsored Catholic healthcare institutions left in the country.

Gamble:  Do you have affiliated physician practices as part of your system?

DiSanzo:  We have owned physician practices. We have actually implemented a number of physician alignment strategies over the past several years. Some of them are as simple as physician employment, and others range from professional services agreements to joint venture agreements, so it really depends on the nature of the physician, what the physician is looking for out of his or her practice in a hospital affiliation, etc. And then we have thousands of physicians that are privileged obviously to work and operate at Saint Peter’s.

Gamble:  Let’s talk a little bit about the clinical application environment. What system are you using in the hospital?

DiSanzo:  We currently use McKesson’s Horizon EHR, both in the ambulatory and inpatient setting. So we have the full gamut basically of Horizon products and are up on CPOE, physician documentation, and nurse documentation.

Gamble:  Have you had to make any changes or do you anticipate having to make any changes as a result of McKesson’s reorganization last year with Horizon?

DiSanzo:  Obviously, as a result of McKesson’s announcement that they were sunsetting Horizon as part of their go-forward strategy in favor of their Paragon product, we, like all Horizon customers, are now looking at some kind of an EHR conversion. That could potentially be to McKesson’s Paragon product, or it could be to a product supplied by another vendor. While McKesson is doing everything they can to ensure a smooth migration from Horizon to Paragon, it is, in fact, a migration, and it is a different system, so there are training requirements for clinical staff and employed and community physicians. And there are workflow considerations, so it is very much like switching an EHR vendor would be. I think Saint Peter’s, like other Horizon customers, has a decision to make and we’re looking at a conversion ultimately over the next several years, regardless of which way we decide to go.

Gamble:  Do you know what kind of timeline you’re working with right now as far as making that decision? Because of course you have all these considerations with Meaningful Use as well.

DiSanzo:  Sure, and that’s exactly right. Right now we’re trying to see where that migration would sit best on our schedule, because you do have Meaningful Use Stage 2, and we have ICD-10, obviously. So we’re trying to see where that kind of migration would fit in our timeline. We really haven’t made a definitive decision yet, but it’s probably somewhere over the course of the next several years I would say.

Meanwhile, McKesson has been very clear that they actually intend to support Horizon, which they have well over 200 clients on, I believe, maybe for as many as five or more years. McKesson hasn’t put a real sense of urgency or instilled a real sense of urgency in their Horizon clients to move. So it’s not as if you need to move tomorrow or in the next 12 or 18 months, but ultimately you have to move. And again, we’re looking very hard in what we’re trying to accomplish around Meaningful Use and things like that and other internal initiatives as well to see where that migration would best fit. In light of everything, we’ll probably have to engage in some kind of vendor selection process whether that’s an RFI, RFP, both, or what have you to kind of kick the tires on Paragon and the other things that are out there relative to making this decision.

Gamble:  Yeah, it’s a big thing to be faced with. When did you actually first roll out McKesson?

DiSanzo:  The outpatient went live in 2010 and inpatient in 2011 on Horizon, so we haven’t been involved with it for all that long.

Gamble:  So that’s got to be difficult. That throws that kind of a wrench on things when you really haven’t had that much time to be on the new system.

DiSanzo:  That’s absolutely true, and we were kind of hit hard by that announcement that Horizon was going to be sunsetted. We were still in the middle of the inpatient implementation when that announcement was made, so that really put us in a tough spot. I mean, here we were still trying to get live on the product and our medical staff was already aware of the fact that the product was being sunsetted. So it was rather awkward, to say the least.

Gamble:  I can imagine. There seems to be a good number of McKesson users around the area in New York and New Jersey, so is it something where you’ve touched based with other CIOs to get their take and see where their head is at with what they’re going to do going forward?

DiSanzo:  Absolutely. We call ourselves the McKesson CIOs, and I meet with them on a regular basis and we discuss those things, among others. But McKesson does have high market penetration, particularly in New Jersey with several hospitals. There are a lot of Horizon clients in New Jersey, and we’re all talking to each other about what kind of move we’re going to make and what the best timing is. We actually receive updates as a group on the progress of McKesson’s Paragon product. So we are trying to work together as far as migration strategy and what that would look like and how we can help each other out around hosting and other things as well. There’s been a great deal of collaboration among the CIOs on this topic, which is really a nice thing to see.

Gamble:  Now, from the standpoint of you and the other senior leaders, when you were in the implementation process and the announcement came, you said it was a little awkward. Is this something where you worry about credibility with the clinician leaders and worry about their perception of the planning process? Is it a difficult conversation to have with them?

DiSanzo:  I think any conversation around change is difficult to have, and the result that we’ll probably be forced to make a change a lot sooner than we would have in the past makes that even harder. I don’t believe that the physicians hold Saint Peter’s directly responsible for the fact, let’s say, that Horizon is being sunsetted. I don’t recall it ever coming up that this was something that perhaps we should have known. I think there is a lot of angst about potentially how forthcoming McKesson was with that news, or when did McKesson know as opposed to when they let the hospitals that run Horizon know, particularly those that were early in the implementation or late in the sales funnel. I don’t think there’s been any impact of a negative nature from the physicians on the institution relative to this change or impending change. At the time that we purchased Horizon, we talked with McKesson about Paragon, in fairness to them, but product really wasn’t ready for an institution of our size.

Gamble:  We’ve spoken to at least one or two CIOs who had also been affected by it, and it’s a difficult thing. It’s something where maybe in your dealings with the board there were some difficult conversations, I would guess.

DiSanzo:  Well, I think everybody realizes that products get sunsetted over time, and I think anybody that’s been in the industry longer than a few years has seen that. These products come and go, vendors get purchased by other vendors, and it’s not like McKesson is going out of the business. At the same time, I think our board understands the issues relative to the sunsetting of the product, and they’re looking to administration and the medical staff to make recommendations as to where we go next. The life cycle of these products is probably five to seven years, so you could argue that Horizon is going to be out there for the duration of what its life cycle would have been either way. And McKesson has made a commitment publicly about supporting the product for the next several years, so there’s really not that sense of urgency that would come with the fact they’re pulling the plug tomorrow. They’ve already committed to their Horizon clients I believe at least to get you through stage 2 Meaningful Use, if not further. So I don’t think there’s as much a feeling of panic.

There’s probably some disappointment relative to the fact that these EHR implementations are tough to do, so I think there’s some disappointment and some angst about having to do one maybe sooner than you would have otherwise. But at the same time, every four to five years these vendors leapfrog each other, and relative to all the changes that are taking place in healthcare today, I believe that this type of thing almost has to be expected going forward.

Gamble:  Yeah, and change is just the way things are right now. Change is the new normal.

DiSanzo:  We have KLAS reports going back to when we made the decision to go with Horizon and showed Horizon was rated higher than Cerner and Meditech and other products. Now the KLAS reports for the last several years say Epic is the way to go. Three years from now, who knows? Paragon has been consistently rated high in the KLAS report, so it almost becomes a revolving door as these vendors implement new products, and again, leapfrog each other as far their offerings.

There are just some things that you just can’t know. We know today that Allscripts is having financial difficulties. Who knows what the future holds for them? You have large Allscripts clients like Northshore-LIJ making public statements saying in the next 15 to 18 months they’re going to have to decide whether or not Allscripts is a long-term partner for them, so I think that’s just the nature of the industry these days.

Gamble:  That certainly seems to be the case. And I suppose one benefit from the fact that you do have some kind of transformation in your near future is that I’m sure that you can apply some of the lessons learned from rolling out Horizon, seeing as it wasn’t that long ago. That may be one kind of a benefit.

DiSanzo:  Absolutely, I think that is one benefit. And additionally, I think McKesson would have been probably much brighter if they had touted Paragon as the next iteration of Horizon. Then people would just look at it as a forklift upgrade to Horizon and they probably would have just moved on with it. Because with a lot of these vendors, when they have major forklift upgrades or they’re converting their database from Oracle to SQL or from MUMPS to Oracle or whatever, these are changes are almost as pervasive and invasive and challenging as a new vendor implementation. And I think if McKesson had couched it that way, there would probably be a lot less Horizon customers out there looking at other products. But to circle back to your comment, we can certainly apply the lessons learned, particularly since it’s been so recent since our last implementation.

Chapter 2