Frank DiSanzo, CIO, St. Peter’s Healthcare System, Chapter 2

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

Chapter 2

• EHR rollouts & revenue loss
• Managing clinician expectations
• A culture of inclusion —“In the interest of transparency…”
• Being proactive about educating patients
• Jersey Health Connect
• RelayHealth’s cloud-based solution
• CIOs “leaving our differences at the door”

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The issues around workflow and getting familiar with the new system are going to definitely impact volume, which then obviously impacts revenue. And I think for anyone to think otherwise, they’re really short-changing themselves.

They need to know that they have the support of the institution, so that on the hospital side, there is recognition that it is going to be difficult for them; that they may not be as productive as they were before, and the hospital is willing to partner with them on that and absorb some of that.

I really don’t think there’s a downside to informing the patient. If you don’t make them aware of it and things go smoothly, that’s wonderful. But if there are hiccups, now you potentially have a PR issue on your hands. I think it’s just better to be proactive.

We’re trying to build a comprehensive patient care record at the physician level by offering them the hospital information electronically. The next phase will be to try and gather information from their EMRs and pull that back together so we really have the complete comprehensive picture.

We’ve been able to leave our differences at the door and really work on the integration of the data and the model for getting the data out to the clinicians. We feel that the information really will raise the tide for all the institutions across Jersey Health Connect.

Gamble:  I don’t know if it was last year at HIMSS, but I saw that you spoke about how EHR rollouts can affect revenues, and how it’s something that senior leaders might not be planning for appropriately. I guess it’s one of the things where you know now just how much a transformation can impact revenue loss.

DiSanzo:  That’s correct, and I think that’s one of the things that St. Peter’s will do quite differently the next time we do a major implementation — we’ll factor in some of that revenue loss and volume loss. On the one hand, going from a completely paper environment to an electronic environment is a lot more jarring for an organization, I think, than going from one electronic record to another. But still, the issues around workflow and getting familiar with the new system are going to definitely impact volume, which then obviously impacts revenue. And I think for anyone to think otherwise, they’re really short-changing themselves.

Gamble:  One of the issues that comes up a lot with clinicians is managing their expectations. I could see that being kind of a difficult thing to do — just really trying to enforce that there is a learning curve. Do you have any lessons learned on that front?

DiSanzo:  I think this is another example where as time moves on, and physicians — particularly those that aren’t employed by the hospital or healthcare system — have implemented their own office practice EMRs, I think they will understand that there is a learning curve and they’ll have first hand experience of how this has affected them in their private practice, as well as their staff. But I think it’s very important to set expectations internally and externally, relative to the fact that it’s going to be disruptive, and that their input not only is desired, but it’s mandatory for these projects to be a success. They also need to know that they have the support of the institution, so that on the hospital side or the healthcare system side, there is recognition that it is going to be difficult for them; that they may not be as productive as they were before, and the hospital is willing to partner with them on that and absorb some of that for them.

Gamble:  It’s difficult to anticipate how hard that’s going to be and how much of a problem it is. It all comes down to transparency.

DiSanzo:  Transparency is the key. You’re absolutely right. Transparency and a culture of inclusion to really keep them abreast of every decision and why you’re taking the direction that you are, what the ramifications are, and, quite frankly, what the impact will be to them and the institution, both on a short-term and long-term basis, so that you can really work at this collaboratively.

Gamble:  As far as the patient side, that’s another issue. And maybe this refers more to going from paper to an electronic system, but the question comes up as to how transparent you want to be with patients and whether you want to disclose this information, or if you think it might just be a little too confusing. What are your thoughts on that?

DiSanzo:  I think it can go either way. When we first went electronic from paper, we did notify the patients. So we put notifications in waiting areas and things like that telling them that we were going to an electronic medical record. We explained a little bit about what we thought the advantages would be, relative to ultimately speeding up the care that they receive, making the care safer, making it more efficient, and the potential for the reduction in errors that could occur using a paper-based system. So I think we were very transparent with our patients relative to this process that we were going through. We put cards in the patients’ rooms. I think going from one electronic system to another, the lesson learned is we probably would do the same thing. I think you really can’t go wrong with the policy that is open and transparent — that goes for your staff that goes for your patients. I think it works both ways.

Gamble:  I can see the school of thought on both, but I would think that in this day and age, patients are becoming more and more educated, so it really could be better off right from the get-go to be transparent.

DiSanzo:  Yeah, I’m not sure what you have to lose with being transparent, because if the process goes smoothly, it’s going to be great. You were transparent. You made the patients aware of this, and everything went well. You’re doing it for them as much as for your institution.

At the same time, if there are hiccups, at least the patients will know. Patients are very vulnerable. They’re at the hospital obviously for a reason — and the reason is serious or they wouldn’t be here at all. So people who come to a hospital are in a heightened state of vulnerability to begin with, and if they see nurse or another clinician muttering about a new computer system or being confused or perhaps requiring extra help to enter data, I think it’s important to have them on board and have the patient understand that this isn’t going to have a direct impact on their care; that the facilities and support are available for these people so that their care or the patient’s care still proceeds efficiently, accurately, and smoothly, ensuring that everything gets done as it should. I really don’t think there’s a downside to informing the patient. If you don’t make them aware of it and things go smoothly, that’s wonderful. But if there are hiccups, now you potentially have a PR issue on your hands as far as getting the word out. I think it’s just better to be proactive.

Gamble:  Yeah, sure. With an organization like yours, you have a children’s hospital and you also have a maternity unit that’s known throughout the state. One of the things you rely upon is word of mouth, so I imagine that PR and patient perception — things like that have to be top of mind.

DiSanzo:  I completely agree. We put a lot of effort into that and we make sure that when we do these rollouts, we have the resources available to make them go as smoothly as possible. So we have a saying here: it starts with “In the interest of transparency,” and then it trails off to whatever topic we’re talking about. So again, I don’t think there’s a downside to informing patients when your hospital’s undergoing a transformation like that, whether it’s an EHR or another system.

Gamble:  All right, I wanted to switch gears a little bit and talk about your involvement in Jersey Health Connect, which is the largest HIE in New Jersey.

DiSanzo:  And the fourth largest in the country.

Gamble:  Is it? That doesn’t surprise me. I’m looking at some of the organizations that are involved, and that’s a pretty big group. Let’s talk about where things are with that and what are the next steps.

DiSanzo:  We’re the fourth largest HIE in the nation. We’re comprised of over 22 organizations, many of which are hospitals, and the hospitals are spread throughout northern and central New Jersey. They consist of hospitals from the Barnabas Healthcare System, Atlantic Health, Saint Peter’s Healthcare System, Robert Wood Johnson, Trinitas, CentraState, Hackensack, and others. We utilize RelayHealth, which is a cloud-based, software-as-a-service solution. We put in results and ED notifications and other pieces of data relative to the patient experience at these individual institutions, and then we offer access to the state and to the physicians for free. They can pull down this data right in their office and incorporate this into their own EMRs.

It’s really to close the loop on patient care. We’re trying to build a comprehensive patient care record at the physician level right now by offering them the hospital information electronically. And then the next phase will be to try and gather information from their EMRs and pull that back together so we really have the complete comprehensive picture for the particular care of a patient that’s taking place in Northern Central New Jersey. The HIE is self-sustaining in so far as the hospital members and the other members as well pay fees to sustain the HIE.

Gamble:  It’s interesting to me what Jersey Health Connect has been able to do. Northern and central New Jersey are areas where you have a good number of large health systems and then some organizations that are either a stand-alone hospital or something along those lines, and it’s encouraging that we’re seeing this level of collaboration. Possibly down the line, it could be something where Jersey Heath Connect is a model or could offer some pieces of advice to other HIEs around the country.

DiSanzo:  I completely agree. I think it is a great model for other HIEs around the country. In many instances here, we have competing health care systems working together to promote patient care in our state. It’s a selfless model, which is great. I like to say that we at New Jersey Health Connect suffer from the almost benign neglect of our CEOs and COOs, which is to say that this was something the CIOs of these organizations were able to put together in conjunction with their legal teams and other teams at their individual institutions, because there was a vision that the future of healthcare was going to involve, ultimately, this collaboration between the major providers in the state and the clinicians in the state. And it has been a great story. We are exchanging millions of transactions per month. We probably have well over a thousand providers connected, and it just keeps growing.

Gamble:  You said 22 organizations, right? I thought it was 18.

DiSanzo:  No, it’s actually 22, and it may even be 23 at this point. We have a board meeting this Friday, so I’ll have the updated numbers.

Gamble:  How often are the meetings?

DiSanzo:  We have board meetings once a month and then there are other various committees that meet on a regular basis between the board meetings. There’s an executive committee, a technology committee, a legal committee, and things like that.

Gamble:  That’s something that’s great to see. We talk with CIOs from all over the country and HIEs are a struggle for so many organizations, because a lot of it does come down to getting organizations to meet and come together and just kind of hash it out.

DiSanzo:  That’s where we’ve been very successful, and again, that’s where I come back to the almost a benign neglect of our COOs and CEOs, because we’ve been able to leave our differences at the door and really work on the integration of the data and the model for getting the data out to the clinicians. We feel that the information really will raise the tide for all the institutions across Jersey Health Connect, relative to inpatient admissions, outpatient services, etc.

Gamble:  That’s a unique thing that I’m finding about CIOs; you’re more likely to see CIOs from competing organizations who know each other. They talk regularly, and I think that’s a pretty unique thing and something that definitely works in your favor.

DiSanzo:  I agree, and I think that’s somewhat unique to healthcare.

Chapter 3