Starting a new CIO role just as an organization is going live with an EHR system can be a mixed bag. On the one hand, a lot of the heavy lifting is done; but on the other hand, there’s an intense post-go-live period during which the staff needs constant support. For CIO Jeff Brown, who joined Lawrence General in 2012, this tumultuous time was an opportunity to leverage the skills he learned working in other areas of the industry. In this interview, Brown talks about his exciting first year as CIO, the pressure to do more with limited resources, his plans to develop an integrate care model, and why he still sometimes needs a “phone-a-friend.”
- About Lawrence General
- Affiliations with Beth Israel Deaconess & Tufts
- Population health — “Connecting the community”
- Linking hospitalists & PCPs
- Working with affiliated docs — “It has to be grounded in collaboration.”
- Physician-led committees
- Finding “quick wins”
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It’s a unique position because we’re an earshot away from some of the leading academic medical centers in the country, and there are a lot of growing accountable care organizations in the area. As you can imagine, it makes for a very interesting market dynamic.
In the physician-owned model it still needs to be collaborative, but a lot of the decisions can be made and directed from the hospital point of view, whereas our model really has to be grounded in collaboration.
We bring in key physicians from within the community and talk about all of the things that center around how can we better coordinate care and coordinate communication between the PCPs in the community and the hospitalists within our system.
It’s an evolution and it’s something that takes a lot of time, but we’re building that framework; that foundation for what we think is a really robust and integrated model to tease out how to best interact with our PCPs in the community to ultimately take better care of our patients.
This is really about the PCPs in the community and really understanding and identifying what their needs and wants are, and how can the hospital help set up the right processes or technology or infrastructure to support them.
Gamble: Hi Jeff, thanks so much for taking the time to speak with us today.
Brown: Thanks for having me.
Gamble: To give the readers and listeners kind of a lay of the land, could you tell us a little bit about Lawrence General — bed size, and then what you have in the way of physician practices, things like that.
Brown: We’re approximately a 200-bed community hospital in Lawrence, Massachusetts. We’re located in a unique spot; we’re about 30 miles north of downtown Boston. For those who follow the Massachusetts and healthcare market and what’s happening in the healthcare environment, it’s a unique position because we’re an earshot away from some of the leading academic medical centers in the country, and there are a lot of growing accountable care organizations in the area. As you can imagine, it makes for a very interesting market dynamic, both being in the Massachusetts area, and how we as a leading community hospital has to shift our strategies in order to compete.
The other thing about Lawrence General that’s unique is we have a thriving emergency room. We tend to see around 75,000 annual visits in our emergency center, which is really a lot — not only on the level of what other hospitals do in the state, but that’s really high for a community medical center like ourselves.
Gamble: You have affiliations with Beth Israel Deaconess and the Children’s Hospital at Tufts Medical Center. What do those affiliations entail?
Brown: We have great affiliations with some leading centers that really provide us with top-notch services around pediatric surgical care. We’ve been able to utilize those affiliation services to really grow our network and provide top-level services for the patients and families in our community. As I mentioned earlier, there’s kind of a growing Massachusetts market dynamic around stronger affiliations, and so we look to hopefully grow those affiliations and those network models in order to provide the best care possible for our patients.
Gamble: Right. Boston really is unique. I happen to be located in New Jersey, but we’re always hearing about Boston as being on the forefront of health IT. That’s got to be exciting to be part of that.
Brown: It’s very exciting. The strategy for healthcare IT, particularly in the last two to three years, is really shifting. There was a time and a place where, thanks to Meaningful Use and other initiatives and incentives, it was really about getting your electronic health record systems in place, which Lawrence General has successfully done. We have a very large hospital-based electronic health record that our physicians and nurses have been up on for well over a year now. And so that’s in place. But just like everywhere else in the country, the shift is really moving toward population health and analytics — what I call ‘connecting the community.’ And so how do you create robust interfaces and infrastructure to send clinical data information outside your own hospital walls — to not only share that with these other leading practices and centers that we’re affiliated with, but with the physicians in the community in general to help them really take better care of their patients.
Gamble: We’re seeing so much emphasis on that now. In terms of physician practices, do you have practices that are owned by Lawrence General or are affiliated with the hospital?
Brown: We’re very unique here. We have a very small practice that we own, but most of our hospital affiliations are through a strong affiliation model, but they are not employed physicians by the hospital. That creates for a very interesting, and in some ways challenging, model. We have several hundred physicians in the community that are affiliated with Lawrence General. We don’t own them, and so from an IT perspective and from many other perspectives, it presents a unique and interesting challenge as to how we can best serve the physicians in the community. What are the best service models and approaches that we can provide for community physicians, not only to provide the best services for the hospital, but to ensure that the patients throughout the entire continuum of care, whether they coming in through the ED or through the hospital, and then going back out in the community. How do we set up the infrastructure, the people, the processes and the technologies with these physicians we don’t own to ensure we have a robust, synergistic and integrated healthcare model for our patients?
What it really represents is a greater need for a collaborative approach, because in the physician-owned model it still needs to be collaborative, but a lot of the decisions can be made and directed from the hospital point of view, whereas our model really has to be grounded in collaboration. Again, we don’t own those physicians, and so we have to take into account their current business models and all of their challenges and make sure we provide the right things for those individual practices to be successful.
Gamble: Do you have a system in place where you have town hall meetings or something along those lines? Do you have certain key people to try to communicate to those different practices who are each their own entity? I can imagine that it gets tricky.
Brown: It really does, and I think this is actually one of the most important ingredients in success in an affiliated model where you don’t directly own your physicians. What we’ve done is we’ve come up with a very strong committee structure that really bridges the gap between the hospital and the community physicians. For example, we have some really amazing physician leaders here — hospitalists within Lawrence General who really understand the value of partnering and communicating with the PCPs that surround our hospital and within the community.
What we did was we’ve kicked off a committee that’s really focused around physician communication. We meet monthly and we bring in key physicians from within the community and talk about all of the things that center around how can we better coordinate care; how can we better coordinate communication between the PCPs in the community and the hospitalists within our system. What has come out of that is a working model and a progression where we’ve identified a greater need to communicate clinical electronic medical record information more robustly.
We have an initiative that works on that, but what’s fascinating is a lot of times what we identify are just common people and process workflows between the hospital and the community physicians where there’s really a lot of quick wins around hospital-to-PCP phone calls at discharge. It’s nice. We have a whole governance structure in place. We have ongoing meetings where the physicians in the community can have real input. We do surveys around what areas the PCPs in the community want to see most improved, from a communication, perspective, an infrastructure perspective, or a hospital clinical information exchange perspective. It’s an evolution and it’s something that takes a lot of time, but we’re building that framework; that foundation for what we think is a really robust and integrated model to tease out how to best interact with our PCPs in the community to ultimately take better care of our patients.
Gamble: It seems like that’s a really interesting dynamic, because even if you aren’t talking about physician practices that are owned, you never want to be the ones who say, ‘Listen, this is how the hospital does things, so this is how you guys are going to do things if you want to work with us.’ You never want to get off on that foot. The two sides need each other, so it seems like it’s really beneficial to have that committee structure and really be getting the input from both sides.
Brown: You’re absolutely right. I think it’s imperative to send a collaborative message, but also be very clear that although these committees and counsels are being held typically within the hospital and are typically chaired and co-chaired by hospital committee members, this is really about the PCPs in the community and really understanding and identifying what their needs and wants are, and how can the hospital help set up the right processes or technology or infrastructure to support them as community physicians.