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.”
- Going live with McKesson Paragon
- Juggling multiple ambulatory EHRs — “The interoperability equation has become a lot less difficult.”
- Readmission prevention
- Forming an ICO — not an ACO
- Merrimack Valley collaborative
- HIEs — “It’s never a one-size-fits-all”
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The good news is that with both large and small players, the interoperability equation has become a lot less difficult. And so it’s becoming easier to integrate with just about any EMR if you have the right technology stack in place.
What we’re trying to do is forge ahead in an integrated care model that has the same methodologies and the same mission and vision as an ACO, but doing it on our own in a coordinated method with our partners in the community.
From a business perspective, we’re a very viable and a very sound hospital institution. So the need for us to become part of a formal ACO with another larger entity isn’t as critical. We actually have a great opportunity to be a leader within the community to help develop this model.
We’ve really had to define what are the use cases and what are the potential best opportunities for clinical data sharing.
It’s not about the technology. The technology is there. It’s about getting the right people at the table and trying to get to a place where everyone has a shared vision, and then really being able to dissect and narrow down what are the quick wins and what are the key areas of opportunity.
Gamble: What type of EMR system do you have in the hospital?
Brown: We went live with McKesson Paragon just over a year and a half ago. So that serves as our main electronic health record. It’s for physician order entry, medication entry, nursing documentation, radiology, and cardiology. Bolted on to that we have a Sunquest Lab system and for our ED we have Picis-Ibex. That’s the physical make up of our infrastructure.
Gamble: And as far as with the physician practices, you’re dealing with a number of different EMR systems, I would imagine.
Brown: Exactly. Like I said, we have several hundred physicians that we’re affiliated with. The basic composition is the main three players in our market are Athena, eClinicalWorks, and GE Centricity. Then we have a few what I call cats and dogs — things like Practice Fusion which are very small EMR systems that are still very robust. As I look at the long-term strategy of connecting the community and integrating in a more robust way with these EMRs, the good news is that with both large and small players, the interoperability equation has become a lot less difficult. And so it’s becoming easier to integrate with just about any EMR if you have the right technology stack in place.
Gamble: In terms of avoiding readmissions, since you are a hospital that deals with such a high ER volume, what are you doing at discharge or what are some of the goals to try to keep those numbers down?
Brown: That’s a great question. We have several initiatives that are committee-based, very community-organized and community-centric around preventable readmissions. We’ve partnered with several folks in our community, including several leading medium to small health centers. We’re also partnering closely with the Home Health VNA, all with an orchestrated effort to prevent readmissions back into the hospital. I would say that as with most hospitals, one of the key ingredients in that model is really building out a robust care and case management team and center. So over the last year, we’ve really ramped up our care in case management coordination, which can really help once the patient leaves the hospital with coordinating with all those different facilities and all those different ancillary services that the patient might face, and really finding ways to do more targeted direct intervention before the patient gets into a risky situation where they have to come back into the hospital.
Gamble: You talked a little about ACOs before. Are you part of an ACO at this point or is that something that you’re working toward?
Brown: You’ve probably heard from several people that the first trick in an ACO is really defining what an ACO is. What we’re doing is we’re not part of a formal ACO. But what we are doing is looking at the notion of forming an ICO — an integrated care organization. Again, it goes back to partnering with key health centers within the community and creating a stronger partnership with the hundreds of physicians that surround our hospital. Regardless of having the real meat and hook that makes up the ACOs and the contracts that are provided around certain risks models and metrics, what we’re trying to do is really forge ahead in an integrated care model that has the same methodologies and the same mission and vision as an ACO, but doing it on our own in a coordinated method with our partners in the community.
We’ve actually already started on that journey. There’s a very strong governance model in place and a very strong structure and a very strong, collaborative, open model that’s forming within the Merrimack Valley on how organizations can partner to coordinate better care for our patients, identify high-risk patients within our model, and prevent readmissions and really keep care local to find the quality metrics and the measures that we can start looking at in order to really track our shared population, with an ultimate goal of higher quality and lower costs. It has the same themes, the same methodologies, and I think the same visions that all formal ACOs have, but we’re doing it in a more collaborative, community-based, integrated model.
Gamble: That’s interesting because sometimes part of the question becomes which ACO do we want to join and do they want us to join, and it becomes about different things and gets a little bit political. I can understand trying to take a different approach to really improve the care coordination in the community and go from there.
Brown: It’s true. I think there are a lot of single-site community hospitals in the country like ourselves with around 200 beds that provide excellent and leading services in many areas that can really provide a robust healthcare experience for the patient, yet at the same time, from a business perspective, we’re a very viable and a very sound hospital institution. So the need for us to become part of a formal ACO with another larger entity isn’t as critical. We actually have, in my opinion, a great opportunity to forge ahead and be a leader within the community to help develop this model out of the great clinical and quality practices that we’re establishing here.
Gamble: I think that’s an interesting model and maybe that’s something that we’ll start to see more of, like you said, with the community hospitals that are doing well and that aren’t necessarily looking for a big ACO to hook onto.
Brown: That’s where these strong, loose affiliation models come into place. As I said earlier, we’re definitely going to consider expanding our affiliation services and grow the current partnerships that we have now.
Gamble: In terms of HIE, what are you doing there? Are you part of Mass HIWay?
Brown: This has actually been one of the more challenging, interesting, and frankly, joyful parts of my job over the last year. We took advantage of the Mass HIWay and the grant funding that they proposed a year ago and we formed a Merrimack Valley HIE collaborative. We’ve partnered with the Home Health VNA, with Pentucket Medical Center, and with Greater Lawrence Family Health Center, and so what we’ve done over this last year is we’ve really had to define what are the use cases and what are the potential best opportunities for clinical data sharing. We expect to be sending our first test data transmissions over the Mass HIWay in the next month or two. Our plans are to definitely expand the level of HIE and interoperability that we can provide to the community.
I will say that in forming an HIE and getting the right stakeholders and getting real collaboration models and synergy put in place, it’s not about the technology. The technology is there. It’s really about getting the right people at the table and trying to get to a place where everyone has a shared vision and a model around what is health information sharing, and then really being able to dissect and narrow down what are the quick wins and what are the key areas of opportunity where clinical data sharing can really provide value.
It’s a long process, and what’s even more fascinating is that although there are a lot of templates and lot of standard playbooks that we could take from other HIE collaboratives throughout the state or throughout the country, every hospital system and community is very unique and they have their own unique challenges. It never really is a one size fits all, and so the collaboration and really getting everyone in the room and identifying your current capabilities and what types of data you’re able to share, and then working with a clinician around what are the best use cases that can really serve both a hospital and the community to transform care — that’s the real challenge around HIE.