If the recent trend in hospital consolidation is providing CIOs an education in change management, then Jonathan Goldberg is on his way to a master’s degree. Two years ago, three organizations — including St. Peter’s Health Care Services, where Goldberg served as CIO — merged to form a $1.2 billion IDN. But, as he quickly learned, “change doesn’t move fast,” particularly when the organizations that are joining together run different EHR platforms. In this interview, he talks about the need to focus on “the people aspect of integration,” why it pays to give physician practices some autonomy, and his organization’s data exchange efforts. Goldberg also talks about improving patient flow, his real motivation for seeking CHCIO certification, and why CIOs need to keep an open mind.
- To integrate or not — “The business needs to be the driver.”
- When it pays to wait
- Creating a physician enterprise
- Saying no to rip-and-replace
- “The days of objecting to good business decisions are over.”
- Real dialogue between docs and IT
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You always say to yourself when you have projects that the business needs to be the driver, and this was proof of concept in that the business really was the one who was ready for it, versus us knowing that they probably will need it at some point.
Sometimes when you wait, you lose some benefit, but you also gain something by understanding that because we’re in such an evolving market, there may be some disruptive technology that comes into play in a couple of years from now that we wouldn’t have anticipated seeing.
We’ve got to simplify the world we’ve created, and undoing it is too hard; you almost have to start with a blank slate. But healthcare has not figured out how to make things as simple as some other industries have.
We can move them onto what we consider our enterprise platform for a lower cost than it would cost them to upgrade, and hence, they would be on the same platform. Those are the types of opportunities we’ll take over time to try to standardize.
When we used to develop our IT strategic plan, it never held. By the time the ink dried it was out of date, because the business strategic plan was evolving faster than the IT strategic plan. You have to figure out how to keep the two in sync.
Gamble: You touched a little bit on the clinical system, and that’s something I want to get into. What was the picture like? Were the hospitals on different EMR systems?
Goldberg: Absolutely. My life couldn’t be that easy, right?
Goldberg: St. Peter’s Hospital was on Siemens Soarian, and we continue to be on that system. Of the other hospitals, three were on a shared Meditech Magic platform, and the other standalone was on a separate Meditech Magic platform. These hospitals range from about 150 to 250 beds, aside from the rehab hospital. They were very successful with it and they continue to be successful with it. It’s very highly customized on all ends. And so at this point, we still live with that world. The health system has some other priorities in terms of large capital expenditures on facilities. And so right now, as much as we want to look at a strategy to integrate the health system from a clinical/financial systems standpoint, we’re not ready yet, from a funding standpoint.
We’re doing a lot of due diligence around what our world will look like going forward, but right now we have the legacy systems. One of the things we are exploring and working on is collapsing the two Meditech platforms on to one so that at least we’re simplifying our world a little bit.
Gamble: I imagine that in it of itself is a pretty significant undertaking.
Goldberg: It will be. And certainly on various levels, collapsing that system will mean a change in process and change in workflow, other than just the change in the system itself. We actually wanted to do that a long time ago. We thought that would be one of the first things we would do as part of the merger coming together. Operationally, though, the hospitals that use those systems were not ready and really weren’t supporting that, and so we put that to the side for the time being. It was probably about a year later when the business came to us and said, okay, ‘now we’re ready. Now we need to get going because the system is in the way, operationally, of some of the things we’re doing as a shared service.’
Again, we try to be at least a little bit more proactive. You always say to yourself when you have projects that the business needs to be the driver, and this was proof of concept in that the business really was the one who was ready for it, versus us knowing that they probably will need it at some point.
Gamble: You said that the three hospitals that are on the shared platform — that’s Meditech Magic?
Gamble: Is that particular version of it up to date as far as meeting Meaningful Use requirements or is that another thing that’s on the short list?
Goldberg: No, we’ve done all the upgrades to both platforms to the latest Meaningful Use certified version. Interestingly enough — and again, I couldn’t be so lucky — all four hospitals are on a totally different timeline in relation to Meaningful Use attestation. We had three hospitals attest last year and we had two attest this year, and even for stage 2, we’re on totally different timelines and there’s no standardization of processes. And so where we can leverage what we’re doing, we certainly will, but we have five hospitals that operate very independently of each other right now, on different systems. There’s no integration clinically between most of the hospitals. We just have to follow the path that we have in terms of being able to get each individual organization ready.
Gamble: You touched on a little bit before on the long-term goal of having an integrated system. I can only imagine the number of things that have to fall into place, not to mention having the finances needed — just everything that would have to be coordinated to make this happen. Is there something that you’re really seeing as an initiative several years down the road?
Goldberg: I would suspect that. Right now, we’re doing our due diligence, as I mentioned earlier, around what are some of the options that we have available to us. There’s the do-nothing option, which means leaving things as is and doing some interfacing and maybe layering some other technologies on top, but leaving the core systems in place. From the process standpoint, as much as that may not seem like a good option, we need to keep our options open and keep an open mind into what we’re doing. And then there’s standardizing on one of these platforms we already have across the health system, and of course, there’s the option of bringing new vendors into the mix. Certainly we’re going to look at all the options that we have that may be available to us and see what happens.
The other thing we keep in mind is that sometimes when you wait, you lose some benefit, but you also gain something. You gain something by understanding that because we’re in such an evolving market, there may be some disruptive technology that comes into play in a couple of years from now that we wouldn’t have anticipated seeing today that may bring us a totally different approach. The markets outside of healthcare have gone to a much more streamlined, cloud-based environment that’s more nimble. They obviously have technologies that are more web-based and lighter in terms of the overhead of managing them. Those are the type of things where I think the legacy vendors that exist haven’t gotten there yet. They may have some skunkworks-type activities going on or maybe there’s another vendor that’s going to pop out of the woodwork at some point and say, ‘hey look what we’ve got.’ But we’ve got to simplify the world we’ve created, and undoing it is too hard; you almost have to start with a blank slate. But healthcare has not figured out how to make things as simple as some other industries have.
Gamble: Right. That’s absolutely true. Now in addition to the hospitals, you have physician practices as well. Earlier this year, St. Peter’s Health Partners Medical Associates formed as a physician practice group. Tell me a little bit about that.
Goldberg: Sure. The ink had just dried on the three-way merger of the health systems and then we developed a physician enterprise, which was aptly named St. Peter’s Health Partners Medical Associates. That was our plan, which many other health systems are doing — to create a structure to bring physicians onboard into the St. Peter’s family. We wanted to leverage and integrate the ones we already had, and continue to grow that network and try to find a way to bring physicians on where they can maintain, from a governance structure, some of their autonomy but be under the St. Peter’s umbrella, and create the best of both worlds. We did some large acquisitions of physician practices, as you mentioned, in the beginning of the year. We have about 350 physicians that are part of our network now.
I like to joke that I’m collecting EMRs. I want to see if I can have one of every system, because as we acquire all these practices, many of them have systems in place already. I’ve got probably half a dozen or more EMRs that make up our health system right now. The rip and replace, financially, just doesn’t work. We would love to have everybody on one system, and maybe at some time we will be, but fiscally and from a disruption standpoint, it’s really hard to sell that.
And so we’ll continue to maintain systems, and we’ll take opportunities where we can. We brought a small practice of a couple of physicians as part of this acquisition spree we’re on. They were on an old software version of their Legacy EMR, and the cost to upgrade them was significant. So that’s when we did the value proposition analysis to say, okay, we can move them onto what we consider our enterprise platform for a lower cost than it would cost them to upgrade, and hence, they would be on the same platform. Those are the types of opportunities we’ll take over time to try to standardize and to leverage the reason we’re pulling this network together.
Gamble: You talked a little bit about physician practices having that autonomy, but when it comes to making those decisions, whether it is upgrading or just going on to an EHR if they weren’t on one already, is that something where the health system has a say as well? How does that work as far as making those big decisions?
Goldberg: The practice itself is governed by the physicians. Certainly it has corporate representation, but they technically have the ability to weigh in on decisions. Now the nice thing is that we had already involved them. One of the large practices we purchased already had an EMR in place, and they had over 100 physicians as part of this practice. So we’re going to leverage that platform to be able to move into the other physicians.
The physicians that have nothing are desperate to get something. They’re not objecting. And as far as the physicians that already have a system, we’ve already told them that right now we’re not pursuing a rip-and-replace model. They’re happy and content right now, but over time, they certainly understand. The days of objecting to good business decisions are over. I think the physicians can understand that there are compelling reasons for a full enterprise EMR to be in place over time, because you can leverage things. You can do enterprise scheduling. You can have an enterprise physician portal. You have single billing options. There’s the ability to have a single touch-type feel from the patient standpoint as well as from the operational standpoint. I think we can sell it, but we don’t want to be too disruptive early on as this network is coming together.
Gamble: As far as facilitating data exchange with those physicians, where are you with that?
Goldberg: Within St. Peter’s Medical Associates, we have a separate subcommittee, which is an IT steering committee, as part of the board. That also integrates into the St. Peter’s Health Partners IT Governance Oversight Council. We’ve tried to get the physicians at the table to be part of these conversations, and we’re trying not to make it too tactical. They fell into the trap in one of our first meetings where it became, why is IT not working well? What’s wrong with it? Why is it so clumsy? Why is it down too many times? Why, why, why? We’re trying now to take it to that next level to say, let’s not talk about just the system. Let’s not make it about the system. Let’s really make it about what does the future look like — how do you want to operate? And it’s still early, but we’re trying the same approach at the health system level to say, ‘forget the technology,’ even though it’s an IT steering committee. Let’s talk about what we want to look like. What are some of the opportunities? And then we’ll figure out how technology may support that.
We want to get that dialogue and that creative thinking going, and if we can get at least a majority of physicians or other leaders agreeing on an approach of how the system wants to operate, then it’s easier to develop that IT strategy. We’re taking the approach of an IT strategy not being its own strategy. In the health system strategy, whether it’s Health Partners Medical Associates or whether it’s the overall health system’s strategy, IT will be a piece of that, versus its own standalone plan.
Gamble: That seems like the way that you have to do it. You can’t have the IT strategy and the health system strategy and let’s see how we can make them work together, because to me, that doesn’t seem like the most productive way to do things.
Goldberg: What happens is over time is when we used to develop our IT strategic plan, it never held. By the time the ink dried it was out of date, because the business strategic plan was evolving faster than the IT strategic plan. You have to figure out how to keep the two in sync, and so we said one strategic plan for the health system should be comprehensive and include everything.
Chapter 3 Coming Soon…