It was early in his career that Marc Chasin learned a critical lesson in change management. While deploying an EHR system into his practice, he had trouble getting buy-in from one of the partners — his father. From that experience, “I learned how to engage stakeholders appropriately,” said Chasin, who is applying those lessons at St. Luke’s, where he is leading an Epic transformation. In this interview, he talks about what it’s like to hold dual roles, the invaluable role of physician leaders in change management, and the innovative work his team is doing with telemedicine and population health management. He also discusses when he realized his affinity for IT, his passion for being involved, and how moving to Idaho has changed his perspective.
- Selling the board on integration
- Using metrics to “move the needle”
- Concerns about HIE sustainability
- Driving change — “I have to be involved.”
- Goal of going from 4 portals to 1
- “Staggering” adoption numbers
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It’s getting the majority of the people moving in the same direction and rowing the boat at the same time.
We share our clinical integration scorecard, which allows clinicians to compare themselves with one another based upon patient satisfaction metrics and clinical metrics. And we’ve seen significant improvement.
It’s very concerning because I can see patients benefiting already from more complete and more accurate data at their primary care physician or when they appear in the emergency department.
I have a very supportive family and I have supportive colleagues who understand that in order to drive change you have to be involved with the change.
Gamble: In terms of the goal of an integrated network, do you have a specific endpoint date for when you aim to have things done? What is your timeline?
Chasin: At St. Luke’s Health System, my boss, Dr. David Pate has committed that we would like to be able to accept full risk by the end of 2015. We are actively developing our metrics, our data warehouse, and our IT systems, not to mention, aligning physicians, patients in our community to drive towards that goal. We presently are already in three risk contracts with partners. One of them is the Medicare Shared Savings Plan, and the others are two local health insurers in our community.
Gamble: As far as the board, is it a difficult sell communicating how long something like this is going to take and how expensive it’s going to be? Has that been a challenge?
Chasin: It hasn’t been a challenge, but it does take ongoing, early, and frequent communication with our board. Many of them are long-time community members. Some of them have been of the board for a long time, and they’ve also seen how medicine has been practiced in the past based upon volume, and so it’s having them understand step by step what transforming to value means, and how we can improve overall care. While it hasn’t been difficult, it does take a long time and a lot of conversations outside of the board and presentations during the board meeting.
Gamble: I can imagine. Once again, communication seems to be the key.
Chasin: It is. It’s all communication. We hire well-intentioned, good people that are experts in their field. It’s getting the majority of the people moving in the same direction and rowing the boat at the same time.
Gamble: Right. Looking at some of the other things on your plate, what kind of ACO activity are you involved in at this point, or what is in the works?
Chasin: Like many other organizations, we’re driving toward population health management. We are actively engaging many of our communities. We’re looking at our Medicare Shared Savings from a diabetic perspective. We’re making sure that we are able to identify the high-risk, high-cost patient, making sure our readmission rate is down. It’s no different than many other organizations. But what I think is significantly different is that we have the 500 employed physicians, as well as a fair amount of our affiliated physicians bought into a clinically integrated network in which we are sharing our clinical pathways so that we have the best data and the best care going to doctors that aren’t directly employed.
Gamble: What’s been required to maintain this type of network? Because like you had touched on before, I’m sure we’re talking about a lot of different data sources.
Chasin: We populate our data warehouse with the information from our own system, as well as any other practice that is clinically aligned and integrated with us. We transparently share our clinical integration scorecard, which allows clinicians to compare themselves with one another based upon patient satisfaction metrics and clinical metrics. And we’ve seen significant improvement in mammography screenings, pap smears, and patients getting routine diabetic care. We’ve actually moved the needle significantly in this region.
Gamble: That’s huge, and that’s going to be big, especially going forward seeing all the changes in health care. Is that something that you’re going to continue to do more with as far as analytics and really using that data to improve outcomes?
Chasin: Yes, our analytics tools continue to mature. We’re looking for prescriptive and predictive analytics now to start to leverage how we can impact our community and how we can predict when something is going to happen and intervene a lot sooner.
Gamble: Okay, now in terms of health information exchange, I know you’re involved in some of the steering committees and boards, but I also wanted to ask first about the HIE picture in Idaho, what that looks like at this point.
Chasin: Right now, we have the Idaho Health Data Exchange, which is a statewide organization that actually started a couple of years before the HITECH Act was even approved. We have robust participation through three or four of our major health systems, as well as a couple of our local insurers. We do image exchange through there, as well as general CCD transfer.
As is the case across the national HIE landscape, this HIE is looking for sustainability models, and so that’s something we are aggressively talking about and looking at how we’re going to sustain this key functionality going forward after these federal grants run out.
Gamble: Unfortunately, that’s something we hear a lot. It’s a big question, and especially when you see that states have really made so much progress, it’s a big concern seeing that come to a halt.
Chasin: I agree. It’s very concerning because I can see patients benefiting already from more complete and more accurate data at their primary care physician or when they appear in the emergency department. It’s one additional data point that a clinician can use to get a better diagnosis or a more timely diagnosis, and save costs to the overall health care system by not repeating modalities, whether it be lab or medical imaging.
Gamble: What types of software or tools are being used by the Idaho Health Data Exchange?
Chasin: The Idaho Health Data Exchange is currently using Optum for their services, and we’re constantly looking at different ways to leverage that. We also use some SureScripts functionality there, but we’re working with the other health systems in the state to build integration right into their respective medical records.
Gamble: That’s something that you’re pretty involved with at this point as far as the national HIE governance steering committee. Is this something that’s pretty important to you?
Chasin: Ubiquitous transfer of patient health information is important to me. I feel that patients should feel just as safe within their doctor’s office or in the hospital as they do at home, and the key to that is having your medical record move with you. I serve on the board of the Idaho Health Data Exchange. I also am the chair of the Epic Care Everywhere Network, which is right now the largest HIE with all the Epic hospitals. I am also one of the steering committee members of the National HIE Governance Steering Committee to drive standards and taxonomy and trust in order to facilitate this seamless transfer of information.
Gamble: I’m sure sometimes it might be difficult from a time standpoint to be involved in these types of initiatives, but is it something where as a CIO it’s too important not to have that input?
Chasin: It’s very important. I have a very supportive family and I have supportive colleagues who understand that in order to drive change you have to be involved with the change. Being a physician and now the CMIO and CIO, it’s something that I feel passionate about; that I have to be involved, because I can understand things from both the technical side as well as the clinical side.
Gamble: Are you doing anything at this point with patient portals?
Chasin: Yes, and I noticed that you mentioned them in the plural. Ideally I would have liked to have one patient portal, but in my situation I have multiple EHRs that I’m trying to rationalize. In the meantime, I still have clinicians that should be attesting or attaining Meaningful Use. Right now I do, in my organization, have four separate patient portals, and we’re working on solutions that can integrate those so there is a seamless, single view for patients. It is an important initiative that we’re going through this year.
Gamble: Another big challenge we hear about is adoption and getting patients engaged. That could be one of the biggest roadblocks, if you have a couple different portals — one for the doctor’s office, one for the hospital, etc. I could see that being a big priority.
Chasin: It is a complex situation that we are working through. We presently have around 70,000 users of our portals. In some larger metropolitan area that might not seem like a lot, but if you look at the city of Boise, which has a population of 200,000 people, we basically have 50 percent of the patients in the community on one patient portal, which is staggering. What’s even more impressive is that 60 percent of the physicians who are engaging patients with the portal have already achieved the 5 percent minimum of engagement of patients for Stage 2 Meaningful Use.
Additionally, we also have around 10 of our providers that are conducting 30 percent or more of their patient encounters through the patient portal. So we’ve seen a lot of traction on this. Since we live in a rural state, the utilization of a patient portal is key, and we’re pairing that up with our telemedicine initiatives to get care into the most rural areas of the state.