One of the biggest challenges for health systems is to be aggressive and stay ahead of the curve while also maintaining a healthy bottom line. And although there is no magic bullet to achieving that balance, one key ingredient, according to Tom Pacek, is having a board that’s committed to excellence and is willing to take risks. In this interview, he talks about his top priorities, including migrating ambulatory onto a single EHR platform, sustaining Inspira’s Medicare ACO, and creating an infrastructure to ensure redundancy as the organization continues to grow. Pacek also discusses the blurring of lines when it comes to data ownership, how he deals with physician trust issues, his team’s strong focus on care coordination, and his strategy for keeping the staff engaged.
- About Inspira
- Soarian in hospitals, ambulatory migrating to Cerner
- Physician bakeoff to select a system
- Inspira’s “enterprise mentality”
- MU attestation on physician side — “The biggest gap is the patients.”
- Onsite portal signups & tests
- “You can’t control the patient; the best you can do is educate them and get them engaged.”
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We were trying to get out in front of the curve and adopt the ambulatory Soarian product, which we were in the process of implementing. We shifted gears quickly after the Cerner announcement and got some feedback on that, and didn’t think that was a viable option anymore.
The biggest gap is really the patients. They’ll sign up for the patient portal, but to be able to send information back and forth with the patient, that’s not happening very rapidly. I don’t know whether they’re unwilling or they’re just nonresponsive to that.
We just wish the rules weren’t so strict and so stringent as to make it certain percentages. We’re just trying to do the best we can and work with our patients. You can’t control the patient; the best you can do is try to educate them and get them engaged.
They’re starting to recognize that we’re headed down the right path; people are doing the right thing and trying to become meaningful users, even if we’re not meeting making the criteria levels.
Gamble: Hi Tom, thank you for taking the time to speak with us today.
Pacek: Hi Kate, you’re more than welcome. I look forward to the dialog.
Gamble: Me too. To give our readers and listeners some background information, can you just talk a little bit about Inspira Health Network — what you have in terms of hospitals, bed size, ambulatory, things like that.
Pacek: Inspira is multiple-merged organization over time, in our most recent merger, we went from two hospitals to three hospitals three years ago; it’ll be three years this November. Our bed size now is 720. We have three acute care facilities. We have a health center with 60 behavioral health beds, so out of that 720, 60 of them are located at the health center. We have all the typical services — ER, pharmacy, lab, and things like that.
We have a very large ambulatory offering now with three urgent care centers and a fourth soon to be opened. We have over 80 owned physicians in a multispecialty group. Primary care is probably 50 or 60 percent of that group. The rest are multiple specialties, including midwifery. We have a home health agency that covers two counties of the three we service. We’re in a geographic area in southern New Jersey that covers about 1200 square miles, so it’s a very large portion of the southern part of the state.
In terms of acute care, we’re the game in town in the southern part of the state. Our latest acquisition or merger was Woodbury Underwood Medical Center, which joined Inspira two and a half years ago. There is some competition for acute care beds in that area, but further south where the other two hospitals are, they’re isolated from other acute care hospitals. Ambulatory is a strong, competitive environment throughout all our facilities. So that’s our landscape right now. We do have four EDs as well as the three urgent care centers.
Gamble: Looking at the clinical application environment, first on the acute side, what are you using for clinical and financial systems?
Pacek: Today, we’re Cerner Soarian customers. We have Soarian Clinicals across the whole enterprise, as well as Soarian Financials. On the ambulatory side, our 80-plus physicians are using four different applications; it’s about almost 50-50 with two outliers. We have one practice that’s using eClinicalWorks. We have another practice using Greenway PrimeSuite, and then the rest of the physicians are split kind of 50-50 between the Centricity product and Greenway Energy product. They’re all going to be migrating to Cerner Ambulatory. The first practices will be up in the beginning of September, and at least those 80 physicians will be all converted by second quarter of 2016.
Gamble: I would imagine that’s been in the works for a little while as far as the decision to get onto one platform.
Pacek: Yes, absolutely. Honestly, before the Cerner acquisition of Siemens, we were headed toward an enterprise solution with Siemens. Obviously that’s changed, and the challenge it brought to us is we were trying to get out in front of that ambulatory curve and adopt the ambulatory Soarian product, which we were in the process of implementing. We shifted gears quickly after the Cerner announcement and got some feedback on that, and didn’t think that was a viable option anymore.
So we quickly looked at what we currently used to see if any of them could be the single ambulatory EMR. Honestly, this organization, as well as myself, really has an enterprise mentality here; we try to do a common platform across the whole enterprise. We’d like to be all part of one electronic health record, and so we like the Epic-Cerner-type approach where it’s totally enterprise. We were going down that path with Siemens, and since Cerner’s acquisition, that’s changed. So right now, we’re all on Soarian and we’re staying that way for the time being, but on the ambulatory side, we are making the migration, the jump to the Cerner Ambulatory platform.
Our physicians really liked it. We did do a bakeoff. We did not look at Epic, but we did do a bakeoff with the products we currently had, and then we also brought the Cerner product in, and they pretty much hands down liked the Cerner product and the direction.
Gamble: I was going to ask you how that worked as far as having those four different systems and finding one people could agree on. I’m sure that’s not always the easiest situation.
Pacek: It wasn’t. We had a very active group of physicians that were very involved. When they gave us their feedback, the Centricity product came up pretty strong as well, but overall with the direction of potentially going Millennium. We haven’t committed to that at this point in time, but that enterprise thought process is leading us down that path. And so the physicians felt most comfortable and they liked the functionality built into the Cerner Ambulatory product at this point in time.
Gamble: And that’s starting this summer or fall?
Pacek: The project is underway right now. I believe we start testing in early July through August, with the go-live beginning in September for our first set of practices.
Gamble: About how many practices are in that first set?
Pacek: In that first group we’re doing two practices, and then I think we have about a six-week gap between that and the next wave. And then we’re doing three and four, and we’re going to hit the urgent care centers last and bring them onto the platform as well. That’s in the second quarter of next year.
Gamble: I would imagine the hope is to be able to apply any lessons learned from one implementation to the next.
Pacek: Absolutely. That’s why we have a little break in the action. And yes, it’ll be a little different for primary care versus some of the specialties as the way we do this. We’re also bringing up common practices, so things like our primary care docs are all involved with the PMCH (Patient-Centered Medical Home) Initiative. We have 5,000 Horizon patients that we’re managing through that process, and so we want to make sure those practices are all implemented simultaneously with the new EMR. We’re doing the proper care management on those patients as well, all at the same time. We don’t want to have to go back in and redo workflow, so we want to do it once right up front.
Gamble: In terms of Meaningful Use, where do you stand right now on the hospital side?
Pacek: On the hospital side, we’ve done three attestations and received three payments on Medicare. We have attested on Medicaid on all three facilities as well. We have not received anything back on this last attestation for Medicaid. There have been some questions, so we’re working with the state on that and going through that information. But so far, we’ve been able to meet the standards as best as I believe to the letter of the law. We’re doing everything at our interpretation, with some outside counsel guiding us to make sure we’re truly understanding the regs and the criteria and meeting that. So we do get certified on our own outside, prior to any audits or anything like that. We want to make sure that it’s just not us thinking that we qualify and we’re meeting the criteria; we also engage an outside firm to help us do that as well and certify that before we do our attestations. We’re tracking right now. We’re tracking for a full year of compliance with the MU2 standards at the hospitals, so we’re feeling pretty good about that right now.
The physician side? That’s different. The physician side has been a real challenge for us, mainly because we have multiple products first of all. So for my staff to work with the physicians to make sure each of those vendors are meeting the standards. The biggest gap is really the patients. They’ll sign up for the patient portal, but to be able to send information back and forth with the patient, that’s not happening very rapidly. I don’t know whether they’re unwilling or they’re just nonresponsive to that. So we have used the relaxing of the rules to be able to submit and attest for eligible providers, but going forward, we’re going to have to do a better job of trying to figure out how to get patients engaged, at least with that particular criteria. Although that’s been relaxed lately. I think you only have to prove that you can do it with one patient, so it’s really been relaxed and that’s been our biggest hurdle is that particular piece of criteria.
Gamble: What are some of the methods you’ve employed to address that, knowing that the requirements are going to change at some point?
Pacek: One of the things we’re doing is trying to be a little more aggressive in the physician practices themselves, like trying to actually take the time to help a patient sign up right there on the spot and to maybe even exchange a message back and forth with us as a test to make sure it’s working, and try to really encourage them. We’re trying to educate the patients, regardless of Meaningful Use, on why they should be engaged with us to begin with, and why they should be engaged in their healthcare. We don’t ever call it Meaningful Use with the patients; that’s not a topic or term that we use with the patients. We really want them to be engaged in their healthcare. It really dovetails nicely into our care management plans, popHealth, etc. It is a nice dovetail into that.
We just wish the rules weren’t so strict and so stringent as to make it certain percentages. We’re just trying to do the best we can and work with our patients. You can’t control the patient; the best you can do is try to educate them and get them engaged. I think everybody can agree that every healthcare community is different. We have a lot of Hispanic population here, a lot of indigent population in two of our facilities, and then the other facility has a completely different patient population who takes to this kind of stuff and understands it better and has the technology to be able to communicate with us electronically. And it shows in our numbers and our compliance by our areas.
Gamble: That’s really interesting, and we are seeing that challenge in a lot of areas, which is why the rules were relaxed, because I think there was a lot of pressure and a lot of input from CIOs who are outside of certain areas where it gets a lot more challenging.
Pacek: Absolutely. Like you said, I think people are starting to recognize that. CMS and ONC are they’re starting to recognize that we’re headed down the right path; people are doing the right thing and trying to become meaningful users, even if we’re not meeting making the criteria levels. So long as we’re moving in the right direction. By 2018, when they’re ready for stage 3, I think we’ll all be in a much better position to meet whatever requirements they’re throwing at us at that time.