To say that security has gained traction as a priority is quite an understatement. In fact, Ken Lawonn gets more questions about security from his CEO and board than any other topic. And so it should come as no surprise that Sharp has changed its entire approach, creating an IT risk management department and recruiting its first CISO. In this interview, Lawonn talks about the rapid evolution of Sharp’s security strategy, how the organization looks to leverage its managed care expertise to thrive in the population health world, and his thoughts on integration — including what his team is currently doing to provide a unified view of data, and how this plan may change in the future. He also discusses what it was like to go from being the acquiring party at Alegent Health to being acquired, why he made the move to San Diego, and what it’s been like to fill Bill Spooner’s shoes.
- About Sharp HealthCare
- Hospitals on Cerner, practices on Allscripts
- Leveraging dbMotion’s HIE to present “an integrated view.”
- Internally developed data warehouse
- Short-term & long-term costs of a single-vendor approach
- Predictive analytics — “You’ve got to be able to capture that data.”
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We’ve done a good job of presenting an integrated view for clinicians; although they have to link out to see that, we believe that we’ve done a fairly good of providing a good patient experience.
It will allow us to step back and let someone else frame the questions and challenge us where appropriate. We just think it’s a better way to go, and that getting some outside assistance will give us that independent perspective that will also leverage what experiences that others have gone through.
You might be able to make the investment upfront, but what’s the long-term cost? That’s what we’re trying to understand — if we were to invest in a single platform, do we gain some efficiencies? Do we reduce our operating costs on an ongoing basis, or is it going to cost us more?
We understand what our charges are and what the utilization is, and now we want to look at analytics that can help us move more to predictive analytics and more decision making on a real-time basis.
Everybody’s looking at measuring people for fallouts from a quality side, or a financial performance side. We’ve got to provide the people that are making the decisions with the information that can help them understand what the necessary requirements are and what the implications are.
Gamble: Hi Ken, thank you so much for taking some time to speak with us today.
Lawonn: You’re welcome.
Gamble: If you could start by just giving a brief overview about Sharp HealthCare — what you have in terms of number of hospitals, where you’re located, things like that.
Lawonn: Sure, I’d be happy to. Sharp HealthCare is an integrated delivery system located in San Diego County. We have seven hospitals — four acute hospitals and three specialty hospitals, including a large women and children’s hospital. We have two affiliated medical groups, Sharp Rees-Stealy, which is a foundation plan medical group that has 550 providers in 22 locations, and then Sharp Community Medical Group, which is an independent practice affiliation (IPA) that aligns over 700 independent physicians with Sharp. We also have 110,000 members in a health plan that’s growing very rapidly. We have two skilled nursing facilities and also have home health and hospice. Sharp employs about 17,000 people.
Gamble: In terms of the clinical application environment, what type of EHR system are you using in the hospitals?
Lawonn: The hospitals are all on Cerner. We’ve been running Cerner for about eight years.
Gamble: What about the medical groups — what are they using?
Lawonn: The medical groups are in TouchWorks, so we run a version of AllScripts TouchWorks for Sharp Rees-Stealy (the SRS group), and the Sharp Community Medical Group has a hosted service that they provide to some of the independent physicians. That’s also a TouchWorks supplementation, but it’s actually a second instance, so they both use AllScripts TouchWorks.
Gamble: What is the level of integration between the hospitals and practices?
Lawonn: We use GE Centricity for our registration and scheduling and revenue cycle system so we have a common registration system that’s used between Sharp Rees-Stealy and the hospitals under GE. And then on the back end, on the clinical side we run dbMotion as kind of a private HIE. So we bring data in from the hospitals in Cerner, Sharp Rees-Stealy AllScripts, and Sharp Community Medical Group AllScripts, as well as our home care system, which runs on an AllScripts system. And so you can view a longitudinal record within dbMotion, and when you’re in either Cerner or AllScripts, you can actually link with patient contacts to the record in the other applications. We’ve done a fair amount of work to try to integrate as best we could having two separate EHRs.
Gamble: With one of the medical groups being independent, you said that they run on a hosted service, have you ran into any issues there just as far as getting all those physicians to use the same EHR?
Lawonn: It’s actually not been too bad. They started this process about seven or eight years ago and had some tough times getting started. But in the last three or four years, they’ve come to agree to a standardized implementation and they’ve just held the line that, if you want to use the system, this is the standard set up. And they’ve actually got about 180 providers on the system now in about 50 different practices. So they’ve done a good job, especially with primary care, in getting them on a single instance of TouchWorks. It’s gone pretty well.
Gamble: Is that something that you foresee being the way things are done in the long term as far as keeping the physicians on AllScripts or is it something that you’re not really sure at this time where that’s going to go?
Lawonn: We have a couple of initiatives underway, one is that the IPA, Sharp Community Medical Group, is evaluating along with Sharp potentially moving to Cerner Ambulatory. We have formed another group called Sharp Care, which is a small foundation model that will allow some physicians who don’t want to join a large multispecialty group like Sharp Rees-Stealy to move into a foundation model. And as we look at the system we want to use there, we’re evaluating Cerner Ambulatory, and then if we were to do that, Sharp Community Medical Group would actually convert their physicians off of AllScripts onto Cerner Ambulatory, and then we would use that as our independent offering as well. We’re close to a decision on that. I’d say certainly in the next 45 to 60 days, we’ll have a decision whether to proceed with that or not.
In addition, we’re working right now to engage in outside firm to help us evaluate our current situation with GE, AllScripts, and Cerner against an integrated solution — for example, fully running a Cerner integrated system, and just kind of weighing out the pros and cons, the costs, and what the long-term viability of those two alternatives are. I think there’s a sense that over time it makes sense to move to a single platform, but there are no immediate plans to do so. And one of the things that’s important is that the medical group, Sharp Rees-Stealy, actually purchased and implemented AllScripts. Although we supported it, it was their decision, and so it’s important that they be a big part of making a decision on what they want to use on going forward.
Gamble: Right. From a management leadership perspective, it’s really wanting to make sure you would have the necessary buy-in.
Lawonn: Absolutely. The other area of concern is do we stay on GE for practice management or revenue cycle for the long term. That’s a system we’ve had for a long time. We’ve done a great job of leveraging it, and it has a very strong managed care platform, which we use for our medical group managed care offerings. But as you begin to look at it, you see the value of having an integrated scheduling and registration system with your EMR. That’s also a big component. It’s possible that we could move everything to Cerner, move parts of just revenue cycle and practice management to Cerner and not the EHR, or stay where we are, but we hope to have a strategy on that in the next six to nine months so then we can begin to plan for it.
Gamble: But as things stand now, you’re able to make it work well enough having these multiple different vendors.
Lawonn: We are. We’ve done a good job of presenting an integrated view for clinicians; although they have to link out to see that, we believe that we’ve done a fairly good of providing a good patient experience. One of the reasons why I feel like we have to look is that the other large providers in our community will all be on Epic. Scripps Health is moving to Epic. University of California San Diego is on Epic. Kaiser’s on Epic. And we just want to make sure that we’re providing our patients and our providers as good of an experience as our competitors are.
Gamble: That’s definitely a competitive area you’re in as far as some of those really large health systems.
Lawonn: It is, very much so.
Gamble: As far as the decision to bring in consultants to evaluate the situation, is the thinking behind just really getting that outside opinion and getting that fresh perspective?
Lawonn: It’s a combination of things. One is it gives us a perspective from someone who’s consulting in the industry. It also provides us with a neutral framework in which to do the evaluation. We also think it will allow us to kind of step back and let someone else frame the questions and challenge us where appropriate. We just think it’s a better way to go, and that getting some outside assistance will give us that independent perspective that will also leverage what experiences that others have gone through. As part of it, we’d like to be able to talk to some other organizations that have faced this decision and see what kind of weight in on their decisions to move forward one way or another.
Gamble: How much do you think the overall cost of everything factors in to the decision?
Lawonn: It certainly does. One of the things we want to look at is cost, both upfront and ongoing. I think one of the concerns a lot of organizations have is really the ongoing cost for systems. You might be able to make the investment upfront, but what’s the long-term cost? That’s what we’re trying to understand — if we were to invest in a single platform, do we gain some efficiencies? Do we reduce our operating costs on an ongoing basis, or is it going to cost us more? And I think that will play a significant role in decision.
Gamble: With the systems you have in place, what has your strategy been with analytics and leveraging that data to give clinicians the best picture possible?
Lawonn: We’ve a very strong data warehouse program and team in place for a number of years. It really goes back to the fact that Sharp has never really exited the managed care business, so we have a lot of contracts that we take risk for. One of the things we did was started building the data warehouse where we could bring the data from the clinical systems, especially, and claims systems to help us monitor and measure our quality to be able to report some of the quality indicators that were required by different pair groups or different organizations. So we have an internally developed data warehouse that leverages industry tools. We provide a lot of quality reports. We do a lot of compliance reporting. We do a lot of measuring performance of individual providers. We look at trying to understand our costs to provide care on like a per member basis because we do get paid that way in a number of situations. So we’ve done a lot of work with that.
We’re also now in the process of evaluating how do we extend that. Do we bring in additional information? We’ve just begun to really bring in the financial information to really look at what the cost is. We understand what our charges are and what the utilization is, and now we want to look at analytics that can help us move more to predictive analytics and more decision making on a real-time basis, because most of what we do today is very retrospective.
We’re beginning to do a proof of concept with a big data project because we believe that with all the unstructured data we have in the EMRs now, along with other outside data that we might get — either information about the environment or even genomic data — it’s probably not going to support a traditional data warehouse. The processing and translation stuff is probably not going to be sufficient for that, so we’re exploring doing a big data pilot with some technology from Cloudera.
We also supplement our data warehouse with analytics tools from organizations like the Advisory Board and others where they have some specific analytics that are focused on performance in the hospitals. One of the things we’re looking at is can we build out capability long-term that will allow us to not have to rely on as many outside organizations. We do an awful lot of analytics, both internally and some secondary programs, and we’re also investing and looking at the big data on an unstructured area.
Gamble: When it comes to getting that real-time data in front of the clinicians, what do you think as the biggest challenge? Is that a matter of standardization in dealing with these different data sets? What do you think it is?
Lawonn: It’s a combination. I think certainly that’s a piece of it because if you’re going to do it real-time, you’ve got to be able to capture that data. You’ve got to be able to do any standardization or translation or normalization of it in real-time, and then you’ve got to be able to present it in a way that’s meaningful and works into the workflow of the clinicians, because the last thing they want to do is stop and pause or go to another system to make a decision. It’s got to be fairly closely integrated back into your EMR.
So we’ve been working with Cerner on some of the things that they’re doing. We’re looking at their platform for population health and analytics. It’s really trying to get the information back into the workflow in a meaningful and useful way without having to ask people to go out. I think for some of the people like our care coordinators that are managing people, it’s not at a necessarily point of care, but they’re following up. They’re interacting with people between care settings. So it’s all okay for them to be able to have to use a separate system to go out and do some evaluations and look at some analytics and then work with the individual. But when you’re talking about a physician at the point of care, it’s got to be real-time. It’s got to be integrated into their workflow.
Gamble: Right. It’s a big goal, but it’s going to take a whole lot to get to that point.
Lawonn: And I think it’s critical. We have so much information and we’re asking people to make decisions and try to do the right thing, and we’re being judged so much more now. Did we perform the right test? Did we achieve the right outcome? Everybody’s looking at measuring people for fallouts from a quality side, or a financial performance side. We’ve got to provide the people that are making the decisions with the information that can help them understand what the necessary requirements are and what the implications are.