chief information officer,
Crouse Hospital, Syracuse, NY
senior vice president & regional chief information officer,
St. Vincent's Health System, Birmingham, AL
senior vice president & chief information officer,
MemorialCare Health System, Fountain Valley, CA
HealthLeaders Media,Brentwood, TN,
director of healthcare sales,
: How are the American Recovery and Reinvestment Act of 2009 (ARRA) and the push for "meaningful use" shaping providers' investment in information technology?
: What is positive is that it's not just electronic health record utilization, it is looking at outcomes and trying to understand what difference can be made from the technology. This is new territory for most hospitals and physicians' offices in terms of implementation. There are different reasons for that—capital, commitment of the clinicians, and commitment of the administration to move in that direction.
: Most providers haven't begun to transition to a paperless environment. Twenty percent or less of hospitals are utilizing CPOE technology. It's evident that a massive effort will be needed to enable hospitals to meet even the minimum criteria. For many providers, the needle is at zero, and we've got to help them get to 60 in record time.
: For the first time, you have a true impetus from board members, the CEO, and, most important, the chief financial officer. You're seeing somebody willing to pay.
: This is not a slam dunk for every healthcare provider. The ROI calculations are taking place, and for some hospitals, it's a clear win. For others, they're just trying to decide whether they can handle the penalties.
: We work with a 50-bed hospital that we provide services to, and we've calculated they could end up with about $4 million from ARRA. But the investment they're going to have to make will be difficult. So do you do the investment more slowly, so that you can spread the cost out enough to be able to at least get some of the money? Rural health is going to be in trouble unless they're partnering with somebody.
: It's like a land rush because stimulus funds have been put out there. The key to success with EMR rests with physicians. We're looking for ways to help physicians achieve meaningful use, not for the sake of receiving funds, but to advance, improve, and partner for better healthcare in areas like disease management.
: Healthcare is still about local culture and relationships. For example, data ownership issues between physicians' EMR and our EMR—how will that work? Physicians are still trying to figure out if this is a carrot they want to take a bite of or a poison apple that they may regret later.
: A lot of physicians are in one-, two-, three-doc practices that are scrambling to figure out what to do. We would like to provide those services. Unfortunately, we don't have the capital available to us to make it happen.
: We're leveraging our economies of scale with Epic and making it available to our physicians. As a result, we are now a service provider to our independent medical staff. We believe this strategy eases the transition of our physicians into the new world of EMRs. We will also integrate physicians using other EMR products. In that way, health information can safely and securely circulate among providers in our communities for the ultimate benefit of our patients.
: If you're not moving toward an integrated care delivery system, then you're going to be in trouble.
: The sustainability of HIEs, even the successful ones, is still in question. How do you keep it going outside of that initial burst of funding?
: Accountability will be the reason exchange happens. We're going to have to move the data around because it's the right thing to do. If you're going to hold a group of providers—however they're organized economically—accountable for a population, you're going to have to move the data around.
: Let's talk about an outcomes-based payment model. If healthcare moves in that direction, how does that affect your IT strategy?
: If you shift to an outcomes-based model from the traditional fee-for-service, and you go to bundled payments, you're saying to the doctor and the hospital, "You figure it out. We're going to give you X amount of money for this outcome, rather than it being driven by each individual episode." It changes the whole dynamic.
: Bundled services and accountable care organizations bring us the additional benefits of EMR, namely the ability to use care data to better manage patient care across the continuum. This represents a new opportunity for every healthcare organization to best "exploit" EMR data. The outcome of data mining helps us better understand best practices and the complete picture of the patient's situation in greater detail than ever before.
: The principal challenge isn't a lack of technological capability or the need for a new IT strategy; it's securing the necessary funding to shift the focus of application and workflow.
: The problem is in the maturity of the actual EHR, not just tool sets. Some of the issues are with standards and data definitions and dictionaries and everything else that is needed to reach a point where you can do meaningful analytics, particularly across EHR platforms.
: Vendors have collected a significant amount of clinical data over the years and have a pretty good sense of where it's working. When a vendor partners with a provider, they may offer a framework to support differential diagnosis data or standardized treatment plans for certain diseases.